Chlamydia

Clinical Presentation:

Chlamydia, caused by the bacterium Chlamydia trachomatis, is the most frequently reported STD in the United States. The highest prevalence of infection is observed in persons 15-25 years of age. Asymptomatic infection is common. Screening of sexually active refugee women <25 years old, or of women >25 years old with risk factors (e.g., new sex partner or multiple sex partners, sex partner with concurrent partners, sex partner who has a sexually transmitted infection), is recommended in the United States. In women, untreated infection can cause pelvic inflammatory disease, ectopic pregnancy, and infertility. Rarely, genital chlamydia infection can cause arthritis that may be accompanied by skin lesions and inflammation of the eye and urethra (reactive arthritis or Reiter’s syndrome)². There are few published data regarding prevalence rates of chlamydia in refugee populations arriving in the United States, although one study of more than 2,500 refugees found a rate of 0.6%, which is substantially lower than U.S. prevalence rates³.

Asymptomatic infection is common; however, women may report abnormal vaginal discharge or a burning sensation when urinating. Other symptoms include abdominal pain, lower back pain, nausea, fever, pain during intercourse (dyspareunia), or bleeding between menstrual periods. Men with signs or symptoms may have penile discharge; an itching or burning sensation when urinating; rectal pain, discharge, or bleeding; or epididymitis. Autoinoculation may occur in men or women, and can be associated with conjunctivitis.

Chlamydia trachomatis infection in infants occurs perinatally and most frequently presents as conjunctivitis that develops 5-12 days after birth. It can also cause an afebrile pneumonia, with onset 1-3 months after birth. Signs of C. trachomatis pneumonia include a repetitive staccato cough with tachypnea and hyperinflation and bilateral diffuse infiltrates on chest radiograph.

Diagnostic Testing:

Diagnosis of C. trachomatis urogenital infection in women can be made by testing first catch urine or cervical or vaginal swab specimens. Urethral C. trachomatis infection in men can be diagnosed by testing first catch urine specimens.

Nucleic acid amplification tests are the most sensitive tests available for detection of C. trachomatis. Further information on diagnostic testing can be obtained from existing guidelines.

References

2. LeFevre ML; U.S. Preventive Services Task Force. Screening for Chlamydia and Gonorrhea: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 2014;161(12):902-10.
3. Stauffer WM, Painter J, Mamo B, et al. Sexually transmitted infections in newly arrived refugees: is routine screening for Neisseria gonorrhoeae and Chlamydia trachomatis infection indicated? Am J Trop Med Hyg 2012;86(2):292-5.