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A 17-year-old girl presents to the sexually transmitted disease (STD) clinic because her boyfriend was diagnosed with a Chlamydia urethritis. Both she and her boyfriend admit to having had sexual partners in the past before starting to be sexually active with each other. On physical examination, there is ectopy and some mucoid discharge (Figure 85-1). The cervix bled easily while obtaining discharge and cells for a wet mount and genetic probe test. The wet mount showed many white blood cells (WBCs) but no visible pathogens. The patient was treated with 1 g of azithromycin taken in front of a clinic nurse. She was sent to the laboratory for rapid plasma reagin (RPR) and HIV tests and given a follow-up appointment in 1 week. The genetic probe test was positive for Chlamydia and all the other examinations were negative. This information was given to the patient on her return visit and safe sex was discussed.

Figure 85-1

Chlamydial cervicitis with ectopy, mucoid discharge, and bleeding. The cervix is inflamed and friable. (Courtesy of Connie Celum and Walter Stamm, Seattle STD/HIV Prevention Training Center, University of Washington.)

Chlamydia trachomatis causes genital infections that can result in pelvic inflammatory disease (PID), ectopic pregnancy, and infertility. Asymptomatic infection is common among both men and women so healthcare providers must rely on screening tests to detect disease. The Centers for Disease Control and Prevention (CDC) recommends annual screening of all sexually active women ages 25 years and younger, and of older women with risk factors, such as having a new sex partner or multiple sex partners.1

  • A very common STD, Chlamydia is the most frequently reported infectious disease in the United States (excluding human papillomavirus [HPV]).1 An estimated 1.2 million cases are reported to the CDC annually in the United States.2
  • The World Health Organization (WHO) estimates there are 140 million cases of Chlamydia trachomatis infection worldwide every year.3
  • The CDC estimates screening and treatment programs can be conducted at an annual cost of $175 million. Every dollar spent on screening and treatment saves $12 in complications that result from untreated Chlamydia.4
  • It is common among sexually active adolescents and young adults.5 As many as 1 in 10 adolescent girls tested for Chlamydia is infected. Based on reports to the CDC provided by states that collect age-specific data, teenage girls have the highest rates of chlamydial infection. In these states, 15- to 19-year-old girls represent 46% of infections and 20- to 24-year-old women represent another 33%.4

  • C. trachomatis is a small Gram-negative bacterium with unique biologic properties among living organisms. Chlamydia is an obligate intracellular parasite that has a distinct life-cycle consisting of two major phases: The small elementary bodies attach and penetrate into cells, and the metabolically active reticulate bodies that form large inclusions within cells.
  • It ...

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