Chlamydial infections — including urethritis in men and urethritis and cervicitis in women — are a group of infections that are linked to one organism: Chlamydia trachomatis. Trachoma inclusion conjunctivitis, a chlamydial infection that seldom occurs in the United States, is a leading cause of blindness in Third World countries. Lymphogranuloma venereum, a rare disease in the United States, is also caused by C. trachomatis. (See Lymphogranuloma venereum.)
Untreated, chlamydial infections can lead to such complications as acute epididymitis, salpingitis, pelvic inflammatory disease (PID) and, eventually, sterility. Some studies show that a chlamydial infection in a pregnant woman is associated with spontaneous abortion and premature delivery.
Transmission of C. trachomatis primarily follows vaginal or rectal intercourse or orogenital contact with an infected person. Because symptoms of chlamydial infections commonly appear late in the disease’s course, sexual transmission of the organism typically occurs unknowingly. Children born of mothers who have chlamydial infections may contract associated conjunctivitis, otitis media, and pneumonia during passage through the birth canal.
Chlamydial infections are the most common sexually transmitted diseases in the United States, affecting an estimated four million people in the United States each year.
Both men and women with chlamydial infections may be asymptomatic or may show signs of infection on physical examination. Individual signs and symptoms vary with the specific type of chlamydial infection and are determined by the organism’s route of transmission to susceptible tissue.
A woman with cervicitis may develop cervical erosion, mucopurulent discharge, pelvic pain, and dyspareunia.
A woman with endometritis or salpingitis may experience signs of PID, such as pain and tenderness of the abdomen, cervix, uterus, and lymph nodes; chills; fever; breakthrough bleeding; bleeding after intercourse; and vaginal discharge. She may also have dysuria.
A woman with urethral syndrome may experience dysuria, pyuria, and urinary frequency.
A man with urethritis may experience dysuria, erythema, tenderness of the urethral meatus, urinary frequency, pruritus, and urethral discharge. In urethritis, such discharge may be copious and purulent or scant and clear or mucoid.
A man with epididymitis may experience painful scrotal swelling and urethral discharge.
A man with prostatitis may have lower back pain, urinary frequency, dysuria, nocturia, and painful ejaculation.
A patient with proctitis may have diarrhea, tenesmus, pruritus, bloody or mucopurulent discharge, and diffuse or discrete ulceration in the rectosigmoid colon.
A swab from the site of infection (urethra, cervix, or rectum) establishes a diagnosis of urethritis, cervicitis, salpingitis, endometritis, or proctitis. A culture of aspirated material establishes a diagnosis of epididymitis.
Antigen detection methods, including the enzyme-linked immunosorbent assay and the direct fluorescent antibody test, have long been used for identifying chlamydial infection. Tissue cell cultures, however, are more sensitive and specific. Newer nucleic acid probes using polymerase chain reactions are also commercially available and have become the diagnostic tests of choice.
The recommended first-line treatment for adults and adolescents who have chlamydial infections is drug therapy with tetracycline, erythromycin, or azithromycin.
For pregnant women with chlamydial infections, erythromycin (stearate base) or azithromycin may be used.
❑ Practice standard precautions when caring for a patient with a chlamydial infection.
❑ Make sure that the patient fully understands the dosage requirements of prescribed medications for this infection.
❑ Stress the importance of completing the entire course of drug therapy even after the symptoms subside.
❑ Teach the patient to follow meticulous personal hygiene measures as recommended.
❑ To prevent eye contamination, instruct the patient to avoid touching any discharge and to wash and dry his hands thoroughly before touching his eyes.
❑ To prevent reinfection during treatment, urge the patient to abstain from intercourse until he and his partner are cured.
❑ Urge the patient to inform sexual contacts of his infection so that they can receive appropriate treatment.
❑ If required in your state, report all cases of chlamydial infection to the appropriate local public health authorities, who will then conduct follow-up notification of the patient’s sexual contacts.
❑ Suggest that the patient and his sex partners receive testing for the human immunodeficiency virus.
❑ Tell the patient to return for follow-up testing.
❑ Check the neonate of an infected mother for signs of chlamydial infection. Obtain appropriate specimens for diagnostic testing.
Review other book chapters online related to Lymphogranuloma venereum:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X 
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