Chlamydial (kla-MIH-dee-ul) infection can take various forms and can affect the urinary and genital systems of the body, as well as the eyes and lungs. One of its most common forms is a sexually transmitted disease (STD), which usually is passed from one person to another through unprotected sexual intercourse.
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Pelvic inflammatory disease (PID)
Sexually transmitted disease
There are different types of chlamydia bacteria. Chlamydia trachomatis (kla-MIH-dee-uh truh-KO-mah-tis) is the bacterium that causes genital (and sometimes throat) infections. People with this form of chlamydial infection might not know they have the disease, because symptoms of infection often do not appear right away. In both men and women, long-term complications can result from an untreated infection. The penis, vagina, cervix*, anus, or urethra* can become infected. Babies born to mothers with chlamydial infection may develop a type of conjunctivitis* shortly after birth. A different type of Chlamydia trachomatis also causes the most common infection-related form of blindness in the world.
- (SIR-viks) is the lower, narrow end of the uterus that opens into the vagina.
- (yoo-REE-thra) is the tube through which urine passes from the bladder to the outside of the body.
- (kon-jung-tih-VY-tis), often called “pinkeye,” is an inflammation of the thin membrane that lines the inside of the eyelids and covers the surface of the eyeball. Conjunctivitis can be caused by viruses, bacteria, allergies, or chemical irritation.
Infection with Chlamydia pneumoniae (kla-MIH-dee-uh nu-MO-nye) can lead to pneumonia in humans and may be linked to an increased risk of heart disease. Humans also can contract Chlamydia psittaci (kla-MIH-dee-uh sih-TAH-see) through contact with infected birds. This infection causes psittacosis (sih-tuh-KO-sis), or “parrot fever,” a pneumonia-like illness. This form of chlamydial infection is the most rare, usually affecting only those people who work closely or live with birds.
Chlamydial infection is the most common STD in the United States. As many as 3 to 4 million new cases occur each year. Most people who contract chlamydia are younger than 25 years old. Of every 10 teenage girls tested for chlamydial infection, 1 girl has the infection.
Spread by oral (by mouth), vaginal, and anal sexual intercourse, Chlamydia trachomatis is easily transmitted from person to person. Chlamydia also can pass from a woman to her baby during birth; infants born to infected mothers have about a 25 percent chance of becoming infected with conjunctivitis or pneumonia.
A microscopic image of a smear of material taken from the cervix of a woman infected with chlamydia shows the presence of the bacteria. Custom Medical Stock Photo, Inc.
The sexually-transmitted infection often is called “the silent epidemic,” and up to half of men and three-fourths of women who have the disease do not know it, because symptoms can be mild or may not even be noticeable. Symptoms can take from 1 to 3 weeks to appear after a person becomes infected. Women may have a milky or yellowish discharge (mucus* or pus*) from the vagina and experience pain while urinating or having sex. Fever, bleeding between periods, abdominal* pain, and the urge to urinate frequently are also signs of infection. Men may have a burning sensation when they urinate or a thin yellowish or milky discharge from the penis and swollen or tender testicles. Some men may not experience any symptoms. Chlamydia spread through oral contact with the genitals can cause an infection in the throat.
- (MYOO-kus) is a thick, slippery substance that lines the insides of many body parts.
- is a thick, creamy fluid, usually yellow or greenish in color, that forms at the site of an infection. Pus contains infection-fighting white cells and other substances.
- (ab-DAH-mih-nul) refers to the area of the body below the ribs and above the hips that contains the stomach, intestines, and other organs.
Specific testing for chlamydia is usually included when a person is screened for STDs. Tests for chlamydial infection and gonorrhea usually are done together, because the symptoms of these two sexually transmitted infections are similar. A doctor will ask about sexual history, collect a sample of urine for examination in a laboratory, and take cotton-swab samples from the cervix or the tip of the penis. If swelling or discharge is present, swabs also will be taken from the throat or anus. The material picked up by the swab is tested for the bacteria. Testing can take up to 3 days. Sometimes a quicker test that diagnoses chlamydial infection from a urine sample is used. Results from a urine sample usually can be obtained from a laboratory within a few hours. It is necessary for all sexual partners of a person who is diagnosed with chlamydial infection to be tested for the disease, even if they do not have symptoms.
Once a person is diagnosed with chlamydial infection, treatment with antibiotics begins. It is important for an infected person to finish all prescribed medication, even if symptoms disappear. If symptoms persist after taking all the medication, a follow-up visit to the doctor is necessary. Babies who contract chlamydia from their mothers also are treated with antibiotics.
If chlamydial infection is left untreated in women, it can move through a woman’s reproductive organs and spread to the cervix, uterus*, fallopian tubes*, or ovaries*, causing pelvic inflammatory disease (PID). PID is a serious condition that can result in infertility (the inability to become pregnant). Each year, PID develops in up to a million women in the United States; half of these cases are the result of chlamydial infection. PID can scar and block the fallopian tubes and cause a woman to be at increased risk for an ectopic (ek-TAH-pik) pregnancy, in which the fertilized egg develops outside the uterus, usually within one of the fallopian tubes. Ectopic pregnancies are removed by emergency surgery to prevent the fallopian tube from rupturing and causing internal bleeding. Without emergency medical treatment, a ruptured ectopic pregnancy can result in severe bleeding that can lead to death. Women with a history of PID are 10 times more likely to have ectopic pregnancies than are other women. Research has shown that women who have chlamydia are up to five times more likely to become infected with the human immunodeficiency virus (HIV)* if they have unprotected sex with someone who has HIV infection.
- (YOO-teh-rus) is the muscular, pear-shaped internal organ in a woman where a baby develops until birth.
- (fah-LO-pee-uhn) tubes are the two slender tubes that connect the ovaries and the uterus in females. They carry the ova, or eggs, from the ovaries to the uterus.
- (O-vuh-reez) are the sexual glands from which ova, or eggs, are released in women.
- *HIV ,
- or human immunodeficiency virus (HYOO-mun ih-myoo-no-dih-FIH-shen-see), is the virus that causes AIDS (acquired immunodeficiency syndrome).
In men, chlamydia can spread from the urethra to the testicles and may result in a condition called epididymitis*, which can lead to sterility (the inability to impregnate a woman). Men also can develop prostatitis (pros-tah-TY-tis), an inflammation of the prostate*, or Reiter syndrome (RYE-ter SIN-drome), a condition associated with arthritis*.
- (eh-pih-dih-duh-MY-tis) is a painful inflammation of the epididymis, a structure attached to the testicles.
- (PRAH-state) is a male reproductive gland located near where the bladder joins the urethra. The prostate produces the fluid part of semen.
- (ar-THRY-tis) refers to any of several disorders characterized by inflammation of the joints.
People who have chlamydial infection may pass the disease on to their sexual partners, even if they are not aware that they are infected. It is wise to approach any sexual relationship with a strong sense of responsibility. People who are sexually active are advised always to use a latex condom for all forms of sexual intercourse. Having several sexual partners puts a person at increased risk of all types of STDs. It is recommended that all men and women who are sexually active be screened regularly for STDs. The U.S. Centers for Disease Control and Prevention advises all sexually active women who have risk factors for chlamydial infection to be screened for STDs at least once a year, as part of a full gynecological exam. Women considered to be at risk are those who have new sex partners or who engage in sex with several partners and who do not use condoms during sex. Pregnant women are also screened, to prevent spreading the infection to their babies.
AIDS and HIV Infection
Sexually Transmitted Diseases
Planned Parenthood Federation of America, 810 Seventh Avenue, New York, NY 10019. Planned Parenthood posts information about sexually transmitted infections at its website.
Telephone 212-541-7800 http://www.plannedparenthood.org
U.S. National Institute of Allergy and Infectious Diseases (NIAID), Building 31, Room 7A-50, 31 Center Drive MSC 2520, Bethesda, MD 20892-2520. NIAID, part of the National Institutes of Health, posts fact sheets about many STDs, including chlamydial infections, at its website.
Telephone 301-496-5717 http://www.niaid.nih.gov
KidsHealth.org. KidsHealth is a website created by the medical experts of the Nemours Foundation and is devoted to issues of children’s health. It contains articles on a variety of health topics, including chlamydial infections and other STDs.
Lymphogranuloma venereum (LGV) is a sexually transmitted systemic disease (STD) caused by a parasitic organism closely related to certain types of bacteria. It affects the lymph nodes and rectal area, as well as the genitals, in humans. The name comes from two Latin words that mean a swelling of granulation tissue in the lymph nodes resulting from sexual intercourse. Granulation tissue is tissue that forms during wound or ulcer healing that has a rough or lumpy surface.
Although LGV is easily treated in its early stages, it can produce serious complications in its later stages. LGV is most likely to occur among people living in tropical or subtropical countries and among military personnel or tourists in countries or large cities with high rates of the disease. Prostitutes play a major role in carrying and transmitting LGV, as was documented during an outbreak in Florida in the late 1980s. There are about 1000 documented cases of LGV in the United States in an average year.
Causes and symptoms
LGV is caused by Chlamydia trachomatis, a globe-shaped parasitic organism that reproduces only inside of living cells. C. trachomatis has 17 subtypes and is responsible for a wide range of infections in both men and women; however, only subtypes L1, L2, and L3 cause lymphogranuloma venereum. The parasite has a two-part lifecycle. In the first stage, it is inert and can survive outside of cells. In its second stage, it lacks a cell wall and actively reproduces after gaining entry to a cell. As the chlamydia organism reproduces inside the cell, it pushes the nucleus aside and forms an inclusion that can be identified with tissue staining. LGV differs from other diseases caused by C. trachomatis in that it affects the body's lymphatic system and not just the moist tissues of the genital region. In humans, the chlamydia organism is transmitted through vaginal or anal intercourse, oral sex, or contact with fluid from open ulcers or infected tissues.
Lymphogranuloma venereum has three stages. In its primary stage, the disease is more likely to be detected in men; it may go unnoticed in women. After an incubation period of four to 30 days, a small painless ulcer or blister develops in the genital area. Second-stage LGV develops between one and six weeks later. In this stage, the infection spreads to the lymphatic system, forming buboes (swellings) in the lymph nodes of the groin area. The buboes often merge, soften, and rupture, forming sinuses and fistulas (hollow passages and ducts) that carry an infectious bloody discharge to the outside of the body. Patients with second-stage LGV may also have fever, nausea, headaches, pains in their joints, skin rashes, and enlargement of the spleen or liver. Third-stage LGV, which is sometimes called anogenitorectal syndrome, develops in about 25% of patients. In men, this stage is usually seen in homosexuals. Third-stage LGV is marked by rectal pain, constipation, a discharge containing pus or bloody mucus, and the development of strictures (narrowing or tightening of a body passage) in the rectum or vagina.
LGV can have a number of serious complications. C. trachomatis infections of any subtype are associated with long-term fertility problems in women. Strictures in the rectum can completely close off the lower bowel, producing eventual rupture of the bowel and inflammation of the abdominal cavity. The patient can develop chronic abscesses or fistulae in the anal area or in the vagina in women. Long-term blockages in the lymph nodes can produce elephantiasis, a condition in which the patient's upper legs and groin area become greatly enlarged. Patients with chronic LGV infection have a higher risk of developing cancer in the inflamed areas.
Chronic LGV can be reactivated in patients who become infected with the AIDS virus. These patients develop open ulcers in the groin that are difficult to treat.
The diagnosis of LGV is usually made on the basis of the patient's history, careful examination of the genital area and lymph nodes, and blood tests or cultures to confirm the diagnosis. In the early stages of the disease, the doctor will need to distinguish between LGV and such other STDs as syphilis and herpes. If the patient has developed buboes, the doctor will need to rule out tuberculosis, cat-scratch disease, bubonic plague, or tularemia (a disease similar to plague that is carried by rabbits and squirrels). If the patient has developed rectal strictures, the doctor will need to rule out tumors or colitis.
There are several blood tests that can be used to confirm the diagnosis of LGV. The most commonly used are the complement fixation (CF) test and the microimmunofluorescence (micro-IF) tests. Although the micro-IF test is considered more sensitive than the CF test, it is less widely available. An antibody titer (concentration) of 1:64 or greater on the CF test or 1:512 or greater on the micro-IF test is needed to make the diagnosis of LGV. In some cases, the diagnosis can be made from culturing C. trachomatis taken from samples of tissue fluid from ulcers or buboes, or from a tissue sample from the patient's rectum.
LGV is treated with oral antibiotics, usually tetracycline or doxycycline for 10-20 days, or erythromycin or trimethoprim sulfamethoxazole for 14 days. Pregnant women are usually treated with erythromycin rather than the tetracyclines, because this class of medications can harm the fetus.
Anogenitorectal syndrome— Another name for third-stage LGV.
Aspiration— A procedure in which pus or other fluid is removed from a body cavity through a hollow needle connected to a syringe.
Bubo— An inflamed swelling inside a lymph node, characteristic of second-stage LGV.
Elephantiasis— Abnormal enlargement of the legs and groin area caused by blockage of the lymphatic system, as a complication of LGV.
Fistula— A passageway formed by a disease or injury that drains fluid from an infected area to the outside or to other parts of the body.
Lymph— A clear yellowish fluid that circulates throughout the body, carrying white blood cells and fats. The system that produces and circulates lymph is called the lymphatic system; it includes lymph vessels, lymph nodes, the thymus gland, and the spleen.
Proctitis— Inflammation of the anus and rectum.
Stricture— An abnormal narrowing or tightening of a body passage. LGV can cause strictures to form in the patient's rectum, or in the vagina of female patients.
Patients who have developed second- and third-stage complications may need surgical treatment. The doctor can treat buboes by withdrawing fluid from them through a hollow needle into a suction syringe. This procedure is called aspiration. Fistulas and abscesses also can be treated surgically. Patients who develop elephantiasis are usually treated by plastic surgeons. Patients with rectal strictures may need surgery to prevent bowel obstruction and rupture into the abdomen.
The prognosis for recovery for most patients is good, with the exception of AIDS patients. Prompt treatment of the early stages of LGV is essential to prevent transmission of the disease as well as fertility problems and other serious complications of the later stages.
Prevention of lymphogranuloma venereum has four important aspects:
- Avoidance of casual sexual contacts, particularly with prostitutes, in countries with high rates of the disease.
- Observance of proper safeguards by health professionals. Doctors and other healthcare workers should wear gloves when touching infected areas of the patient's body or handling soiled dressings and other contaminated items. All contaminated materials and instruments should be double-bagged before disposing.
- Tracing and examination of an infected person's recent sexual contacts.
- Monitoring the patient for recurring symptoms for a period of six months after antibiotic treatment.
Chambers, Henry F. "Infectious Diseases: Bacterial & Chlamydial." In Current Medical Diagnosis and Treatment, 1998, edited by Stephen McPhee, et al., 37th ed. Stamford: Appleton & Lange, 1997.