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Source: Knodel LC. Sexually Transmitted Diseases. In: DiPiro, JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic Approach. 8th edition. http://www.accesspharmacy.com/content.aspx?aid=8004605. Accessed July 16, 2012.

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  • Sexually transmitted infection (STI)

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

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  • Requires cellular material from host cells for replication.
  • Maintains cellular identity throughout development.
  • Frequent coinfection with gonorrhea.

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  • Most common STI in the United States

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  • Mutually monogamous sexual relationship between uninfected partners
  • Barrier contraceptive methods

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  • Patients who seek STI testing should be screened for syphilis and HIV.
  • Annual screening recommended by CDC for sexually active females:
    • 25 years of age or younger
    • With new sex partners or multiple sex partners

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  • Unprotected sex
  • Number of sexual partners
  • Sexual preference
  • Age: Two-thirds of STIs occur in persons in their teens and twenties.

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  • 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.

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Table Graphic Jump Location
Table 1. Presentation of Chlamydia Infections
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Signs and Symptoms

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Means of Confirmation and Diagnosis

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

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Laboratory Tests

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  • Culture of endocervical or urethral epithelial cell scrapings
    • Most specific method (close to 100%)
    • Sensitivity is as low as 70%.
    • Results available in 3–7 days.
  • Non-culture tests:
    • Enzyme immunosorbent assay (EIA), DNA hybridization, nucleic acid amplification tests (NAATs)
      • Allow rapid identification of chlamydial antigens and nucleic acid.
      • Technically less demanding
      • Less costly, and in some situations have greater sensitivity ...

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