Infections by Chlamydia trachomatis  are the leading  cause for sexually transmitted diseases in U.S.A.  but are also prevalent   in other parts of the world.  Chlamydia  are intracellular bacteria .

They usually produce a spectrum of illness ranging from asymptomatic infections to frank disease.

Route of infection is sexual.  It can affect persons of any age or gender but it produces more symptoms in men, particularly young men probably because of their susceptibility to sexual indiscipline.

To begin with, there is a painful urethral discharge, more in the morning before voiding of the bladder. It is associated with painful urination. As infection progresses, there is inflammation of the testes, epididymis and anus.

Urinary bladder can be infected due to contamination adding to the pain and discomfort.  Anus and rectum can be infected independently in those indulging in anal sex.

In case of infection by Lymphogranuloma venereum, a strain of Chlamydia, there is painful enlargement of inguinal lymph nodes, which due to their   sheer size are named as, "inguinal bubo”.

In women the infection is mostly silent. It can infect the uterine cervix leading to clear or whitish yellow painless discharge. Infection can spread upwards causing pelvic inflammatory disease.

Due to this, the patient can suffer from chronic low back pain, lower abdominal pain with or without discharge. After menses women are more prone to these infections as blood provides a rich media for germs to grow.

Fallopian tubes can get infected causing severe pain. If tubes get blocked,  there is risk of ectopic pregnancy.

Both men and women are at the risk for developing sterility due to blockade of tubes caused by untreated Chlamydia infection.

Another risk of untreated infection is development of Reiter’s syndrome. In this the individual suffers from conjunctivitis (inflammation of conjunctiva of eye) causing redness and mucopurulent discharge, multiple joint swelling and pain and   flat dry  rashes over palms and soles. Eyes may also be infected by auto inoculation by a contaminated finger leading to conjunctivitis.

Children suffer from Chlamydia infections for no fault of theirs. Being contaminated during delivery, a new born may develop infection of the eyes ( opthalmia neonatorum)  which can lead to blindness.

An older infant can also suffer from infection of the eyes due to his eyes being touched by the contaminated finger of either parent. Apart from this, the new born is at the risk of having pneumonia up to 3 months after birth due to infection acquired from the mother’s birth canal.

Considering the risks to the baby, center for disease control and prevention (CDC) has recommended that even with a doubt for Chlamydia infection, treatment should be initiated immediately empirically for women
All those infected with Chlamydia are at a high risk of acquiring HIV infection.

On the other hand if already immune depressed, they tend to have a more severe form of disease with more risk for complications.

Diagnosis is established by isolating the infectious agents from swabs obtained from the genital secretions or lymph nodes and culture.

It has to be differentiated from gonorrhea, another sexually transmitted disease causing similar symptoms.

Treatment is by suitable antibiotic like azithromycin,  doxycycline, erythromycin, e.t.c. , given for a week.

In case of persistent of symptoms or infection with lymphogranuloma venereum, treatment is sometimes given for 3 weeks to prevent relapse. Ideally both partners have to be treated simultaneously to prevent re introduction of infection

But treatment given once does not protect from re infection. Thus to prevent infection occurring again, a person has to become disciplined in sexual activity and should stick to one partner for life.

Good quality condoms used correctly are also useful in preventing exposure to Chlamydia.

Musanze – 7th September 2009

E-mail – rachna212002@yahoo.co.uk