Chlamydia trachomatis is the most common sexually-transmitted bacterial infection in the United States. The incidence of chlamydial infection in women increased nearly six times between 1987 and 2003, from 79 to 467 per 100,000. Much of this increase is probably due to improved screening and reporting modalities. (Sexually transmitted disease surveillance 2003 supplement. Atlanta: Centers for Disease Control and Prevention, 2004)
In men, chlamydial infection is usually symptomatic, causing urethritis (inflammation of the urethra) and dysuria (discomfort with urination). Occasionally—particularly if left untreated—the organism infects the epididymis as well.
Chlamydia can also cause urethritis in women, but it does not cause vaginitis. Symptoms of vaginal inflammation point to a different diagnosis or perhaps co-infection with two or more organisms. (Miller K. Diagnosis and treatment of Chlamydia trachomatis infection. Am Fam Physician 2006;73(8):1411-16)
Chlamydial infection of the lower female genital tract is often asymptomatic or minimally symptomatic. The organism becomes established in the mucosa of the endocervix, where it may cause an odorless, mucoid vaginal discharge. If it ascends into the upper urogenital tract in females, chlamydia can cause pelvic inflammatory disease.
Complications of Chlamydial Infection
- Infertility: Chlamydia can damage a woman’s fallopian tubes and interfere with fertilization or implantation; 20% of women who develop PID become infertile. Men, too, can experience a drop in fertility, apparently due to fragmentation of spermatic DNA.
- Chronic pelvic pain: Even when treated, women with PID due to chlamydial infection may develop longstanding pelvic pain and dyspareunia (pain with intercourse).
- Ectopic pregnancy: Fallopian tube scarring can cause implantation of a fertilized ovum in abnormal sites.
- Pregnancy-related: Untreated infection can lead to miscarriage, premature rupture of membranes, preterm labor, low birth weight, and infection of the newborn (ophthalmia neonatorum or chlamydial pneumonia).
- Reiter syndrome: Rarely, individuals with untreated chlamydial infection can develop urethritis (possibly cervicitis in women), conjunctivitis, painless lesions of the skin and mucous membranes, and, occasionally, arthritis (the male-to-female ratio is 5:1). The initial episode of Reiter syndrome usually only lasts three to four months, but symptoms may persist for a year or more.
Screening for Chlamydial Infection
- The US Preventive Services Task Force (USPSTF) and the Centers for Disease Control (CDC) recommend routine screening for chlamydial infection in all sexually active women, whether pregnant or not, 24 years of age or younger and in older women who are at risk of STIs (i.e., new sexual partners or multiple partners).
- The USPSTF recommends against screening for chlamydial infection in women over 25 years of age if they are not at increased risk of exposure.
- Current evidence does not provide sufficient information to assess the balance of benefits and harms of screening for chlamydial infection in men. Even though screening in men could lead to a decreased incidence of infection in women, the USPSTF concedes that there is a critical gap in the evidence that would allow it to make a recommendation for screening in men.
- The CDC recommends that anyone who is screened for chlamydia should also be tested for gonorrhea, due to evidence that the two organisms often coexist. (Lyss S, et al. Chlamydia trachomatis among patients infected with and treated for Neisseria gonorrhoeae in sexually transmitted disease clinics in the United States. Ann Intern Med 2003;139:178-85)
- Partners of infected individuals should be tested and treated, if infected, or treated presumptively.
- Nucleic acid amplification tests, which can be obtained from urine and vaginal swabs, are accepted screening modalities for both chlamydia and gonorrhea.
Chlamydial infection represents an obvious--and possibly growing--health problem in America. Regular screening and prompt treatment can reduce morbidty, mortality, and financial burdens associated with this disease.
 |
