Chlamydia: Sexually Transmitted Infection

Chlamydia is a common sexually transmitted disease (STD) caused by infection with Chlamydia trachomatis. It can cause cervicitis in women and urethritis and proctitis in both men and women. Chlamydial infections in women can lead to serious consequences including pelvic inflammatory disease (PID), tubal factor infertility, ectopic pregnancy, and chronic pelvic pain. Lymphogranuloma venereum (LGV), another type of STD caused by different serovars of the same bacterium, occurs commonly in the developing world, and has more recently emerged as a cause of outbreaks of proctitis among men who have sex with men (MSM) worldwide.

Chlamydia is the most frequently reported bacterial sexually transmitted infection in the United States. In 2010, 1.4 million cases of chlamydia were reported to the U.S.CDC from 50 states and the District of Columbia, but an estimated 2.86 million infections occur annually. Many cases are not reported because most people with chlamydia do not have symptoms and do not seek testing. Chlamydia is most common among young people. It is estimated that one in 15 sexually active females aged 14-19 years has chlamydia.

People at risk for chlamydia

Any sexually active person can be infected with chlamydia. Anyone with genital symptoms such as discharge, burning during urination, unusual sores, or rash should refrain from having sex until they are able to see a health care provider about their symptoms.

Also, anyone with an oral, anal or vaginal sex partner who has been recently diagnosed with an STD should see a health care provider for evaluation.

Because chlamydia is usually asymptomatic, screening is necessary to identify most infections. Screening programs have been demonstrated to reduce rates of adverse sequelae in women. CDC recommends yearly chlamydia screening of all sexually active women age 25 or younger and older women with risk factors for chlamydial infections (e.g., women who have a new or more than one sex partner). Pregnant women should be screened during their first prenatal care visit. Pregnant women younger than 25 or at increased risk for chlamydia (e.g., women who have a new or more than one sex partner) should be screened again in their third trimester. Any woman who is sexually active should discuss her risk factors with a health care provider who can then determine if more frequent screening is necessary.

Routine screening is not recommended for men. However, the screening of sexually active young men should be considered in clinical settings with a high prevalence of chlamydia (e.g., adolescent clinics, correctional facilities, and STD clinics) when resources permit and do not hinder screening efforts in women.

Men who have sex with men (MSM) who have receptive anal sex should be screened for chlamydia each year. MSM who have multiple and/or anonymous sex partners should be screened more frequently (e.g., at three to six-month intervals).

HIV-infected sexually active women who are age 25 or younger or have other risk factors, and all HIV-infected patients who report having receptive anal sex should be screened for chlamydia at their first HIV care visit and then at least annually. A patient’s health care provider might determine more frequent screening is necessary, based on the patient’s risk factors.

Symptoms

Chlamydia is known as a “silent” infection because most infected people have no symptoms. If symptoms do occur, they may not appear until several weeks after exposure. Even when it causes no symptoms, chlamydia can damage a woman’s reproductive organs.

In women, the bacteria first infect the cervix (structure that connects the vagina or birth canal to the uterus or womb) and/or the urethra (urine canal). Some infected women have an abnormal vaginal discharge or a burning sensation when urinating. Untreated infections can spread upward to the uterus and fallopian tubes (tubes that carry fertilized eggs from the ovaries to the uterus), causing pelvic inflammatory disease (PID). PID can be silent or can cause symptoms such as abdominal and pelvic pain. Even if PID causes no symptoms initially, it can lead to infertility (not being able to get pregnant) and other complications later on.

Some infected men have discharge from their penis or a burning sensation when urinating. Pain and swelling in one or both testicles (known as “epididymitis”) may occur but is less common.

Chlamydia can infect the rectum in men and women, either through receptive anal sex, or possibly via spread from the cervix and vagina. While these infections often cause no symptoms, they can cause rectal pain, discharge, and/or bleeding (known as “proctitis”).

Complications due to Chlamydia Infection

The initial damage that chlamydia causes often goes unnoticed. However, chlamydial infections can lead to serious health problems.

In women, Untreated infection can spread upward to the uterus and fallopian tubes (tubes that carry fertilized eggs from the ovaries to the uterus), causing pelvic inflammatory disease (PID). PID can be silent or can cause symptoms such as abdominal and pelvic pain. Both symptomatic and silent PID can cause permanent damage to a woman’s reproductive tract and lead to long-term pelvic pain, inability to get pregnant and potentially deadly ectopic pregnancy (pregnancy outside the uterus).

Complications are rare in men. Infection sometimes spreads to the tube that carries sperm from the testis, causing pain, fever, but, rarely, preventing a man from being able to father children.

Chlamydia in pregnant woman

In pregnant women, untreated chlamydia has been associated with pre-term delivery, and can spread to the new born, causing an eye infection or pneumonia. Screening and treatment of chlamydia during pregnancy is the best way to prevent these complications. All pregnant women should be screened for chlamydia at their first prenatal visit.

Diagnosis

There are laboratory tests to diagnose chlamydia. Specimens commonly used for testing include a cotton swab of the vagina (collected by the woman herself or her health care provider) or a urine sample.

Chlamydia Treatment

Penicillin is not effective against chlamydia.

Chlamydia can be easily treated and cured with antibiotics. HIV-positive persons with chlamydia should receive the same treatment as those who are HIV-negative.

Persons with chlamydia should abstain from having sex for seven days after single dose antibiotics, or until completion of a seven-day course of antibiotics, to prevent spreading the infection to partners.

Repeat infection with chlamydia is common. Persons whose sex partners have not been appropriately treated are at high risk for re-infection. Having multiple chlamydial infections increases a woman's risk of serious reproductive health complications, including pelvic inflammatory disease and ectopic pregnancy. Women and men with chlamydia should be retested about three months after treatment of an initial infection, regardless of whether they believe that their sex partners were successfully treated.

Infants infected with chlamydia may develop conjunctivitis (infection of the membrane lining the eyelids) and/or pneumonia. Chlamydial infection in infants can be treated with antibiotics.

Prevention Strategies

Not having sex is the best protection against chlamydia and other STDs. Having sex with only one uninfected partner who only has sex with you is also safe. Latex male condoms, when used consistently and correctly, can reduce the risk of getting or giving chlamydia. The surest way to avoid chlamydia is to abstain from vaginal, anal and oral sex or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.

To submit your abstracts at the conference STD 2018: http://bit.ly/stdabst2018

Source: http://www.dph.illinois.gov/topics-services/diseases-and-conditions/diseases-a-z-list/chlamydia

Hopes for Gonorrhea Vaccine

Beginning in 2004 and lasting through 2006, a mass vaccination campaign inoculated most of the New Zealand population: about 90%, including 81% of those under age 20. New Zealand scientists then published their results for the impact of the vaccine on the outbreak.

"The emergence of completely drug-resistant gonorrhoea is a major concern," Dr. Helen Petousis-Harris, lead author of the new study and a senior lecturer at the University of Auckland, wrote in an email.

Evidence from a mass vaccination campaign for an outbreak of bacterial meningitis in New Zealand had unexpected results: reduced rates of the sexually transmitted disease gonorrhea, a study published Monday in the journal The Lancet finds. It is the first time a vaccine has shown any protection against gonorrhea.

In recent years, gonorrhea has shown increasing antibiotic resistance, with some patients unable to be treated with any available drug. Because of this, the World Health Organization includes gonorrhea in its list of bacteria that pose the greatest threat to human health.

She explained that "even moderate protection" against the sexually transmitted disease could have significant impact because the bacteria that cause it "are very tricky." They develop resistance to drugs by transferring genes in atypical ways and recombining with related bacterial species.

Meningococcal disease, the bacterial form of meningitis, is a serious infection of the meninges, the membrane covering the brain. It's transmitted from person to person, usually in close contact, such as kissing, sneezing or coughing, or living in close quarters with an infected person.

A vaccine targeting the specific strain of bacteria causing meningococcal disease in the New Zealand outbreak was eventually "developed in a collaboration between Chiron Vaccines, the National Institute of Public Health of Norway (NIPH) and the New Zealand government," according to Mary Anne Rhyne, director of corporate communications at GlaxoSmithKline, the pharmaceutical company that inherited the vaccine from Chiron through a series of corporate acquisitions.

The vaccine targeted the vesicle, or sac, on the outer membrane of the bacteria.

"I wondered, in looking at their results from the outbreak, if there was any possibility that this vaccine might have had any other effects," said Black, who focused on the country's gonorrhea statistics in particular.

Neisseria gonorrhoeae bacteria (which cause gonorrhea) and Neisseria meningitidis bacteria (which cause meningococcal disease) are "two related organisms. They're cousins, if you will," he said, explaining that the genetic makeup of the two is "85 to 90% similar."

Petousis-Harris and her co-researchers, who had access to a database recording events during the meningococcal B outbreak, set to work testing his hypothesis.

"We compared the vaccination rates in two groups of people," Petousis-Harris explained. One group had gonorrhea, and the other group had chlamydia, both of which are spread through sexual contact.

If the vaccine had an effect against gonorrhea because it is an organism related to meningococcal disease, the researchers hypothesized, then no effect should be seen against chlamydia, an unrelated organism.

"This is exactly what we saw," Petousis-Harris wrote in an email. "We found that people with gonorrhoea were less likely to be vaccinated than people with chlamydia," indicating that the vaccine protected against gonorrhea but not chlamydia.

The researchers also discovered that vaccinated people were significantly less likely to become infected with gonorrhea than people who had not received the vaccine: 41% vs. 51%.

Taking other factors into account, including ethnicity and gender, the researchers concluded that having received the meningococcal vaccine reduced the incidence of gonorrhea by about 31%.

"Given the emergence of drug resistance, a vaccine may be our only avenue," Petousis-Harris said.

Source: https://edition.cnn.com/2017/07/10/health/gonorrhea-vaccine-study/index.html