According to World Health Organization estimates, 105 million new cases of chlamydia were recorded globally in 2008. The most frequent STD in the US had 1.4 million documented cases in 2011. It continues to be the most typically diagnosed bacterial sexually transmitted infection in Europe and the UK. One obligatory intracellular pathogen of the Chlamydia genus that causes infection is Chlamydia trachomatis. Three kinds of chlamydia cause sickness in humans. Chlamydia mostly strikes young people, with a peak incidence in those under 25. Ten to fifteen percent of sexually active teenagers in the UK have infection. A poor application of barrier measures and changing partners are two other risk factors. Men and women both run a 10% risk of contracting UPSI (Unprotected sexual intercourse) from a single act. Cervix, urethra, rectum, conjunctiva, throat are the sites of infection.
Symptoms and signs
Females
- For at least 70% of women, chlamydia is asymptomatic.
- Symptoms include dysuria, pelvic pain, significant dyspareunia, PCB (Post coital bleeding) or IMB (Inter menstrual bleeding), and vaginal discharge. Symptoms of cervicitis include a friable cervix that bleeds when touched and discharges mucopurulent fluid.
Males
- In half of cases, chlamydia has no symptoms.
- Among the symptoms is dysuria, or urethral discharge. Urethral meatal edema, erythema, and clear or opaque urethral discharge are signs.
Rectal infection
Usually asymptomatic, but it can occasionally result in anorectal discomfort and discharge.
Anal discharge, oedema, and erythema during proctoscopy are indications.
Pharyngeal infection
Often, a pharyngeal infection shows no symptoms.
Conjunctival infection (adult)
Conjunctival irritation, discharge, and photophobia are symptoms. A 60–70% of cases contain anogenital chlamydia infection, and symptoms include unilateral or bilateral follicular conjunctivitis.
Diagnosis
Tissue cultures and EIAs are no longer the recommended diagnostic procedure for Chlamydia; the NAAT test is.
Numerous commercial NAAT tests are offered.
Neisseria gonorrhoeae and Chlamydia trachomatis can both be found in a single specimen by certain assays.
Self-taken endocervical or lower vaginal swabs work similarly to first-void urine (FVU) and are more sensitive. The unpleasant urethral swab is not as liked for males as an FVU. One hour must pass after urine is collected.
Swabs from the pharyngeal and rectal areas can be obtained, but NAATS are not licenced for use with these specimens, hence an NAAT is still the recommended test.
Though very accurate, NAAT tests lack 100% sensitivity and specificity, which could result in false-positive findings.
When someone first presents, they should be tested, and then again two weeks following any likely exposure during the preceding two weeks.
Complications
Infections might be asymptomatic or symptomatic. Ectopic pregnancy, chronic pelvic pain, and tubal factor infertility can all result from endometritis, bartholinitis, or pelvic inflammatory disease (PID). Men with ascending infections develop epididymo-orchitis.
Among the systemic effects include SARA (sexually acquired reactive arthritis) and peri-hepatitis (Fitz-Hugh-Curtis syndrome). Disease has a major financial effect on healthcare systems. Complications from chlamydia can arise in both pregnant women and babies.
Management
Treatment
- Doxycycline – taken every day for a week.
- Azithromycin – one dose of 1g, followed by 500mg once a day for 2 days.
General
- Post azithromycin therapy, advise complete abstinence (no sexual activity, not even with a condom) for seven days for both the patient and their partner.
- Offer written information on the infection.
- Offer to screen for different sexually transmitted diseases.
- Talk about using barrier methods consistently and precisely.
Partner notification
About two thirds of the sexual contacts of the index patient will also be chlamydia carriers.
For men with symptoms, the “look-back” period is four weeks.
‘Look-back’ periods for males with asymptomatic infections and women with symptomatic infections are either six months before to manifestation or, if longer, until the previous sexual partner. Test contacts, then treat them epidemiologically.
Follow-up and test of cure (TOC)
Usually done over the phone, follow-up one week after therapy can verify treatment adherence, evaluate the chance of re-infection, and monitor PN. Generally speaking, if therapy has been completed and there is no risk of re-infection, TOC is not advised. Women who are expecting should have a TOC. TOC should be done five weeks after therapy ends (6 weeks after azithromycin) to avoid false positive results from NAATs recognizing nonviable organisms.
Chlamydia screening
Targeted, opportunistic, and registry-based screening are among the several approaches used for chlamydia screening and testing. While the normal course of silent chlamydia infections is unknown, research indicates that about 50% of them heal on their own after a year.
Moreover, there might be less problems from infections than first believed. Though the true rate may be as low as 2%, PID was believed to affect up to 40% of untreated women. This obviously affects screening systems’ cost-effectiveness.
In 2003, England put into place the National Chlamydia Screening Programme (NCSP). Testing is concentrated in other nations on groups, such as TOP patients, sexual partners of chlamydia positive people, and visitors to sexual health clinics.
New variant chlamydia
Sweden discovered a novel genetic variety of C. trachomatis (nvCT) in 2006. False negative results were caused, nonetheless, by the inability of certain NAAT testing kits at the time to detect this mutation. Seldom seen instances have been found in Scotland, France, Ireland, and Scandinavia. Several testing kits have been modified to identify this difference. This Chlamydia strain appears to cause the same illness as the “regular” strain, and the same medications can be used to treat infection.
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