CHLAMYDIA

Alice Beckholt RN, MS, CNS

Chlamydia trachomatis, a really weird bacterium

• Intermediate between virus and bacteria• Obligate intracellular parasite• Kills the host cell• Susceptible to some antibiotics

Chlamydia trachomatis life cycle

• Life cycle estimated at 24-72 hours

• Elemental body (EB)• Reticulate body (RB)

Virulence factors

• Gram negative?

• Most infections are asymptomatic, but infectious

• Also causes LGV and trachoma

transmission

• Sexual

• Non-sexual

Symptoms of genital chlamydia

• The vast majority of persons with chlamydial infections are blissfully unaware

• Usually none

Symptoms in men

• Non-gonococcal urethritis (NGU)

• Discharge• Dysuria

Complications - epididymitis

• Fever• Unilateral scrotal pain• Swelling• Tenderness • PAIN!!

Reiter’s syndrome

• Arthritis• Conjunctivitis• Urethritis• Also known as reactive arthritis

Symptoms in women

• Usually none• Cervicitis• Urethritis • Vaginal discharge• Pelvic pain

Complications in women

• Pelvic Inflammatory Disease

• (PID)•

Chlamydia and HIV

Untreated Chlamydia can increase the risk of HIV transmission

Chlamydia in pregnancy and neonates

• Preterm delivery• Neonatal conjunctivitis• Neonatal pneumonia

Lymphogranuloma venereum

• LGV is caused by chlamydial serovars L1, L2, and L3

• Genital ulcer• Lymphadenopathy• Proctitis• Systemic• Serovar-specific tests not widely available

Trachoma

• Caused by Chlamydia trachomatis

• Not sexually transmitted• Hygiene-related

Diagnosis

• Cell culture

Diagnosis (continued)

• Nucleic Acid Amplification Tests (NAATs)• Non-Amplification Tests

Treating Chlamydia

• Recommended regimens for uncomplicated infections

• Azithromycin 1 gram orally once

• Doxycycline 100 mg twice daily for 7 days

• Alternative regimens for uncomplicated infections

• Erythromycin• Ofloxacin• Levofloxacin• Amoxacillin

Treatment (continued)

• TREAT ALL PARTNERS WITHIN THE LAST 60-90 DAYS, EVEN IF THEY ARE ASYMPTOMATIC !

Prevention, Education and Patient Counseling

• Nature of the disease• Transmission• Risk reduction• Screening

Safe Sex

• Nature o