Welcome to Learning in 10 series. I am Dr. Jenny Long, infectious diseases consultant with the Department of Infectious Diseases at Singapore General Hospital. We will be touching on the subject of chlamydia infection today. I will bring you through the topic according to the following learning objectives. By the end of this presentation, you should be able to explain how chlamydia infection is acquired, describe the signs and symptoms of chlamydia infections in males and females, list treatment regimens for chlamydia infection, appreciate the importance of prevention counseling messages for patients with chlamydia infection, and describe public health measures for the prevention of chlamydia infection. This is a topic outline for today.
What is chlamydia? What causes chlamydia infection? What are the symptoms of chlamydia infections? How is chlamydia diagnosed? How is chlamydia treated? And how can chlamydia be prevented? Chlamydia is an infection that is transmitted sexually or via mother to child during childbirth. It is the most common cause of sexually transmitted infections in the United States. Risk factors identified for acquisition of this infection include adolescence, new or multiple sex partners, history of STI, presence of another STI, oral contraceptive user, and lack of barrier contraception. It infects the urethra in males, and in females, it infects the cervix and the reproductive organs. The bacterial chlamydia trachomatis is an obligatory intracellular bacteria. It infects columnar epithelial cells and survives by replication that results in the death of the cell. It is a highly transmissible disease with an incubation period of about 7 to 21 days.
Most importantly, there is a significant asymptomatic reservoir, and reinfection is common. After an incubation period of about one two three weeks, in women, symptomatic cases can present with dysuria, vaginal discharge, dysparenuia, and intermenstrual bleeding. If left untreated, the infection progresses to cause ascending infection and pelvic inflammatory disease and infertility. In male, the commonest symptoms are penile discharge and dysuria, but once again, the majority are asymptomatic. Men or women who have receptive anal intercourse may acquire chlamydia infection in the rectum, which can lead to rectal pain, discharge, or bleeding. It can also cause pharyngitis through oral sex with an infected partner.
Babies born to infected mothers can develop pneumonia and inclusion conjunctivitis. Perinatal transmission results in neonatal conjunctivitis in 30% to 50% of exposed babies. Laboratory diagnosis of chlamydia-- the cell culture is historically the gold standard.
It has a variable sensitivity of 50% to 80%, but it is highly specific. It can be used in legal investigations, but it is generally not suitable for widespread screening use. There are several non-amplified tests. The direct fluorescent antibody test detects the intact bacterial with a fluorescent antibody. A variety of specimen sites can be used for this test. The enzyme immunoassay detects bacterial antigen with an enzyme labeled antibody. A nucleic acid hybridization test detects specific DNA or RNA sequences of the chlamydia trachomatis. DNA amplification assays-- the DNA amplification test amplifies and detects organisms specific genomic or plasmic DNA or rRNA.
There are several commercially available tests, and it is significantly more sensitive than the other tests stated. There are several antibiotic options for the treatment of chlamydia infection-- doxycycline 100 milligrams orally twice a day for seven days, azithroymycin, one gram orally once, erythromycin base, 500 milligrams orally twice a day for 14 days, erythromycin ethylsuccinate, 800 milligrams orally four times a day for seven days, ofloxacin, 300 milligrams orally twice a day for seven days, or levofloxacin, 500 milligrams orally once a day for seven days. There are several treatment regiments available for the treatment of chlamydia infection in pregnant women. Azithromycin, one gram orally in a single dose, amoxicillin, 500 milligrams, orally three times a day for seven days, erythromycin is another alternative. For newborn babies with neonatal conjunctivitis and/or pneumonia, the antibiotic options will be erythromycin base or ethysuccinate, 50 milligrams per kilograms per day orally divided into four doses daily for 14 days.
Other issues to consider in the management of patients with chlamydia infections include partner management. Sex partners should be evaluated, tested, and treated accordingly. Reporting to State Health Authority. Repeat testing after treatment for pregnant women.
Repeat testing should be done three weeks after completion of treatment using nucleic acid amplification test method. For non-pregnant women, repeat testing three months after completion of treatment, especially for adolescents due to high reinfection rate. Opportune screening at next health care visit.
Chlamydia infection can be prevented by screening and prevention counseling. Screening has been shown to be effective in reducing the incidence of pelvic inflammatory disease among women by more than 50%, as most of these infections are asymptomatic. Screening decreases the prevalence of infection in the general population, and thereby reducing the transmission of the disease. In summary, chlamydia infection is transmitted sexually or vertically.
It is highly transmissible. It is often asymptomatic in both male and female. It can cause long term sequelae such as pelvic inflammatory disease and infertility in women. Reinfection is common. Treatment, retesting, partner treatment, screening, and prevention counseling can reduce the overall prevalence of this infection in the population and reduce transmission of the disease.
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