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Chlamydia, which can cause infertility when left untreated, has evolved a stealth operation to grow while evading the host's immune system. Its infectious form enters the host cell sheathed in a protective layer of host cell membrane. It then changes into a replicative form and multiplies. In the process, it somehow imports all necessary amino acids, energy, and other supplies from the host cell's cytoplasm, possibly with the help of the newly discovered protein _____ (black dots). Chlamydia reverts to its infectious form when the cell can no longer tolerate the growing vacuole (see light micrograph on right). The cell finally bursts, releasing infectious particles. Micrograph by Zarine Balsara
Cap1
-transmitted from person to person on hands
- Primarily a disease of people in developing countries (crowding, poor sanitation, poverty)
- Repeated injections fum childhood into adulthood lead to vision loss
- Begins as a follicular conjunctivitis with diffuse inflammation, leads to scarring eyelid turns inwards eye lashes abrade cornea, corneal ulcerations scarring, & loss of vision
- Painful, debilitating
- 7 million people are blind due to _______
Trachoma
-Inflammation of the cervix
-patient complains of the following symptoms:
-- Abnormal vaginal discharge & intermenstrual vaginal bleeding Legs after sexual intercourse).
-- May also be asymptomatic
Cervicitis
What are the causes of cervicitis?
infectious or non-infectious
What are the infectious causes of cervicitis?
-Chlamydia trachomatis
- Neisseria gonorrhoea
- Less frequent causes
-- Trichomoniasis
--genital herpes
What are non-infectious causes of cervicitis?
-Persistent abnormality of vagina flora
-douching or exposure to chemical irritants
-idiopathic inflammation
This clear to purulent discharge stores on example of what disease (condition)?
Cervicitis
Urethritis
-urethal inflammation
-can result from infectious and non-infection conditions
What are the following symptoms associated with discharge of mucopurulent or purulent materials. dysuria, or urethral pruritis
Urethitis
Are asymptomatic infections common?
Yes
what is Chlamydia trachomatis ?
An obligate intracellular pathogen.
What forms does Chlamydia Trachomatis exist
Elementary and Reticulate Bodies
Which form is metabolically inactive and is the infectious form?
Elementary bodies.
Which form is metabolically active and is non-infections?
Reticulate bodies.
What are biovars based on?
The types of cells they infect
How many biovars does Chlamydia trachomatis have!
2
What host cell does the Trachoma Biovar infect?
ciliated mucosal epithelial cells and conjunctiva cells
What infections does the trachoma biovar cause ?
Urogenital infections, neonatal infections and trachoma
What host cell does the Lymphogranuloma venereum infect?
Macrophages
What disease does lymphogranuloma venereum cause?
Lymphogranuloma venereum
What diseases are associated with C.Trachomatis?
-Urogenital infections
-Eye infections
-- Trachoma
-- Neonatal conjunctivitis
When is neonatal conjunctivitis transmitter?
At birth
What biovar of Chlamydia Trachomatis caused this condition?
Lymphogranuloma venerum
what host cell is infected?
Macrophage
what is the most frequent reported injections disease in the US
Urogenital Chlamydia infection
What are manifestations of urogenital Chlamydia Trachomatis infections
-Urethritis
-Cervicitis
-Endometritis
- Pelvic Inflammatory Disease (salpingitis)
Is the unorganized infection of Lymphogranuloma venereum frequent in the U.S.?
No, it is rarely seen in the U.S.
What specimens do you use for diagnosis of C. trachomatis in women?
urine specimen or endocervix or vaginal swab
What specimens do you use for diagnosis of C. trachomatis in men?
urethral swab or urine specimen
What specimens do you use for people who are receptive to anal intercourse?
rectal swab specimen
What are the diagnostic methods to diagnose C. trachomatis?
-NAATs
-Culture
-Direct immunofluorescence (DFA)
-Enzyme immunoassay (EIA)
-Nucleic Acid hybridization tests
What should you do in a person diagnosed with Chlamydia?

** Important Question * *
Test for other STDs.
What are the most sensitive tests?
NAATs
What are the recommended Regimens for treatment of a patient with an urogenital Chlamydia infection?
-Azithomycin 1g PO in a single close that is directly observed.
-Doxycycline 100 mg PO bid for 7 days.
What are the advantages of Azithromycin?
-Safe & effective in pregnant women
-May be preferred therapy despite cost due to:
-- treatment of patients for whom compliance with multistory during is in question.
--in populations that have erratic health-care seeking behavior, poor treatment compliances or unpredictable follow-ups.
What are the advantages of doxycycline?
Less costly than azithromycin.
What are the alternative Regimens for treatment of a patient with an urogenital Chlamydia infection?
-erythromycin
-- 500 mg PO qid for 7 days
-- GI upset may occur-patients less likely to complete regimen
-Ofloxacin & Levofloxacin
-- more expensive and offer no advantage to above
-- contraindicated in pregnant women.
-Treatment of sex partners is essential for decreasing risk of reinfection
-Instruct patients to refer their partners for evaluation, testing, and treatment
- Sex partners should be tested and treated if they had sexual contact with the patient during the 60 days preceding onset of symptom or diagnosis of Chlamydia in the patient
- Instruct patients to abstain from sexual intercourse until they and then partners have completed treatment
Partner Notification following diagnosis of Chlamydia infection