Know in Depth
Chlamydia trachoma tis - it is an obligate intracellular organism which preferentially infects the columnar and transitional epithelial cells.
- Most common bacterial Sexually transmitted infection in the US (developed countries)
- Often associated with Neisseria gonorrheae.
- The infection is mostly localized in the urethra, Bartholin's gland, and cervix. It can ascend upwards like gonococcal infection to produce acute PID.
- Asymptomatic (80% of women)
- Mucopurulent endocervical discharge
- Urethral syndrome: dysuria, frequency, pyuria, no bacteria
- Pelvic pain
- Postcoital bleeding or intermenstrual bleeding.
- Nucleic Acid Amplification Test (NAAT) is the preferred method for diagnosis
- First void urine sample or vaginal swab is most effective and specific
- It can also be detected by Polymerase chain reaction
- It is an obligate intracellular parasite - tissue culture on Me Coy cells or Hela cells can be done.
- Doxycycline 100 mg BID for 7 day, or azithromycin 1 g in a single dose (may be used in pregnancy). Since single dose of azithromycin has results similar to doxycyline so it is the DOC
- Treat partners simultaneously
- In pregnancy- Azithromycin 19 in a single dose or Amoxicillin 500 mg 3 times daily for 7 days.
Screening for Chlamydia
It should be done:
- In high-risk groups including all sexually active women less than 25 years as well as older at risk women (e.g. women with a new partner or multiple partners)
- During pregnancy.
- Acute salpingitis, PID
- Fitz-Hugh-Curtis syndrome (liver capsule infection)
- Reiters syndrome - Arthritis, conjunctivitis, urethritis (Reactive arthritis - male predominance, HLA-B27)
- Intertility - tubal obstruction from low-grade salpingitis
- Ectopic pregnancy
- Chronic pelvic pain
- Perinatal infection - conjunctivitis, pneumonia.