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Chlamydia

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SOURCE

Source: Knodel LC, Duhon B, Argamany J. Sexually transmitted diseases. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861&sectionid=146072585. Accessed March 8, 2017.

DEFINITION

  • Sexually transmitted infection (STI)

ETIOLOGY

  • Chlamydia trachomatis is an obligate intracellular parasite with some similarities to viruses and bacteria.

PATHOPHYSIOLOGY

  • Requires cellular material from host cells for replication.

  • Maintains cellular identity throughout development.

  • Frequent coinfection with gonorrhea.

EPIDEMIOLOGY

  • Second most common reported infectious disease in the United States behind HPV

PREVENTION

  • Mutually monogamous sexual relationship between uninfected partners.

  • Barrier contraceptive methods.

SCREENING

  • Patients who seek STI testing should be screened for syphilis and HIV.

  • Annual screening recommended by Centers for Disease Control and Prevention (CDC) for sexually active females:

    • 25 years of age or younger.

    • With new sex partners or multiple sex partners.

RISK FACTORS

  • Unprotected sex.

  • Number of sexual partners.

  • Sexual preference.

  • Age: two-thirds of STIs occur in persons in their teens and twenties.

CLINICAL PRESENTATION

  • Chlamydial genital infections more frequently asymptomatic, and when present, symptoms tend to be less noticeable (Table 1)

  • Nearly two-thirds of infants acquire chlamydial infection after endocervical exposure, with primary morbidity associated with seeding of infant’s eyes, nasopharynx, rectum, or vagina.

TABLE 1.Presentation of Chlamydia Infections
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TABLE 1. Presentation of Chlamydia Infections
Men Women
General Incubation period—35 days Incubation period—7–35 days
Symptom onset—7–21 days Usual symptom onset—7–21 days
Site of infection Most common—urethra Most common—endocervical canal
Others—rectum (receptive anal intercourse), oropharynx, eye Others—urethra, rectum (usually due to perineal contamination), oropharynx, eye
Symptoms >50% of urethral and rectal infections asymptomatic >66% of cervical infections asymptomatic
Urethral infection—mild dysuria, discharge Urethral infection—usually subclinical; dysuria and frequency uncommon
Pharyngeal infection—asymptomatic to mild pharyngitis Rectal and pharyngeal infection—symptoms same as for men
Signs Scant to profuse, mucoid to purulent urethral or rectal discharge Abnormal vaginal discharge or uterine bleeding; purulent urethral or rectal discharge can be scant to profuse
Rectal infection—pain, discharge, bleeding
Complications Epididymitis, Reiter syndrome (rare) Pelvic inflammatory disease and associated complications (ie, ectopic pregnancy, infertility)
Reiter syndrome (rare)

Reprinted with permission from Wells BG, DiPiro JT, Schwinghammer TL, et al. Pharmacotherapy Handbook. 10th ed. New York, NY: McGraw-Hill; 2017.

SIGNS AND SYMPTOMS

DIAGNOSIS

MEANS OF CONFIRMATION AND DIAGNOSIS

  • Cell culture is reference standard but 3- to 7-day delay in results has led to use of tests that rapidly detect chlamydial ...

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