Chlamydia: Difference between revisions
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'''Chlamydia''', or more specifically a '''chlamydia infection''', is a [[sexually transmitted disease|sexually transmitted infection]] caused by the bacterium ''[[Chlamydia trachomatis]]''.<ref name=CDCStats2015/> Most people who are infected have no symptoms.<ref name=CDCFact2016/> When symptoms do appear, they may occur only several weeks after infection;<ref name=CDCFact2016/> the [[incubation period]] between exposure and being able to infect others is thought to be on the order of two to six weeks.<ref>{{cite book|title=Krasner's Microbial Challenge|date=2018|page=366| vauthors = Shors T }}</ref> Symptoms in women may include [[vaginal discharge]] or [[burning with urination]].<ref name=CDCFact2016/> Symptoms in men may include discharge from the penis, burning with urination, or [[epididymitis|pain and swelling of one or both testicles]].<ref name=CDCFact2016/> The infection can spread to the upper genital tract in women, causing [[pelvic inflammatory disease]], which may result in future [[infertility]] or [[ectopic pregnancy]].<ref name="CDC2015">{{cite web |title=2015 Sexually Transmitted Diseases Treatment Guidelines |url=https://www.cdc.gov/std/tg2015/chlamydia.htm |publisher=CDC |access-date=10 June 2016|date=June | '''Chlamydia''', or more specifically a '''chlamydia infection''', is a [[sexually transmitted disease|sexually transmitted infection]] caused by the bacterium ''[[Chlamydia trachomatis]]''.<ref name=CDCStats2015/> Most people who are infected have no symptoms.<ref name=CDCFact2016/> When symptoms do appear, they may occur only several weeks after infection;<ref name=CDCFact2016/> the [[incubation period]] between exposure and being able to infect others is thought to be on the order of two to six weeks.<ref>{{cite book|title=Krasner's Microbial Challenge|date=2018|page=366| vauthors = Shors T }}</ref> Symptoms in women may include [[vaginal discharge]] or [[burning with urination]].<ref name=CDCFact2016/> Symptoms in men may include discharge from the penis, burning with urination, or [[epididymitis|pain and swelling of one or both testicles]].<ref name=CDCFact2016/> The infection can spread to the upper genital tract in women, causing [[pelvic inflammatory disease]], which may result in future [[infertility]] or [[ectopic pregnancy]].<ref name="CDC2015">{{cite web |title=2015 Sexually Transmitted Diseases Treatment Guidelines |url=https://www.cdc.gov/std/tg2015/chlamydia.htm |publisher=CDC |access-date=10 June 2016|date=4 June 2015 |url-status=live |archive-url=https://web.archive.org/web/20160611072758/http://www.cdc.gov/std/tg2015/chlamydia.htm|archive-date=11 June 2016}}</ref> | ||
Chlamydia infections can occur in other areas besides the genitals, including the anus, eyes, throat, and lymph nodes. Repeated chlamydia infections of the eyes that go without treatment can result in [[trachoma]], a common cause of blindness in the [[developing world]].<ref name="CDC2009Eye">{{cite web | title = CDC – Trachoma, Hygiene-related Diseases, Healthy Water | publisher = Centers for Disease Control and Prevention | url = https://www.cdc.gov/healthywater/hygiene/disease/trachoma.html | access-date = 2015 | Chlamydia infections can occur in other areas besides the genitals, including the anus, eyes, throat, and lymph nodes. Repeated chlamydia infections of the eyes that go without treatment can result in [[trachoma]], a common cause of blindness in the [[developing world]].<ref name="CDC2009Eye">{{cite web | title = CDC – Trachoma, Hygiene-related Diseases, Healthy Water | publisher = Centers for Disease Control and Prevention | url = https://www.cdc.gov/healthywater/hygiene/disease/trachoma.html | access-date = 24 July 2015 | date = 28 December 2009 | url-status = live | archive-url = https://web.archive.org/web/20150905105656/http://www.cdc.gov/healthywater/hygiene/disease/trachoma.html | archive-date = 5 September 2015 }}</ref> | ||
Chlamydia can be spread during [[vaginal intercourse|vaginal]], [[anal sex|anal]], [[oral sex|oral]], or [[Non-penetrative sex#Manual sex|manual sex]] and can be passed from an infected mother to her baby during childbirth.<ref name="CDCFact2016">{{cite web |title=Chlamydia – CDC Fact Sheet |url=https://www.cdc.gov/std/chlamydia/stdfact-chlamydia.htm |publisher=CDC |access-date=10 June 2016|date=May | Chlamydia can be spread during [[vaginal intercourse|vaginal]], [[anal sex|anal]], [[oral sex|oral]], or [[Non-penetrative sex#Manual sex|manual sex]] and can be passed from an infected mother to her baby during childbirth.<ref name="CDCFact2016">{{cite web |title=Chlamydia – CDC Fact Sheet |url=https://www.cdc.gov/std/chlamydia/stdfact-chlamydia.htm |publisher=CDC |access-date=10 June 2016|date=19 May 2016|url-status=live|archive-url=https://web.archive.org/web/20160611024217/http://www.cdc.gov/std/chlamydia/stdfact-chlamydia.htm|archive-date=11 June 2016}}</ref><ref>{{cite book| last1 = Hoyle | first1 = Alice | last2 = McGeeney | first2 = Ester |title=Great Relationships and Sex Education|publisher=Taylor and Francis|year=2019|access-date=11 July 2023|isbn=978-1-35118-825-8|url=https://books.google.com/books?id=KE7ADwAAQBAJ&pg=PT261}}</ref> The eye infections may also be spread by personal contact, flies, and contaminated towels in areas with poor sanitation.<ref name=CDC2009Eye/> Infection by the bacterium ''Chlamydia trachomatis'' only occurs in humans.<ref>{{cite book| vauthors = Graeter L |title=Elsevier's Medical Laboratory Science Examination Review|date=2014|publisher=Elsevier Health Sciences|isbn=978-0-323-29241-2|page=30|url=https://books.google.com/books?id=Uc9sBQAAQBAJ&pg=PA30|url-status=live|archive-url=https://web.archive.org/web/20170910235426/https://books.google.com/books?id=Uc9sBQAAQBAJ&pg=PA30|archive-date=10 September 2017}}</ref> Diagnosis is often by [[screening test|screening]], which is recommended yearly in sexually active women under the age of 25, others at higher risk, and at the first [[prenatal visit]].<ref name=CDCFact2016/><ref name=CDC2015/> Testing can be done on the urine or a swab of the cervix, vagina, or [[urethra]].<ref name=CDC2015/> Rectal or mouth swabs are required to diagnose infections in those areas.<ref name=CDC2015/> | ||
Prevention is by [[Sexual abstinence|not having sex]], the use of [[condom]]s, or having sex with only one other person, who is not infected.<ref name=CDCFact2016/> Chlamydia can be cured by [[antibiotic]]s, with typically either [[azithromycin]] or [[doxycycline]] being used.<ref name=CDC2015/> [[Erythromycin]] or azithromycin is recommended in babies and during pregnancy.<ref name=CDC2015/> Sexual partners should also be treated, and infected people should be advised not to have sex for seven days and until symptom free.<ref name=CDC2015/> [[Gonorrhea]], [[syphilis]], and [[HIV/AIDS|HIV]] should be tested for in those who have been infected.<ref name=CDC2015/> Following treatment, people should be tested again after three months.<ref name=CDC2015/> | Prevention is by [[Sexual abstinence|not having sex]], the use of [[condom]]s, or having sex with only one other person, who is not infected.<ref name=CDCFact2016/> Chlamydia can be cured by [[antibiotic]]s, with typically either [[azithromycin]] or [[doxycycline]] being used.<ref name=CDC2015/> [[Erythromycin]] or azithromycin is recommended in babies and during pregnancy.<ref name=CDC2015/> Sexual partners should also be treated, and infected people should be advised not to have sex for seven days and until symptom free.<ref name=CDC2015/> [[Gonorrhea]], [[syphilis]], and [[HIV/AIDS|HIV]] should be tested for in those who have been infected.<ref name=CDC2015/> Following treatment, people should be tested again after three months.<ref name=CDC2015/> | ||
Chlamydia is one of the most common sexually transmitted infections, affecting about 4.2% of women and 2.7% of men worldwide.<ref name="New2015">{{cite journal | vauthors = Newman L, Rowley J, Vander Hoorn S, Wijesooriya NS, Unemo M, Low N, Stevens G, Gottlieb S, Kiarie J, Temmerman M | title = Global Estimates of the Prevalence and Incidence of Four Curable Sexually Transmitted Infections in 2012 Based on Systematic Review and Global Reporting | journal = PLOS ONE | volume = 10 | issue = 12 | article-number = e0143304 | date = 8 December 2015 | pmid = 26646541 | pmc = 4672879 | doi = 10.1371/journal.pone.0143304 | doi-access = free | bibcode = 2015PLoSO..1043304N }}</ref><ref name="WHO2015Fact">{{cite web|title=Sexually transmitted infections (STIs) Fact sheet N°110|url=https://www.who.int/mediacentre/factsheets/fs110/en/|website=who.int|access-date=10 June 2016|date=December 2015|url-status=live|archive-url=https://web.archive.org/web/20141125133056/http://www.who.int/mediacentre/factsheets/fs110/en/|archive-date=25 November 2014}}</ref> In 2015, about 61 million new cases occurred globally.<ref name="GBD2015Pre">{{cite journal | title = Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015 | journal = Lancet | volume = 388 | issue = 10053 | pages = 1545–1602 | date = October 2016 | pmid = 27733282 | pmc = 5055577 | doi = 10.1016/S0140-6736(16)31678-6 | vauthors = Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, Carter A, Casey DC, Charlson FJ, Chen AZ, Coggeshall M, Cornaby L, Dandona L, Dicker DJ, Dilegge T, Erskine HE, Ferrari AJ, Fitzmaurice C, Fleming T, Forouzanfar MH, Fullman N, Gething PW, Goldberg EM, Graetz N, Haagsma JA, Hay SI, Johnson CO, Kassebaum NJ, Kawashima T, Kemmer L, etal }}</ref> In the United States, about 1.4 million cases were reported in 2014.<ref name="CDCStats2015">{{cite web|title=2014 Sexually Transmitted Diseases Surveillance Chlamydia|url=https://www.cdc.gov/std/stats14/chlamydia.htm|access-date=10 June 2016|date=November | Chlamydia is one of the most common sexually transmitted infections, affecting about 4.2% of women and 2.7% of men worldwide.<ref name="New2015">{{cite journal | vauthors = Newman L, Rowley J, Vander Hoorn S, Wijesooriya NS, Unemo M, Low N, Stevens G, Gottlieb S, Kiarie J, Temmerman M | title = Global Estimates of the Prevalence and Incidence of Four Curable Sexually Transmitted Infections in 2012 Based on Systematic Review and Global Reporting | journal = PLOS ONE | volume = 10 | issue = 12 | article-number = e0143304 | date = 8 December 2015 | pmid = 26646541 | pmc = 4672879 | doi = 10.1371/journal.pone.0143304 | doi-access = free | bibcode = 2015PLoSO..1043304N }}</ref><ref name="WHO2015Fact">{{cite web|title=Sexually transmitted infections (STIs) Fact sheet N°110|url=https://www.who.int/mediacentre/factsheets/fs110/en/|website=who.int|access-date=10 June 2016|date=December 2015|url-status=live|archive-url=https://web.archive.org/web/20141125133056/http://www.who.int/mediacentre/factsheets/fs110/en/|archive-date=25 November 2014}}</ref> In 2015, about 61 million new cases occurred globally.<ref name="GBD2015Pre">{{cite journal | title = Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015 | journal = Lancet | volume = 388 | issue = 10053 | pages = 1545–1602 | date = October 2016 | pmid = 27733282 | pmc = 5055577 | doi = 10.1016/S0140-6736(16)31678-6 | vauthors = Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, Carter A, Casey DC, Charlson FJ, Chen AZ, Coggeshall M, Cornaby L, Dandona L, Dicker DJ, Dilegge T, Erskine HE, Ferrari AJ, Fitzmaurice C, Fleming T, Forouzanfar MH, Fullman N, Gething PW, Goldberg EM, Graetz N, Haagsma JA, Hay SI, Johnson CO, Kassebaum NJ, Kawashima T, Kemmer L, etal }}</ref> In the United States, about 1.4 million cases were reported in 2014.<ref name="CDCStats2015">{{cite web|title=2014 Sexually Transmitted Diseases Surveillance Chlamydia|url=https://www.cdc.gov/std/stats14/chlamydia.htm|access-date=10 June 2016|date=17 November 2015|url-status=live|archive-url=https://web.archive.org/web/20160610151338/http://www.cdc.gov/std/stats14/chlamydia.htm|archive-date=10 June 2016}}</ref> Infections are most common among those between the ages of 15 and 25 and are more common in women than men.<ref name=CDC2015/><ref name=CDCStats2015/> In 2015, infections resulted in about 200 deaths.<ref name="GBD2015De">{{cite journal | title = Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015 | journal = Lancet | volume = 388 | issue = 10053 | pages = 1459–1544 | date = October 2016 | pmid = 27733281 | pmc = 5388903 | doi = 10.1016/s0140-6736(16)31012-1 | vauthors = Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, Casey DC, Charlson FJ, Chen AZ, Coates MM, Coggeshall M, Dandona L, Dicker DJ, Erskine HE, Ferrari AJ, Fitzmaurice C, Foreman K, Forouzanfar MH, Fraser MS, Fullman N, Gething PW, Goldberg EM, Graetz N, Haagsma JA, Hay SI, Huynh C, Johnson CO, Kassebaum NJ, Kinfu Y, Kulikoff XR, etal }}</ref> The word ''chlamydia'' is from the [[Ancient Greek|Greek]] {{Lang|grc|χλαμύδα}}, meaning 'cloak'.<ref>{{cite book| vauthors = Stevenson A |title=Oxford dictionary of English.|date=2010|publisher=Oxford University Press|location=New York, NY|isbn=978-0-19-957112-3|page=306|edition=3rd|url=https://books.google.com/books?id=anecAQAAQBAJ&pg=PA306|access-date=10 June 2016|url-status=live|archive-url=https://web.archive.org/web/20170910235426/https://books.google.com/books?id=anecAQAAQBAJ&pg=PA306|archive-date=10 September 2017}}</ref><ref>{{cite journal | vauthors = Byrne GI | title = Chlamydia uncloaked | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 100 | issue = 14 | pages = 8040–8042 | date = July 2003 | pmid = 12835422 | pmc = 166176 | doi = 10.1073/pnas.1533181100 | bibcode = 2003PNAS..100.8040B | quote = The term was coined based on the incorrect conclusion that Chlamydia are intracellular protozoan pathogens that appear to cloak the nucleus of infected cells. | doi-access = free }}</ref> | ||
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Chlamydial infection of the [[cervix]] (neck of the womb) is a sexually transmitted infection which has [[asymptomatic|no symptoms]] for around 70% of women infected. The infection can be passed through vaginal, anal, oral, or manual sex. Of those who have an asymptomatic infection that is not detected by their doctor, approximately half will develop [[pelvic inflammatory disease]] (PID), a generic term for infection of the [[uterus]], [[fallopian tubes]], and/or [[ovaries]]. PID can cause scarring inside the [[reproductive organ]]s, which can later cause serious complications, including chronic [[pelvis|pelvic]] pain, difficulty becoming pregnant, [[ectopic pregnancy|ectopic (tubal) pregnancy]], and other dangerous complications of pregnancy.<ref name="pmid28835360"/> | Chlamydial infection of the [[cervix]] (neck of the womb) is a sexually transmitted infection which has [[asymptomatic|no symptoms]] for around 70% of women infected. The infection can be passed through vaginal, anal, oral, or manual sex. Of those who have an asymptomatic infection that is not detected by their doctor, approximately half will develop [[pelvic inflammatory disease]] (PID), a generic term for infection of the [[uterus]], [[fallopian tubes]], and/or [[ovaries]]. PID can cause scarring inside the [[reproductive organ]]s, which can later cause serious complications, including chronic [[pelvis|pelvic]] pain, difficulty becoming pregnant, [[ectopic pregnancy|ectopic (tubal) pregnancy]], and other dangerous complications of pregnancy.<ref name="pmid28835360"/> | ||
Chlamydia is known as the "silent epidemic", as at least 70% of genital ''C. trachomatis'' infections in women (and 50% in men) are asymptomatic at the time of diagnosis,<ref name="NHS Chlamydia page">[http://www.nhs.uk/conditions/Chlamydia/Pages/Introduction.aspx NHS Chlamydia page] {{webarchive|url=https://web.archive.org/web/20130116082623/http://www.nhs.uk/conditions/Chlamydia/Pages/Introduction.aspx |date=2013 | Chlamydia is known as the "silent epidemic", as at least 70% of genital ''C. trachomatis'' infections in women (and 50% in men) are asymptomatic at the time of diagnosis,<ref name="NHS Chlamydia page">[http://www.nhs.uk/conditions/Chlamydia/Pages/Introduction.aspx NHS Chlamydia page] {{webarchive|url=https://web.archive.org/web/20130116082623/http://www.nhs.uk/conditions/Chlamydia/Pages/Introduction.aspx |date=16 January 2013 }}</ref> and can linger for months or years before being discovered. Signs and symptoms may include abnormal [[vaginal bleeding]] or discharge, abdominal pain, [[Dyspareunia|painful sexual intercourse]], [[fever]], [[Dysuria|painful urination]] or the urge to urinate more often than usual ([[urinary urgency]]).<ref name="pmid28835360">{{cite journal | vauthors = Witkin SS, Minis E, Athanasiou A, Leizer J, Linhares IM | title = Chlamydia trachomatis: the Persistent Pathogen | journal = Clinical and Vaccine Immunology | volume = 24 | issue = 10 | date = October 2017 | pmid = 28835360 | pmc = 5629669 | doi = 10.1128/CVI.00203-17 }}</ref> | ||
For sexually active women who are not pregnant, screening is recommended in those under 25 and others at risk of infection.<ref name="AmFamPhys">{{cite journal | vauthors = Meyers D, Wolff T, Gregory K, Marion L, Moyer V, Nelson H, Petitti D, Sawaya GF | title = USPSTF recommendations for STI screening | journal = American Family Physician | volume = 77 | issue = 6 | pages = 819–824 | date = March 2008 | pmid = 18386598 | url = http://www.aafp.org/afp/20080315/819.html | access-date = 2008 | For sexually active women who are not pregnant, screening is recommended in those under 25 and others at risk of infection.<ref name="AmFamPhys">{{cite journal | vauthors = Meyers D, Wolff T, Gregory K, Marion L, Moyer V, Nelson H, Petitti D, Sawaya GF | title = USPSTF recommendations for STI screening | journal = American Family Physician | volume = 77 | issue = 6 | pages = 819–824 | date = March 2008 | pmid = 18386598 | url = http://www.aafp.org/afp/20080315/819.html | access-date = 17 March 2008 | archive-url = https://web.archive.org/web/20210828031335/https://www.aafp.org/afp/2008/0315/p819.html | archive-date = 28 August 2021 }}</ref> Risk factors include a history of chlamydial or other sexually transmitted infection, new or multiple sexual partners, and inconsistent [[condom]] use.<ref name="USPSTF">{{cite journal | vauthors = ((U.S. Preventive Services Task Force)) | title = Screening for chlamydial infection: U.S. Preventive Services Task Force recommendation statement | journal = Annals of Internal Medicine | volume = 147 | issue = 2 | pages = 128–134 | date = July 2007 | pmid = 17576996 | doi = 10.7326/0003-4819-147-2-200707170-00172 | s2cid = 35816540 | url = http://www.ahrq.gov/clinic/uspstf07/chlamydia/chlamydiars.htm | url-status = live | doi-access = | archive-url = https://web.archive.org/web/20080303022755/http://www.ahrq.gov/clinic/uspstf07/chlamydia/chlamydiars.htm | archive-date = 3 March 2008 | url-access = subscription }}</ref> Guidelines recommend all women attending for [[emergency contraception|emergency contraceptive]] are offered chlamydia testing, with studies showing up to 9% of women aged under 25 years had chlamydia.<ref>{{cite journal | vauthors = Yeung EY, Comben E, McGarry C, Warrington R | title = STI testing in emergency contraceptive consultations | journal = The British Journal of General Practice | volume = 65 | issue = 631 | pages = 63.1–64 | date = February 2015 | pmid = 25624285 | pmc = 4325454 | doi = 10.3399/bjgp15X683449 }}</ref> | ||
====Men==== | ====Men==== | ||
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{{Main|Trachoma}} | {{Main|Trachoma}} | ||
[[File:SOA-conjunctivitis.jpg|thumb|Conjunctivitis due to chlamydia]] | [[File:SOA-conjunctivitis.jpg|thumb|Conjunctivitis due to chlamydia]] | ||
[[Trachoma]] is a chronic [[conjunctivitis]] caused by ''Chlamydia trachomatis''.<ref name=":0">{{cite book|title=Medical-surgical nursing: assessment and management of clinical problems| vauthors = Lewis SM |others=Bucher, Linda; Heitkemper, Margaret M. (Margaret McLean); Harding, Mariann|isbn=978-0-323-32852-4|edition=10th|location=St. Louis, Missouri|oclc=944472408|year = 2017}}</ref> It was once the leading cause of blindness worldwide, but its role diminished from 15% of blindness cases by trachoma in 1995 to 3.6% in 2002.<ref name="WHO1995">{{cite journal | vauthors = Thylefors B, Négrel AD, Pararajasegaram R, Dadzie KY | title = Global data on blindness | journal = Bulletin of the World Health Organization | volume = 73 | issue = 1 | pages = 115–121 | year = 1995 | pmid = 7704921 | pmc = 2486591 | url = http://whqlibdoc.who.int/bulletin/1995/Vol73-No1/bulletin_1995_73(1)_115-121.pdf | archive-url = https://web.archive.org/web/20080625212421/http://whqlibdoc.who.int/bulletin/1995/Vol73-No1/bulletin_1995_73(1)_115-121.pdf | archive-date = 2008 | [[Trachoma]] is a chronic [[conjunctivitis]] caused by ''Chlamydia trachomatis''.<ref name=":0">{{cite book|title=Medical-surgical nursing: assessment and management of clinical problems| vauthors = Lewis SM |others=Bucher, Linda; Heitkemper, Margaret M. (Margaret McLean); Harding, Mariann|isbn=978-0-323-32852-4|edition=10th|location=St. Louis, Missouri|oclc=944472408|year = 2017}}</ref> It was once the leading cause of blindness worldwide, but its role diminished from 15% of blindness cases by trachoma in 1995 to 3.6% in 2002.<ref name="WHO1995">{{cite journal | vauthors = Thylefors B, Négrel AD, Pararajasegaram R, Dadzie KY | title = Global data on blindness | journal = Bulletin of the World Health Organization | volume = 73 | issue = 1 | pages = 115–121 | year = 1995 | pmid = 7704921 | pmc = 2486591 | url = http://whqlibdoc.who.int/bulletin/1995/Vol73-No1/bulletin_1995_73(1)_115-121.pdf | archive-url = https://web.archive.org/web/20080625212421/http://whqlibdoc.who.int/bulletin/1995/Vol73-No1/bulletin_1995_73(1)_115-121.pdf | archive-date = 25 June 2008 }}</ref><ref name="WHO2002">{{cite journal | vauthors = Resnikoff S, Pascolini D, Etya'ale D, Kocur I, Pararajasegaram R, Pokharel GP, Mariotti SP | title = Global data on visual impairment in the year 2002 | journal = Bulletin of the World Health Organization | volume = 82 | issue = 11 | pages = 844–851 | date = November 2004 | pmid = 15640920 | pmc = 2623053 | hdl = 10665/269277 }}</ref> The infection can be spread from eye to eye by fingers, shared towels or cloths, coughing and sneezing and eye-seeking flies.<ref name="LancetTrachoma">{{cite journal | vauthors = Mabey DC, Solomon AW, Foster A | title = Trachoma | journal = Lancet | volume = 362 | issue = 9379 | pages = 223–229 | date = July 2003 | pmid = 12885486 | doi = 10.1016/S0140-6736(03)13914-1 | s2cid = 208789262 }}</ref> Symptoms include [[Pus|mucopurulent]] ocular discharge, irritation, redness, and lid swelling.<ref name=":0" /> Newborns can also develop chlamydia eye infection through childbirth (see below). Using the SAFE strategy (acronym for surgery for [[trichiasis|in-growing]] or [[entropion|in-turned]] lashes, [[antibiotics]], facial cleanliness, and environmental improvements), the [[World Health Organization]] aimed (unsuccessfully) for the global elimination of trachoma by 2020 (GET 2020 initiative).<ref name="GET2020">[[World Health Organization]]. [https://www.who.int/blindness/causes/trachoma/en/index.html Trachoma] {{webarchive|url=https://web.archive.org/web/20121021121158/http://www.who.int/blindness/causes/trachoma/en/index.html |date=21 October 2012 }}. Accessed 17 March 2008.</ref><ref name="LancetSAFE">{{cite journal | vauthors = Ngondi J, Onsarigo A, Matthews F, Reacher M, Brayne C, Baba S, Solomon AW, Zingeser J, Emerson PM | title = Effect of 3 years of SAFE (surgery, antibiotics, facial cleanliness, and environmental change) strategy for trachoma control in southern Sudan: a cross-sectional study | journal = Lancet | volume = 368 | issue = 9535 | pages = 589–595 | date = August 2006 | pmid = 16905023 | doi = 10.1016/S0140-6736(06)69202-7 | s2cid = 45018412 }}</ref> The updated World Health Assembly neglected tropical diseases road map (2021–2030) sets 2030 as the new timeline for global elimination.<ref>{{cite web |title=Trachoma |url=https://www.who.int/news-room/fact-sheets/detail/trachoma |access-date=27 June 2023 |website=www.who.int |language=en}}</ref> | ||
===Joints=== | ===Joints=== | ||
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===Infants=== | ===Infants=== | ||
As many as half of all infants born to mothers with chlamydia will be born with the disease. Chlamydia can affect infants by causing spontaneous abortion; [[premature birth]]; [[conjunctivitis]], which may lead to blindness; and [[pneumonia]].<ref name="CDC">{{cite web | title = STD Facts – Chlamydia | publisher = Center For Disease Control | date = December | As many as half of all infants born to mothers with chlamydia will be born with the disease. Chlamydia can affect infants by causing spontaneous abortion; [[premature birth]]; [[conjunctivitis]], which may lead to blindness; and [[pneumonia]].<ref name="CDC">{{cite web | title = STD Facts – Chlamydia | publisher = Center For Disease Control | date = 16 December 2014 | url = https://www.cdc.gov/std/Chlamydia/STDFact-Chlamydia.htm | access-date = 24 July 2015 | url-status = live | archive-url = https://web.archive.org/web/20150714002621/http://www.cdc.gov/std/chlamydia/stdfact-chlamydia.htm | archive-date = 14 July 2015 }}</ref> Conjunctivitis due to chlamydia typically occurs one week after birth (compared with chemical causes (within hours) or gonorrhea (2–5 days)).<ref>{{Citation | vauthors = Hansford P |title=Palliative Care in the United Kingdom |date=April 2010 |work=Oxford Textbook of Palliative Nursing |pages=1265–1274 |publisher=Oxford University Press |doi=10.1093/med/9780195391343.003.0072 |isbn=978-0-19-539134-3 }}</ref> | ||
===Other conditions=== | ===Other conditions=== | ||
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Chlamydia can be transmitted during vaginal, anal, oral, or manual sex or direct contact with infected tissue such as [[conjunctiva]]. Chlamydia can also be passed from an infected mother to her baby during vaginal childbirth.<ref name=CDC/> It is assumed that the probability of becoming infected is proportionate to the number of bacteria one is exposed to.<ref>{{cite journal | vauthors = Gambhir M, Basáñez MG, Turner F, Kumaresan J, Grassly NC | title = Trachoma: transmission, infection, and control | journal = The Lancet. Infectious Diseases | volume = 7 | issue = 6 | pages = 420–427 | date = June 2007 | pmid = 17521595 | doi = 10.1016/S1473-3099(07)70137-8 }}</ref> | Chlamydia can be transmitted during vaginal, anal, oral, or manual sex or direct contact with infected tissue such as [[conjunctiva]]. Chlamydia can also be passed from an infected mother to her baby during vaginal childbirth.<ref name=CDC/> It is assumed that the probability of becoming infected is proportionate to the number of bacteria one is exposed to.<ref>{{cite journal | vauthors = Gambhir M, Basáñez MG, Turner F, Kumaresan J, Grassly NC | title = Trachoma: transmission, infection, and control | journal = The Lancet. Infectious Diseases | volume = 7 | issue = 6 | pages = 420–427 | date = June 2007 | pmid = 17521595 | doi = 10.1016/S1473-3099(07)70137-8 }}</ref> | ||
Recent research using [[Droplet Digital PCR|droplet digital PCR]] and viability assays found evidence of high-viability ''C. trachomatis'' in the gastrointestinal tract of women who abstained from receptive anal intercourse. Rectal ''C. trachomatis'' appeared independent of cervical infection—with distinct [[Multilocus sequence typing|MLST]] types detected in rectal versus endocervical samples—suggesting persistent gastrointestinal colonization likely acquired through prior vaginorectal or oral routes, rather than direct anal exposure.<ref>{{Cite journal |last1=Karlsson |first1=Philip A. |last2=Wänn |first2=Mimmi |last3=Wang |first3=Helen |last4=Falk |first4=Lars |last5=Herrmann |first5=Björn |date=2025 | Recent research using [[Droplet Digital PCR|droplet digital PCR]] and viability assays found evidence of high-viability ''C. trachomatis'' in the gastrointestinal tract of women who abstained from receptive anal intercourse. Rectal ''C. trachomatis'' appeared independent of cervical infection—with distinct [[Multilocus sequence typing|MLST]] types detected in rectal versus endocervical samples—suggesting persistent gastrointestinal colonization likely acquired through prior vaginorectal or oral routes, rather than direct anal exposure.<ref>{{Cite journal |last1=Karlsson |first1=Philip A. |last2=Wänn |first2=Mimmi |last3=Wang |first3=Helen |last4=Falk |first4=Lars |last5=Herrmann |first5=Björn |date=10 January 2025 |title=Highly viable gastrointestinal Chlamydia trachomatis in women abstaining from receptive anal intercourse |journal=Scientific Reports |language=en |volume=15 |issue=1 |article-number=1641 |doi=10.1038/s41598-025-85297-4 |issn=2045-2322 |pmc=11724036 |pmid=39794438|bibcode=2025NatSR..15.1641K }}</ref> | ||
==Pathophysiology== | ==Pathophysiology== | ||
Chlamydia bacteria have the ability to establish long-term associations with host cells. When an infected host cell is starved for various nutrients such as [[amino acid]]s (for example, [[tryptophan]]),<ref name="pmid17724071">{{cite journal | vauthors = Leonhardt RM, Lee SJ, Kavathas PB, Cresswell P | title = Severe tryptophan starvation blocks onset of conventional persistence and reduces reactivation of Chlamydia trachomatis | journal = Infection and Immunity | volume = 75 | issue = 11 | pages = 5105–5117 | date = November 2007 | pmid = 17724071 | pmc = 2168275 | doi = 10.1128/IAI.00668-07 }}</ref> [[iron]], or [[vitamin]]s, this has a negative consequence for chlamydia bacteria since the organism is dependent on the host cell for these nutrients. Long-term cohort studies indicate that approximately 50% of those infected clear within a year, 80% within two years, and 90% within three years.<ref name="Fairley2007">{{cite journal | vauthors = Fairley CK, Gurrin L, Walker J, Hocking JS | title = "Doctor, how long has my Chlamydia been there?" Answer: ".... years" | journal = Sexually Transmitted Diseases | volume = 34 | issue = 9 | pages = 727–728 | date = September 2007 | pmid = 17717486 | doi = 10.1097/OLQ.0b013e31812dfb6e | doi-access = free }}</ref> | Chlamydia bacteria have the ability to establish long-term associations with host cells. When an infected host cell is starved for various nutrients such as [[amino acid]]s (for example, [[tryptophan]]),<ref name="pmid17724071">{{cite journal | vauthors = Leonhardt RM, Lee SJ, Kavathas PB, Cresswell P | title = Severe tryptophan starvation blocks onset of conventional persistence and reduces reactivation of Chlamydia trachomatis | journal = Infection and Immunity | volume = 75 | issue = 11 | pages = 5105–5117 | date = November 2007 | pmid = 17724071 | pmc = 2168275 | doi = 10.1128/IAI.00668-07 }}</ref> [[iron]], or [[vitamin]]s, this has a negative consequence for chlamydia bacteria since the organism is dependent on the host cell for these nutrients. Long-term cohort studies indicate that approximately 50% of those infected clear within a year, 80% within two years, and 90% within three years.<ref name="Fairley2007">{{cite journal | vauthors = Fairley CK, Gurrin L, Walker J, Hocking JS | title = "Doctor, how long has my Chlamydia been there?" Answer: ".... years" | journal = Sexually Transmitted Diseases | volume = 34 | issue = 9 | pages = 727–728 | date = September 2007 | pmid = 17717486 | doi = 10.1097/OLQ.0b013e31812dfb6e | doi-access = free }}</ref> | ||
The starved chlamydia bacteria can enter a persistent growth state where they stop [[cell division]] and become morphologically aberrant by increasing in size.<ref name="pmid16338585">{{cite journal | vauthors = Mpiga P, Ravaoarinoro M | title = Chlamydia trachomatis persistence: an update | journal = Microbiological Research | volume = 161 | issue = 1 | pages = 9–19 | year = 2006 | pmid = 16338585 | doi = 10.1016/j.micres.2005.04.004 | doi-access = }}</ref> Persistent organisms remain viable as they are capable of returning to a normal growth state once conditions in the host cell improve.<ref>{{cite book | vauthors = Kushwaha AK |url=https://books.google.com/books?id=r4vtDwAAQBAJ&dq=persistent+organisms+remain+viable+as+they+are+capable+of+returning+to+a+normal+growth+state+once+conditions+in+the+host+cell+improve&pg=PA202 |title=Textbook of Microbiology |date=2020 | The starved chlamydia bacteria can enter a persistent growth state where they stop [[cell division]] and become morphologically aberrant by increasing in size.<ref name="pmid16338585">{{cite journal | vauthors = Mpiga P, Ravaoarinoro M | title = Chlamydia trachomatis persistence: an update | journal = Microbiological Research | volume = 161 | issue = 1 | pages = 9–19 | year = 2006 | pmid = 16338585 | doi = 10.1016/j.micres.2005.04.004 | doi-access = }}</ref> Persistent organisms remain viable as they are capable of returning to a normal growth state once conditions in the host cell improve.<ref>{{cite book | vauthors = Kushwaha AK |url=https://books.google.com/books?id=r4vtDwAAQBAJ&dq=persistent+organisms+remain+viable+as+they+are+capable+of+returning+to+a+normal+growth+state+once+conditions+in+the+host+cell+improve&pg=PA202 |title=Textbook of Microbiology |date=26 July 2020 |publisher=Dr. A.K KUSHWAHA |language=en}}</ref> | ||
There is debate as to whether persistence has relevance: some believe that persistent chlamydia bacteria are the cause of chronic chlamydial diseases. Some antibiotics such as [[β-lactam]]s have been found to induce a persistent-like growth state.<ref name="bayramova2018insight">{{cite journal | vauthors = Bayramova F, Jacquier N, Greub G | title = Insight in the biology of Chlamydia-related bacteria | journal = Microbes and Infection | volume = 20 | issue = 7–8 | pages = 432–440 | year = 2018 | pmid = 29269129 | doi = 10.1016/j.micinf.2017.11.008 | publisher = Elsevier | doi-access = free }}</ref><ref name="klockner2016deconstructing">{{cite book| vauthors = Klöckner A, Bühl H, Viollier P, Henrichfreise B | title=Biology of Chlamydia | volume=412 | editor=Häcker, Georg | chapter=Deconstructing the Chlamydial Cell Wall | year=2018 | publisher=Springer International Publishing | location=Cham | pages=1–33|doi=10.1007/82_2016_34| pmid=27726004 |isbn=978-3-319-71232-1| series=Current Topics in Microbiology and Immunology }}</ref> | There is debate as to whether persistence has relevance: some believe that persistent chlamydia bacteria are the cause of chronic chlamydial diseases. Some antibiotics such as [[β-lactam]]s have been found to induce a persistent-like growth state.<ref name="bayramova2018insight">{{cite journal | vauthors = Bayramova F, Jacquier N, Greub G | title = Insight in the biology of Chlamydia-related bacteria | journal = Microbes and Infection | volume = 20 | issue = 7–8 | pages = 432–440 | year = 2018 | pmid = 29269129 | doi = 10.1016/j.micinf.2017.11.008 | publisher = Elsevier | doi-access = free }}</ref><ref name="klockner2016deconstructing">{{cite book| vauthors = Klöckner A, Bühl H, Viollier P, Henrichfreise B | title=Biology of Chlamydia | volume=412 | editor=Häcker, Georg | chapter=Deconstructing the Chlamydial Cell Wall | year=2018 | publisher=Springer International Publishing | location=Cham | pages=1–33|doi=10.1007/82_2016_34| pmid=27726004 |isbn=978-3-319-71232-1| series=Current Topics in Microbiology and Immunology }}</ref> | ||
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At present, the NAATs have regulatory approval only for testing urogenital specimens, although rapidly evolving research indicates that they may give reliable results on rectal specimens. | At present, the NAATs have regulatory approval only for testing urogenital specimens, although rapidly evolving research indicates that they may give reliable results on rectal specimens. | ||
Because of improved test accuracy, ease of specimen management, convenience in specimen management, and ease of screening sexually active men and women, the NAATs have largely replaced culture, the historic [[Gold standard (test)|gold standard]] for chlamydia diagnosis, and the non-amplified probe tests. The latter test is relatively insensitive, successfully detecting only 60–80% of infections in asymptomatic women, and often giving falsely-positive results. Culture remains useful in selected circumstances and is currently the only assay approved for testing non-genital specimens. Other methods also exist including: [[ligase chain reaction]] (LCR), direct fluorescent antibody resting, [[ELISA|enzyme immunoassay]], and cell culture.<ref>{{cite web|url=https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6302a1.htm|title=Recommendations for the Laboratory-Based Detection of Chlamydia trachomatis and Neisseria gonorrhoeae — 2014|website=Centers for Disease Control and Prevention|access-date=2016 | Because of improved test accuracy, ease of specimen management, convenience in specimen management, and ease of screening sexually active men and women, the NAATs have largely replaced culture, the historic [[Gold standard (test)|gold standard]] for chlamydia diagnosis, and the non-amplified probe tests. The latter test is relatively insensitive, successfully detecting only 60–80% of infections in asymptomatic women, and often giving falsely-positive results. Culture remains useful in selected circumstances and is currently the only assay approved for testing non-genital specimens. Other methods also exist including: [[ligase chain reaction]] (LCR), direct fluorescent antibody resting, [[ELISA|enzyme immunoassay]], and cell culture.<ref>{{cite web|url=https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6302a1.htm|title=Recommendations for the Laboratory-Based Detection of Chlamydia trachomatis and Neisseria gonorrhoeae — 2014|website=Centers for Disease Control and Prevention|access-date=12 June 2016|url-status=live|archive-url=https://web.archive.org/web/20160627175218/http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6302a1.htm|archive-date=27 June 2016}}</ref> | ||
The swab sample for chlamydial infections does not show difference whether the sample was collected in home or in clinic in terms of numbers of patient treated. The implications in cured patients, reinfection, partner management, and safety are unknown.<ref>{{cite journal | vauthors = Fajardo-Bernal L, Aponte-Gonzalez J, Vigil P, Angel-Müller E, Rincon C, Gaitán HG, Low N | title = Home-based versus clinic-based specimen collection in the management of Chlamydia trachomatis and Neisseria gonorrhoeae infections | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 9 | article-number = CD011317 | date = September 2015 | pmid = 26418128 | pmc = 8666088 | doi = 10.1002/14651858.CD011317.pub2 | collaboration = Cochrane STI Group }}</ref> | The swab sample for chlamydial infections does not show difference whether the sample was collected in home or in clinic in terms of numbers of patient treated. The implications in cured patients, reinfection, partner management, and safety are unknown.<ref>{{cite journal | vauthors = Fajardo-Bernal L, Aponte-Gonzalez J, Vigil P, Angel-Müller E, Rincon C, Gaitán HG, Low N | title = Home-based versus clinic-based specimen collection in the management of Chlamydia trachomatis and Neisseria gonorrhoeae infections | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 9 | article-number = CD011317 | date = September 2015 | pmid = 26418128 | pmc = 8666088 | doi = 10.1002/14651858.CD011317.pub2 | collaboration = Cochrane STI Group }}</ref> | ||
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# Reduce onward transmission to sexual partners; | # Reduce onward transmission to sexual partners; | ||
# Prevent the consequences of untreated infection; | # Prevent the consequences of untreated infection; | ||
# Test at least 25 percent of the sexually active under 25 population annually.<ref>{{cite web|url=http://www.chlamydiascreening.nhs.uk/ps/data/data_tables.html|title=National Chlamydia Screening Programme Data tables|access-date=2009 | # Test at least 25 percent of the sexually active under 25 population annually.<ref>{{cite web|url=http://www.chlamydiascreening.nhs.uk/ps/data/data_tables.html|title=National Chlamydia Screening Programme Data tables|access-date=28 August 2009|website=www.chlamydiascreening.nhs.uk|archive-url=https://web.archive.org/web/20090504185725/http://www.chlamydiascreening.nhs.uk/ps/data/data_tables.html|archive-date=4 May 2009}}</ref> | ||
# Retest after treatment.<ref name="DesaiWoodhall2015">{{cite journal | vauthors = Desai M, Woodhall SC, Nardone A, Burns F, Mercey D, Gilson R | title = Active recall to increase HIV and STI testing: a systematic review | journal = Sexually Transmitted Infections | volume = 91 | issue = 5 | pages = 314–323 | date = August 2015 | pmid = 25759476 | doi = 10.1136/sextrans-2014-051930 | doi-access = free | quote = Strategies for improved follow up care include the use of text messages and emails from those who provided treatment. }}</ref> | # Retest after treatment.<ref name="DesaiWoodhall2015">{{cite journal | vauthors = Desai M, Woodhall SC, Nardone A, Burns F, Mercey D, Gilson R | title = Active recall to increase HIV and STI testing: a systematic review | journal = Sexually Transmitted Infections | volume = 91 | issue = 5 | pages = 314–323 | date = August 2015 | pmid = 25759476 | doi = 10.1136/sextrans-2014-051930 | doi-access = free | quote = Strategies for improved follow up care include the use of text messages and emails from those who provided treatment. }}</ref> | ||
==Treatment== | ==Treatment== | ||
''C. trachomatis'' infection can be effectively cured with [[antibiotic]]s. Guidelines recommend [[azithromycin]], [[doxycycline]], [[erythromycin]], [[levofloxacin]], or [[ofloxacin]].<ref>{{cite book|veditors=Eliopoulos GM, Gilbert DN, Moellering RC|title=The Sanford guide to antimicrobial therapy 2011|publisher=Antimicrobial Therapy, Inc.|location=Sperryville, VA|isbn=978-1-930808-65-2|pages=[https://archive.org/details/sanfordguidetoan00davi_0/page/20 20]|url=https://archive.org/details/sanfordguidetoan00davi_0/page/20|year=2015}}</ref> In men, doxycycline (100 mg twice a day for 7 days) is probably more effective than azithromycin (1 g single dose) but evidence for the relative effectiveness of antibiotics in women is very uncertain.<ref>{{cite journal | vauthors = Páez-Canro C, Alzate JP, González LM, Rubio-Romero JA, Lethaby A, Gaitán HG | title = Antibiotics for treating urogenital Chlamydia trachomatis infection in men and non-pregnant women | journal = The Cochrane Database of Systematic Reviews | volume = 1 | issue = 1 | article-number = CD010871 | date = January 2019 | pmid = 30682211 | pmc = 6353232 | doi = 10.1002/14651858.CD010871.pub2 }}</ref> Agents recommended during pregnancy include erythromycin or [[amoxicillin]].<ref name="CDC2015" /><ref name="urlDiagnosis and Treatment of Chlamydia trachomatis Infection - April 15, 2006 - American Family Physician">{{cite journal | vauthors = Miller KE | title = Diagnosis and treatment of Chlamydia trachomatis infection | journal = American Family Physician | volume = 73 | issue = 8 | pages = 1411–1416 | date = April 2006 | pmid = 16669564 | url = http://www.aafp.org/afp/2006/0415/p1411.html | access-date = 2010 | ''C. trachomatis'' infection can be effectively cured with [[antibiotic]]s. Guidelines recommend [[azithromycin]], [[doxycycline]], [[erythromycin]], [[levofloxacin]], or [[ofloxacin]].<ref>{{cite book|veditors=Eliopoulos GM, Gilbert DN, Moellering RC|title=The Sanford guide to antimicrobial therapy 2011|publisher=Antimicrobial Therapy, Inc.|location=Sperryville, VA|isbn=978-1-930808-65-2|pages=[https://archive.org/details/sanfordguidetoan00davi_0/page/20 20]|url=https://archive.org/details/sanfordguidetoan00davi_0/page/20|year=2015}}</ref> In men, doxycycline (100 mg twice a day for 7 days) is probably more effective than azithromycin (1 g single dose) but evidence for the relative effectiveness of antibiotics in women is very uncertain.<ref>{{cite journal | vauthors = Páez-Canro C, Alzate JP, González LM, Rubio-Romero JA, Lethaby A, Gaitán HG | title = Antibiotics for treating urogenital Chlamydia trachomatis infection in men and non-pregnant women | journal = The Cochrane Database of Systematic Reviews | volume = 1 | issue = 1 | article-number = CD010871 | date = January 2019 | pmid = 30682211 | pmc = 6353232 | doi = 10.1002/14651858.CD010871.pub2 }}</ref> Agents recommended during pregnancy include erythromycin or [[amoxicillin]].<ref name="CDC2015" /><ref name="urlDiagnosis and Treatment of Chlamydia trachomatis Infection - April 15, 2006 - American Family Physician">{{cite journal | vauthors = Miller KE | title = Diagnosis and treatment of Chlamydia trachomatis infection | journal = American Family Physician | volume = 73 | issue = 8 | pages = 1411–1416 | date = April 2006 | pmid = 16669564 | url = http://www.aafp.org/afp/2006/0415/p1411.html | access-date = 30 October 2010 | url-status = live | archive-url = https://web.archive.org/web/20111127054457/http://www.aafp.org/afp/2006/0415/p1411.html | archive-date = 27 November 2011 }}</ref> | ||
An option for treating sexual partners of those with chlamydia or [[gonorrhea]] includes [[patient-delivered partner therapy]] (PDT or PDPT), which is the practice of treating the sex partners of index cases by providing prescriptions or medications to the patient to take to his/her partner without the health care provider first examining the partner.<ref name="EPTFinalReport2006">[https://www.cdc.gov/std/treatment/EPTFinalReport2006.pdf Expedited Partner Therapy in the Management of Sexually Transmitted Diseases (2 February 2006)] {{webarchive|url=https://web.archive.org/web/20170729185320/https://www.cdc.gov/std/treatment/eptfinalreport2006.pdf |archive-url=https://web.archive.org/web/20060321102011/http://www.cdc.gov/std/treatment/EPTFinalReport2006.pdf |archive-date=2006 | An option for treating sexual partners of those with chlamydia or [[gonorrhea]] includes [[patient-delivered partner therapy]] (PDT or PDPT), which is the practice of treating the sex partners of index cases by providing prescriptions or medications to the patient to take to his/her partner without the health care provider first examining the partner.<ref name="EPTFinalReport2006">[https://www.cdc.gov/std/treatment/EPTFinalReport2006.pdf Expedited Partner Therapy in the Management of Sexually Transmitted Diseases (2 February 2006)] {{webarchive|url=https://web.archive.org/web/20170729185320/https://www.cdc.gov/std/treatment/eptfinalreport2006.pdf |archive-url=https://web.archive.org/web/20060321102011/http://www.cdc.gov/std/treatment/EPTFinalReport2006.pdf |archive-date=21 March 2006 |url-status=live |date=29 July 2017 }} U.S. Department of Health and Human Services Public Health Service. Centers for Disease Control and Prevention National Center for HIV, STD, and TB Prevention</ref> | ||
Following treatment people should be tested again after three months to check for reinfection.<ref name=CDC2015/> Test of cure may be [[false-positive]] due to the limitations of NAAT in a bacterial (rather than a viral) context, since targeted genetic material may persist in the absence of viable organisms.<ref name="toc">{{cite journal | vauthors = Dukers-Muijrers N, Morré S, Speksnijder A, Sande M, Hoebe C | title = ''Chlamydia trachomatis'' Test-of-Cure Cannot Be Based on a Single Highly Sensitive Laboratory Test Taken at Least 3 Weeks after Treatment | journal = PLOS ONE | volume = 7 | issue = 3 | article-number = e34108 | date = 28 March 2012 | pmid = 22470526 | pmc = 3314698 | doi = 10.1371/journal.pone.0034108 | doi-access = free | bibcode = 2012PLoSO...734108D }}</ref> | Following treatment people should be tested again after three months to check for reinfection.<ref name=CDC2015/> Test of cure may be [[false-positive]] due to the limitations of NAAT in a bacterial (rather than a viral) context, since targeted genetic material may persist in the absence of viable organisms.<ref name="toc">{{cite journal | vauthors = Dukers-Muijrers N, Morré S, Speksnijder A, Sande M, Hoebe C | title = ''Chlamydia trachomatis'' Test-of-Cure Cannot Be Based on a Single Highly Sensitive Laboratory Test Taken at Least 3 Weeks after Treatment | journal = PLOS ONE | volume = 7 | issue = 3 | article-number = e34108 | date = 28 March 2012 | pmid = 22470526 | pmc = 3314698 | doi = 10.1371/journal.pone.0034108 | doi-access = free | bibcode = 2012PLoSO...734108D }}</ref> | ||
==Epidemiology== | ==Epidemiology== | ||
[[File:Chlamydia world map - DALY - WHO2004.svg|thumb|upright=1.3|[[Disability-adjusted life year]] (DALY) for chlamydia per 100,000 inhabitants in 2004<ref>{{cite web |url=https://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html |title=WHO Disease and injury country estimates |year=2004 |work=World Health Organization |access-date= | [[File:Chlamydia world map - DALY - WHO2004.svg|thumb|upright=1.3|[[Disability-adjusted life year]] (DALY) for chlamydia per 100,000 inhabitants in 2004<ref>{{cite web |url=https://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html |title=WHO Disease and injury country estimates |year=2004 |work=World Health Organization |access-date=11 November 2009 |url-status=live |archive-url=https://web.archive.org/web/20091111101009/http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html |archive-date=11 November 2009 }}</ref>{{Div col|small=yes|colwidth=10em}} | ||
{{legend|#b3b3b3|no data}} | {{legend|#b3b3b3|no data}} | ||
{{legend|#ffff65|≤10}} | {{legend|#ffff65|≤10}} | ||
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Globally, as of 2015, sexually transmitted chlamydia affects approximately 61 million people.<ref name=GBD2015Pre/> It is more common in women (3.8%) than men (2.5%).<ref name="LancetEpi2012">{{cite journal | vauthors = Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, Ahn SY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, Basáñez MG, Baxter A, Bell ML, Benjamin EJ, Bennett D, Bernabé E, Bhalla K, Bhandari B, Bikbov B, Bin Abdulhak A, Birbeck G, Black JA, Blencowe H, Blore JD, Blyth F, Bolliger I, Bonaventure A, Boufous S, Bourne R, Boussinesq M, Braithwaite T, Brayne C, Bridgett L, Brooker S, Brooks P, Brugha TS, Bryan-Hancock C, Bucello C, Buchbinder R, Buckle G, Budke CM, Burch M, Burney P, Burstein R, Calabria B, Campbell B, Canter CE, Carabin H, Carapetis J, Carmona L, Cella C, Charlson F, Chen H, Cheng AT, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahiya M, Dahodwala N, Damsere-Derry J, Danaei G, Davis A, De Leo D, Degenhardt L, Dellavalle R, Delossantos A, Denenberg J, Derrett S, Des Jarlais DC, Dharmaratne SD, Dherani M, Diaz-Torne C, Dolk H, Dorsey ER, Driscoll T, Duber H, Ebel B, Edmond K, Elbaz A, Ali SE, Erskine H, Erwin PJ, Espindola P, Ewoigbokhan SE, Farzadfar F, Feigin V, Felson DT, Ferrari A, Ferri CP, Fèvre EM, Finucane MM, Flaxman S, Flood L, Foreman K, Forouzanfar MH, Fowkes FG, Franklin R, Fransen M, Freeman MK, Gabbe BJ, Gabriel SE, Gakidou E, Ganatra HA, Garcia B, Gaspari F, Gillum RF, Gmel G, Gosselin R, Grainger R, Groeger J, Guillemin F, Gunnell D, Gupta R, Haagsma J, Hagan H, Halasa YA, Hall W, Haring D, Haro JM, Harrison JE, Havmoeller R, Hay RJ, Higashi H, Hill C, Hoen B, Hoffman H, Hotez PJ, Hoy D, Huang JJ, Ibeanusi SE, Jacobsen KH, James SL, Jarvis D, Jasrasaria R, Jayaraman S, Johns N, Jonas JB, Karthikeyan G, Kassebaum N, Kawakami N, Keren A, Khoo JP, King CH, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Lalloo R, Laslett LL, Lathlean T, Leasher JL, Lee YY, Leigh J, Lim SS, Limb E, Lin JK, Lipnick M, Lipshultz SE, Liu W, Loane M, Ohno SL, Lyons R, Ma J, Mabweijano J, MacIntyre MF, Malekzadeh R, Mallinger L, Manivannan S, Marcenes W, March L, Margolis DJ, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGill N, McGrath J, Medina-Mora ME, Meltzer M, Mensah GA, Merriman TR, Meyer AC, Miglioli V, Miller M, Miller TR, Mitchell PB, Mocumbi AO, Moffitt TE, Mokdad AA, Monasta L, Montico M, Moradi-Lakeh M, Moran A, Morawska L, Mori R, Murdoch ME, Mwaniki MK, Naidoo K, Nair MN, Naldi L, Narayan KM, Nelson PK, Nelson RG, Nevitt MC, Newton CR, Nolte S, Norman P, Norman R, O'Donnell M, O'Hanlon S, Olives C, Omer SB, Ortblad K, Osborne R, Ozgediz D, Page A, Pahari B, Pandian JD, Rivero AP, Patten SB, Pearce N, Padilla RP, Perez-Ruiz F, Perico N, Pesudovs K, Phillips D, Phillips MR, Pierce K, Pion S, Polanczyk GV, Polinder S, Pope CA, Popova S, Porrini E, Pourmalek F, Prince M, Pullan RL, Ramaiah KD, Ranganathan D, Razavi H, Regan M, Rehm JT, Rein DB, Remuzzi G, Richardson K, Rivara FP, Roberts T, Robinson C, De Leòn FR, Ronfani L, Room R, Rosenfeld LC, Rushton L, Sacco RL, Saha S, Sampson U, Sanchez-Riera L, Sanman E, Schwebel DC, Scott JG, Segui-Gomez M, Shahraz S, Shepard DS, Shin H, Shivakoti R, Singh D, Singh GM, Singh JA, Singleton J, Sleet DA, Sliwa K, Smith E, Smith JL, Stapelberg NJ, Steer A, Steiner T, Stolk WA, Stovner LJ, Sudfeld C, Syed S, Tamburlini G, Tavakkoli M, Taylor HR, Taylor JA, Taylor WJ, Thomas B, Thomson WM, Thurston GD, Tleyjeh IM, Tonelli M, Towbin JA, Truelsen T, Tsilimbaris MK, Ubeda C, Undurraga EA, van der Werf MJ, van Os J, Vavilala MS, Venketasubramanian N, Wang M, Wang W, Watt K, Weatherall DJ, Weinstock MA, Weintraub R, Weisskopf MG, Weissman MM, White RA, Whiteford H, Wiersma ST, Wilkinson JD, Williams HC, Williams SR, Witt E, Wolfe F, Woolf AD, Wulf S, Yeh PH, Zaidi AK, Zheng ZJ, Zonies D, Lopez AD, Murray CJ, AlMazroa MA, Memish ZA | title = Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010 | journal = Lancet | volume = 380 | issue = 9859 | pages = 2163–2196 | date = December 2012 | pmid = 23245607 | pmc = 6350784 | doi = 10.1016/S0140-6736(12)61729-2 }}</ref> In 2015 it resulted in about 200 deaths.<ref name=GBD2015De/> | Globally, as of 2015, sexually transmitted chlamydia affects approximately 61 million people.<ref name=GBD2015Pre/> It is more common in women (3.8%) than men (2.5%).<ref name="LancetEpi2012">{{cite journal | vauthors = Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, Ahn SY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, Basáñez MG, Baxter A, Bell ML, Benjamin EJ, Bennett D, Bernabé E, Bhalla K, Bhandari B, Bikbov B, Bin Abdulhak A, Birbeck G, Black JA, Blencowe H, Blore JD, Blyth F, Bolliger I, Bonaventure A, Boufous S, Bourne R, Boussinesq M, Braithwaite T, Brayne C, Bridgett L, Brooker S, Brooks P, Brugha TS, Bryan-Hancock C, Bucello C, Buchbinder R, Buckle G, Budke CM, Burch M, Burney P, Burstein R, Calabria B, Campbell B, Canter CE, Carabin H, Carapetis J, Carmona L, Cella C, Charlson F, Chen H, Cheng AT, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahiya M, Dahodwala N, Damsere-Derry J, Danaei G, Davis A, De Leo D, Degenhardt L, Dellavalle R, Delossantos A, Denenberg J, Derrett S, Des Jarlais DC, Dharmaratne SD, Dherani M, Diaz-Torne C, Dolk H, Dorsey ER, Driscoll T, Duber H, Ebel B, Edmond K, Elbaz A, Ali SE, Erskine H, Erwin PJ, Espindola P, Ewoigbokhan SE, Farzadfar F, Feigin V, Felson DT, Ferrari A, Ferri CP, Fèvre EM, Finucane MM, Flaxman S, Flood L, Foreman K, Forouzanfar MH, Fowkes FG, Franklin R, Fransen M, Freeman MK, Gabbe BJ, Gabriel SE, Gakidou E, Ganatra HA, Garcia B, Gaspari F, Gillum RF, Gmel G, Gosselin R, Grainger R, Groeger J, Guillemin F, Gunnell D, Gupta R, Haagsma J, Hagan H, Halasa YA, Hall W, Haring D, Haro JM, Harrison JE, Havmoeller R, Hay RJ, Higashi H, Hill C, Hoen B, Hoffman H, Hotez PJ, Hoy D, Huang JJ, Ibeanusi SE, Jacobsen KH, James SL, Jarvis D, Jasrasaria R, Jayaraman S, Johns N, Jonas JB, Karthikeyan G, Kassebaum N, Kawakami N, Keren A, Khoo JP, King CH, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Lalloo R, Laslett LL, Lathlean T, Leasher JL, Lee YY, Leigh J, Lim SS, Limb E, Lin JK, Lipnick M, Lipshultz SE, Liu W, Loane M, Ohno SL, Lyons R, Ma J, Mabweijano J, MacIntyre MF, Malekzadeh R, Mallinger L, Manivannan S, Marcenes W, March L, Margolis DJ, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGill N, McGrath J, Medina-Mora ME, Meltzer M, Mensah GA, Merriman TR, Meyer AC, Miglioli V, Miller M, Miller TR, Mitchell PB, Mocumbi AO, Moffitt TE, Mokdad AA, Monasta L, Montico M, Moradi-Lakeh M, Moran A, Morawska L, Mori R, Murdoch ME, Mwaniki MK, Naidoo K, Nair MN, Naldi L, Narayan KM, Nelson PK, Nelson RG, Nevitt MC, Newton CR, Nolte S, Norman P, Norman R, O'Donnell M, O'Hanlon S, Olives C, Omer SB, Ortblad K, Osborne R, Ozgediz D, Page A, Pahari B, Pandian JD, Rivero AP, Patten SB, Pearce N, Padilla RP, Perez-Ruiz F, Perico N, Pesudovs K, Phillips D, Phillips MR, Pierce K, Pion S, Polanczyk GV, Polinder S, Pope CA, Popova S, Porrini E, Pourmalek F, Prince M, Pullan RL, Ramaiah KD, Ranganathan D, Razavi H, Regan M, Rehm JT, Rein DB, Remuzzi G, Richardson K, Rivara FP, Roberts T, Robinson C, De Leòn FR, Ronfani L, Room R, Rosenfeld LC, Rushton L, Sacco RL, Saha S, Sampson U, Sanchez-Riera L, Sanman E, Schwebel DC, Scott JG, Segui-Gomez M, Shahraz S, Shepard DS, Shin H, Shivakoti R, Singh D, Singh GM, Singh JA, Singleton J, Sleet DA, Sliwa K, Smith E, Smith JL, Stapelberg NJ, Steer A, Steiner T, Stolk WA, Stovner LJ, Sudfeld C, Syed S, Tamburlini G, Tavakkoli M, Taylor HR, Taylor JA, Taylor WJ, Thomas B, Thomson WM, Thurston GD, Tleyjeh IM, Tonelli M, Towbin JA, Truelsen T, Tsilimbaris MK, Ubeda C, Undurraga EA, van der Werf MJ, van Os J, Vavilala MS, Venketasubramanian N, Wang M, Wang W, Watt K, Weatherall DJ, Weinstock MA, Weintraub R, Weisskopf MG, Weissman MM, White RA, Whiteford H, Wiersma ST, Wilkinson JD, Williams HC, Williams SR, Witt E, Wolfe F, Woolf AD, Wulf S, Yeh PH, Zaidi AK, Zheng ZJ, Zonies D, Lopez AD, Murray CJ, AlMazroa MA, Memish ZA | title = Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010 | journal = Lancet | volume = 380 | issue = 9859 | pages = 2163–2196 | date = December 2012 | pmid = 23245607 | pmc = 6350784 | doi = 10.1016/S0140-6736(12)61729-2 }}</ref> In 2015 it resulted in about 200 deaths.<ref name=GBD2015De/> | ||
In the United States about 1.6 million cases were reported in | In the United States about 1.6 million cases were reported in 2023.<ref>{{cite web|title=Sexually Transmitted Infections Surveillance, 2024 (Provisional)|url=https://www.cdc.gov/sti-statistics/annual/index.html |website=Centers for Disease Control and Prevention|language=en-us|date=24 September 2025 }}</ref> The CDC estimates that if one includes unreported cases there are about 2.9 million each year.<ref name="CDC2016Stat">{{cite web|title=Detailed STD Facts – Chlamydia|url=https://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm|website=Centers for Disease Control and Prevention|access-date=14 January 2018|language=en-us|date=20 September 2017}}</ref> It affects around 3% of younger adults aged 18–29.<ref>{{cite journal | vauthors = Torrone E, Papp J, Weinstock H | title = Prevalence of Chlamydia trachomatis genital infection among persons aged 14-39 years--United States, 2007-2012 | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 63 | issue = 38 | pages = 834–838 | date = September 2014 | pmid = 25254560 | pmc = 4584673 }}</ref> [[African Americans]] have disproportionately higher rates of chlamydia compared to other racial and ethnic groups.<ref>{{cite web |title=Health Disparities in Black or African American People |url=https://www.cdc.gov/health-disparities-hiv-std-tb-hepatitis/populations/black-african-american.html |website=Centers for Disease Control and Prevention |date=17 January 2024}}</ref> Chlamydial infection is the most common bacterial sexually transmitted infection in the UK.<ref>{{cite web|title=Chlamydia|url=http://www.hpa.org.uk/Publications/InfectiousDiseases/Factsheets/factChlamydia/|publisher=UK Health Protection Agency|access-date=31 August 2012|archive-url=https://web.archive.org/web/20120913212016/http://www.hpa.org.uk/Publications/InfectiousDiseases/Factsheets/factChlamydia|archive-date=13 September 2012}}</ref> | ||
Chlamydia causes more than 250,000 cases of epididymitis in the U.S. each year. Chlamydia causes 250,000 to 500,000 cases of PID every year in the United States. Women infected with chlamydia are up to five times more likely to become infected with HIV, if exposed.<ref name=CDC/> | Chlamydia causes more than 250,000 cases of epididymitis in the U.S. each year. Chlamydia causes 250,000 to 500,000 cases of PID every year in the United States. Women infected with chlamydia are up to five times more likely to become infected with HIV, if exposed.<ref name=CDC/> | ||
Latest revision as of 21:04, 15 December 2025
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Chlamydia, or more specifically a chlamydia infection, is a sexually transmitted infection caused by the bacterium Chlamydia trachomatis.[1] Most people who are infected have no symptoms.[2] When symptoms do appear, they may occur only several weeks after infection;[2] the incubation period between exposure and being able to infect others is thought to be on the order of two to six weeks.[3] Symptoms in women may include vaginal discharge or burning with urination.[2] Symptoms in men may include discharge from the penis, burning with urination, or pain and swelling of one or both testicles.[2] The infection can spread to the upper genital tract in women, causing pelvic inflammatory disease, which may result in future infertility or ectopic pregnancy.[4]
Chlamydia infections can occur in other areas besides the genitals, including the anus, eyes, throat, and lymph nodes. Repeated chlamydia infections of the eyes that go without treatment can result in trachoma, a common cause of blindness in the developing world.[5]
Chlamydia can be spread during vaginal, anal, oral, or manual sex and can be passed from an infected mother to her baby during childbirth.[2][6] The eye infections may also be spread by personal contact, flies, and contaminated towels in areas with poor sanitation.[5] Infection by the bacterium Chlamydia trachomatis only occurs in humans.[7] Diagnosis is often by screening, which is recommended yearly in sexually active women under the age of 25, others at higher risk, and at the first prenatal visit.[2][4] Testing can be done on the urine or a swab of the cervix, vagina, or urethra.[4] Rectal or mouth swabs are required to diagnose infections in those areas.[4]
Prevention is by not having sex, the use of condoms, or having sex with only one other person, who is not infected.[2] Chlamydia can be cured by antibiotics, with typically either azithromycin or doxycycline being used.[4] Erythromycin or azithromycin is recommended in babies and during pregnancy.[4] Sexual partners should also be treated, and infected people should be advised not to have sex for seven days and until symptom free.[4] Gonorrhea, syphilis, and HIV should be tested for in those who have been infected.[4] Following treatment, people should be tested again after three months.[4]
Chlamydia is one of the most common sexually transmitted infections, affecting about 4.2% of women and 2.7% of men worldwide.[8][9] In 2015, about 61 million new cases occurred globally.[10] In the United States, about 1.4 million cases were reported in 2014.[1] Infections are most common among those between the ages of 15 and 25 and are more common in women than men.[4][1] In 2015, infections resulted in about 200 deaths.[11] The word chlamydia is from the Greek Script error: No such module "Lang"., meaning 'cloak'.[12][13]
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Signs and symptoms
Genital disease
Women
Chlamydial infection of the cervix (neck of the womb) is a sexually transmitted infection which has no symptoms for around 70% of women infected. The infection can be passed through vaginal, anal, oral, or manual sex. Of those who have an asymptomatic infection that is not detected by their doctor, approximately half will develop pelvic inflammatory disease (PID), a generic term for infection of the uterus, fallopian tubes, and/or ovaries. PID can cause scarring inside the reproductive organs, which can later cause serious complications, including chronic pelvic pain, difficulty becoming pregnant, ectopic (tubal) pregnancy, and other dangerous complications of pregnancy.[14]
Chlamydia is known as the "silent epidemic", as at least 70% of genital C. trachomatis infections in women (and 50% in men) are asymptomatic at the time of diagnosis,[15] and can linger for months or years before being discovered. Signs and symptoms may include abnormal vaginal bleeding or discharge, abdominal pain, painful sexual intercourse, fever, painful urination or the urge to urinate more often than usual (urinary urgency).[14]
For sexually active women who are not pregnant, screening is recommended in those under 25 and others at risk of infection.[16] Risk factors include a history of chlamydial or other sexually transmitted infection, new or multiple sexual partners, and inconsistent condom use.[17] Guidelines recommend all women attending for emergency contraceptive are offered chlamydia testing, with studies showing up to 9% of women aged under 25 years had chlamydia.[18]
Men
In men, those with a chlamydial infection show symptoms of infectious inflammation of the urethra in about 50% of cases.[15] Symptoms that may occur include: a painful or burning sensation when urinating, an unusual discharge from the penis, testicular pain or swelling, or fever. If left untreated, chlamydia in men can spread to the testicles causing epididymitis, which in rare cases can lead to sterility if not treated.[15] Chlamydia is also a potential cause of prostatic inflammation in men, although the exact relevance in prostatitis is difficult to ascertain due to possible contamination from urethritis.[19]
Eye disease
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Trachoma is a chronic conjunctivitis caused by Chlamydia trachomatis.[20] It was once the leading cause of blindness worldwide, but its role diminished from 15% of blindness cases by trachoma in 1995 to 3.6% in 2002.[21][22] The infection can be spread from eye to eye by fingers, shared towels or cloths, coughing and sneezing and eye-seeking flies.[23] Symptoms include mucopurulent ocular discharge, irritation, redness, and lid swelling.[20] Newborns can also develop chlamydia eye infection through childbirth (see below). Using the SAFE strategy (acronym for surgery for in-growing or in-turned lashes, antibiotics, facial cleanliness, and environmental improvements), the World Health Organization aimed (unsuccessfully) for the global elimination of trachoma by 2020 (GET 2020 initiative).[24][25] The updated World Health Assembly neglected tropical diseases road map (2021–2030) sets 2030 as the new timeline for global elimination.[26]
Joints
Chlamydia may also cause reactive arthritis—the triad of arthritis, conjunctivitis and urethral inflammation—especially in young men. About 15,000 men develop reactive arthritis due to chlamydia infection each year in the U.S., and about 5,000 are permanently affected by it. It can occur in both sexes, though is more common in men.Script error: No such module "Unsubst".
Infants
As many as half of all infants born to mothers with chlamydia will be born with the disease. Chlamydia can affect infants by causing spontaneous abortion; premature birth; conjunctivitis, which may lead to blindness; and pneumonia.[27] Conjunctivitis due to chlamydia typically occurs one week after birth (compared with chemical causes (within hours) or gonorrhea (2–5 days)).[28]
Other conditions
A different serovar of Chlamydia trachomatis is also the cause of lymphogranuloma venereum, an infection of the lymph nodes and lymphatics. It usually presents with genital ulceration and swollen lymph nodes in the groin, but it may also manifest as rectal inflammation, fever or swollen lymph nodes in other regions of the body.[29]
Transmission
Chlamydia can be transmitted during vaginal, anal, oral, or manual sex or direct contact with infected tissue such as conjunctiva. Chlamydia can also be passed from an infected mother to her baby during vaginal childbirth.[27] It is assumed that the probability of becoming infected is proportionate to the number of bacteria one is exposed to.[30]
Recent research using droplet digital PCR and viability assays found evidence of high-viability C. trachomatis in the gastrointestinal tract of women who abstained from receptive anal intercourse. Rectal C. trachomatis appeared independent of cervical infection—with distinct MLST types detected in rectal versus endocervical samples—suggesting persistent gastrointestinal colonization likely acquired through prior vaginorectal or oral routes, rather than direct anal exposure.[31]
Pathophysiology
Chlamydia bacteria have the ability to establish long-term associations with host cells. When an infected host cell is starved for various nutrients such as amino acids (for example, tryptophan),[32] iron, or vitamins, this has a negative consequence for chlamydia bacteria since the organism is dependent on the host cell for these nutrients. Long-term cohort studies indicate that approximately 50% of those infected clear within a year, 80% within two years, and 90% within three years.[33]
The starved chlamydia bacteria can enter a persistent growth state where they stop cell division and become morphologically aberrant by increasing in size.[34] Persistent organisms remain viable as they are capable of returning to a normal growth state once conditions in the host cell improve.[35]
There is debate as to whether persistence has relevance: some believe that persistent chlamydia bacteria are the cause of chronic chlamydial diseases. Some antibiotics such as β-lactams have been found to induce a persistent-like growth state.[36][37]
Diagnosis
The diagnosis of genital chlamydial infections evolved rapidly from the 1990s through 2006. Nucleic acid amplification tests (NAAT), such as polymerase chain reaction (PCR), transcription mediated amplification (TMA), and the DNA strand displacement amplification (SDA) now are the mainstays. NAAT for chlamydia may be performed on swab specimens sampled from the cervix (women) or urethra (men), on self-collected vaginal swabs, or on voided urine.[38] NAAT has been estimated to have a sensitivity of approximately 90% and a specificity of approximately 99%, regardless of sampling from a cervical swab or by urine specimen.[39] In women seeking treatment in a sexually transmitted infection clinic where a urine test is negative, a subsequent cervical swab has been estimated to be positive in approximately 2% of the time.[39]
At present, the NAATs have regulatory approval only for testing urogenital specimens, although rapidly evolving research indicates that they may give reliable results on rectal specimens.
Because of improved test accuracy, ease of specimen management, convenience in specimen management, and ease of screening sexually active men and women, the NAATs have largely replaced culture, the historic gold standard for chlamydia diagnosis, and the non-amplified probe tests. The latter test is relatively insensitive, successfully detecting only 60–80% of infections in asymptomatic women, and often giving falsely-positive results. Culture remains useful in selected circumstances and is currently the only assay approved for testing non-genital specimens. Other methods also exist including: ligase chain reaction (LCR), direct fluorescent antibody resting, enzyme immunoassay, and cell culture.[40]
The swab sample for chlamydial infections does not show difference whether the sample was collected in home or in clinic in terms of numbers of patient treated. The implications in cured patients, reinfection, partner management, and safety are unknown.[41]
Rapid point-of-care tests are, as of 2020, not thought to be effective for diagnosing chlamydia in men of reproductive age and non-pregnant women because of high false-negative rates.[42]
Prevention
Prevention is by not having sex, the use of condoms, or having sex only in a long-term monogamous relationship with someone who has been tested and confirmed not to be infected.[2]
Screening
For sexually active women who are not pregnant, screening is recommended in those under 25 and others at risk of infection.[16] Risk factors include a history of chlamydial or other sexually transmitted infection, new or multiple sexual partners, and inconsistent condom use.[17] For pregnant women, guidelines vary: screening women with age or other risk factors is recommended by the U.S. Preventive Services Task Force (USPSTF) (which recommends screening women under 25) and the American Academy of Family Physicians (which recommends screening women aged 25 or younger). The American College of Obstetricians and Gynecologists recommends screening all at risk, while the Centers for Disease Control and Prevention recommend universal screening of pregnant women.[16] The USPSTF acknowledges that in some communities there may be other risk factors for infection, such as ethnicity.[16] Evidence-based recommendations for screening initiation, intervals and termination are currently not possible.[16] For men, the USPSTF concludes evidence is currently insufficient to determine if regular screening of men for chlamydia is beneficial.[17] They recommend regular screening of men who are at increased risk for HIV or syphilis infection.[17] A Cochrane review found that the effects of screening are uncertain in terms of chlamydia transmission but that screening probably reduces the risk of pelvic inflammatory disease in women.[43]
In the United Kingdom the National Health Service (NHS) aims to:
- Prevent and control chlamydia infection through early detection and treatment of asymptomatic infection;
- Reduce onward transmission to sexual partners;
- Prevent the consequences of untreated infection;
- Test at least 25 percent of the sexually active under 25 population annually.[44]
- Retest after treatment.[45]
Treatment
C. trachomatis infection can be effectively cured with antibiotics. Guidelines recommend azithromycin, doxycycline, erythromycin, levofloxacin, or ofloxacin.[46] In men, doxycycline (100 mg twice a day for 7 days) is probably more effective than azithromycin (1 g single dose) but evidence for the relative effectiveness of antibiotics in women is very uncertain.[47] Agents recommended during pregnancy include erythromycin or amoxicillin.[4][48]
An option for treating sexual partners of those with chlamydia or gonorrhea includes patient-delivered partner therapy (PDT or PDPT), which is the practice of treating the sex partners of index cases by providing prescriptions or medications to the patient to take to his/her partner without the health care provider first examining the partner.[49]
Following treatment people should be tested again after three months to check for reinfection.[4] Test of cure may be false-positive due to the limitations of NAAT in a bacterial (rather than a viral) context, since targeted genetic material may persist in the absence of viable organisms.[50]
Epidemiology
Globally, as of 2015, sexually transmitted chlamydia affects approximately 61 million people.[10] It is more common in women (3.8%) than men (2.5%).[52] In 2015 it resulted in about 200 deaths.[11]
In the United States about 1.6 million cases were reported in 2023.[53] The CDC estimates that if one includes unreported cases there are about 2.9 million each year.[54] It affects around 3% of younger adults aged 18–29.[55] African Americans have disproportionately higher rates of chlamydia compared to other racial and ethnic groups.[56] Chlamydial infection is the most common bacterial sexually transmitted infection in the UK.[57]
Chlamydia causes more than 250,000 cases of epididymitis in the U.S. each year. Chlamydia causes 250,000 to 500,000 cases of PID every year in the United States. Women infected with chlamydia are up to five times more likely to become infected with HIV, if exposed.[27]
See also
References
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- ↑ World Health Organization. Trachoma Template:Webarchive. Accessed 17 March 2008.
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- ↑ Script error: No such module "Citation/CS1".
- ↑ Script error: No such module "Citation/CS1".
- ↑ Expedited Partner Therapy in the Management of Sexually Transmitted Diseases (2 February 2006) Template:Webarchive U.S. Department of Health and Human Services Public Health Service. Centers for Disease Control and Prevention National Center for HIV, STD, and TB Prevention
- ↑ Script error: No such module "Citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "Citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "Citation/CS1".
- ↑ Script error: No such module "citation/CS1".
- ↑ Script error: No such module "citation/CS1".
Script error: No such module "Check for unknown parameters".
External links
Template:Offline Template:STD/STI Template:Bacterial cutaneous infections Template:Medical resources Template:Authority control