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Chlamydia trachomatis

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Chlamydia trachomatis

  • Transmission
    • C trachomatis is sexually transmitted
  • Presentation
    • Trachoma (eye infection)
      • Serotypes A, B, C 
      • May be complicated by blindness
    • Urethritis or cervicitis
      • Serotypes D-K
      • Presents with dysuria and cervical irritation
      • Rarely presents with orchitis in sexually active men
      • Can be complicated by pelvic inflammatory disease (PID)
        • Scarring may lead to ectopic pregnancy and infertility
      • Can pass to neonate via birth canal
        • pneumonia (staccato cough) with eosinophilia
        • conjunctivitis (1-2 weeks after birth)
    • Lymphogranuloma venereum (LGV)
      • Serotypes L1, L2, and L3
      • Painful lymphadenopathy
        • Classic feature of LGV
        • swollen inguinal lymph nodes may ulcerate, creating genital buboes
      • Treat with doxycycline
    • All infections may be complicated by reactive arthritis 
      • Asymmetric joint arthralgias, conjunctivitis, and urethritis
        • “Cant see, can’t pee, can’t climb a tree”
  • Diagnosis
    • Cytoplasmic inclusions seen on microscopy
      • By Giemsa staining or fluorescent antibody-stained smear
    • PCR or nucleic acid amplification test (NAAT) is the gold standard
      • Not frequently tested since it is too obvious
  • Treatment
    • Rule out N. gonorrhoeae or empirically treat for coinfection
    • Macrolide (azithromycin) or doxycycline
      • Topical and oral macrolide (erythromycin) for neonatal chlamydial conjunctivitis