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14-September-2008 11:27:25 - Chlamydia infection Chlamydia Classification and external resources Pap smear showing C. trachomatis HE stain ICD-10 A55.-A56.8, A70.-A74.9 ICD-9 099.41, 483.1 DiseasesDB 2384 eMedicine med/340 MeSH D002690 Chlamydia infection from the Greek, χλαμÏ?δος meaning cloak is a common sexually transmitted infection STI in humans caused by the bacterium Chlamydia trachomatis. The term Chlamydia infection can also refer to infection caused by any species belonging to the bacterial family Chlamydiaceae. C. trachomatis is only found in humans.1 Chlamydia is a major infectious cause of human genital and eye disease. Chlamydia infection is one of the most common sexually transmitted infections in people worldwide - about 2.8 million cases of chlamydia infection occur in the United States each year.2 It is the most common bacterial STI in humans.3 C. trachomatis is naturally found living only inside human cells. Chlamydia can be transmitted during vaginal, anal, or oral sex, and can be passed from an infected mother to her baby during vaginal childbirth. Many people with Chlamydia exhibit no symptoms of infection. Between half and three-quarters of all women who have chlamydia have no symptoms and do not know that they are infected. If untreated, chlamydial infections can cause serious reproductive and other health problems with both short-term and long-term consequences. Chlamydia is easily treated with antibiotics. Chlamydia conjunctivitis or trachoma is a common cause of blindness worldwide. The World Health Organization estimates that it accounted for 15% of blindness cases in 1995, but only 3.6% in 2002.456 Contents 1 Related conditions 1.1 Genital disease 1.2 Eye disease 1.3 Rheumatological conditions 1.4 Perinatal infections 1.5 Other conditions 2 Diagnosis 2.1 Screening 2.2 Laboratory detection 3 Treatment 3.1 Areas of research 4 Pathophysiology 5 Footnotes 6 External links Related conditions Genital disease Chlamydial cervicitis in a female patient characterized by mucopurulent cervical discharge, erythema, and inflammation. Chlamydial cervicitis in a female patient characterized by mucopurulent cervical discharge, erythema, and inflammation. Chlamydial infection of the neck of the womb cervicitis is an asymptomatic sexually transmitted illness for about 50-70% of the female population. Of those who have an asymptomatic infection that is not detected by their doctor, approximately half will develop pelvic inflammatory disease PID, a generic term for infection of the uterus, fallopian tubes, and/or ovaries. PID can cause scarring inside the reproductive organs, which can later cause serious complications, including chronic pelvic pain, difficulty becoming pregnant, ectopic tubal pregnancy, and other dangerous complications of pregnancy. Chlamydia causes 250,000 to 500,000 cases of PID every year in the United States. Women infected with chlamydia are up to five times more likely to become infected with HIV, if exposed.7 Chlamydia is known as the Silent Epidemic because in women, it may not cause any symptoms and will linger for months or years before being discovered. Symptoms that may occur include: unusual vaginal bleeding or discharge, pain in the abdomen, painful sexual intercourse dyspareunia, fever, painful urination or the urge to urinate more frequently than usual urinary urgency. Male patients may develop a white, cloudy or watery discharge shown from the tip of the penis. Male patients may develop a white, cloudy or watery discharge shown from the tip of the penis. In men, Chlamydia shows symptoms of infectious urethritis inflammation of the urethra in about 50% of cases. Symptoms that may occur include: a painful or burning sensation when urinating, an unusual discharge from the penis, swollen or tender testicles, or fever. Discharge, or the purulent exudate, is generally less viscous and lighter in color than for gonorrhea. If left untreated, it is possible for Chlamydia in men to spread to the testicles causing epididymitis, which in rare cases can cause sterility if not treated within 6 to 8 weeks. Chlamydia causes more than 250,000 cases of epididymitis in the U.S. each year. Chlamydia is also a potential cause of prostatitis in men, although the exact relevance in prostatitis is difficult to ascertain due to possible contamination from urethritis.8 Eye disease Conjunctivitis due to chlamydia. Conjunctivitis due to chlamydia. Chlamydia conjunctivitis or trachoma was once the second most important cause of blindness worldwide, but its role diminished from 15% of blindness cases by trachoma in 1995 to 3.6% in 2002, according to WHO estimates.645 The infection can be spread from eye to eye by fingers, shared towels or cloths, coughing and sneezing and eye-seeking flies.9 Newborns can also develop chlamydia eye infection through childbirth see below. Using the SAFE strategy acronym for surgery for in-growing or in-turned lashes, antibiotics, facial cleanliness, and environmental improvements, the World Health Organisation aims for the global elimination of trachoma by 2020 GET 2020 initiative.1011 Rheumatological conditions Chlamydia may also cause reactive arthritis - the triad of arthritis, conjunctivitis and urethritis inflammation of the urethra - especially in young men. About 15,000 men develop reactive arthritis due to chlamydia infection each year in the U.S., and about 5,000 are permanently affected by it. It can occur in both sexes, though is more common in men. Perinatal infections As many as half of all infants born to mothers with chlamydia will be born with the disease. Chlamydia can affect infants by causing spontaneous abortion; premature birth; conjunctivitis, which may lead to blindness; and pneumonia. Conjunctivitis due to chlamydia typically occurs one week after birth compare with chemical causes within hours or gonorrhea 2-5 days. Other conditions Chlamydia trachomatis is also the cause of lymphogranuloma venereum, an infection of the lymph nodes and lymphatics. It usually presents with genital ulceration and swollen lymph nodes in the groin, but it may also manifest as proctitis inflammation of the rectum, fever or swollen lymph nodes in other regions of the body.12 Diagnosis Screening For sexually active women who are not pregnant, screening is recommended in those under 25 and others at risk of infection.13 Risk factors include a history of chlamydial or other sexually transmitted infection, new or multiple sexual partners, inconsistent condom use.14 For pregnant women, guidelines vary: screening women with age or other risk factors is recommended by the U.S. Preventive Services Task Force USPSTF which recommends screening women under 25 and the American Academy of Family Physicians which recommends screening women aged 25 or younger. The American College of Obstetricians and Gynecologists recommends screening all at risk, while the Centers for Disease Control and Prevention recommend universal screening of pregnant women.13 The USPSTF acknowledges than in some communities there may be other risk factors for infection, such as ethnicity.13 Evidence-based recommendations for screening initiation, intervals and termination are currently not possible.13 There is no universal agreement on screening men for chlamydia. Laboratory detection The diagnosis of genital chlamydial infections evolved rapidly from the 1990s through 2006. Nucleic acid amplification tests NAAT, such as polymerase chain reaction PCR, transcription mediated amplification TMA, and the DNA strand displacement amplification SDA now are the mainstays. NAAT for chlamydia may be performed on swab specimens collected from the cervix women or urethra men, on self-collected vaginal swabs, or on voided urine. Urine and self-collected swab testing facilitates the performance of screening tests in settings where genital examination is impractical. At present, the NAATs have regulatory approval only for testing urogenital specimens, although rapidly evolving research indicates that they may give reliable results on rectal specimens. Because of improved test accuracy, ease of specimen management, convenience in specimen management, and ease of screening sexually active men and women, the NAATs have largely replaced culture, the historic gold standard for chlamydia diagnosis, and the non-amplified probe tests. The latter test is relatively insensitive, successfully detecting only 60-80% of infections in asymptomatic women, and often giving falsely positive results. Culture remains useful in selected circumstances and is currently the only assay approved for testing non-genital specimens. Treatment Chlamydia trachomatis inclusion bodies brown in a McCoy cell culture. Chlamydia trachomatis inclusion bodies brown in a McCoy cell culture. C. trachomatis infection can be effectively cured with antibiotics once it is detected. Current Centers for Disease Control guidelines provide for the following treatments: Azithromycin 1 gram oral as a single dose, or Doxycycline 100 milligrams twice daily for ten days. Tetracycline Erythromycin Untested Treatments Ciprofloxacin 500 milligrams twice daily for 3 days. Although this is not an approved method of treatment. β-lactams are not suitable drugs for the treatment of chlamydia. While they have the ability to halt growth of the organism i.e. are microbistatic, these antibiotics do not eliminate the bacteria. Once treatment is stopped, the bacteria will begin to grow once more. See below for Persistence. Areas of research Recent phylogenetic studies have revealed that chlamydia shares a common ancestor with modern plants, and retains unusual plant-like traits both genetically and physiologically. In particular, the enzyme L,L-diaminopimelate aminotransferase, which is related to lysine production in plants, is also linked with the construction of chlamydia's cell wall. The genetic encoding for the enzymes is remarkably similar in plants and chlamydia, demonstrating a close common ancestry.15 This unexpected discovery may help scientists develop new treatment avenues: if scientists could find a safe and effective inhibitor of L,L-diaminopimelate aminotransferase, they might have a highly effective and extremely specific new antibiotic against chlamydia. Pathophysiology For Chlamydia's life cycle, see Chlamydia bacterium Chlamydiae have the ability to establish long-term associations with host cells. When an infected host cell is starved for various nutrients such as amino acids e.g. tryptophan,16 iron, or vitamins, this has a negative consequence for Chlamydiae since the organism is dependent on the host cell for these nutrients. The starved chlamydiae enter a persistent growth state wherein they stop cell division and become morphologically aberrant by increasing in size.17 Persistent organisms remain viable as they are capable of returning to a normal growth state once conditions in the host cell improve. There is much debate as to whether persistence has in vivo relevance. Many believe that persistent chlamydiae are the cause of chronic chlamydial diseases. Some antibiotics such as β-lactams can also induce a persistent-like growth state, which can contribute to the chronicity of chlamydial diseases. Footnotes ^ www.chlamydiae.com professional - Taxonomy diagram. Retrieved on 2007-10-27. ^ Chlamydia fact sheet from the Centers for Disease Control and Prevention ^ Gerbase AC, Rowley JT, Mertens TE 1998. Global epidemiology of sexually transmitted diseases. Lancet 351 Suppl 3: 2-4. PMID 9652711. ^ a b Thylefors B, Négrel AD, Pararajasegaram R, Dadzie KY 1995. Global data on blindness. Bull World Health Organ 73 1: 115-21. PMID 7704921. ^ a b Resnikoff S, Pascolini D, Etya'ale D et al 2004. Global data on visual impairment in the year 2002. Bull World Health Organ 82 11: 844-851. PMID 15640920. ^ a b Belland R, Ojcius D, Byrne G 2004. Chlamydia. Nat Rev Microbiol 2 7: 530-1. doi:10.1038/nrmicro931. PMID 15248311. ^ STD Facts - Chlamydia. Retrieved on 2007-10-26. ^ Wagenlehner FM, Naber KG, Weidner W 2006. Chlamydial infections and prostatitis in men. BJU Int. 97 4: 687-90. doi:10.1111/j.1464-410X.2006.06007.x. PMID 16536754. ^ Mabey DC, Solomon AW, Foster A 2003. Trachoma. Lancet 362 9379: 223-9. doi:10.1016/S0140-67360313914-1. PMID 12885486. ^ World Health Organisation. Trachoma. Accessed March 17, 2008. ^ Ngondi J, Onsarigo A, Matthews F, et al 2006. Effect of 3 years of SAFE surgery, antibiotics, facial cleanliness, and environmental change strategy for trachoma control in southern Sudan: a cross-sectional study. Lancet 368 9535: 589-95. doi:10.1016/S0140-67360669202-7. PMID 16905023. ^ Williams D, Churchill D 2006. Ulcerative proctitis in men who have sex with men: an emerging outbreak. BMJ 332 7533: 99-100. doi:10.1136/bmj.332.7533.99. PMID 16410585. ^ a b c d Meyers D, Wolff T, Gregory K. et al. USPSTF Recommendations for STI Screening. Am Fam Physician. 2008;776:819-824. ^ U.S. Preventive Services Task Force 2007. Screening for chlamydial infection: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 147 2: 128-34. PMID 17576996. ^ McCoy AJ, Adams NE, Hudson AO, Gilvarg C, Leustek T, Maurelli AT 2006. L,L-diaminopimelate aminotransferase, a trans-kingdom enzyme shared by Chlamydia and plants for synthesis of diaminopimelate/lysine. Proc. Natl. Acad. Sci. U.S.A. 103 47: 17909-14. doi:10.1073/pnas.0608643103. PMID 17093042. ^ Leonhardt RM, Lee SJ, Kavathas PB, Cresswell P 2007. Severe Tryptophan Starvation Blocks Onset of Conventional Persistence and Reduces Reactivation of Chlamydia trachomatis. Infect. Immun. 75 11: 5105-17. doi:10.1128/IAI.00668-07. PMID 17724071. ^ Mpiga P, Ravaoarinoro M 2006. Chlamydia trachomatis persistence: an update. Microbiol. Res. 161 1: 9-19. doi:10.1016/j.micres.2005.04.004. PMID 16338585. External links Wikimedia Commons has media related to: Chlamydia Chlamydia Fact Sheet from the CDC STI: Chlamydia a website information for adolescents NetDoctor Chlamydia fact sheet Links to chlamydia pictures at University of Iowa Chlamydiae.com - Information for patients, as well as for doctors and researchers about Chlamydial infections. Note: Patient info is in multiple languages. v d e Sexually transmitted diseases and infections STD/STI primarily A50-A64, 090-099 Bacterial Chancroid Haemophilus ducreyi Chlamydia Chlamydia trachomatis Donovanosis Granuloma Inguinale Lymphogranuloma venereum LGV Gonorrhea Neisseria gonorrhoeae Syphilis Treponema pallidum Ureaplasma urealyticum Protozoal Trichomoniasis Trichomonas vaginalis Parasitic Crab louse/crabs Scabies Viral AIDS HIV-1/HIV-2 Cervical cancer Genital warts condyloma Human papillomavirus HPV Hepatitis B Herpes simplex virus HSV1/HSV2 Molluscum contagiosum MCV General inflammation female: Cervicitis Pelvic inflammatory disease PID male: Epididymitis Prostatitis either: Proctitis Urethritis/Non-gonococcal urethritis NGU Other Ectopic pregnancy Premature birth Infertility Reactive arthritis v d e Infectious diseases - Bacterial diseases primarily A00-A79, 001-041,080-109 G+ Firmicutes Clostridium Pseudomembranous colitis - Botulism - Tetanus - Gas gangrene Bacilli class Coccus Strep-: Alpha pneumoniae, mutans, viridans - Beta A pyogenes Scarlet fever, Erysipelas, Rheumatic fever, Streptococcal pharyngitis, B agalactiae - D Entero- Staphylo- - Toxic shock syndrome Bacillus shape Bacillus Anthrax - Listeria Listeriosis Actinobacteria Actinomycetales Actinomycosis/Actinomycetoma Whipple's disease - Corynebacterium Diphtheria, Erythrasma - Nocardia Nocardiosis, Maduromycosis Mycobacterium M. tuberculosis Tuberculosis: Ghon focus/Ghon's complex - Pott disease - brain Meningitis, Rich focus - cutaneous Scrofula, Bazin disease, Lupus vulgaris, Prosector's wart - Miliary M. leprae Leprosy Nontuberculous: Mycobacterium avium Lady Windermere syndrome - Mycobacterium ulcerans Buruli ulcer G- Spirochetal Treponema: Syphilis Bejel - Yaws - Pinta Borrelia: Relapsing fever - Lyme disease Erythema chronicum migrans, Neuroborreliosis other/multiple/unknown: Noma - Trench mouth - Rat-bite fever Sodoku - Leptospirosis Intracellular Mycoplasmatales Mycoplasma pneumonia - Ureaplasma infection Chlamydiae Chlamydophila Psittacosis - Chlamydia Chlamydia, Lymphogranuloma venereum, Trachoma Proteobacteria primarily rods, except Neisseria =cocci α/ Intra- Rickettsiales/ Rickettsioses/ Anaplasmataceae Typhus Murine typhus, Epidemic typhus spotted fever Rocky Mountain spotted fever, Boutonneuse fever, Rickettsialpox Ehrlichiosis Human granulocytic ehrlichiosis, Human monocytic ehrlichiosis OTHER: Coxiella Q fever - Bartonella Trench fever - Orientia Scrub typhus Rhizobiales Brucellosis - Cat scratch fever - Bartonellosis Bacillary angiomatosis β Neisseriaceae: Meningococcus Meningococcal disease, Waterhouse-Friderichsen syndrome - Gonorrhea Burkholderiales: Glanders - Melioidosis - Pertussis γ Enterobacteriaceae: Salmonella Typhoid fever, Paratyphoid fever, Salmonellosis - Yersinia pestis Plague/Bubonic plague - Klebsiella Rhinoscleroma, Donovanosis - Shigella Shigellosis - Escherichia coli/O157:H7 - Proteus Pasteurellaceae: Pasteurella Pasteurellosis - Haemophilus Brazilian purpuric fever, Chancroid - Actinobacillus Actinobacillosis other: Francisella Tularemia - Vibrio Cholera - Legionella Legionellosis - Pseudomonas - Serratia ε Campylobacteriosis - Helicobacter Bacteroidetes Bacteroides Other Gardnerella Retrieved from http://en..org/wiki/Chlamydia_infection Categories: Sexually transmitted diseases and infections | Bacterial diseases | Chlamydiae Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages العربية Dansk Deutsch Español Français Bahasa Indonesia Italiano עברית МакедонÑ?ки Bahasa Melayu Nederlands 日本語 ქáƒ?რთული ‪Norsk bokmÃ¥l‬ Polski Português РуÑ?Ñ?кий SlovenÅ¡Ä?ina Suomi Svenska தமிழà¯? 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