Symptoms
Genital chlamydial infections are among the most common sexually transmitted diseases. In men, the infection manifests as purulent inflammation of the urethra with discharge. The anus and epididymis can also become infected. In women, the urethra and cervix are usually affected. Possible symptoms include back pain, lower abdominal pain, urinary urgency, burning, itching, discharge, fever, pain during intercourse, and bleeding between periods. However, the infection often remains asymptomatic. An ascending disease is called adnexitis or in English as and circumscribes a co-participation of the uterus, the fallopian tubes and the ovary. In some cases, the peritoneum is also infected (perihepatitis). In newborns, the infection manifests as neonatal conjunctivitis and, less commonly, as pneumonia.
Cause
The cause of the disease is infection of the genital tract with the bacterium (Chlamydiaceae, serotypes D-K). The small bacterium with incomplete metabolism replicates obligately intracellularly and has no peptidoglycan layer. The extracellular and infectious form, called the elementary body, cannot divide. The intracellular and proliferating form is called the reticular body.
Transfer
The pathogens are transmitted during sexual intercourse. Infection of newborns during birth is a special form of transmission. Outside the body, chlamydia die quickly. The incubation period ranges from a few days to weeks, rarely up to years. Risk factors include young age (adolescents and young adults between 15-24 years), unprotected sexual intercourse, and frequently changing sexual partners.
Complications
Possible complications include female infertility, scarring, ectopic pregnancy, and chronic pelvic pain. Reactive arthritis and Reiter’s syndrome may develop rarely as a result of the infection, especially in men.
Diagnosis
Diagnosis is made by medical treatment based on patient interview, clinical symptoms, and various laboratory analytical methods. A diagnosis based solely on symptoms is unreliable.
Prevention
Condoms are used to prevent STD.
Drug treatment
Current and previous sexual partners must be co-treated to prevent re-infection and further spread. Oral antibiotics are used for drug treatment, usually either tetracyclines, e.g., doxycycline, or macrolides, e.g., roxithromycin, azithromycin, and erythromycin, for uncomplicated infection. Newer quinolones such as ofloxacin and levofloxacin may also be considered as alternatives. Azithromycin is also administered as a 1000 mg single dose due to good compliance. For detailed treatment guidelines, please refer to the literature and the appropriate drug reference information.
