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  • • Clinical diagnosis is difficult because most genital chlamydial infections are asymptomatic and even when symptoms or signs are present, they are nonspecific.
  • • Diagnosis relies on tests that detect the causative organism, Chlamydia trachomatis.
  • • Nucleic acid amplification tests (NAATs) have the greatest sensitivity and can be performed on noninvasively collected specimens (eg, urine or self-collected vaginal swabs).

Chlamydia trachomatis is responsible for a wide spectrum of clinical disease, particularly in the genital tract (see Table 13–1). Despite the availability of effective antimicrobial therapy and improved preventive efforts, genital chlamydial infections remain a worldwide public health concern, and the World Health Organization estimates that 90 million new cases occur worldwide each year. Genital chlamydial infection remains the most commonly reported bacterial sexually transmitted disease (STD) in the United States, producing an estimated four million new infections each year, according to the Centers for Disease Control and Prevention (CDC).

Table 13–1. Clinical Syndromes Caused by Chlamydia trachomatis.

From the time genital chlamydial infections first became a reportable disease in the United States in 1986, a greater number of cases have been reported in women versus men, a finding that has been attributed to emphasis on chlamydial screening in women. Chlamydia causes significant morbidity, especially in women, who can develop upper genital tract infection (pelvic inflammatory disease [PID]), which can lead to chronic pelvic pain, tubal abscesses, ectopic pregnancy, and infertility; chlamydia is the leading preventable cause of infertility worldwide. Genital chlamydia can also increase the risk of acquisition and transmission of HIV.

Among the many risk factors for genital chlamydial infection (see Table 13–2), age is the strongest risk factor, with CDC surveillance studies demonstrating the highest chlamydial prevalence occurring in men and women younger than 25 years of age. A history of prior chlamydial infection is another strong predictor for current chlamydial infection. The majority of chlamydial infections in men and women are asymptomatic; therefore, the diagnosis of infection relies on identification of the organism through diagnostic testing. The availability of highly sensitive nucleic acid amplification tests (NAATs) should help to facilitate both improved rates of diagnosis and more widespread chlamydial screening, because such tests can be performed on noninvasively collected specimens (eg, urine and self-collected vaginal swabs). However, many barriers to screening exist, including lack of patient access to health care ...

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