180 - Chlamydia trachomatis (Trachoma and Urogenital Infections)

Abstract

Chlamydia trachomatis is an intracellular bacterium that causes trachoma, a disease of the underdeveloped world and the leading cause of infectious blindness. Trachoma is diagnosed by eye examination, treated on a community-wide basis with single-dose azithromycin, and prevented by face washing, access to clean water, and improved sanitation. Chlamydia trachomatis also causes urogenital infection, which is highly prevalent in sexually active adolescents and young adults, and the most common bacterial sexually transmitted infection (STI) in the world. Uncomplicated cases present in men as nongonococcal urethritis and in women as cervicitis that can cause vaginal discharge but is usually asymptomatic. In a minority of women, spread to the upper genital tract causes pelvic inflammatory disease (PID) that can lead to ectopic pregnancy and infertility. Infants born to infected women may develop neonatal conjunctivitis and pneumonia. Specific C. trachomatis serovars cause lymphogranuloma venereum (LGV), a more invasive STI characterized by enlarged inguinal lymph nodes or severe proctocolitis. Chlamydia urogenital infections are diagnosed with a nucleic acid amplification test, ideally of first-catch urine in men and vaginal swabs in women. Uncomplicated genital infections are treated with single-dose azithromycin or doxycycline for 1 week, but longer courses are needed for PID, epididymitis, and LGV. Annual screening is recommended for sexually active women less than 25 years old and other high-risk individuals, with the goal of reducing transmission and reproductive sequelae. Pregnant women are screened to prevent neonatal infection. Other prevention strategies include behavioral changes and partner notification and treatment. There is no chlamydial vaccine.