Chlamydia; Overview.

Genital chlamydia (pronounced kla-mid-ee-uh) is the most frequently reported bacterial sexually transmitted disease (STD) in the U.S. today, and it has been estimated there are over three million new cases of chlamydia each year. It is particularly prevalent among teen-agers and young adults, according to the American Social Health Association. An estimated three million Americans are infected annually with chlamydia, which is caused by the bacterium Chlamydia trachomatis.

Initially, the bacteria invade cells lining the endocervix (the opening to the uterus). As it spreads into the reproductive tract, it can eventually lead to infertility, ectopic pregnancy and chronic pelvic pain. It has been estimated that chlamydia causes no symptoms in three of every four infected women and in half of all men. It is sometimes called the "silent epidemic" for this reason. In 1999, the annual cost of treating the infection and its complications was well over $2 billion.

According to the National Center for HIV, STD and TB Prevention, chlamydia is so common in young women that, by the time they reach age 30, half of sexually active women have evidence of having had the disease at some time during their lives. In fact, the U.S. Centers for Disease Control and Prevention estimates that one of 10 adolescent girls tested for chlamydia is infected.

When diagnosed, chlamydia is easily treated and cured. Left untreated, it can lead to significant medical problems for women, one of the most serious being pelvic inflammatory disease (PID). PID is a generic term indicating various inflammatory disorders of the upper genital tract, including endometritis and tubo-ovarian abscess. Acute PID can be difficult to diagnose. Its signs and symptoms vary widely and many women have only subtle symptoms.

Risk Factors for Pelvic Inflammatory Disease (PID):

Previous episodes of PID or STDs

Multiple sex partners or a partner with multiple sex partners

Being under age 19

Douching

Chlamydia infection is one of the most common causes of PID. It has been estimated that up to 40 percent of women with untreated chlamydia will develop PID. About one out of five persons with PID will become infertile. Another 18 percent will experience chronic pelvic pain. About nine percent will have life-threatening ectopic pregnancy, which is a leading cause of pregnancy-related deaths for American women in the first trimester. Chlamydia also can harm a newborn by causing serious eye and lung infections.

Chlamydia also can cause proctitis (inflamed rectum) and conjunctivitis (inflammation of the eye lining). Chlamydia can also infect the throat as a result of oral sex with an infected partner, yet it is not know if this leads to any symptoms or complications.

Chlamydia and HIV

The consequences of chlamydia are not limited to pregnancy. Research has shown that women infected with chlamydia are two to five times more likely to acquire HIV if exposed to the virus. The reason for the increased risk is that chlamydia causes a spike in the number of leukocytes at the site of infection. Some of these immune system cells, while needed to fight the infection, also happen to be the main target for HIV.

Chlamydia and Cervical Cancer

A study, published in the January 2001 issue of the Journal of the American Medical Association (JAMA), suggested that certain strains of Chlamydia trachomatis may increase the risk of cervical cancer in infected women. Although infections with cancer-causing strains of human papillomavirus (HPV) remain the prime cause of cervical cancer, infection with certain subtypes of Chlamydia trachomatis may contribute to that risk, according to the study. Previous studies also indicated that chlamydia is associated with cervical cancer, but it was unknown if the risk was subtype specific.

Six years ago, Congress set aside funds to begin a national STD-related infertility prevention program that has led to significant increases in chlamydia screening. As a result, more public and private health care professionals have been screening patients. Because most persons still aren't tested, however, health officials estimate that the actual number of infections is much higher. Reported cases for women greatly exceed those for men. The reasons for this are unclear, yet it may be that fewer men are screened routinely for chlamydia, often presenting for screening only when they have symptoms.

Fortunately, increased awareness of the seriousness of chlamydia has put pressure on health care professionals to offer regular screening to younger women. Some states now require insurance companies to cover the cost of chlamydia screening. In the year 2000, chlamydia was added to the list of performance measures for the Health Plan and Employer Data Information Set, known by its acronym HEDIS. This tool rates how well managed care organizations perform on a variety of clinical measures, including prevention efforts for breast cancer, cholesterol intake, and childhood immunizations. While this step won't make chlamydia screening mandatory, health maintenance organizations (HMOs) will be evaluated on how well they meet the established guideline of offering yearly chlamydia testing to sexually active women between ages 15 and 25.

Chlamydia and Arthritis

Chlamydia infection can also lead to a painful condition called reactive arthritis (or Reiter's syndrome), particularly in those who are genetically susceptible. Symptoms may include knee, toe or ankle swelling, genital sores, a burning sensation while urinating, and burning, redness and/or blurred vision in the eye. Reactive arthritis is more common in men, but can also occur in women. Treatment may include non-steroidal anti-inflammatory drugs (such as ibuprofen), steroid injections (in inflamed joints), and sometimes painkillers. The underlying infection should also be treated with antibiotics. Reactive arthritis usually fades in three to four months, but can sometimes become chronic.

Chlamydia in Pregnancy

A small percentage of pregnant women are infected with chlamydia. Transmission to the newborn results from exposure to the mother's infected cervix during birth. Infants with chlamydia may be born prematurely. They also may experience eye inflammation (conjunctivitis) and breathing problems. Chlamydia infection also can involve the oropharynx, genital tract and rectum. Infection sometimes can cause pneumonia during an infant's first months. Recommended treatment for neonatal chlamydia is erythromycin base divided in four daily doses for 14 days.

References

Planned Parenthood. "Chlamydia: Questions and Answers." http://www.plannedparenthood.org. Revised March 2004. Accessed June 12, 2004.

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Facts & Answers about STDs: Chlamydia. " American Social Health Association. http://www.ashastd.org. Accessed October 2001.

STD Surveillance 1999. National Profile. Centers for Disease Control and Prevention.

Centers for Disease Control and Prevention. (2002). Sexually transmitted diseases treatment guidelines 2002. MMWR, 2002, 51(No. RR-6).

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Connett, H. "What you need to know about chlamydia." STD Advisor, 1999; Vol. 2. Insert.

"The Hidden Epidemic: Confronting Sexually Transmitted Diseases." Institute of Medicine. Washington, D.C. National Academy Press. 1997.

"Chlamydia in the United States" Centers for Disease Control and Prevention Fact Sheet. Updated Aug. 2001. http://www.cdc.gov. Accessed Sept. 2001.

"Chlamydial Infection" National Institute of Allergy and Infectious Diseases, National Institutes of Health. Fact Sheet. Updated Jan. 2001. http://www.niaid.nih.gov. Accessed Sept. 2001.

Tarja A. et al. "Serotypes of Chlamydia trachomatis and Risk for Development of Cervical Squamous Cell Carcinoma" JAMA 2001;285: 47-51. http://jama.ama-assn.org.

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Keywords: chlamydia, sexually transmitted disease, std, ectopic pregnancy, pelvic inflammatory disease, pid, symptoms, hiv, cervical cancer, chlamydia screening, reactive arthritis, pregnancy, infertility