What
is chlamydia trachomatis?Chlamydia is a sexually transmitted bacterial
disease, caused by Chlamydia trachomatis. Where
is chlamydia usually found?Chlamydia occurs in sexually active men and
women throughout the world. How common is chlamydia?Very
common. In 2004, nearly one million cases were reported in the USA alone. Underreporting
is common because many people with chlamydia experience no symptoms from their
infections and do not seek treatment. Too frequently, patients are treated for
symptom with no tests to confirm the cause. Some estimates put the real
rate of infection as three times higher - almost three million in the USA each
year. Re-infection is a major problem, as symptom-free sex partners may not be
treated. How is chlamydia transmitted?Chlamydia
is sexually transmitted during vaginal, oral, or anal sex. Chlamydia can also
be transmitted during vaginal childbirth. Any sexually active person can
be infected with chlamydia. The more sex partners, the higher the risk of infection.
Young women are at particularly high risk of infection, because the cervix is
not fully matured. Chlamydia is transmissable by oral and anal sex, putting
at risk men who have sex with men. What are the
symptoms of chlamydia?Any genital symptom, including discharge, burning
sensation during urination, pain during intercourse, unexpalined sores or rash
should be a signal to abstain from sexual activity and to seek advice without
delay. As many as three quarters of infected women and half of infected
men never experience symptoms from the original infection, so chlamydia may not
be diagnosed or treated until complications develop, or a partner reports the
disease. If symptoms do occur, they usually appear within 1 to 3 weeks of
exposure. Chlamydia is highly transmissable; it is a safe assumption for any infected
person that all recent sex partners either also have the disease, or are at risk
- they need to be told. In women, the disease attacks the cervix
and the urethra. this may cause an abnormal vaginal discharge or a burning sensation
when urinating. The infection may then spread from the cervix to the fallopian
tubes; some women will still have no signs or symptoms, while others may report
lower abdominal pain, low back pain, pain during sexual intercourse, nausea, fever,
and bleeding between menstrual periods. If the infection is allowed to spread
into the higher reproductive system, irreversible damage may occur. Men
may report a discharge from the penis and a burning sensation when urinating.
Men may also experience itching or burning around the opening of the penis or
pain and swelling in the testicles, sometimes both. How
is chlamydia diagnosed?There are laboratory tests to confirm Chlamydia
trachomatis, including urine testing, or culturing specimens from the cervix
or urethra. Is there a treatment for chlamydia?First
line treatment is a 7-day course of twice daily doxycycline 100 mg tablets. Azithromycin
1g in a single oral dose, has the advantage of being effective when compliance
over seven days is in doubt. However, there is increasing evidence of disease
resistance to azithromycin. Erythromycin, ofloxacin and levofloxacin are
also effective, amoxicillin or erythromycin are the treatment of choice in pregnancy
and for nursing mothers. Coinfection with Chlamydia trachomatis often
occurs among patients who have gonococcal infection;
many doctors recommend dual treatment if one or the other infection is known to
be present. Good practice, however, suggests that in all cases, swabs and spcimens
are taken before treatment is commenced, in order to compile an accurate patient
history, and to add to the general knowledge of disease incidence. Is
there a way to prevent infection?The surest way to avoid transmission
of sexually transmitted diseases is to abstain from sexual contact, or maintain
along-term mutually monogamous relationship with a partner who has been tested
and is known not to be infected with Chlamydia trachomatis. A latex
condom, used consistently and correctly, can reduce the risk of transmission of
Chlamydia trachomatis; it offers no guarantee, however, as transmission
does not depend on copulation itself - foreplay offers ample opportunity. Treating
an infected patient will prevent transmission to future sex partners - but as
many people experience no symptoms when the disease is present, simultaneous treatment
of both partners, while abstaining from all sexual activity, is the only way to
be sure of avoiding reinfection, which is very common. Treatment of chlamydia
in pregnant women usually prevents transmission of Chlamydia trachomatis
to infants during birth. Treatment of sex partners helps to prevent reinfection
of the index patient and infection of other partners. Chlamydia screening
is a wise precaution for all sexually active women. An annual screen for women
up to the age of 25, and older women with a new sex partner or multiple sex partners.
All pregnant women should have a screening test for chlamydia. Anyone infected
with Chlamydia trachomatis should ensure that all recent sex partners are
advised to seek investigation and treament. This will reduce the risk that they
will develop serious complications from chlamydia and will also reduce everyone's
risk of becoming re-infected. The spread of Chlamydia trachomatis can only
be ensured if all infected people abstain from all sexual activity until treatment
is complete. While it is not azodium's intention to preach or lecture,
Chlamydia trachomatis has reached epic proportions, and will cause increasing
misery for many if responsble action is not taken. What
is the mortality rate for chlamydia?The damage caused by Chlamydia
trachomatis can leave a woman at increased risk of ectopic pregnancy (pregnancy
outside the uterus), which can be fatal. Genital infections account for
up to 40% of premature births, and so are a major cause of infant mortality. What
are the long term effects of chlamydia?In women, untreated Chlamydia
trachomatis can spread into the uterus and fallopian tubes, causing pelvic
inflammatory disease (PID). This probably occurs in about 40% of women with untreated
Chlamydia trachomatis. PID can - and frequently does - cause permanent
damage to the fallopian tubes, the uterus and surrounding tissues. The damage
can lead to chronic pelvic pain, infertility, and ectopic pregnancy. Women
who have been infected with chlamydia much more likely to become infected with
HIV, if exposed to it later. Chlamydia trachomatis can cause proctitis,
infection of the lining of the rectum, in people who have anal sex with a partner
who has chlamydia. Chlamydia trachomatis can also be found in the
throats of people who have oral sex. Untreated Chlamydia trachomatis
in men may spread to the sperm delivery system. This may cause pain, fever, and
even infertility.
Is there a chlamydia vaccine?Currently,
there is no vaccine available - but development and testing are taking place.
However, screening is available in some countries, particularly for pregnant
women, who - with their baby - are at increased risk of harm, and research
suggests this is welcomed by women1,2
Is there legal protection for those infected? There
is unlikely to be any specific protection in your country; but long term problems
due to failures of diagnosis and treatment have been taken to court in more than
one country. Failure to abstain from sex while knowingly infected, probably constitutes
assault - but would be a difficult case to prove. Bibliography
and Further Information Sources
References
- Jade
E Bilardi, J. E. et al., (2010) Young
pregnant women's views on the acceptability of screening for chlamydia
as part of routine antenatal care
BMC Public Health. 2010; 10: 505.
- Pavlin, N. L., et al., (2006)
Implementing chlamydia screening: what do women think? A systematic
review of the literature
BMC Public Health. 2006; 6: 221
I regret I cannot assist with individual cases or essays and school projects,
but if it's something I've missed, I'll be happy to try and help.
Article written by Andrew Heenan BA (Hons), RGN, RMN
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