Chlamydia Trachomatis
Scientific Details
Life Cycle of Chlamydia Trachomatis in the Human Body
Infection & Symptoms
Diagnosis
Screening
Prevention of Chlamydia Infection
Chlamydia trachomatis, a bacterium, has a tendency to infect the columnar epithelium of the cervix, the urethra, and the rectum. Apart from genital areas the bacteria can affect and infect other areas of the body like the lungs and the eyes. This bacterium is one of the prime sources of most of the sexually transmitted diseases. There are practically no prior symptoms of infection by this bacterium (Breguet, 2007). However several complications such as pelvic inflammatory disease, infertility, and ectopic pregnancy in women can occur if the infection if left untreated for a long time. Men can also develop disease complications like epididymitis and orchitis from this bacterium.
Treatment for the uncomplicated state of this infection is fairly simple and should include simple antibiotics like azithromycin or doxycycline. However prevention is more important for this disease than ever and this can be done by screening of women younger than 25 years and in all pregnant women as well as those women who are considered to be a high risk group. This bacterium can also affect the neonatal and the infants and cause diseases like conjunctivitis and pneumonia. Adults tend to be affected by trachoma, an ocular infection the reoccurs often and is a result of infection by Chlamydia bacterium (Wollter-Svensson, 1995).
Scientific Details
Chlamydia trachomatis is a human pathogenic bacterium and is a member of the species of bacteria called Chalmydia. Being a gram negative bacterium, Chlamydia trachomatis appears with a pink hue under a microscope as its cell wall tend to contain the counter strain called safranin (Breguet, 2007). The bacterium generally appears in a rod shape or coccoid shape.
Given below is a microscopic picture of the bacteria
(Source: www.lookingfordiagnosis.com)
Life Cycle of Chlamydia Trachomatis in the Human Body
There are two form that Chlamydia trachomatis exists in. these are the infectious elementary body (EB) and the intracellular reticulate body. Both have the capability to replicate and multiply. When the elementary body gets attached to the epithelium of the cell membrane of the urogenital tract the bacterium causes infection. Then the elementary body of the bacterium then enters the cell and within two hours the bacterium transforms into reticulate body. These reticulate bodies then begin to grow by division in the next hours dramatically increasing the number of bacterium. At this point in the life cycle of the bacterium it again gets transformed into elementary bodies and within two to four days of the infection, the infectious elementary bodies are released by bursting of the cells (Wollter-Svensson, 1995).
Given below is a pictorial representation of the life cycle of the bacterium in a woman
(Source: http://bitesized.immunology.org)
The notable difference of the cell wall of chlamydia trachomatis bacterium is that it is gram negative and it has little muramic acid unlike in other bacteria. This characteristic makes the bacterium resistant to antibiotics like penicillin as these antibiotics affect the typical cell walls of bacteria where as the cell wall of Chlamydia trachomatis is different from the typical cell walls. The host body is also damaged due to the presence of LPS, which is a characteristic of gram negative bacteria. Sialic acid receptors, usually found in environments which are mucous rich, are bound by the chalmydia bacterium once it gets into a host. The primary problem with this bacterium is that it is mostly asymptomatic and the infections are generally sub-clinical (Breguet, 2007).
Infection & Symptoms
Being pathogenic in nature, this bacterium generally is transmitted through body fluids and affects people who have multiple sex partners. Women are believed to be more susceptible to this infection than men (Sutton, 2013). The primary diseases caused by the bacterium are genital diseases like Chlamydial infection of the neck of the womb. Such diseases can be caused through the vaginal, oral or anal sex. The common name for the disease caused by the bacterium in women is pelvic inflammatory disease which refers to infection of the uterus, fallopian tubes, and/or ovaries. The reproductive organs can be scarred by this disease which can lead to serious complications like chronic pelvic pain, difficulty becoming pregnant and ectopic pregnancy. It has often been observed that the bacterium can remain in women for months and even years without showing any significant symptoms and hence is a silent epidemic.
Similar to women, men too are affected by the bacterium and their condition called inflammation of the urethra. In such a conditions t he discomforts experienced by most men are painful or burning sensation while urinating, any sort of unusual discharge from the penis, testicular pain or swelling accompanied with fever. Epididymitis can be caused if the bacterium is not treated and can spread to the testicles. Epididymitis, if not treated within two months, can cause sterility in men (Sutton, 2013). Other diseases that are caused by the bacterium are conjunctivitis due to Chlamydia in children and adults, reactive arthritis and pneumonia in infants.
Given below is a diagram of the diseases caused by the chlamydia trachomatis bacterium.
(Source: microbewiki.kenyo.edu)
Diagnosis
The most sensitive tests for detecting Chlamydia is the nucleic acid amplification tests. This procedure is performed on urine samples or samples of endocervical, urethral, vaginal, pharyngeal, rectal secretions. For samples that are taken directly from the cervix or the urethra, the tests have been found to be most accurate. For people who are used to oral or anal intercourse and sex, oropharyngeal and rectal swabs are useful. Other methods of diagnosis are by the microscopical examination of samples and by serological tests like ELISA techniques.
Treatment
If the disease caused by chlamydia infection remains fairly uncomplicated then the condition can be treated by simple doses of antibiotic medicines like azithromycin or doxycycline. Treating the disease with both the medicines can be equally effective. While patients get treated with gonorrhea, doctors generally prescribe associated treatment of Chlamydia as well but the reverse is not done. There are other treatment methods for the disease. Uncomplicated chlamydia infection can also be treated with medicines like erythromycin, erythromycin ethylsuccinate, levofloxacin or ofloxacin.
For treating pregnant women diagnosed with the disease, azithromycin or amoxicillin is used (Miller, 2004). Erythromycin and erythromycin ethylsuccinate can also be prescribed. It has been recommended that pregnant women should be tested for cure after a period of three to four weeks from the completion of the treatment. In the case of men and non-pregnant women, such a test needs to be carried out after three months from the end of the treatment.
It is also essential that partners of people infected with chlamydia trachomatis bacterium be informed about the partner’s infection and provided appropriate treatment. Expedited partner therapy gives good results for the management of partners related to heterosexual males and women infected with chlamydia trachomatis. The partners, who do not show symptoms of chlamydia trachomatis infection, need to be screened and tested if they had engaged in sex in between a 60 day period prior to the onset of symptoms of the partner. The couples or partners should refrain from any sexual contact till after seven days from the completion of the treatment as well as after completion of treatment of the partner (Miller, 2004).
Given below is a schematic diagram of the process of treatment for chlamydia infection
(Source: annals.org)
Screening
It is recommended that all women below the age of 25 years who are sexually active should undergo regular screenings for chlamydia infection. Such screening is also recommended for women who are over 25 years of age, sexually active and have multiple partners because such women have a larger risk of getting infected (Landers, Wiesenfeld, Phillip Heine, Krohn & Hillier, 2004). During the first prenatal visit all the pregnant women who are at high risk need sot undergo screening for chlamydia infection because leaving the infection untreated can result in intrauterine and postnatal complications. Women who want to terminate their pregnancy also need to undergo tests for chlamydia infection. Women are at the focus of screening and testing for chlamydia infection because they are the are three times more susceptible to infection than men (Landers, Wiesenfeld, Phillip Heine, Krohn & Hillier, 2004).
Regular screening of all men is not necessary for chlamydia infection. However studies have shown that men from specific groups, like sexually active men who engage with other men, can be screened for chlamydia infection (Marrazzo & Cates, 2011). For men, screening of high risk groups is cost effective and helpful. Such screening of men can also be done in clinics in areas where there is a historically high prevalence of chlamydia infection.
Prevention of Chlamydia Infection
Incidents of genitourinary chlamydia infection can be prevented in a number of ways. Even if complete prevention is not possible, the steps would help reduce the prevalence of the infection. Mutually monogamous relationship engagement and long-term relationships are the best prescribed methods to prevent chlamydia infection. Some experts also suggests abstinence for prevention (Marrazzo & Cates, 2011). Unprotected sex or engaging with multiple sexual partners should not be encouraged, especially for patients who have a history chlamydia infection. It has been already established that infection by sexually transmitted diseases can be reduced to a great extent by the use of condoms. Since adolescents are viewed as gourps at high risk for chlamydia infection, sexual education and education about the methods and ways of the transmission of the disease needs o tbe undertaken at the school and the college level (Niccolai, 2005). The youth should be warned and educated about the possible consequences of disease transmission through unprotected vaginal, anal, or oral sex.
References
Breguet, A. (2007). Chlamydia. New York: Rosen Pub. Group.
Landers, D., Wiesenfeld, H., Phillip Heine, R., Krohn, M., & Hillier, S. (2004). Predictive value of the clinical diagnosis of lower genital tract infection in women. American Journal Of Obstetrics And Gynecology, 190(4), 1004-1008. doi:10.1016/j.ajog.2004.02.015
Marrazzo, J., & Cates, W. (2011). Interventions to Prevent Sexually Transmitted Infections, Including HIV Infection. Clinical Infectious Diseases, 53(suppl 3), S64-S78. doi:10.1093/cid/cir695
Miller, W. (2004). Prevalence of Chlamydial and Gonococcal Infections Among Young Adults in the United States. JAMA, 291(18), 2229. doi:10.1001/jama.291.18.2229
Niccolai, L. (2005). Condom effectiveness for prevention of Chlamydia trachomatis infection. Sexually Transmitted Infections, 81(4), 323-325. doi:10.1136/sti.2004.012799
Sutton, A. (2013). Sexually transmitted diseases sourcebook. Detroit, MI: Omnigraphics, Inc.
Wollter-Svensson, L. (1995). Genital infections by Chlamydia trachomatis in women. Uppsala: Acta Univ. Upsaliensis.
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