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__NOTOC__ | __NOTOC__ | ||
{{CMG}} {{AE}} {{Maliha}}{{AA}} | {{CMG}}; {{AE}} {{Maliha}}, {{AA}} | ||
{{Chlamydia infection}} | {{Chlamydia infection}} | ||
==Overview== | ==Overview== | ||
Chlamydia is a common [[sexually transmitted disease]] (STD) caused by the | [[Chlamydia]] is a common [[sexually transmitted disease]] (STD) caused by the [[gram negative]] bacterium ''[[Chlamydia trachomatis]]''. [[Chlamydia]] is the most frequently reported bacterial sexually transmitted infection in the United States and is a major infectious cause of human eye and [[genital]] disease.<ref name=ccc>[http://www.cdc.gov/std/Chlamydia/STDFact-Chlamydia.htm Chlamydia fact sheet from the Centers for Disease Control and Prevention]</ref> Chlamydia infection must be differentiated from other genital tract infections, such as [[gonorrhea]] infection, [[bacterial vaginosis]], vaginal [[candidiasis]], infection with ''[[Trichomonas vaginalis]]'', and [[mycoplasma]] infection.<ref name=def> Genital Tract Chlamydia infection. BMJ. http://bestpractice.bmj.com/best-practice/monograph/52/diagnosis/differential.html. Accessed on December 27, 2015</ref> Almost two-thirds of new [[chlamydia]] infections occur among youth aged 15-24 years. Females are more commonly affected with [[chlamydia]] infection than males. The female to male ratio is approximately 1.52 to 1.<ref name=abc> Chlamydia Infection. Wikipedia.https://en.wikipedia.org/wiki/Chlamydia_infection#cite_note-LancetEpi2012-26. Accessed on December 29, 2015</ref> Common risk factors in the development of [[chlamydia]] infection include unprotected sexual activity, multiple sexual partners, age, men who have sex with men, and low socioeconomic status.<ref name=abc> Chlamydia CDC Fact Sheet. CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm#_ENREF_3. Accessed on December 29, 2015</ref><ref name="pmid18159391">{{cite journal |vauthors=Navarro C, Jolly A, Nair R, Chen Y |title=Risk factors for genital chlamydial infection |journal=Can J Infect Dis |volume=13 |issue=3 |pages=195–207 |year=2002 |pmid=18159391 |pmc=2094865 |doi= |url=}}</ref><ref name="pmid23316985">{{cite journal| author=Mishori R, McClaskey EL, WinklerPrins VJ| title=Chlamydia trachomatis infections: screening, diagnosis, and management. | journal=Am Fam Physician | year= 2012 | volume= 86 | issue= 12 | pages= 1127-32 | pmid=23316985 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23316985 }} </ref> According to the 2015 Sexually Transmitted Diseases Treatment Guidelines released by the CDC, screening for chlamydia is recommended for sexually active individuals under 25 years of age, women over 25 who are at increased risk, all pregnant women under 25 years, pregnant women over 25 who are at increased risk, men who have sex with men, and individuals with [[HIV]].<ref name=abc> Screening Recommendations Referenced in Treatment Guidelines and Original Recommendation Sources. CDC. http://www.cdc.gov/std/tg2015/screening-recommendations.htm. Accessed on January 6th, 2016</ref> If left untreated, chlamydia can cause [[pelvic inflammatory disease]] in females and [[epididymitis]] and [[orchitis]] in males.<ref name=abc> Chlamydia trachomatis. Wikipedia.https://en.wikipedia.org/wiki/Chlamydia_trachomatis. Accessed on December 22, 2015</ref><ref name="pmid23316985">{{cite journal| author=Mishori R, McClaskey EL, WinklerPrins VJ| title=Chlamydia trachomatis infections: screening, diagnosis, and management. | journal=Am Fam Physician | year= 2012 | volume= 86 | issue= 12 | pages= 1127-32 | pmid=23316985 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23316985 }} </ref> Common complications of chlamydia among women include [[cervicitis]], [[infertility]], [[ectopic pregnancy]], and chronic pelvic pain. Complications of chlamydia in men include [[proctitis]], [[epididymitis]], and [[sterility]]. Prognosis of chlamydia is generally good with adequate treatment. Common symptoms of chlamydia infection among women include abnormal vaginal bleeding or discharge, [[abdominal pain]], painful sexual intercourse, painful urination, and urinary urgency. Symptoms of chlamydia infection among men include [[penile discharge]] and [[pruritus]], [[testicular pain]] or swelling, and [[Dysuria|pain during urination]].<ref name=cde> Chlamydia Infection. Wikipedia.https://en.wikipedia.org/wiki/Chlamydia_infection. Accessed on January 11, 2016</ref> Physical examination of women with chlamydia infection is usually remarkable for a cloudy, yellow mucoid cervical discharge; a friable appearance of the [[cervix]]; and [[cervical motion tenderness]].<ref name=abc> Chlamydia CDC Fact Sheet. CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm#_ENREF_3. Accessed on January 11, 2016</ref><ref name="pmid16669564">{{cite journal| author=Miller KE| title=Diagnosis and treatment of Chlamydia trachomatis infection. | journal=Am Fam Physician | year= 2006 | volume= 73 | issue= 8 | pages= 1411-6 | pmid=16669564 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16669564 }} </ref> Common physical examination findings of [[Chlamydia infection|chlamydia]] infection among men include a clear or white [[urethral discharge]], [[Testicular pain|testicular tenderness]], and testicular swelling.<ref name=abc> Chlamydia CDC Fact Sheet. CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm#_ENREF_3. Accessed on January 11, 2016</ref><ref name="pmid16669564">{{cite journal| author=Miller KE| title=Diagnosis and treatment of Chlamydia trachomatis infection. | journal=Am Fam Physician | year= 2006 | volume= 73 | issue= 8 | pages= 1411-6 | pmid=16669564 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16669564 }} </ref> Transvaginal ultrasound, pelvic MRI, and laboratory nucleic acid amplification tests ([[Nucleic acid test|NAAT]]) may be used in the diagnosis of chlamydia infection. The mainstay of therapy for chlamydia is [[antimicrobial]] therapy with [[doxycycline]]. Effective measures for the primary prevention of chlamydia infection include practicing [[Abstinence, be faithful, use a condom|abstinence]], avoiding high-risk sexual behaviors such as unprotected sex or multiple sexual partners, and using latex condoms.<ref name=abc> Chlamydia CDC Fact Sheet. CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm#_ENREF_3. Accessed on December 29, 2015</ref><ref name="pmid23316985">{{cite journal| author=Mishori R, McClaskey EL, WinklerPrins VJ| title=Chlamydia trachomatis infections: screening, diagnosis, and management. | journal=Am Fam Physician | year= 2012 | volume= 86 | issue= 12 | pages= 1127-32 | pmid=23316985 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23316985 }} </ref> Secondary prevention of chlamydia infection includes early detection, treatment of sexual partners, and treatment of other sexually transmitted infections (such as [[gonorrhea]]). | ||
==Historical Perspective== | ==Historical Perspective== | ||
''Chlamydia trachomatis'' was first discovered in 1907 by Halberstaedter and von Prowazek.<ref name="pmid17523388">{{cite journal| author=Budai I| title=Chlamydia trachomatis: milestones in clinical and microbiological diagnostics in the last hundred years: a review. | journal=Acta Microbiol Immunol Hung | year= 2007 | volume= 54 | issue= 1 | pages= 5-22 | pmid=17523388 | doi=10.1556/AMicr.54.2007.1.2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17523388 }} </ref> The inclusion bodies of ''Chlamydia trachomatis'' were first described in 1942.<ref name=abc> Chlamydia trachomatis. Wikipedia.https://en.wikipedia.org/wiki/Chlamydia_trachomatis. Accessed on December 22, 2015</ref> | ''[[Chlamydia trachomatis]]'' was first discovered in 1907 by Halberstaedter and von Prowazek.<ref name="pmid17523388">{{cite journal| author=Budai I| title=Chlamydia trachomatis: milestones in clinical and microbiological diagnostics in the last hundred years: a review. | journal=Acta Microbiol Immunol Hung | year= 2007 | volume= 54 | issue= 1 | pages= 5-22 | pmid=17523388 | doi=10.1556/AMicr.54.2007.1.2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17523388 }} </ref> The inclusion bodies of ''[[Chlamydia trachomatis]]'' were first described in 1942.<ref name=abc> Chlamydia trachomatis. Wikipedia.https://en.wikipedia.org/wiki/Chlamydia_trachomatis. Accessed on December 22, 2015</ref> | ||
==Pathophysiology== | ==Pathophysiology== | ||
''C. trachomatis'' is naturally found living only inside human cells. Chlamydia can be transmitted during [[vaginal intercourse|vaginal]], | ''[[C. trachomatis]]'' is naturally found living only inside human cells. [[Chlamydia infection|Chlamydia]] can be transmitted during [[vaginal intercourse|vaginal]], anal, or oral sex, and can be passed from an infected mother to her baby during vaginal [[childbirth]]. | ||
==Causes== | ==Causes== | ||
Chlamydia is a common [[sexually transmitted infection]] (STI) caused by the | Chlamydia is a common [[sexually transmitted infection]] (STI) caused by the [[gram-negative]] bacterium ''[[Chlamydia trachomatis]]''. | ||
==Differentiating Chlamydia infection from other diseases== | ==Differentiating Chlamydia infection from other diseases== | ||
Chlamydia must be differentiated from other genital tract infections such as [[ | Chlamydia must be differentiated from other genital tract infections such as [[gonorrhea]] infection, [[bacterial vaginosis]], vaginal [[candidiasis]], infection with ''[[Trichomonas vaginalis]]'', and [[mycoplasma]] infection.<ref name=def> Genital Tract Chlamydia infection. BMJ. http://bestpractice.bmj.com/best-practice/monograph/52/diagnosis/differential.html. Accessed on December 27, 2015</ref> | ||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
In 2014, the incidence of | In 2014, the incidence of [[Chlamydia infection|chlamydia]] was estimated to be 439 cases per 100,000 individuals in the United States.<ref name=abc> Chlamydia CDC Fact Sheet. CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm#_ENREF_3. Accessed on December 29, 2015</ref> The incidence of [[Chlamydia infection|chlamydia]] in women has increased greatly between 1987 and 2003 from 79 to 467 cases per 100,000 individuals.<ref name="pmid16669564">{{cite journal| author=Miller KE| title=Diagnosis and treatment of Chlamydia trachomatis infection. | journal=Am Fam Physician | year= 2006 | volume= 73 | issue= 8 | pages= 1411-6 | pmid=16669564 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16669564 }} </ref> Almost two-thirds of new [[Chlamydia infection|chlamydia]] infections occur among young adults aged 15-24 years. It is estimated that 1 in 20 sexually active young women aged 14-24 years has chlamydia.<ref name=abc> Chlamydia CDC Fact Sheet. CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm#_ENREF_3. Accessed on December 29, 2015</ref> Females are more commonly affected with [[Chlamydia infection|chlamydia]] infection than males. The female to male ratio is approximately 1.52 to 1.<ref name=abc> Chlamydia Infection. Wikipedia.https://en.wikipedia.org/wiki/Chlamydia_infection#cite_note-LancetEpi2012-26. Accessed on December 29, 2015</ref> The prevalence of [[Chlamydia infection|chlamydia]] among non-Hispanic African Americans is 6.7 times the prevalence among non-Hispanic Whites.<ref name=abc> Chlamydia CDC Fact Sheet. CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm#_ENREF_3. Accessed on December 29, 2015</ref> | ||
==Risk Factors== | ==Risk Factors== | ||
Common risk factors in the development of [[chlamydia]] infection include unprotected sexual activity, multiple sexual partners, age, men who have sex with men, and low socio-economic status.<ref name=abc> Chlamydia CDC Fact Sheet. CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm#_ENREF_3. Accessed on December 29, 2015</ref><ref name="pmid18159391">{{cite journal| | Common risk factors in the development of [[chlamydia]] infection include unprotected sexual activity, multiple sexual partners, age, men who have sex with men, and low socio-economic status.<ref name=abc> Chlamydia CDC Fact Sheet. CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm#_ENREF_3. Accessed on December 29, 2015</ref><ref name="pmid18159391">{{cite journal |vauthors=Navarro C, Jolly A, Nair R, Chen Y |title=Risk factors for genital chlamydial infection |journal=Can J Infect Dis |volume=13 |issue=3 |pages=195–207 |year=2002 |pmid=18159391 |pmc=2094865 |doi= |url=}}</ref><ref name="pmid23316985">{{cite journal| author=Mishori R, McClaskey EL, WinklerPrins VJ| title=Chlamydia trachomatis infections: screening, diagnosis, and management. | journal=Am Fam Physician | year= 2012 | volume= 86 | issue= 12 | pages= 1127-32 | pmid=23316985 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23316985 }} </ref> | ||
==Screening== | ==Screening== | ||
According to the 2015 Sexually Transmitted Diseases Treatment Guidelines by the CDC, screening for chlamydia is recommended for sexually active under 25 years, women over 25 who are at increased risk, all pregnant women under 25 years, pregnant women over 25 who are at increased risk, men who have sex with men, and individuals with HIV.<ref name=abc> Screening Recommendations Referenced in Treatment Guidelines and Original Recommendation Sources. CDC. http://www.cdc.gov/std/tg2015/screening-recommendations.htm. Accessed on January 6th, 2016</ref> | According to the 2015 Sexually Transmitted Diseases Treatment Guidelines by the CDC, screening for [[Chlamydia infection|chlamydia]] is recommended for sexually active under 25 years, women over 25 who are at increased risk, all pregnant women under 25 years, pregnant women over 25 who are at increased risk, men who have sex with men, and individuals with HIV.<ref name=abc> Screening Recommendations Referenced in Treatment Guidelines and Original Recommendation Sources. CDC. http://www.cdc.gov/std/tg2015/screening-recommendations.htm. Accessed on January 6th, 2016</ref> | ||
==Natural History, Complications and Prognosis== | ==Natural History, Complications and Prognosis== | ||
If left untreated, chlamydia can cause [[pelvic inflammatory disease]] in women and [[epididymitis]] and [[orchitis]] in males.<ref name=abc> Chlamydia trachomatis. Wikipedia.https://en.wikipedia.org/wiki/Chlamydia_trachomatis. Accessed on December 22, 2015</ref><ref name="pmid23316985">{{cite journal| author=Mishori R, McClaskey EL, WinklerPrins VJ| title=Chlamydia trachomatis infections: screening, diagnosis, and management. | journal=Am Fam Physician | year= 2012 | volume= 86 | issue= 12 | pages= 1127-32 | pmid=23316985 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23316985 }} </ref> Common complications of chlamydia among women include [[cervicitis]], [[infertility]], [[ectopic pregnancy]], and chronic pelvic pain. Complications of chlamydia in men include [[proctitis]], [[epididymitis]], and [[sterility]]. Other complications of chlamydia include [[reactive arthritis]].<ref name=ddd> Chlamydia - CDC Fact Sheet (Detailed). CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm. Accessed on January 6th, 2016 </ref> Prognosis of chlamydia is generally good with adequate treatment. | If left untreated, chlamydia can cause [[pelvic inflammatory disease]] in women and [[epididymitis]] and [[orchitis]] in males.<ref name=abc> Chlamydia trachomatis. Wikipedia.https://en.wikipedia.org/wiki/Chlamydia_trachomatis. Accessed on December 22, 2015</ref><ref name="pmid23316985">{{cite journal| author=Mishori R, McClaskey EL, WinklerPrins VJ| title=Chlamydia trachomatis infections: screening, diagnosis, and management. | journal=Am Fam Physician | year= 2012 | volume= 86 | issue= 12 | pages= 1127-32 | pmid=23316985 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23316985 }} </ref> Common complications of chlamydia among women include [[cervicitis]], [[infertility]], [[ectopic pregnancy]], and chronic pelvic pain. Complications of chlamydia in men include [[proctitis]], [[epididymitis]], and [[sterility]]. Other complications of chlamydia include [[reactive arthritis]].<ref name=ddd> Chlamydia - CDC Fact Sheet (Detailed). CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm. Accessed on January 6th, 2016 </ref> Prognosis of [[Chlamydia infection|chlamydia]] is generally good with adequate treatment. | ||
==Diagnosis== | ==Diagnosis== | ||
===History and Symptoms=== | ===History and Symptoms=== | ||
It is crucial to collect a detailed and thorough sexual history from the patient. Specific areas of focus when obtaining a history include number and type of sexual partners (new, casual, or regular), contraception use, and previous history of [[Chlamydia infection|chlamydia]] infection or other sexually transmitted diseases.<ref name="pmid16669564">{{cite journal| author=Miller KE| title=Diagnosis and treatment of Chlamydia trachomatis infection. | journal=Am Fam Physician | year= 2006 | volume= 73 | issue= 8 | pages= 1411-6 | pmid=16669564 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16669564 }} </ref><ref name=ddd> Chlamydia - CDC Fact Sheet (Detailed). CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm. Accessed on January 6th, 2016 </ref><ref name="pmid18159391">{{cite journal |vauthors=Navarro C, Jolly A, Nair R, Chen Y |title=Risk factors for genital chlamydial infection |journal=Can J Infect Dis |volume=13 |issue=3 |pages=195–207 |year=2002 |pmid=18159391 |pmc=2094865 |doi= |url=}}</ref> The majority of women with [[Chlamydia infection|chlamydia]] infection are asymptomatic or present with minimal symptoms.<ref name="pmid16669564">{{cite journal| author=Miller KE| title=Diagnosis and treatment of Chlamydia trachomatis infection. | journal=Am Fam Physician | year= 2006 | volume= 73 | issue= 8 | pages= 1411-6 | pmid=16669564 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16669564 }} </ref><ref name=ddd> Chlamydia - CDC Fact Sheet (Detailed). CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm. Accessed on January 6th, 2016 </ref> Common symptoms of chlamydia infection among women include [[Vaginal bleeding|abnormal vaginal bleeding]] or [[Vaginal discharge|discharge]], [[abdominal pain]], [[painful sexual intercourse]], [[painful urination]], and [[urinary urgency]]. Symptoms of chlamydia infection among men include [[penile discharge]] and [[pruritus]], [[testicular pain]] or swelling, and [[Painful urination|pain during urination.]]<ref name=cde> Chlamydia Infection. Wikipedia.https://en.wikipedia.org/wiki/Chlamydia_infection. Accessed on January 11, 2016</ref> | |||
===Physical Examination=== | ===Physical Examination=== | ||
Patients with chlamydia infection | Patients with [[chlamydia infection]] usually appear to be in good health. A [[fever]] may be present. Physical examination of women with [[chlamydia infection]] is usually remarkable for a cloudy, yellow mucoid [[cervical]] [[discharge]]; a friable appearance of the [[cervix]]; and [[Cervical motion tenderness|cervical motion tendernes]]<nowiki/>s.<ref name=abc> Chlamydia CDC Fact Sheet. CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm#_ENREF_3. Accessed on January 11, 2016</ref><ref name="pmid16669564">{{cite journal| author=Miller KE| title=Diagnosis and treatment of Chlamydia trachomatis infection. | journal=Am Fam Physician | year= 2006 | volume= 73 | issue= 8 | pages= 1411-6 | pmid=16669564 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16669564 }} </ref> Common physical examination findings of [[chlamydia infection]] among men include a clear or white [[urethral discharge]], [[Testicular pain|testicular tenderness]], and testicular swelling.<ref name=abc> Chlamydia CDC Fact Sheet. CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm#_ENREF_3. Accessed on January 11, 2016</ref><ref name="pmid16669564">{{cite journal| author=Miller KE| title=Diagnosis and treatment of Chlamydia trachomatis infection. | journal=Am Fam Physician | year= 2006 | volume= 73 | issue= 8 | pages= 1411-6 | pmid=16669564 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16669564 }} </ref> | ||
===Laboratory Findings=== | ===Laboratory Findings=== | ||
Laboratory tests used in the diagnosis of chlamydia infection include nucleic acid amplification tests (NAAT) such as [[polymerase chain reaction]] (PCR), transcription mediated amplification (TMA), and the DNA strand displacement assay (SDA). NAAT for chlamydia infection may be performed on swab specimens sampled from the cervix (women) or urethra (men), on self-collected vaginal swabs, or on voided urine.<ref name=cde> Chlamydia Infection. Wikipedia.https://en.wikipedia.org/wiki/Chlamydia_infection. Accessed on January 11, 2016</ref> | Laboratory tests used in the diagnosis of chlamydia infection include [[NAAT|nucleic acid amplification tests]] (NAAT) such as [[polymerase chain reaction]] (PCR), transcription mediated amplification (TMA), and the DNA strand displacement assay (SDA). [[NAAT]] for [[chlamydia infection]] may be performed on swab specimens sampled from the [[cervix]] (women) or [[urethra]] (men), on self-collected vaginal swabs, or on voided urine.<ref name=cde> Chlamydia Infection. Wikipedia.https://en.wikipedia.org/wiki/Chlamydia_infection. Accessed on January 11, 2016</ref> | ||
===Ultrasound=== | ===Ultrasound=== | ||
Transvaginal ultrasound may be helpful in the diagnosis of chlamydia infection when pelvic inflammatory disease has occurred. Findings on ultrasound suggestive of pelvic inflammatory disease include thickened/dilated fallopian tubes, incomplete septa in the fallopian tube, increased vascularity around the fallopian tubes, and positive cogwheel sign (thickened loops of fallopian tubes).<ref name=abc> Pelvic Inflammatory Disease. Radiopaedia.http://radiopaedia.org/articles/pelvic-inflammatory-disease Accessed on January 12, 2016</ref> | [[Transvaginal ultrasound]] may be helpful in the diagnosis of [[Chlamydia infection|chlamydia]] infection when [[pelvic inflammatory disease]] has occurred. Findings on ultrasound suggestive of [[pelvic inflammatory disease]] include thickened/dilated [[fallopian tubes]], incomplete septa in the [[fallopian tube]], increased vascularity around the [[fallopian tubes]], and positive cogwheel sign (thickened loops of [[fallopian tubes]]).<ref name=abc> Pelvic Inflammatory Disease. Radiopaedia.http://radiopaedia.org/articles/pelvic-inflammatory-disease Accessed on January 12, 2016</ref> | ||
===Other Imaging Findings=== | ===Other Imaging Findings=== | ||
Other imaging studies for chlamydia infection include pelvic MRI, which demonstrates an ill-defined adnexal mass containing fluid with various signal intensities.<ref name=abc> Pelvic Inflammatory Disease. Radiopaedia.http://radiopaedia.org/articles/pelvic-inflammatory-disease Accessed on January 12, 2016</ref> | Other imaging studies for chlamydia infection include pelvic [[Magnetic resonance imaging|MRI]], which demonstrates an ill-defined [[Adnexal mass causes|adnexal mass]] containing fluid with various signal intensities.<ref name=abc> Pelvic Inflammatory Disease. Radiopaedia.http://radiopaedia.org/articles/pelvic-inflammatory-disease Accessed on January 12, 2016</ref> | ||
==Treatment== | ==Treatment== | ||
===Medical Therapy=== | ===Medical Therapy=== | ||
The mainstay of therapy for chlamydia is antimicrobial therapy with [[doxycycline]]. Recent sex partners (i.e., individuals having sexual contact with the patient within the 60 days preceding onset of symptoms or chlamydia diagnosis) should also be referred for evaluation, testing, and treatment.<ref name= NC>http://www.cdc.gov/std/tg2015/chlamydia.htm Accessed on September 14,2016</ref><ref>Geisler, William M., et al. "The natural history of untreated Chlamydia trachomatis infection in the interval between screening and returning for treatment." Sexually transmitted diseases 35.2 (2008): 119-123.</ref> | The mainstay of therapy for [[Chlamydia infection|chlamydia]] is [[antimicrobial]] therapy with [[doxycycline]]. Recent sex partners (i.e., individuals having sexual contact with the patient within the 60 days preceding onset of symptoms or chlamydia diagnosis) should also be referred for evaluation, testing, and treatment.<ref name= NC>http://www.cdc.gov/std/tg2015/chlamydia.htm Accessed on September 14,2016</ref><ref>Geisler, William M., et al. "The natural history of untreated Chlamydia trachomatis infection in the interval between screening and returning for treatment." Sexually transmitted diseases 35.2 (2008): 119-123.</ref> | ||
===Primary Prevention=== | ===Primary Prevention=== | ||
Effective measures for the primary prevention of chlamydia infection include practicing abstinence, avoidance of high-risk sexual behaviors such as unprotected sex or multiple sexual partners, and use of latex condoms.<ref name=abc> Chlamydia CDC Fact Sheet. CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm#_ENREF_3. Accessed on December 29, 2015</ref><ref name="pmid23316985">{{cite journal| author=Mishori R, McClaskey EL, WinklerPrins VJ| title=Chlamydia trachomatis infections: screening, diagnosis, and management. | journal=Am Fam Physician | year= 2012 | volume= 86 | issue= 12 | pages= 1127-32 | pmid=23316985 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23316985 }} </ref> | Effective measures for the primary prevention of [[chlamydia infection]] include practicing abstinence, avoidance of high-risk sexual behaviors such as unprotected sex or multiple sexual partners, and use of latex [[condoms]].<ref name=abc> Chlamydia CDC Fact Sheet. CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm#_ENREF_3. Accessed on December 29, 2015</ref><ref name="pmid23316985">{{cite journal| author=Mishori R, McClaskey EL, WinklerPrins VJ| title=Chlamydia trachomatis infections: screening, diagnosis, and management. | journal=Am Fam Physician | year= 2012 | volume= 86 | issue= 12 | pages= 1127-32 | pmid=23316985 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23316985 }} </ref> | ||
===Secondary Prevention=== | ===Secondary Prevention=== | ||
Secondary prevention of chlamydia infection includes early detection, treatment of sexual partners, and treatment of other sexually transmitted infections (such as gonorrhea).<ref name="pmid16669564">{{cite journal| author=Miller KE| title=Diagnosis and treatment of Chlamydia trachomatis infection. | journal=Am Fam Physician | year= 2006 | volume= 73 | issue= 8 | pages= 1411-6 | pmid=16669564 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16669564 }} </ref> | Secondary prevention of chlamydia infection includes early detection, treatment of sexual partners, and treatment of other sexually transmitted infections (such as [[gonorrhea]]).<ref name="pmid16669564">{{cite journal| author=Miller KE| title=Diagnosis and treatment of Chlamydia trachomatis infection. | journal=Am Fam Physician | year= 2006 | volume= 73 | issue= 8 | pages= 1411-6 | pmid=16669564 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16669564 }} </ref> | ||
==References== | ==References== | ||
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Latest revision as of 20:54, 29 July 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maliha Shakil, M.D. [2], Aysha Anwar, M.B.B.S[3]
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Overview
Chlamydia is a common sexually transmitted disease (STD) caused by the gram negative bacterium Chlamydia trachomatis. Chlamydia is the most frequently reported bacterial sexually transmitted infection in the United States and is a major infectious cause of human eye and genital disease.[1] Chlamydia infection must be differentiated from other genital tract infections, such as gonorrhea infection, bacterial vaginosis, vaginal candidiasis, infection with Trichomonas vaginalis, and mycoplasma infection.[2] Almost two-thirds of new chlamydia infections occur among youth aged 15-24 years. Females are more commonly affected with chlamydia infection than males. The female to male ratio is approximately 1.52 to 1.[3] Common risk factors in the development of chlamydia infection include unprotected sexual activity, multiple sexual partners, age, men who have sex with men, and low socioeconomic status.[3][4][5] According to the 2015 Sexually Transmitted Diseases Treatment Guidelines released by the CDC, screening for chlamydia is recommended for sexually active individuals under 25 years of age, women over 25 who are at increased risk, all pregnant women under 25 years, pregnant women over 25 who are at increased risk, men who have sex with men, and individuals with HIV.[3] If left untreated, chlamydia can cause pelvic inflammatory disease in females and epididymitis and orchitis in males.[3][5] Common complications of chlamydia among women include cervicitis, infertility, ectopic pregnancy, and chronic pelvic pain. Complications of chlamydia in men include proctitis, epididymitis, and sterility. Prognosis of chlamydia is generally good with adequate treatment. Common symptoms of chlamydia infection among women include abnormal vaginal bleeding or discharge, abdominal pain, painful sexual intercourse, painful urination, and urinary urgency. Symptoms of chlamydia infection among men include penile discharge and pruritus, testicular pain or swelling, and pain during urination.[6] Physical examination of women with chlamydia infection is usually remarkable for a cloudy, yellow mucoid cervical discharge; a friable appearance of the cervix; and cervical motion tenderness.[3][7] Common physical examination findings of chlamydia infection among men include a clear or white urethral discharge, testicular tenderness, and testicular swelling.[3][7] Transvaginal ultrasound, pelvic MRI, and laboratory nucleic acid amplification tests (NAAT) may be used in the diagnosis of chlamydia infection. The mainstay of therapy for chlamydia is antimicrobial therapy with doxycycline. Effective measures for the primary prevention of chlamydia infection include practicing abstinence, avoiding high-risk sexual behaviors such as unprotected sex or multiple sexual partners, and using latex condoms.[3][5] Secondary prevention of chlamydia infection includes early detection, treatment of sexual partners, and treatment of other sexually transmitted infections (such as gonorrhea).
Historical Perspective
Chlamydia trachomatis was first discovered in 1907 by Halberstaedter and von Prowazek.[8] The inclusion bodies of Chlamydia trachomatis were first described in 1942.[3]
Pathophysiology
C. trachomatis is naturally found living only inside human cells. Chlamydia can be transmitted during vaginal, anal, or oral sex, and can be passed from an infected mother to her baby during vaginal childbirth.
Causes
Chlamydia is a common sexually transmitted infection (STI) caused by the gram-negative bacterium Chlamydia trachomatis.
Differentiating Chlamydia infection from other diseases
Chlamydia must be differentiated from other genital tract infections such as gonorrhea infection, bacterial vaginosis, vaginal candidiasis, infection with Trichomonas vaginalis, and mycoplasma infection.[2]
Epidemiology and Demographics
In 2014, the incidence of chlamydia was estimated to be 439 cases per 100,000 individuals in the United States.[3] The incidence of chlamydia in women has increased greatly between 1987 and 2003 from 79 to 467 cases per 100,000 individuals.[7] Almost two-thirds of new chlamydia infections occur among young adults aged 15-24 years. It is estimated that 1 in 20 sexually active young women aged 14-24 years has chlamydia.[3] Females are more commonly affected with chlamydia infection than males. The female to male ratio is approximately 1.52 to 1.[3] The prevalence of chlamydia among non-Hispanic African Americans is 6.7 times the prevalence among non-Hispanic Whites.[3]
Risk Factors
Common risk factors in the development of chlamydia infection include unprotected sexual activity, multiple sexual partners, age, men who have sex with men, and low socio-economic status.[3][4][5]
Screening
According to the 2015 Sexually Transmitted Diseases Treatment Guidelines by the CDC, screening for chlamydia is recommended for sexually active under 25 years, women over 25 who are at increased risk, all pregnant women under 25 years, pregnant women over 25 who are at increased risk, men who have sex with men, and individuals with HIV.[3]
Natural History, Complications and Prognosis
If left untreated, chlamydia can cause pelvic inflammatory disease in women and epididymitis and orchitis in males.[3][5] Common complications of chlamydia among women include cervicitis, infertility, ectopic pregnancy, and chronic pelvic pain. Complications of chlamydia in men include proctitis, epididymitis, and sterility. Other complications of chlamydia include reactive arthritis.[9] Prognosis of chlamydia is generally good with adequate treatment.
Diagnosis
History and Symptoms
It is crucial to collect a detailed and thorough sexual history from the patient. Specific areas of focus when obtaining a history include number and type of sexual partners (new, casual, or regular), contraception use, and previous history of chlamydia infection or other sexually transmitted diseases.[7][9][4] The majority of women with chlamydia infection are asymptomatic or present with minimal symptoms.[7][9] Common symptoms of chlamydia infection among women include abnormal vaginal bleeding or discharge, abdominal pain, painful sexual intercourse, painful urination, and urinary urgency. Symptoms of chlamydia infection among men include penile discharge and pruritus, testicular pain or swelling, and pain during urination.[6]
Physical Examination
Patients with chlamydia infection usually appear to be in good health. A fever may be present. Physical examination of women with chlamydia infection is usually remarkable for a cloudy, yellow mucoid cervical discharge; a friable appearance of the cervix; and cervical motion tenderness.[3][7] Common physical examination findings of chlamydia infection among men include a clear or white urethral discharge, testicular tenderness, and testicular swelling.[3][7]
Laboratory Findings
Laboratory tests used in the diagnosis of chlamydia infection include nucleic acid amplification tests (NAAT) such as polymerase chain reaction (PCR), transcription mediated amplification (TMA), and the DNA strand displacement assay (SDA). NAAT for chlamydia infection may be performed on swab specimens sampled from the cervix (women) or urethra (men), on self-collected vaginal swabs, or on voided urine.[6]
Ultrasound
Transvaginal ultrasound may be helpful in the diagnosis of chlamydia infection when pelvic inflammatory disease has occurred. Findings on ultrasound suggestive of pelvic inflammatory disease include thickened/dilated fallopian tubes, incomplete septa in the fallopian tube, increased vascularity around the fallopian tubes, and positive cogwheel sign (thickened loops of fallopian tubes).[3]
Other Imaging Findings
Other imaging studies for chlamydia infection include pelvic MRI, which demonstrates an ill-defined adnexal mass containing fluid with various signal intensities.[3]
Treatment
Medical Therapy
The mainstay of therapy for chlamydia is antimicrobial therapy with doxycycline. Recent sex partners (i.e., individuals having sexual contact with the patient within the 60 days preceding onset of symptoms or chlamydia diagnosis) should also be referred for evaluation, testing, and treatment.[10][11]
Primary Prevention
Effective measures for the primary prevention of chlamydia infection include practicing abstinence, avoidance of high-risk sexual behaviors such as unprotected sex or multiple sexual partners, and use of latex condoms.[3][5]
Secondary Prevention
Secondary prevention of chlamydia infection includes early detection, treatment of sexual partners, and treatment of other sexually transmitted infections (such as gonorrhea).[7]
References
- ↑ Chlamydia fact sheet from the Centers for Disease Control and Prevention
- ↑ 2.0 2.1 Genital Tract Chlamydia infection. BMJ. http://bestpractice.bmj.com/best-practice/monograph/52/diagnosis/differential.html. Accessed on December 27, 2015
- ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 3.19 Chlamydia Infection. Wikipedia.https://en.wikipedia.org/wiki/Chlamydia_infection#cite_note-LancetEpi2012-26. Accessed on December 29, 2015
- ↑ 4.0 4.1 4.2 Navarro C, Jolly A, Nair R, Chen Y (2002). "Risk factors for genital chlamydial infection". Can J Infect Dis. 13 (3): 195–207. PMC 2094865. PMID 18159391.
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 Mishori R, McClaskey EL, WinklerPrins VJ (2012). "Chlamydia trachomatis infections: screening, diagnosis, and management". Am Fam Physician. 86 (12): 1127–32. PMID 23316985.
- ↑ 6.0 6.1 6.2 Chlamydia Infection. Wikipedia.https://en.wikipedia.org/wiki/Chlamydia_infection. Accessed on January 11, 2016
- ↑ 7.0 7.1 7.2 7.3 7.4 7.5 7.6 7.7 Miller KE (2006). "Diagnosis and treatment of Chlamydia trachomatis infection". Am Fam Physician. 73 (8): 1411–6. PMID 16669564.
- ↑ Budai I (2007). "Chlamydia trachomatis: milestones in clinical and microbiological diagnostics in the last hundred years: a review". Acta Microbiol Immunol Hung. 54 (1): 5–22. doi:10.1556/AMicr.54.2007.1.2. PMID 17523388.
- ↑ 9.0 9.1 9.2 Chlamydia - CDC Fact Sheet (Detailed). CDC.http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm. Accessed on January 6th, 2016
- ↑ http://www.cdc.gov/std/tg2015/chlamydia.htm Accessed on September 14,2016
- ↑ Geisler, William M., et al. "The natural history of untreated Chlamydia trachomatis infection in the interval between screening and returning for treatment." Sexually transmitted diseases 35.2 (2008): 119-123.