Dr  Sampurna Roy  MD

Chlamydia trachomatis is a well recognized sexually transmitted pathogen.    Visit: Chlamydial Infection  ; Trachoma ; Psittacosis (Ornithosis,Parrot Fever) ; Lymphogranuloma Venereum ; Chlamydial Conjunctivitis (Inclusion Conjunctivitis) ; 

Chlamydia trachomatis (D-K) causes urethritis , epididymitis, and proctitis in men and cervicitis, salpingitis, urethritis and proctitis in women.

The highest age-specific rates for chlamydia are found in adolescents. Female adolescents are more susceptible to STDs than older women because their cervical anatomic development is incomplete and especially sensitive to infection by certain sexually transmitted pathogens, and for some other features that characterize sexual behavior and health care behavior of the young people.

Non-specific urethritis (NSU) is a sexually transmitted disease; 50% of cases are due to Chlamydia trachomatis, so that this is the commonest sexually transmitted infection in the developed world.  

Chlamydia trachomatis also causes epididymitis, usually in those under age 35, and may occasionally be responsible for chronic prostatitis.

In women, C. trachomatis infection of the cervix is more common than gonorrhea.  30% to 60 % of women with gonorrhea have concurrent C. trachomatis infection, and this organism is now recognized as a cause of acute salpingitis.      Visit: Gonococcal Infection 

The spectrum of disease parallels gonococcal disease. For instance, chlamydial urethritis in men typically causes dysuria and a scant mucoid discharge, and in women cervicitis causes a mucopurulent exudates in the cervical os, hypertrophic cervical erythema, and friable surface epithelium. The clinical presentation of acute chlamydial salpingitis -namely pelvic pain and fever - resembles that of gonococcal salpingitis.

Genital chlamydial infection is recognized as the world's most common sexually transmitted disease, with estimates of greater than 4 million new infections occurring annually in the United States.

Although most C. trachomatis infections in men and women are asymptomatic, infection can lead to severe reproductive complications in women.

The high prevalence in women of child-bearing age results in exposure of an estimated 100,000 neonates in the United States annually. Besides its potential to produce genital tract infection, C. trachomatis is increasingly being associated with long-term complications like infertility.

Chlamydial infection is now readily diagnosable and the evidence increasingly suggests that it is underdiagnosed.

The diagnosis of chlamydial infections is best established by isolating the organism in tissue culture.

Direct fluorescent staining of cervical or urethral smears with monoclonal reagents is diagnostic, but light microscopy seldom discloses chlamydial inclusions in smear from the genital tract.

Serodiagnosis is also acceptable, particularly when there is a rising titer.

Chlamydia trachomatis infections are the most prevalent bacterial sexually transmitted infections (STI) recognized throughout the world. Worldwide, the magnitude of morbidity associated with sexually transmitted chlamydial infections is enormous. C.trachomatis is a common cause of urethritis and cervicitis, and sequelae include pelvic inflammatory disease (PID), ectopic pregnancy, tubal factor infertility, epididymitis, proctitis and reactive arthritis. The sharp worldwide increase in the incidence of PID during the past two decades has led to the secondary epidemics of tubal factor infertility and ectopic pregnancy. Chlamydial PID is the most important preventable cause of infertility and adverse pregnancy outcome. Chlamydial infections, like STI in general, are primarily a woman's health care issue since the manifestations and consequences are more damaging to the reproductive health in women than in men. Based on the available evidence, approximately 20% of women with chlamydial lower genital tract infection will develop PID, approximately 4% develop chronic pelvic pain, 3% infertility, and 2% adverse pregnancy outcome. However, these estimates are based on relatively weak evidence. Research on the link between C.trachomatis and male aspects of infertility has been much more limited. Currently recommended treatment regimens include azithromycin in a single dose or doxycycline for 7 days. These therapies are highly efficacious. Timely management of sex partners is essential for decreasing the risk for re-infection. Immunopathogenesis of C.trachomatis infection is one of the main focal points of current research into Chlamydia. Chlamydial infection fills the general prerequisites for disease prevention by screening, i.e. chlamydial infections are highly prevalent, usually asymptomatic, are associated with significant morbidity, can be reliably diagnosed, and are treatable. Screening programmes for C.trachomatis will be of paramount importance in the prevention of long-term sequelae. The cost of screening is only a fraction of the health care costs incurred due to complications resulting from undiagnosed and untreated chlamydial infections. Current strategies to control C.trachomatis still largely depend on clinic-based screening of symptomatic patients, and have not been successful. The development of highly sensitive and specific nucleic acid amplification tests for the diagnosis of chlamydial infections has been an important advance in the ability to conduct population-based screening programmes to prevent complications. Thus, the case for screening is clearly made, but much detail remains to be worked out.

Productivity losses attributable to untreated chlamydial infection and associated pelvic inflammatory disease in reproductive-aged women.
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Risk factors for Clamydia infections of the genital organs in adolescent females.Srp Arh Celok Lek. 2001 Jul-Aug;129(7-8):169-74

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Colposcopic and histologic findings in cervical chlamydial infection.
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Gynecological chlamydial infections.Infection. 1982;10 Suppl 1:S40-5.