Chlamydia trachomatis
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Etiology
- risk factors
- age <= 25 years
- new or multiple sexual partners
- unprotected sex
Epidemiology
- exclusively a human pathogen
- major cause of sexually transmitted disease & perinatal infection
- at least 20 serotypes of Chlamydia trachomatis
- prevalence 4.2% in adolescents, grades 7-12 1.9% in whites, 5.9% in Latinos, 12.5% in blacks
- prevelance 2% in younger people[15]
Pathology
- vaginal flora dominated by Lactobacillus iners associated with increased risk for Chlamydia trachomatis infection, compared with flora dominated by Lactobillus crispatus (RR-2.6)[21]
Clinical manifestations
- subacute presentation
- disorders of Chlamydia trachomatis in both sexes
- disorders Chlamydia trachomatis in men
- disorders Chlamydia trachomatis in women
- cervicitis
- mucopurulent cervix
- friable cervix
- endometritis
- inter menstrual or post-coital bleeding
- lower abdominal pain
- acute salpingitis
- bartholinitis
- cervicitis
- infrequent manifestations
- endocarditis
- peritonitis
- periappendicitis
Laboratory
- culture for Chlamydia trachomatis
- culture in mammalian cell lines
- Chlamydia trachomatis antigen in specimen
- ELISA
- direct fluorescent antibody slide test
- Chlamydia trachomatis DNA, Chlamydia trachomatis rRNA or GenProbe
- probably test of choice for genitourinary infection
- endocervical or urethral swab[1][13]
- urine is adequate specimen[8]
- rectal & oropharyngeal specimens as indicated
- chlamydia rapid test <women> (point-of-care test)
- self-collected vaginal swab
- specificity 99%, sensitivity 84%
- Chlamydia+gonorrhea point of care test[22]
- results available in 30 minutes
- allows one visit diagnoisis & treatment
- Chlamydia trachomatis serology of limited use
- complement fixation tests
- micro-immunofluorescence
- measures antibodies by sero specificity & immunoglobulin class
- may be useful in infant pneumonia & salpingitis
- urinalysis may show pyuria without bacteriuria
- test of cure not indicated except in pregnancy[1]
- retest after 3 months for possible repeat infection[1]
Complications
- pelvic inflammatory disease
- ectopic pregnancy
- tubal infertility
- blindness (most common cause of infectious blindness)[16]
Differential diagnosis
- Neisseria gonorrhoeae:
- generally more prululent discharge
- cannot be distinguished on clinical grounds[1]
- Ureaplasma urealyticum
- Herpes simplex
Management
- antibiotics
- doxycycline 100 mg PO BID for 7 days
- treatment of choice, 100% effective[17]
- more effective than azithromycin for rectal chlamydia
- 21 days of therapy for acute proctitis (treat as lymphogranuloma venereum)
- azithromycin 1 g PO single dose (pregnant)[9] 97% effective[17]
- erythromycin 500 mg PO QID for 7 days (pregnant)
- sulfisoxazole 500 mg PO QID for 7 days
- ofloxacin (Floxin) 300 mg PO BID for 7 days
- pelvic inflammatory disease
- ceftriaxone 250 mg IM single dose
- ceftriaxone 2 g IM single dose plus probenecid 1 g PO once
- another 3rd generation cephalosporin plus doxycycline 100 mg PO BID for 14 days
- doxycycline 100 mg PO BID for 7 days
- sexual partners should be offered evaluation & treatment[1]
- follow-up 1 week after treatment
- screening
- behavioral counseling for sexually-active women < 25 years of age & older women at risk[14]
Notes
- experimental vaccine effective in humanized mice[16]
- vaccine consists of nanoparticles that complex a synthetic & biodegradable adjuvant with ultraviolet light-inactivated C trachomatis
- nanoparticles are taken up by mucosal epithelial cells
- vaccine was applied to mucosal surfaces (uterus or nasal) of mice[16]
More general terms
Additional terms
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2009, 2012, 2015, 2018, 2021.
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 1055-64.
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 442-43
- ↑ 4.0 4.1 Kaiser Permanente, Northern California, current recommendations, 3/2000
- ↑ 5.0 5.1 Journal Watch 21(11):89, 2001
- ↑ 6.0 6.1 Prescriber's Letter 9(6):31 2002
- ↑ Journal Watch 24(12):99, 2004 Miller WC, Ford CA, Morris M, Handcock MS, Schmitz JL, Hobbs MM, Cohen MS, Harris KM, Udry JR. Prevalence of chlamydial and gonococcal infections among young adults in the United States. JAMA. 2004 May 12;291(18):2229-36. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15138245
- ↑ 8.0 8.1 8.2 8.3 Journal Watch 25(1):10, 2005 Centers for Disease Control and Prevention (CDC). Chlamydia screening among sexually active young female enrollees of health plans--United States, 1999-2001. MMWR Morb Mortal Wkly Rep. 2004 Oct 29;53(42):983-5. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/15514579 <Internet> http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5342a1.htm
- ↑ 9.0 9.1 Prescriber's Letter 13(9): 2006 Summary Chart of 2006 CDC treatment guidelines for STDs Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=220912&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 10.0 10.1 10.2 Meyers DS, Halvorson H, Luckhaupt S; U.S. Preventive Services Task Force. Screening for chlamydial infection: an evidence update for the U.S. Preventive Services Task Force. Ann Intern Med. 2007 Jul 17;147(2):135-42. Epub 2007 Jun 18. Review. Summary for patients in: Ann Intern Med. 2007 Jul 17;147(2):I44. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17576995
U.S. Preventive Services Task Force. Screening for chlamydial infection: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2007 Jul 17;147(2):128-34. Epub 2007 Jun 18. Summary for patients in: Ann Intern Med. 2007 Jul 17;147(2):I44. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17576996
corresponding NGC guideline withdrawn Jan 2013 - ↑ Prescriber's Letter 15(6): 2008 Expedited Partner Therapy (EPT) for Chlamydia and Gonorrhea Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=240601&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Schoeman SA et al Assessment of best single sample for finding chlamydia in women with and without symptoms: a diagnostic test study. BMJ 2012;345:e8013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23236032 <Internet> http://www.bmj.com/content/345/bmj.e8013
- ↑ 13.0 13.1 Papp JR et al Recommendations for the Laboratory-Based Detection of Chlamydia trachomatis and Neisseria gonorrhoeae. MMWR. Weekly, March 14, 2014 / 63(RR02);1-19 http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6302a1.htm
- ↑ 14.0 14.1 14.2 14.3 Zakher B et al Screening for Gonorrhea and Chlamydia: An Update for the U.S. Preventive Services Task Force. Ann Intern Med. Published online 23 September 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25244000 <Internet> http://annals.org/article.aspx?articleid=1906845
LeFevre ML et al Behavioral Counseling Interventions to Prevent Sexually Transmitted Infections: U.S. Preventive Services Task Force Recommendation Statement Ann Intern Med. Published online 23 September 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25244227 <Internet> http://annals.org/article.aspx?articleid=1906847
O'Connor EA et al Behavioral Sexual Risk-Reduction Counseling in Primary Care to Prevent Sexually Transmitted Infections: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force. Ann Intern Med. Published online 23 September 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25243895 <Internet> http://annals.org/article.aspx?articleid=1906844
U.S. Preventive Services Task Force. Screening for chlamydia and gonorrhea: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014 Dec 16;161(12):902-10. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25243785 - ↑ 15.0 15.1 Torrone E et al Prevalence of Chlamydia trachomatis Genital Infection Among Persons Aged 14-39 Years - United States, 2007-2012 MMWR. September 26, 2014 / 63(38);834-838 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6338a3.htm PMID: https://www.ncbi.nlm.nih.gov/pubmed/25243785
- ↑ 16.0 16.1 16.2 16.3 Komaroff AL Major Step Toward a Vaccine for Chlamydia trachomatis. NEJM Journal Watch. Junly 9, 2015 Massachusetts Medical Society (subscription needed) http://www.jwatch.org
Stary G et al. A mucosal vaccine against Chlamydia trachomatis generates two waves of protective memory T cells. Science 2015 Jun 19; 348:aaa8205. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26089520 <Internet> http://www.sciencemag.org/content/348/6241/aaa8205 - ↑ 17.0 17.1 17.2 Geisler WM et al Azithromycin versus Doxycycline for Urogenital Chlamydia trachomatis Infection. N Engl J Med 2015; 373:2512-2521. December 24, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26699167 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1502599
Quinn TC, Gaydos CA Treatment for Chlamydia Infection - Doxycycline versus Azithromycin. N Engl J Med 2015; 373:2573-2575. December 24, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26699174 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1513001 - ↑ Workowski K. In the clinic. Chlamydia and gonorrhea. Ann Intern Med. 2013 Feb 5;158(3):ITC2-1. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23381058
- ↑ World Health Organization (WHO). 2016 WHO Guidelines for the treatment of Chlamydia trachomatis. http://apps.who.int/iris/bitstream/10665/246165/1/9789241549714-eng.pdf
- ↑ Wiesenfeld HC Screening for Chlamydia trachomatis Infections in Women. N Engl J Med 2017; 376:765-773. February 23, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28225683 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMcp1412935
- ↑ 21.0 21.1 van Houdt R, Ma B, Bruisten SM et al Lactobacillus iners-dominated vaginal microbiota is associated with increased susceptibility to Chlamydia trachomatis infection in Dutch women: a case-control study. Epidemiology. Sexually Transmitted Infections article. Online Sept 26, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28947665 <Internet> http://sti.bmj.com/content/early/2017/08/30/sextrans-2017-053133
- ↑ 22.0 22.1 Van Der Pol B, Taylor SN, Mena L et al Evaluation of the Performance of a Point-of-Care Test for Chlamydia and Gonorrhea. JAMA Netw Open. 2020;3(5):e204819. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32407506 Free Article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2765941
- ↑ Dombrowski JC et al. Doxycycline versus azithromycin for the treatment of rectal chlamydia in men who have sex with men: A randomized controlled trial. Clin Infect Dis 2021 Feb 19. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33606009 https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciab153/6144986