Chlamydia

Definition

Chlamydia is the most common sexually transmitted disease (STD) in the United States, with about three million new cases diagnosed in the country each year. The disease is caused by a bacterium called Chlamydia trachomatis. The following areas in the body can be affected:

• cervix
• fallopian tubes, which carry ova (eggs) from the ovaries to the uterus
• urethra, which carries urine from the bladder to outside the body
• epididymis, a small organ attached to the testicles that is responsible for sperm production
• prostate gland, a gland at the base of the penis which provides nutrients for sperm
• anus
• throat
• eyes

In addition, Chlamydia trachomatis also causes lung and eye infections in newborns whose mothers have a chlamydial infection during the last part of their pregnancy .

Description

Chlamydia is most often found in sexually active adolescents aged 15–19. Data gathered by the Centers for Disease Control (CDC) suggest that sexually active girls in this age group may account for up to 46% of chlamydial infections.

According to the CDC, approximately 40% of women infected with chlamydia will develop pelvic inflammatory disease (PID). If untreated, 18% of women with PID will have chronic inflammatory pain . In addition, chlamydia may cause extensive damage to the fallopian tubes. Scarring can block the tube and prevent the egg from being fertilized. As a result, one of every five women with PID will not be able to conceive. Tube scarring may also cause the fertilized egg to be trapped inside the tube, unable to reach the uterus. When the fertilized egg develops inside the tube rather than in the uterus, the condition is called tubal pregnancy. The condition is potentially fatal if the tube ruptures. In America, tubal pregnancy is the number one cause of death of women in early pregnancy.

Causes & symptoms

Cause

Chlamydia is caused by a bacterial parasite called Chlamydia trachomatis. The organism lives inside humans, who act as hosts. It is dependent on humans for energy because it is unable to produce energy for itself. C. trachomatis often causes genital and urinary tract infections in sexually active men and women.

Mode of transmission

A person can be infected with C. trachomatis by:

• having sex (oral, genital, or anal) with an infected partner
• sharing infected sex toys
• passing through the infected birth canal of a mother who has chlamydia
• sex abuse in children

Risk factors

The following are risk factors for contracting chlamydia infections:

• Age. Young sexually active people aged 15–19 are most frequently affected.
• Race. Blacks contract this disease more often than whites or Hispanics.
• Marital status. Chlamydia is most often found in single women. Married women have the lowest risk.
• Behavioral factors. Douching increases risk of chlamydial infections. Smoking also increases one's risk of contracting this disease. Those who have sex with many different partners or with strangers are at high risk. Also at increased risk are those who have unprotected sex with partners of unknown disease status. Previous induced abortions also increase a woman's chance of getting this disease.
• Socio-economic status. Poor, uneducated women living in big cities are more often affected by this disease.
• Postpartum period. Increased risk of contracting chlamydia is observed during the period immediately

after giving birth or undergoing an induced abortion. This is because the cervix is not entirely closed, allowing more chance for becoming infected.

Symptoms

Approximately 75% of women do not have symptoms. If a woman is going to have any symptoms, they should develop one to three weeks after she is infected. Her symptoms may include:

• burning pain during urination
• more frequent urination
• abnormal vaginal discharge
• dull pelvic pain
• bleeding between periods and after sexual intercourse
• menstrual bleeding that is heavier than usual
• more painful periods

Chlamydia infection in men may develop in the urethra, epididymis and/or the prostate. Approximately 50% of infected men do not have any symptoms. If he is going to have symptoms, they should develop one to three weeks after he is infected. His symptoms may include:

• burning pain during urination
• more frequent urination
• white or yellow discharge from the penis
• redness at the tip of the penis
• itchy or irritated urethra (urethritis)
• pain and swelling in the testicles (epididymitis)
• pain between the scrotum and anal area and difficult and frequent urination (prostatitis)

On rare occasions, chlamydia infection in men and women can develop outside of the genital areas. These patients may have infections at the following sites:

• the eyes (due to a contaminated hand touching the eyes): itching , redness and itching of the eyelids
• the throat (following oral sex with infected men): throat irritation or no symptoms
• the anus (following anal intercourse with infected men): rectal bleeding, mucous rectal discharge, diarrhea , and pain with bowel movement.

Diagnosis

Diagnosis is based on patients' history, laboratory testing for chlamydia, and physical exam for men and pelvic exam for women to determine if the patient is infected and/or the extent of infection.

There are several tests available for chlamydial infection. They often require swipes from the site of infection or urine samples. Tests for chlamydia include:

• Cell culture test. This old test is reliable but requires 48–72 hours to complete. It is being replaced by faster and more convenient tests. In 2001, the U.S. Food and Drug Administration (FDA) receommended routine screening for chlamydia among sexually active young women. One year later, they approved a new test called ThinPrep, a new type of Pap smear that allows doctors to screen for chlamydia, gonorrhea , and the human papillomavirus at the same time women have annual pap exams for cervical cancer.
• Direct fluorescent antibody (DFA) staining. This test is faster than the traditional culture test.
• Enzyme immunoassay (EIA). It is easy to perform and also faster than the traditional culture test but is not as accurate.
• DNA probe. This test is expensive but is more specific and convenient than culture, EIA, or DFA tests. Genital swipe samples are not necessary. Urine tests can provide accurate results.
• Nucleic acid amplification (PCR and LCR) tests. These tests look for genetic material of the organism. These are the tests of choice because they are the most sensitive (more than 90% accurate) and the most specific. They are also convenient because they can be performed on urine samples and do not require a pelvic exam.

In 2002, a presentation to gynecologists pointed out that more doctors should assume some overlap when patients present with symptoms of urinary tract infections. These may signal hidden chlamydia as well. In fact, the two conditions often can be present at the same time.

Treatment

Alternative therapy should be complementary to antibiotic therapy. Because of the potentially serious nature of this disease, patients should first consult an allopathic physician to start antibiotic treatment for infections. Traditional medicine is better equipped to quickly eradicate the infection while alternative treatments can help the body fight the disease and relieve symptoms associated with this disease. Some alternative treatments include nutritional therapy, herbal remedies, traditional Chinese medicine , and homeopathy .

Nutritional therapy

The following dietary changes may be helpful:

• Following a low-fat, high-fiber diet . The diet should include a variety of fresh fruits and vegetables. These foods contain high amounts of phytonutrients and essential vitamins that help keep the body strong and stimulate the immune system to fight infections.
• Limited intake of fat, sugar, highly processed foods, caffeine , and alcohol, which depresses the immune function.
• Taking a multivitamin/mineral supplement daily.
• Drinking cranberry juice. Cranberry juice helps prevent urinary tract infections.
• Taking acidophilus pills to prevent yeast infections while on antibiotics.
• Eating fresh garlic or taking garlic pills to help fight infection.

Herbal treatment

Echinacea and berberine-containing herbs such as saw palmetto (Serenoa repens ) and goldenseal are natural antibiotics. These herbs can assist the action of prescription antibiotics.

Traditional Chinese medicine

An experienced Chinese herbalist will prepare a specific herbal mixture based on a patient's specific condition and symptoms.

Homeopathy

A homeopathic practitioner may prescribe a patient-specific remedy to help reduce some of the symptoms associated with disease. Remedies for chlamydial symptoms include Cannabis sativa, Cantharis, and Salidago virga.

Allopathic treatment

Once detected, chlamydia can be easily treated with antibiotics. However, if not detected early enough, scarring of fallopian tubes (and resulting infertility ) may not be preventable. The two most commonly used drugs are azithromycin and doxycycline. Azithromycin is a more expensive drug but is much more convenient to administer. Only one dose is needed to treat the disease. Doxycycline is cheaper but needs to be taken twice a day for more than seven days. Because patients tend to stop taking drugs after a few days, doxycycline is not as effective as azithromycin. Therefore, many doctors prefer to give azithromycin. Patients are advised to refrain from sex for a full week after taking azithromycin or until they finish doxycycline treatment.

An infected person should contact all partners within the last two months so that they can be treated for chlamydia.

Infected pregnant women should be given erythromycin for seven days, instead of other drugs, because this drug is safer during pregnancy.

Follow-up testing is done four weeks after drug treatment to see if the infection is eradicated. If tests continues to be positive, the patient will be given another course of antibiotics.

Expected results

A woman's prognosis depends on the duration of infection, whether the infection has spread through the uterus and the fallopian tubes, and the number of previous chlamydial infections. If caught early, the disease can be completely cured with antibiotic treatment in seven days. However, if left untreated, chlamydia can spread through the uterus to the fallopian tubes and cause chronic pelvic inflammatory disease. Infertility may occur as a result of serious damage to the female reproductive tract. Potentially fatal tubal pregnancy is also a risk.

Prevention

Prevention is the most important means of stopping the spread of this disease. The following practices are recommended to prevent the spread of this and other sexually transmitted diseases:

• Abstinence. Abstinence is the only 100% way to prevent chlamydia and other STD infections.
• Monogamy. Having a mutually monogamous relationship with an uninfected partner reduces the chance of getting STD infections.
• Avoiding a sexual relationship with an unknown partner or a partner whose infection status is unknown.
• If having sex with an unknown partner, using a barrier contraceptive such as a condom (for men) or diaphragm (for women) is recommended. However, condoms (or diaphragms) are not 100% effective against chlamydia or other STDs.
• Refraining from douching.
• Avoiding sex soon after giving birth or undergoing an induced abortion.
• Getting tested for chlamydia at yearly pelvic examinations.

Resources

BOOKS

"Chlamydia." In The Medical Advisor: The Complete Guide to Alternative & Conventional Treatment, home ed. Alexandria, VA: Time-Life, Inc., 1997.

"Chlamydia." In Reader's Digest Guide to Medical Cures & Treatments. Pleasantville, NY: Reader's Digest Assn., Inc., 1996.

"Chlamydial Infections." In 1997 Report of the Committee on Infectious Diseases, 2nd ed. Elk Grove Village, IL: American Academy of Pediatrics, 1997.

Jones, Robert B. and Byron E. Batteiger. "Introduction to Chlamydial Diseases." In Mandell, Douglas & Bennett's Principles & Practice of Infectious Diseases. 5th ed. Philadelphia: W. B. Saunders Co., 1999. http://home.mdconsult.com.

"Section I. Screening Part D. Infectious Diseases. Screening for Chlamydial Infections-Including Ocular Prophylaxis in Newborns." In Guide to Clinical Preventive Services: Report of the U. S. Preventive Services Task Force. 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 1996. http://home.mdconsult.com.

The Burton Goldberg Group. "Sexually Transmitted Diseases." In Alternative Medicine: The Definitive Guide. Tiburon, CA: Future Medicine Publishing, Inc., 1999.

Tuomala, Ruth E. and Katherine T. Chen. "Gynecologic Infections. Part I." Kistner's Gynecology & Women's Health. 7th ed. St. Louis, MO: Mosby, Inc., 1999.

Zand, Janet, Allan N. Spreen and James B. LaValle. "Chlamydia." In Smart Medicine for Healthier Living. Garden City Park, NY: Avery Publishing Group, 1999.

PERIODICALS

"FDA: ThinPrep can Detect Chlamydia, Gonorrhea." TB & Outbreaks Week (July 2, 2002): 15.

Johnson, Kate. "Urinary Symptoms? Test for Chlamydia and UTI (Not Just Vaginal Symptoms)." OB GYN News (August 15, 2002): 12.

Torrey, Brian. "FDA Approval of Chlamydia and Gonorrhea Tests." American Family Physician (August 15, 2002): 690.

ORGANIZATIONS

CDC National STDs Hotline. (800) 227-8922.

NIH's National Institute of Allergy and Infectious Diseases. NIAID Office of Communications, 31 Center Drive (MSC-2520), Building 31, Room 7A50, Bethesda, MD 208922520. http://www.niaid.nih.gov/publications/stds.htm.

OTHER

Centers for Disease Control and Prevention. "CDC Fact Sheet: Some Facts about Chlamydia." WebMD. http://webmd.lycos.com/content/dmk/dmk_article_58818.

Nordenburg, Tamar. "Chlamydia's Quick Cure." WebMD. http://webmd.lycos.com/content/dmk/dmk_article_5462446.

Peeling, Rosanna W. "Chlamydiae as Pathogens: New Species and New Issues." Medscape. http://www.medscape.com.

U.S. Department of Health and Human Services. "Counseling to Prevent HIV Infection and Other Sexually Transmitted Diseases." WebMD. http://webmd.lycos.com/content/dmk/dmk_article_5462254.

Mai Tran

Teresa G. Odle

CHLAMYDIA

Chlamydia is a common sexually transmitted disease (STD) caused by Chlamydia trachomatis, a bacterium. Chlamydia can be transmitted during vaginal, anal, or oral sex. An estimated 3 million Americans are infected with chlamydia each year. Three-quarters of infected women and half of infected men have no symptoms. Sexually active girls and young women are especially susceptible to chlamydia because the cells that form the lining of the immature cervix are easily invaded by the bacteria. Women with symptoms might have an abnormal vaginal discharge or a burning sensation when urinating. When the infection spreads from the cervix to the fallopian tubes, some women still have no symptoms; others have lower abdominal pain, low back pain, nausea, fever, pain during intercourse, and bleeding between menstrual periods. Whenever the infection spreads past the cervix, permanent and irreversible damage can occur to the fallopian tubes, uterus, and tissues surrounding the ovaries. This damage can lead to chronic pelvic pain, infertility, and potentially fatal ectopic pregnancy.

Widely available laboratory tests can accurately detect chlamydia bacteria in a urine sample. Chlamydia can be treated and cured with antibiotics. Persons who engage in sexual behaviors that place them at risk of STDs should use latex or polyurethane condoms every time they have sex, limit the number of sex partners, and not alternate partners. All young, sexually active, unmarried persons who do not use condoms every time they have sex should be screened for chlamydia yearly. Infected persons should notify all sex partners so they can receive treatment.

Allison L. Greenspan

Joel R. Greenspan

(see also: Sexually Transmitted Diseases )

Bibliography

Centers for Disease Control and Prevention (1998). "1998 Guidelines for Treatment of Sexually Transmitted Diseases." Morbidity and Mortality Weekly Report 47 (RR-1):53–59.

Stamm, W. E. (1999). "Chlamydia trachomatis Infections of the Adult." In Sexually Transmitted Diseases, 3rd edition, eds. K. Holmes, P. Mardh, P. Sparling et al. New York: McGraw-Hill.

chla·myd·i·a / kləˈmidēə/ • n. (pl. same or chlamydiae / -ˈmidēˌē/ ) a very small parasitic bacterium (genus Chlamydia, order Chlamydiales) that, like a virus, requires the biochemical mechanisms of another cell in order to reproduce. Bacteria of this type cause various diseases including trachoma, psittacosis, and nonspecific urethritis.DERIVATIVES: chla·myd·i·al adj. .

chlamydia Small, virus-like bacteria that live as parasites in animals and cause disease. One strain, C. trachomatis, is responsible for trachoma and is also a major cause of pelvic inflammatory disease (PID) in women. C. psittaci causes psittacosis. Chlamydial infection is the most common sexually transmitted disease (STD) in many developed countries.

Chlamydia (order Chlamydiales) A genus of bacteria with the characteristics of the order. There are 2 species, both of which are parasitic and capable of causing disease (e.g. trachoma and psittacosis).