- • 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
Table 13–1. Clinical Syndromes Caused by Chlamydia trachomatis. ||Download (.pdf)
Table 13–1. Clinical Syndromes Caused by Chlamydia trachomatis.
|Urethritis (men or women)|
|Pelvic inflammatory disease|
|Perihepatitis (ie, Fitz-Hugh-Curtis syndrome)|
|Proctitis and proctocolitis (men or women)|
|Conjunctivitis (men, women, or neonates)|
|Pharyngitis (men, women, or neonates)|
|Respiratory tract infection (neonates or immunosuppressed adults)|
|Upper: Rhinitis or bronchitis|
|Lower: Pneumonitis or pneumonia|
|Reiter syndrome (men or women)|
|Culture-negative endocarditis (men or women)a|
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 ...