Chlamydial infections

Chlamydial infections: Excerpt from Handbook of Diseases

Urethritis in men and urethritis and cervicitis in women make up a group of infections that are linked to one organism: Chlamydia trachomatis. These chlamydial infections are the most common sexually transmitted diseases in the United States, affecting an estimated 4 million Americans each year.

Trachoma inclusion conjunctivitis, a chlamydial infection that occurs rarely 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.

Untreated, chlamydial infections can lead to such complications as acute epididymitis, salpingitis, pelvic inflammatory disease and, eventually, sterility. Some studies show that chlamydial infections in pregnant women are associated with spontaneous abortion and premature delivery. Other studies haven’t confirmed these findings.

Causes

Transmission of C. trachomatis primarily follows vaginal or rectal intercourse or oral-genital contact with an infected person. Because signs and symptoms of chlamydial infections commonly appear late in the course of the disease, 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.

Signs and symptoms

Both men and women with chlamydial infections may be asymptomatic or may show signs of infection on physical examination. (See Signs and symptoms of chlamydial infections.) 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.

Diagnosis

The following laboratory test results provide a definitive diagnosis of chlamydial infection:

❑ 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, are the diagnostic tests of choice for identifying chlamydial infection, although tissue cell cultures are more sensitive and specific.

❑ Newer nucleic acid probes using polymerase chain reactions are also commercially available.

Treatment

The recommended first-line treatment for adults and adolescents who have a chlamydial infection is drug therapy with oral doxycycline for 7 days or oral azithromycin in a single dose. (See What your patient needs to know about chlamydial infections, page 182.)

For pregnant women with a chlamydial infection, azithromycin, in a single 1-g dose for both the male and female partners, is the treatment of choice.

Special considerations

❑ Practice standard precautions when caring for a patient with a chlamydial infection.

❑ Teach the patient what he needs to know before discharge.

❑ Make sure that the patient fully understands the dosage requirements of any prescribed medications for this infection.

❑ 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 sexual partners receive testing for human immunodeficiency virus.

❑ Check neonates of infected mothers for signs of chlamydial infection. Obtain appropriate specimens for diagnostic testing.

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Book Source Details

• Book Title: Handbook of Diseases
• Author(s): Springhouse
• Year of Publication: 2003
• Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Handbook of Diseases Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 1-58255-266-5

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