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Chlamydia

Overview

Chlamydia is a common sexually transmitted infection (STI) caused by bacteria. STI alludes to the fact that chlamydia can be passed on while engaging in unprotective sex<a href="#accordion">[1]</a>.&nbsp;

Chlamydia is one of the most occurring sexually transmitted infections (STI). Its origins can be traced back to a microscopic bacterial organism called chlamydia trachomatis (C. trachomatis). When an individual&#39;s infected, they can spread chlamydia to their sexual partners through penetrative, anal, or oral sex. Chlamydia can also spread through sharing of sex toys that are infected and tainted with chlamydia-causing microbes. Chlamydia infections are treatable. However, it should be stressed that getting treatment straightaway is significant. Left untreated, chlamydia can prompt serious and damaging complications<a href="#accordion">[2]</a>.&nbsp;

<div>&nbsp;</div>

Signs And Symptoms

Chlamydia is an obligate intracellular microscopic organism. It comes up short on metabolic and biosynthetic pathways and relies upon the host cell for intermediates, including ATP.

Chlamydia functions in one of two phases: (1) infectious particles that are referred to as elementary bodies, and (2) intracytoplasmic structures called reticulate bodies.

There are three strains of Chlamydiae: C trachomatis, C psittaci, and C pneumoniae. The initial two constitute numerous serotypes because of contrasts in the cell walls and external membrane proteins. However, chlamydia pneumoniae possesses a single serotype, the TWAR organism.&nbsp;

These strains cause diverse infections including<a href="#accordion">[3]</a>:

&nbsp;

<ul>
	<li>
	<h5>Genital Infections</h5>
	</li>
</ul>

Certain C trachomatis variants are responsible for genital infections, such as nongonococcal urethritis in men and salpingitis and cervicitis in women. But other strains lead to lymphogranuloma venereum, a venereal illness that prompts painful lesions around the genitals and can also be characterized by local lymph node involvement (buboes).

&nbsp;

<ul>
	<li>
	<h5>Ocular Infections</h5>
	</li>
</ul>

The same strain can trigger inclusion conjunctivitis and trachoma. The latter is identified by the advancement and progressions of aggressive follicles and aggravated conjunctivae. The overcast and vascularized cornea is also a diagnostic symptom. Moreover, recurrent and frequent infections have been viewed as the leading cause of visual impairment. However, inclusion conjunctivitis is a milder inflammatory conjunctival contamination with the release of pus.

&nbsp;

<ul>
	<li>
	<h5>Respiratory Infections</h5>
	</li>
</ul>

The other two strains are commonly associated with respiratory diseases. Such as the chlamydia psittaci typically triggers a disease called psittacosis which resembles that of the influenza virus. Whereas chlamydia pneumoniae (TWAR organism) leans more toward causing atypical pneumonitis in infected individuals.&nbsp;

&nbsp;

While the most common are genital infections, each type of infection necessitates a different treatment. Therefore, it is always advised to consult a doctor for more informed guidance.&nbsp;

<div>&nbsp;</div>

Causes

Infectious chlamydia is transmitted through sexual activities, explicitly when a genital fluid such as vaginal discharge or semen containing the microorganisms makes a trip starting with one individual and then onto the next. Types of sexual activities that could risk the spread of the infection are vast and include a wide range of sexual contact and are not limited to just penetrative sex or any other kind of sexual intercourse that results in ejaculation. Chlamydia supports creative transmission and is spread through a myriad of methods that expose the infected fluid of a patient to their partner. The contaminated fluid can enter another individual&rsquo;s system in one of the following ways<a href="#accordion">[2][4]</a>:

&nbsp;

<ul>
	<li>Vaginal Penetration: This involves direct contact with genital organs and microorganisms pass from one individual&#39;s penis to their partner&rsquo;s vagina or the other way around.</li>
</ul>

&nbsp;

<ul>
	<li>Oral Intercourse: Any form of unprotected sex would risk individuals from infecting one another. This type of intercourse allows microorganisms to pass from one individual&#39;s mouth to their partner&rsquo;s penis, vagina, anus, or the other way around.&nbsp;</li>
</ul>

&nbsp;

<ul>
	<li>Anal Intercourse: Like the ones mentioned before, this increases the risk of exposure as the bacterial pathogens can easily travel from one individual&#39;s penis to their partner via the anal opening, or the other way around.</li>
</ul>

&nbsp;

<ul>
	<li>Intercourse Involving Sex Toys: Some individuals prefer indulging in sex toys to excite the intimate time spent with their partner. However, this sometimes proves to be detrimental as they might have purchased toys or borrowed them from unhygienic places. Through such practices, the infectious bacteria find a path from the toy to the individual&rsquo;s genitals or mouth.</li>
</ul>

&nbsp;

<ul>
	<li>Manual Stimulation Of The Genitals: Seldom, contaminated fluid from the vagina or semen ejaculated can interact with an individual&#39;s eye, leading to a pestering infection known as conjunctivitis. For instance, this can occur on the off chance that an individual is exposed to the genitals, mainly the penis, vagina, or anus of an infected individual, or absent-mindedly rubbing their eyes without properly disinfecting hands.&nbsp;</li>
</ul>

&nbsp;

Chlamydia can also be transmitted vertically i.e. infected pregnant mothers can transmit chlamydia to their baby via contaminated vaginal fluid during delivery<a href="#accordion">[1]</a>.&nbsp;

Several medical research centers and health clinics have a priority list of people to screen for chlamydia. These include<a href="#accordion">[5]</a>:

&nbsp;

<ul>
	<li>Sexually Active Women Above The Age Of Twenty-Five</li>
</ul>

Statistically speaking, the confirmed diagnosis rate for chlamydia infection is the most prevalent within this demographic. Therefore, it is important to get an annual STD test that includes gonorrhea and syphilis along with chlamydia. It is also important to repeat this test after intimate contact with a new sexual partner(s).&nbsp;

&nbsp;

<ul>
	<li>Pregnant Individuals</li>
</ul>

All individuals that are pregnant ought to be tested for chlamydia immediately. This can be done during the initial prenatal test. Because the infection has a risk of being transmitted to the child during delivery, it is important to test for chlamydia during different gestational stages if a partner has been changed, regardless of the negative result during the prenatal test.

&nbsp;

<ul>
	<li>Individuals At A&nbsp; Higher Risk</li>
</ul>

Individuals with many sex partners, individuals who prefer unprotected sex (not using a condom), or men who have intercourse with other men should prioritize and consider regular chlamydia screening. Other risk factors include existing sexually transmitted infections (STI) and the chance of exposure to an STI because of sexual contact with an infected individual.

&nbsp;

Individuals who fall into the above categories or suspect contact with a possible infected person should consult a doctor and visit a clinic for a confirmed diagnosis.&nbsp;

<div>&nbsp;</div>

Diagnosis

The most common type of test is the nucleic acid amplification test (NAAT), which requires the extraction of fluid from contaminated regions of the body. These samples can be taken in two ways<a href="#accordion">[6]</a>:

&nbsp;

<ul>
	<li>Urine Test: A clean sample of urine is used&nbsp;for a special PCR test called the Xpert CT/NG.</li>
</ul>

&nbsp;

<ul>
	<li>Swab: The regions from where the swab sample is taken differ in men and women. For men, a doctor may insert the swab gently at the exterior end of the urethra. Some cases may require an additional swab to be taken from the anus6. However, for women, the swab is swiped for vaginal discharge as the consultant may prefer culture or antigen testing.</li>
</ul>

&nbsp;

Samples can be taken by a doctor at a clinic or by the patient at home. If the latter route is chosen, then the patient should follow the instructions carefully from a verified source such as the hospital&rsquo;s helpline, to ensure an accurate and precise result. Regardless of the location, the sample needs to be submitted to a laboratory where pathologists investigate the submitted samples. Because most of the time chlamydia proves to be asymptomatic, patients who are at substantial risk need to be tested every couple of months, to ensure an early diagnosis for effective treatment.

<div>&nbsp;</div>

Treatment

Fortunately, chlamydia is treatable, and the cure is easily accessible. Since the underlying infection is a bacterial disease, specialists convincingly prescribe antibiotics. If an individual has been clinically assessed and tested positive for chlamydia infection, then there is an indubitable possibility that the doctor in charge will endorse oral antibiotics.

The most common antibiotics prescribed are either azithromycin (Zithromax) or doxycycline<a href="#accordion">[1]</a>. Moreover, the consultants will also educate the patient about risks associated with unprotected sex and different methods of protection that can be used during sex and also suggest the diagnostic evaluation of the individual&#39;s partner(s). These measures will help avoid delay of treatment, the risk of reinfection, and prevent further spread of infection to other individuals.&nbsp;

Through regular and determined administration of treatment, the contamination ought to clear up in about 14 days. However, it is critical to complete the course of antibiotics, regardless of how improved or better an individual feels to reduce the risk of patients developing antibiotic resistance.&nbsp;

Treatment may also be more robust in cases where the infection was severe. This is more common for women who experience a rare and more intense chlamydia infection that might require treatment in an emergency clinic. Intravenous antibiotics (medications that are inserted into the system via the veins), and pain alleviation drugs help ease continuous discomfort<a href="#accordion">[1]</a>.&nbsp;

Once the recommended duration of the course of antibiotics is completed, then the patient is expected to retest following 3 months after the initial diagnosis. This is done to ensure that there is no remaining trace of the infection and that the patient is cured<a href="#accordion">[6]</a>. This is strongly advised and is beneficial for those individuals who have vague connections with their partners and are not certain that their partner was cured. Therefore, doctors advise the discharged patient to go through another round of diagnostic tests, regardless of whether their partner(s) were treated.&nbsp;

Moreover, individuals during treatment and a few months succeeding it should not engage in sexual relations unless they have laboratory proof that they or their partners do not carry the infection. Research indicates that individuals that test positive for one sexually transmitted infection (STI) are likely to be carriers of other STIs. Therefore, patients should also volunteer and be guided through tests for gonorrhea, human immunodeficiency virus (<a href="https://www.merisehat.pk/disease/hiv-61" target="_blank">HIV</a>), acquired immunodeficiency syndrome (<a href="https://www.merisehat.pk/disease/aids" target="_blank">AIDS</a>), syphilis, and <a href="https://www.merisehat.pk/disease/genital-herpes" target="_blank">herpes</a><a href="#accordion">[2]</a>.

<div>&nbsp;</div>

While chlamydia is treatable and antibiotics are the reliable course of treatment, medications might not help if the condition was discovered late, or if the treatment was delayed due to any reason. Chlamydia can cause serious complications such as the following<a href="#accordion">[5]</a>:

&nbsp;

<ul>
	<li>
	<h5>Pelvic Inflammatory Disease (PID)</h5>
	</li>
</ul>

PID is a disease of the uterus and fallopian tubes, wherein the hallmark symptoms include a consistent fever and agonizing discomfort in the pelvic region. Prolonged and intense infections can require hospitalization for the administration of intravenous antibiotics and symptomatic management. PID can adversely affect many parts of the female reproductive system including the fallopian tubes, the ovaries, the uterus, and the adjoining cervix.

&nbsp;

<ul>
	<li>
	<h5>Infection Near The Testicles (Epididymitis)</h5>
	</li>
</ul>

Epididymitis is defined as a specific infection close to the testicular region in men. Chlamydia infection can inflame the twisted and looped tubes situated close to the gonads or testicles, called the epididymis. Such an infection can bring about undesirable and uncomfortable symptoms such as unmanageable fever, scrotal agony, and unprecedented swelling.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Prostate Gland Infection</h5>
	</li>
</ul>

This is not common but exceptional cases may witness the chlamydia microbial organism spread to a man&#39;s prostate gland. This infection known as prostatitis is characterized by inexplicable pain during or after intercourse, fever followed by or accompanied by shivers and chills, difficulty in urination due to exceeding pain, spasms, and muscle cramps in the lower back.

&nbsp;

<ul>
	<li>
	<h5>Infections In Newborns</h5>
	</li>
</ul>

Because there is a risk of the chlamydia infection spreading from the vaginal channel to the newborn during delivery, there are various infections that can sprout in the child. These could lead to pneumonia or debilitating eye infections.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Ectopic Pregnancy</h5>
	</li>
</ul>

A positive test for chlamydia infection increases an individual&#39;s risk of having an ectopic pregnancy. It is extremely rare, but it occurs when a completely fertilized egg embeds in an atypical region such as the fallopian tube rather than the normal and healthy reproductive organ, the uterus. Ectopic pregnancy requires immediate and critical medical attention as it poses a threat to the impregnated individual&rsquo;s life.&nbsp;

&nbsp;

<ul>
	<li>
	<h5><a href="https://www.merisehat.pk/disease/infertility-in-men" target="_blank">Infertility</a></h5>
	</li>
</ul>

Regardless of the nature of the infection, symptomatic and asymptomatic chlamydia increases the risk of infertility. While it is misconceived that the absence of visible signs and symptoms indicates a milder infection, any degree or kind of chlamydia infection can lead to irreparable scarring and impediment in the fallopian tubes, which could trigger a lifespan of infertility in individuals.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Reactive <a href="http://www.merisehat.pk/disease/arthritis">Arthritis&nbsp;</a></h5>
	</li>
</ul>

Individuals who are diagnosed with chlamydia trachomatis form the demographic of individuals susceptible to developing reactive arthritis. This is characterized by immune-mediated inflammation of the joints. Commonly referred to as Reiter&#39;s syndrome, the condition majorly impacts the joints, eyes, and urethra &mdash; the tract that provides a channel for the urine to leave the body from the bladder.

<div>&nbsp;</div>

To find similar patterns, vast research has been conducted to investigate markers and risk factors that could predict a future chlamydia infection. Some of them include the following:

&nbsp;

<ul>
	<li>
	<h5>Age And Gender</h5>
	</li>
</ul>

Younger people are at a higher risk of contracting chlamydia due to the higher chance of being sexually active<a href="#accordion">[7]</a>. Females are more susceptible to sexually transmitted infections (STIs), owing to the presence of columnar epithelium in the cervix, which bolsters the development of C. trachomati and is prone to change within vaginal development and bodily fluid creation<a href="#accordion">[8]</a>.

Additionally, the older population might have also developed some degree of partial immunity following an incipient or history of sequential infection<a href="#accordion">[9]</a>. Contrasts in the rates of the disease between younger and older adults exist due to differences in sexual behaviors between the two groups e.g. younger adults are more likely to have multiple sexual partners while older adults are more inclined towards monogamous relationships<a href="#accordion">[10]</a>.

Furthermore, young adults might be less ready and capable to carry out the perplexing demonstration of correct condom application or to impart and express serious concerns regarding sexuality<a href="#accordion">[8][11]</a>. Moreover, they might be less inclined to recognize the harrowing dangers attributed to unsafe sexual engagement<a href="#accordion">[12]</a>. Thus, widespread and standard screening for youths and young adolescents, as is by and large suggested<a href="#accordion">[13]</a>.

These outcomes likewise feature the requirement for more initiative-taking sexual awareness seminars and methodologies for teenagers and young adolescents for the essential prevention of chlamydia and different STDs.

&nbsp;

<ul>
	<li>
	<h5>Multiple Sexual Partners</h5>
	</li>
</ul>

Multiple sexual partners might grow the probability of experiencing a sexually transmitted pathogen because of the expanded likelihood of picking a romantic or sexual partner who has tested positive for contamination. Moreover, having casual sexual contact with different partners also places one at a higher risk of contracting STIs<a href="#accordion">[14]</a>. Hence, regular screening helps in detecting more asymptomatic cases resulting in prompt treatment. This in turn reduces the chances of transmission<a href="#accordion">[15]</a>.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Contraceptive Use</h5>
	</li>
</ul>

Studies on the effectiveness of barrier methods in chlamydia transmission have revealed mixed results. In 2 out of 5 studies, the use of the barrier method was associated with a reduced risk of disease<a href="#accordion">[16]</a>. Furthermore, when compared to no contraceptives, the use of barrier contraception was protective against chlamydia for females in most of the studies<a href="#accordion">[17]</a>.

However, some studies have not been able to demonstrate the effectiveness of barrier contraceptives in protecting against chlamydia and there are three potential explanations for these results. Firstly, it is possible that people were already infected before they started using contraception. Secondly, people may over-report the use of condoms, diaphragms, etc. Finally, it is difficult to assess if the participants used the contraceptive (condoms, diaphragms) correctly<a href="#accordion">[18]</a>.

A few investigations laid out a period for use (e.g., recent months, last sexual experience), while others estimated the current utilization of contraceptive barriers. Nonetheless, there are plenty of studies that have shown the effectiveness of barrier contraceptives against STI transmission, and hence it is strongly recommended that such methods (condoms, diaphragms) are employed for safe sex<a href="#accordion">[7]</a>.

<div>&nbsp;</div>

There are preventive measures individuals can take to reduce the chances of developing chlamydia. These include<a href="#accordion">[1]</a>:

&nbsp;

<ul>
	<li>Be cautious to use condoms accurately in every sexual engagement</li>
	<li>Restrict the number of sex partners, and refrain from alternating between partners</li>
	<li>If someone suspects an infection, individuals should immediately abstain from sexual contact, get tested, and inform all sexual partners to do the same&nbsp;</li>
</ul>

&nbsp;

All abnormal genital observations and changes, like a discharge or a burning sensation during urination or a strange sore or rash, ought to be a sign to quit engaging in sexual relations and to see a specialist immediately.&nbsp;

If the individual tests positive for chlamydia or some other sexually transmitted disease (STD), it is their responsibility to inform all their sexual partners so they can see a specialist and get tested.&nbsp;

Since chlamydia is often asymptomatic, hence infected individuals might accidentally spread it to their sex partners. Many specialists suggest that all individuals who have more than one sex partner ought to be tested for chlamydia routinely.&nbsp;

<div>&nbsp;</div>

There is another immunization not too far off from the future that might possess the potential to realistically safeguard individuals against genital chlamydia. This potential chlamydia immunization is the first of its sort, is viewed as safe, and will stimulate a resistant reaction, as per a review in The Lancet Infectious Diseases diary<a href="#accordion">[19]</a>. Even though chlamydia is treatable and the required prescriptions are easily accessible, the nature of the infection causes most of the cases to go unnoticed which then deteriorates to avoidable complications. A successful and safe vaccine could prevent countless individuals from developing serious illnesses and coexisting conditions.

&nbsp;

Key Points

<ul>
	<li>Chlamydia is a sexually transmitted disease (STD) caused by a bacterial microorganism that comprises three strains, C trachomatis, C psittaci, and C pneumoniae. These cause genital, ocular, and respiratory infections.</li>
	<li>Chlamydia is spread through sexual intercourse such as vaginal sex, anal sex, oral sex, and sex involving toys. It can also be passed on from an infected mother to a child during birth.</li>
	<li>Most cases are asymptomatic which is why people who engage in unprotected sex with multiple partners should get tested frequently. Diagnosis is through a swab or urine test.</li>
	<li>The infection is treatable and usually, doctors only prescribe oral antibiotics.</li>
	<li>Complications could range from pelvic infections and testicular infections to infertility and reactive arthritis.</li>
	<li>Risk factors include age, gender,&nbsp;number of sexual partners, and use of barrier contraceptives.&nbsp;</li>
	<li>It can be prevented by limiting sexual partners, using condoms/diaphragms, and taking breaks from sexual contact.</li>
</ul>

<div>&nbsp;</div>

[1] Nazario, B. (2020, August 21). Chlamydia. Retrieved from WebMD.

[2] Cleveland Clinic. (2021, November 1). Chlamydia.

[3] Becker, Y. (1996). Chlamydia. In S. Baron, Medical Microbiology, 4th edition. Galveston, TX: University of Texas Medical Branch at Galveston.

[4] Henigsman, S. A. (2021, November 29). Everything You Need To Know About Chlamydia. Retrieved from Healthline.

[5] Mayo Clinic. (2022, February 11). Chlamydia Trachomatis.

[6] The Aga Khan University Hospital. (2022). Chlamydia.

[7] Navarro, C., Jolly, A., Nair, R., & Chen, Y. (2002). Risk factors for genital chlamydial infection. The Canadian journal of infectious diseases = Journal canadien des maladies infectieuses, 13(3), 195–207.

[8] Bolan, G., Ehrhardt, A., & Wasserheit, J. (1999). Gender perspectives and STDs. In K. Holmes, P. Sparling, & P. Mardh, Sexually Transmitted Diseases (pp. 117-127). New York, NY: McGraw-Hill.

[9] Schachter, J. (1999). Biology of Chlamydia trachomatis. In K. Holmes, P. Sparling, & P. Mardh, Sexually Transmitted Diseases (pp. 391-405). New York, NY: McGraw-Hill.

[10] Tanfer, K. (1994). Sex and disease. Playing the odds in the 1990s. Sexually transmitted diseases, 21(2 Suppl), S65–S72.

[11] Cates, W. J., & Rauh, J. L. (1985). Journal of adolescent health care: official publication of the Society for Adolescent Medicine, 6(4). Adolescents and sexually transmitted diseases: an expanding problem. Introduction, 257–261.

[12] Cates, W. (1990). The Epidemiology and Control of Sexually Transmitted Diseases in Adolescents. Adolescent medicine (Philadelphia, Pa.), 1(3), 409–428.

[13] Evans, B. A., Kell, P. D., Bond, R. A., & MacRae, K. D. (1995). Heterosexual relationships and condom use in the spread of sexually transmitted diseases to women. Genitourinary medicine, 71(5), 291–294.

[14] Laumann, E., Gagnon, J., Michael, R., & Michaels, S. (2000). The social organization of sexuality: Sexual practices in the United States. Chicago: The University of Chicago Press

[15] Wasserheit, J., & Aral, S. (1996). The dynamic topology of sexually transmitted disease epidemics: implications for prevention strategies. The Journal of infectious diseases, 174 Suppl 2, S201–S213.

[16] McCormack, W., Rosner, B., McComb, D., Evrard, J., & Zinner, S. (1985). American journal of epidemiology, 121(1). Infection with Chlamydia trachomatis in female college students, 107-115.

[17] Harrison, H., Costin, M., Meder, J., Bownds, L., Sim, D., Lewis, M., & Alexander, E. (1985). Cervical Chlamydia trachomatis infection in university women: relationship to history, contraception, ectopy, and cervicitis. American journal of obstetrics and gynecology, 153(3), 244-251.

[18] Stone, K., Timyan, J., & Thomas, E. (1999). Barrier methods for the prevention of sexually transmitted diseases. In S. Aral, K. Holmes, P. Sparling, & P. Mardh, Sexually Transmitted Diseases (pp. 1307-1321). New York, NY: McGraw-Hill.

[19] Abraham S, Juel HB, Bang P, et al. Safety and immunogenicity of the Chlamydia vaccine candidate CTH522 adjuvanted with CAF01 liposomes or aluminium hydroxide: A first-in-human, randomised, double-blind, placebo-controlled, phase 1 trial. The Lancet Infectious Diseases. 2019;19(10):1091-1100. doi:10.1016/s1473-3099(19)30279-8