Chlamydia trachomatis – clinical signs of infection

Chlamydia trachomatis is the most common species of chlamydia. According to the reports of the World Health Organization (WHO), about 90 million new cases of this etiology are registered in the world each year.

Characteristics of Chlamydia Trachomatis

The species Chlamydia trachomatis has two biotypes: LGV i trachoma. Within these two biotypes, due to the differences in the antigenic structure, which were found on the basis of cross-reactions in microimmunofluorescence according to Wang and Grayston, 15 serotypes were distinguished. Strains belonging to the trachoma biotype cause various types of diseases, depending on their serotype.

Chlamydia trachomatis strains belonging to the LGV biotype include serotypes L1, L2, L3 and cause venereal granuloma.

Clinical symptoms of Chlamydia Trachomatis infection

1. Primrose

It is a chronic inflammation of the conjunctiva and the cornea that scars the surface of the conjunctiva and causes blindness. It is spread through close contact with an infected person.

1. Urethritis

The incubation period for symptomatic urethritis is 7-14 days. After this time, scanty discharge from the urethra appears, it is serous or mucous, sometimes muco-purulent. It is never purulent, which distinguishes it from the discharge seen in gonorrhea. The discharge may be accompanied, but not always, by urination disorders, slight burning or itching in the urethra.

The diagnosis is based on the performance of diagnostic tests that differentiate from gonococcal urethritis. In order to exclude Neisseria gonorrhoeae infection, a Gram stained preparation is made from the secretions. The presence of more than 4 polynuclear leukocytes in the field of view and the absence of gram-negative bacteria in the smear, confirmed by negative culture of this organism, suggest non-nongonococcal urethritis (NGU).

In adult men, the presence of 10 leukocytes in the visual field in the preparation made of 15-20 ml of the first morning urine is also an important indicator of NGU.

Epididymitis

C. trachomatis and N. gonorrhoeae are the most common causes of epididymitis in men under 35 (Escherichia coli is responsible for men over 36). Typically epididymitis presents with unilateral swelling of the epididymis or testicle or both, pain on urination, fever, and in some cases chills.

1. The most common causes of a painful urge to urinate

Many patients require hospitalization. C. trachomatis proctitis occurs in homosexual men or women as a result of anal intercourse with an infected partner. Secondary infection can also occur through urethral discharge in people with NGU. Infection is usually asymptomatic.

1. Mucopurulent inflammation of the cervix

Mucopurulent cervicitis is a typical manifestation of Chlamydia trachomatis infection in women. About 70% of women have no symptoms. In some infected, inflammation of the cervical canal with mucopurulent discharge is found. There are more than 30 multinuclear leukocytes in the field of view in the stained cervical exudate preparation.

The symptoms are very mild and nonspecific, such as discharge, bleeding, pelvic pain and a burning sensation when urinating. Complications include inflammation of the fallopian tubes with possible secondary obstruction, inflammation of the ovaries, and sometimes inflammation of the vestibular gland (Bartholin).

1. What are vaginal discharge?

Ovarian inflammation caused by C. trachomatis can spread to surrounding tissues and organs through continuity and become the cause of peritonitis, gastrointestinal abscess, and hepatic abscess.

1. Conjunctivitis in adults

Conjunctivitis in adults results from the transmission of C. trachomatis infection from the urogenital system to the conjunctiva of the eye. Patients have eye pain and redness. Multinucleated leukocytes are found in the preparation of the swab from the conjunctival sac. Bacteria (elementary bodies) are detected by direct immunofluorescence.

1. Infertility and ectopic pregnancy

Infertility and ectopic pregnancies may be long-term sequelae of acute or asymptomatic pelvic inflammatory disease (PID) caused by C. trachomatis.

1. Venereal granuloma (groin venereal granuloma)

Venereal granuloma is a sexually transmitted disease caused by strains of the LGV biotype and can affect many organs. This disease is rare, mainly in tropical climates. After an incubation period of 3 days to 3 weeks, the disease develops (in three stages).

At the first stage, maculo-vesicular, sometimes ulcerative changes appear on the skin of the external genitalia. The second period begins after 2-6 weeks. There is an enlargement of the inguinal lymph nodes.

These processes may be accompanied by general symptoms of varying severity, such as fever, headaches and lack of appetite. The third stage of the disease develops in untreated people. Fibrosis and scarring cause narrowing of the urethra and rectum. After a year or several years, the obstruction of the lymphatic vessels leads to elephantiasis of the perineum, penis or labia.

Since 2003, there have been cases of the atypical form of LVG in Europe. The disease is found in homosexual men. It is manifested by inflammation of the rectum and colon, usually without urethritis and swelling of the inguinal nodes.

1. Other forms of Chlamydia trachomatis infections in adults

Although C. trachomatis pneumonia is a neonatal disease, there have been cases of C. trachomatis pneumonia confirmed by the isolation of these pathogens in immunocompromised adults. C. trachomatis can also cause pneumonia in laboratory workers exposed to high doses of bacteria, especially the LGV biotype. There have been isolated reports of the involvement of C. trachomatis in the induction of endocarditis, myocarditis and meningitis.

1. Infections of newborns with Chlamydia trachomatis

During delivery, perinatal infection and colonization of the nasopharyngeal cavity in newborns may occur in the infected C. trachomatis birth canal. In 22-44 percent children of mothers infected with this bacterium develop inclusion conjunctivitis in the first days after birth, and 11-20% in this group of newborns, usually up to 3 months of age, pneumonia. About 50 percent. Newborns with C. trachomatis pneumonia suffer from inclusion of conjunctivitis of this etiology.

Epidemiology of Chlamydia trachomatis

C. trachomatis occurs only in humans. The infection is transmitted from person to person through sexual contact, through close direct contact (trachoma, conjunctivitis), and perinatal.

The incidence of trachoma is limited to areas of poor sanitary level. The disease is endemic in North Africa, the Sahara and Southeast Asia.

Infections with oculogenital strains of C. trachomatis, belonging to the DL serotypes, are the most common cause of sexually transmitted bacterial diseases in developed countries.

There is no immunity to infection. Being ill does not protect against re-infection.

Since C. trachomatis is often transmitted with Neisseria gonorrhoeae, 20-30% of men and 30-60 percent. women with gonococcal urethritis are also infected with C. trachomatis. Many patients develop chlamydial infection after their gonococcal infection has healed. Infection with C. trachomatis also increases the possibility of becoming infected with HIV.

Chlamydiosis is the most commonly reported sexually transmitted disease in Europe, affecting 10% of people. sexually active people. The greatest number of infections of this etiology occurs in young people aged 15-24. According to the reports of the European Center for Disease Prevention and Control in the Old Continent, this age group has 250 new cases per year. Such a high and increasing incidence is most likely related to greater health awareness and more frequent testing in this field.

The risk of post-infection complications and the need to limit the spread of C. trachomatis have prompted some European countries to introduce mandatory screening tests in young people.

Diagnosis of Chlamydia trachomatis infection

Among C. trachomatis infections, only trachomatis can only be diagnosed on the basis of clinical symptoms. Other infections of this etiology are associated with less significant symptoms, therefore it is necessary to perform laboratory tests showing the presence of C. trachomatis in the clinical specimen.

Treatment of Chlamydia trachomatis infection

In in vitro studies on cell lines, the tetracycline and macrolide antibiotics, clindamycin and rifampicin, and some fluoroquinolones (ofloxacin) show the highest activity against C. trachomatis. Although chlamydia in the cell wall do not contain peptoglycan, penicillin and ampicillin have limited activity against them, but these antibiotics penetrate poorly into the host cell. C. trachomatis is naturally resistant to cephalosporins.

For many years, standard therapy for uncomplicated cases of C. trachomatis urogenital inflammation was the administration of 100 mg of doxycycline orally in two doses for 7 days. Alternatively, treatment with erythromycin was used. Treatment with one dose of azithromycin was found to be as effective as 7 days of tetracycline. Therefore, the CDC currently recommends one dose of azithromycin in the treatment of these conditions. Treatment of uncomplicated nongonococcal urethritis with ofloxacin at a daily dose of 300 mg for 7 days is also acceptable. Ofloxacin can not be used in people under 18 years of age and in pregnant women.

In pregnant women, the standard dose of erythromycin 500 mg 4 times a day for 7 days or 250 mg 4 times a day for 14 days is used to treat C. trachomatis infection. An alternative is treatment with amoxicillin orally at a dose of 500 mg, 3 times a day, for 7-10 days. Azithromycin is not approved for the treatment of these infections in pregnant women as there are no studies on the safety and efficacy of this preparation.

In cases of inclusion in adults, tetracycline or its derivatives are used topically for 2-3 weeks. An alternative is treatment with erythromycin. Inclusive conjunctivitis in newborns is most effectively prevented with oral erythromycin at a dose of 10 mg / kg body weight per day in 14 doses for 50-4 days. The effectiveness of such therapy is estimated at 80%, so it may be necessary to repeat it.

The same regimen is recommended for the treatment of neonatal pneumonia. In cases of confirmed infection with C. trachomatis in neonates, treatment should be performed by the mother and her partner.