Chlamydial Infections

Description
Chlamydia is a common sexually transmitted disease (STD) caused by a bacterium.
Chlamydia can infect both men and women and can cause serious, permanent damage
to a woman's reproductive organs.
Chlamydia is the most frequently reported bacterial sexually transmitted infection in the
United States. In 2011, 1,412,791 cases of chlamydia were reported to CDC from 50
states and the District of Columbia, but an estimated 2.8 million infections occur
annually. A large number of cases are not reported because most people with
chlamydia do not have symptoms and do not seek testing. Chlamydia is most common
among young people. It is estimated that 1 in 15 sexually active females aged 14-19
years has chlamydia.
Any sexually active person can be infected with chlamydia. It is a very common STD,
especially among young people. It is estimated that 1 in 15 sexually active females
aged 14-19 years has chlamydia.
Sexually active young people are at high risk of acquiring chlamydia for a combination
of behavioral and biological reasons. Men who have sex with men (MSM) are also at
risk for chlamydial infection since chlamydia can be transmitted by oral or anal sex.

Incubation Period
7-21 days

Mode of Transmission
People get chlamydia by having sex with someone who has the infection. Having sex
means anal, vaginal, or oral sex. Chlamydia can still be transmitted even if a man does
not ejaculate. People who have had chlamydia and have been treated can get infected
again if they have sex with an infected person.
Chlamydia can also be spread from an infected woman to her baby during childbirth.

Clinical Manifestation
Genital disease
2/3 of women and 1/2 of men who have chlamydia have no symptoms at all; others
have symptoms so mild they aren't noticeable.
Chlamydia Symptoms in Women:

an unusual vaginal discharge

pain or a burning sensation when passing urine
bleeding between periods
pain during sex or bleeding after sex
low abdominal pain sometimes with nausea

Chlamydia Symptoms in Men:

white/cloudy, watery discharge from the tip of the penis

pain or a burning sensation when passing urine
testicular pain and/or swelling

Eye disease
Chlamydia conjunctivitis or trachoma was once the most important cause of blindness
worldwide, but its role diminished from 15% of blindness cases by trachoma in 1995 to
3.6% in 2002.The infection can be spread from eye to eye by fingers, shared towels or
cloths, coughing and sneezing and eye-seeking flies.Newborns can also develop
chlamydia eye infection through childbirth. Using the SAFE strategy (acronym for
surgery for in-growing or in-turned lashes, antibiotics, facial cleanliness, and
environmental improvements), the World Health Organisation aims for the global
elimination of trachoma by 2020 (GET 2020 initiative).

Rheumatological conditions
Chlamydia may also cause reactive arthritis (reiter's syndrome) - the triad of arthritis,
conjunctivitis and urethritis (inflammation of the urethra) - 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.
Perinatal infections

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. Conjunctivitis due to
chlamydia typically occurs one week after birth (compared with chemical causes (within
hours) or gonorrhea (25 days).
Other conditions
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 proctitis (inflammation of the
rectum),fever or swollen lymph nodes in other regions of the body.

Diagnostic Evaluation
1. DNA detection test on cervical smear or urine sample (by DNA amplification
method).
2. Chlamydia culture from cervical exudate.
3. Screening urinalysis in males for leukocytes; if positive result, confirmed by DNA
detection test.
4. ELISA
5. Direct fluorescent anti-body test.
6. The Centers for Disease Control and Prevention (CDC) recommends annual
screening for all sexually active adolescents women as well as young women,
ages 20 to 24, and older women at high risk (multiple sex partners or new
partner).
Complications

The initial damage that chlamydia causes often goes unnoticed. However,
chlamydial infections can lead to serious health problems.
In women, untreated infection can spread upward to the uterus and fallopian
tubes (tubes that carry fertilized eggs from the ovaries to the uterus), causing
pelvic inflammatory disease (PID). PID can be silent, or can cause symptoms
such as abdominal and pelvic pain. Both symptomatic and silent PID can cause
permanent damage to a womans reproductive tract and lead to long-term pelvic
pain, inability to get pregnant, and potentially deadly ectopic pregnancy
(pregnancy outside the uterus).
In pregnant women, untreated chlamydia has been associated with pre-term
delivery, and can spread to the newborn, causing an eye infection or pneumonia.
Complications are rare in men. Infection sometimes spreads to the tube that
carries sperm from the testis, causing pain, fever, and, rarely, preventing a man
from being able to father children.

Treatment
Chlamydia is simple to treat with antibiotics, either a single dose or a course lasting up
to two weeks:

Treatment of Chlamydia:

Doxycycline 100 mg 2-3 times a day for 10-14 days, or

Zithromax (azithromycin) 1.0 gm (4 x 250 mg) a single dose, or
Zithromax Z-pak (azithromycin) - 500mg on day 1, followed by 1 tab (250mg)

once a day for 4 more days

To avoid re-infection, any sexual partners should be treated too. Treating gonorrhea is
advocated for patients being treated for chlamydia, and vice versa (50% have both
infections together)
Treatment of Gonorrhea:

Cipro XR 500 mg a single dose, or

Levaquin 500 mg a single dose, or
Tequin 400 mg a single dose;

Once chlamydia has been successfully treated, it won't come back unless a new
infection is picked up.

Epidemiology
CDC estimates that there are approximately 2.8 million new cases of chlamydia in the
United States each year. Chlamydial infection is the most common bacterial sexually
transmitted infection in the UK.
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.

Nursing Interventions
1. Advice abstinence from sexual intercourse until treatment has been completed.
No follow-up culture is necessary to ensure cure; however, re-screening is
recommended 3 to 4 months after treatment to detect reinfection, particularly in
adolescents and young women.
2. Ensure that the partner is treated at the same time; recent partners should
receive treatment despite lack of symptoms and negative Chlamydia result.
3. Report case to local public health department (Chlamydia is a reportable
infectious disease).
4. Ensure that the patient begins treatment and will have access to prescription
follow up.
5. Explain mode of transmission, complications, and the risk for other STDs.
6. Teach about all STDs and their symptoms.
7. Explain the treatment regimen to patient and advise her of adverse effects.
8. Encourage abstinence, monogamy, or safer sex methods, such as female or
male condom.

9. Stress the importance of follow-up examination and testing to eradication of

infection. Recurrence rates are highest in young patients.

References:

http://www.std-gov.org/stds/chlamydia_prevention.htm
http://www.cdc.gov/std/chlamydia/stdfact-chlamydia.htm
http://en.wikipedia.org/wiki/Chlamydia_infection#Transmission
http://www.cdc.gov/std/treatment/2010/chlamydial-infections.htm
http://nursingcrib.com/communicable-diseases/chlamydial-infection/