Chlamydia is a sexually transmitted infection caused due to bacteria of Chlamydia trachomatis genus.

They are small gram-negative obligate intracellular Chlamydiae that infect epithelial cells. They include the genera Chlamydia from chlamydia trachomatis and Chlamydophila species.

Chlamydia infection impacts several reproductive and respiratory organs thus considered as prevalent bacterial STD.

They have a unique life cycle in form of:

Elementary body is an infectious form that enters in host cells.

A reticulate body is a reproductive form that replicates inside host cells.

Key Species of Chlamydia as follows:

Chlamydia trachomatis: It is a common STI species that causes eye infections.

Chlamydia pneumoniae: It causes respiratory infections such as pneumonia and bronchitis.

Chlamydia psittaci: It causes pneumonia in humans called psittacosis.

The common route for transmission is unprotected vaginal, anal, or oral sex. From mother to baby during childbirth to cause conjunctivitis or pneumonia in newborns.

Chlamydial infection most reported infectious disease in US and it has prevalence highest between age group of 15 to 24 years old.

About 20% of sexually active females carry chlamydia without symptoms but shows high incidence.

Chlamydia rates are high at 14% in African American females aged 18 to 26 years old and 17% in those with recent gonorrhoea/chlamydia.

Chlamydial genitourinary infection acquisition rates are comparable between sexes. It is influenced with first sexual exposure and frequency.

Chlamydia targets columnar epithelial cells found at the squamocolumnar junction on the ectocervix in young females.

Cytokines and interferons from infected cells start inflammatory response. Chlamydial infection triggers production of IgA, IgM, and IgG antibodies.

The bacteria are transmitted through sex with a 25% chance of male-to-female transmission.

Genital tract infection is common. It is asymptomatic in males (50%) and females (80%) and has incubation period of 1 to 3 weeks.

The causes for Chlamydia are:

Causative Agent

Sexual Transmission

Perinatal Transmission

Direct Contact with Infected Secretions

Respiratory Transmission

Sexual Behaviors

Poor Hygiene and Sanitation

95% effectiveness rate for first-time antibiotic therapy ensures excellent prognosis with early initiation and completion.

Reinfection common due to untreated sexual partners or new partners hence treat all sexual partners to prevent.

Rare deaths result from progression to salpingitis and tubo-ovarian abscess with rupture and peritonitis.

Chlamydia indirectly causes ectopic pregnancy mortality more than death from tubo-ovarian abscess.

Clinical History:

Collect details including sexual behaviours, symptom duration, partner status, and medical history to understand clinical history of patient.

Genital Examination

Rectal Examination

Respiratory Examination

Abdominal Examination

Acute Symptoms are:

In Women:

Mucopurulent vaginal discharge

Dysuria

Postcoital bleeding

Mild lower abdominal or pelvic pain

In Men:

Urethral discharge

Testicular or scrotal pain

Chronic symptoms are:

In women:

Infertility

Chronic pelvic pain

In men:

Infertility

Chronic testicular pain

If untreated, chlamydia leads to pelvic inflammatory disease that causes infertility if infected at a young age.

Chlamydiae treated with tetracyclines, macrolides, and quinolones to interfere protein synthesis.

Rifalazil used to treat chlamydial nongonococcal urethritis effectively with single-dose administration.

PID management for gonorrhea should always include therapy for C trachomatis, N gonorrhoeae, and anaerobic bacteria.

Chlamydial conjunctivitis and pneumonia are treated for 14 days. Sexual partners within 60 days of onset should receive treatment for longer periods.

Retesting in pregnancy after erythromycin or amoxicillin therapy recommended to avoid false positive results.

Patients should avoid sex for a week post single-dose treatment or until all partners are cured from this infection.

Infectious Disease

Regular STI screening arranged for sexually active individuals under 25 years old with multiple partners.

Wash the face regularly to prevent spread of infectious secretions from infected individuals.

Provide latrines and waste disposal to reduce Chlamydia trachomatis transmission through waste contact.

Regular condom uses and few sex partners decrease STI transmission in individuals.

Proper awareness about Chlamydia should be provided and its related causes with management strategies.

Appointments with a sexologist and preventing recurrence of disorder is an ongoing life-long effort.

Infectious Disease

Pulmonology

Azithromycin:

It binds to 50S ribosomal subunit of susceptible microorganisms and blocks dissociation of peptidyl tRNA.

Levofloxacin:

It inhibits DNA gyrase activity to promote breakage of DNA strands.

Doxycycline:

It binds to the 30S ribosomal subunits of the bacteria to inhibit bacterial protein synthesis.

Cefoxitin:

It inhibits bacterial cell wall synthesis to bind with one or more penicillin-binding proteins.

Ampicillin:

It binds with penicillin-binding proteins to inhibit final transpeptidation step in bacterial cell wall synthesis.

Clindamycin:

It inhibits bacterial growth that causes RNA-dependent protein synthesis.

Metronidazole:

It is an intermediate metabolized compounds that inhibit protein synthesis to cause cell death.

Infectious Disease

Certain procedures are required in complication cases as follows:

Trichiasis surgery for advanced trachoma to prevent blindness.

Laparoscopy is useful for treating complications like PID and abscesses.

Abscess drainage is used to avoid rupture and systemic infection.

Salpingectomy/salpingostomy is performed in ectopic pregnancy cases.

Epididymectomy is necessary for chronic/recurrent epididymitis in men.

Infectious Disease

In the initial assessment phase, evaluation of patient history, physical examination, and laboratory test to confirm diagnosis.

Pharmacologic therapy is effective in the treatment phase as it includes use of antibiotic therapy.

In supportive care and management phase, patients should receive required attention such as lifestyle modification and intervention therapies.

The regular follow-up visits with the physician are scheduled to check the improvement of patients along with treatment response.