A must know compendium of genital chlamydia for health care providers
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20241209Keywords:
Genital chlamydia, Ectopic pregnancy, Pelvic inflammatory disease, NAATAbstract
Chlamydia comprises the largest proportion of all sexually transmitted infections (STIs) worldwide. It is caused by Chlamydia trachomatis, an obligate intracellular bacterium and exists in two stages; an extracellular elementary body which is an infectious state and an intracellular reticulate body, a dormant state. The elementary body increases the risk of transfer of chlamydial infection during oral, genital or anal sex. On the other hand, the vegetative state of the reticulate body promotes the chance of latent and recurrent infection. In 2020, WHO estimated 129 million new chlamydia infections. Most of the chlamydial infections are asymptomatic (85-90%) which promotes transfer between partners. If untreated, it can lead to an ascending infection which greatly impacts sexual and reproductive health. In addition, it can infect the baby around childbirth and may result in stillbirth or neonatal death. The immuno-pathogenesis of the chlamydial infection is predominantly evoked by major outer membrane protein (MOMP), a dominant chlamydial antigen on the cell wall; along with the chlamydial antigen, heat shock protein 60 (HSP60) triggers host immune responses. The innate and adaptive immune responses result in extensive fibrosis and permanent damage to the fallopian tube resulting in tubal factor infertility and ectopic tubal pregnancy. The improved strategies in screening, diagnosis, treatment and follow up of Chlamydial infection can have noticeable effects on prevention of incidence, retarding the progression and avoiding recurrence of infection leading to a reduction in the global burden of STIs and the consequent adverse neonatal outcome.
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References
WHO. Report on global sexually transmitted infection surveillance, 2022. Available at: https://www.who.int/reproductivehealth/publications/stis-surveillance-2022/en/. Accessed on 20 February 2024.
Rowley J, Vander Hoorn S, Korenromp E, Low N, Unemo M, Abu-Raddad LJ, et al. Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016. Bull World Health Organ. 20191;97(8):548-62.
Peipert JF. Clinical practice. Genital chlamydial infections. N Engl J Med. 2003;349(25):2424-30.
Manavi K. A review on infection with Chlamydia trachomatis. Best Pract Res Clin Obstet Gynaecol. 2006;20(6):941-51.
Low N, Redmond S, Uusküla A, Bergen J, Ward H, Andersen B, et al. Screening for genital chlamydia infection. Cochrane Database Syst Rev. 2016;9(9):CD010866.
Black CM. Chlamydial Infection: A Clinical and Public Health Perspective. Infect Dis Basel. Karger; 2013: 1-8.
Bébéar C, de Barbeyrac B. Genital Chlamydia trachomatis infections. Clin Microbiol Infect. 2009;15(1):4-10.
Price MJ, Ades AE, Soldan K, Welton NJ, Macleod J, Simms I, et al. The natural history of Chlamydia trachomatis infection in women: a multi-parameter evidence synthesis. Health Technol Assess. 2016;20(22):1-250.
Nwokolo NC, Dragovic B, Patel S, Tong CY, Barker G, Radcliffe K. 2015 UK national guideline for the management of infection with Chlamydia trachomatis. Int J STD AIDS. 2016;27(4):251-67.
Agrawal T, Vats V, Salhan S, Mittal A. The mucosal immune response to Chlamydia trachomatis infection of the reproductive tract in women. J Reprod Immunol. 2009;83(1-2):173-8.
Hafner LM. Pathogenesis of fallopian tube damage caused by Chlamydia trachomatis infections. Contraception. 2015;92(2):108-15.
Johnson RE, Newhall WJ, Papp JR, Knapp JS, Black CM, Gift TL, et al. Screening tests to detect Chlamydia trachomatis and Neisseria gonorrhoeae infections--2002. MMWR Recomm Rep. 2002;51(RR-15):1-38.
Meyer T. Diagnostic Procedures to Detect Chlamydia trachomatis Infections. Microorganisms. 2016;4(3):25.
Lane AB, Decker CF. Chlamydia trachomatis infections. Dis Mon. 2016;62(8):269-73.
Pearce DM, Shenton DP, Holden J, Gaydos CA. Evaluation of a novel electrochemical detection method for Chlamydia trachomatis: application for point-of-care diagnostics. IEEE Trans Biomed Eng. 2011;58(3):755-8.
Lanjouw E, Ouburg S, de Vries HJ, Stary A, Radcliffe K, Unemo M. 2015 European guideline on the management of Chlamydia trachomatis infections. Int J STD AIDS. 2016;27(5):333-48.
Bashh Clinical Effectiveness Group. Update on the treatment of Chlamydia trachomatis (CT) infection, 2018. Available at: https://www.bashhguidelines.org/media/1191/update-on-the-treatment-ofchlamydiatrachomatisinfection-final-16-9-18. Accessed on 20 February 2024.
Kong FY, Tabrizi SN, Law M, Vodstrcil LA, Chen M, Fairley CK, et al. Azithromycin versus doxycycline for the treatment of genital chlamydia infection: a meta-analysis of randomized controlled trials. Clin Infect Dis. 2014;59(2):193-205.
Kong FY, Tabrizi SN, Fairley CK, Vodstrcil LA, Huston WM, Chen M, et al. The efficacy of azithromycin and doxycycline for the treatment of rectal chlamydia infection: a systematic review and meta-analysis. J Antimicrob Chemother. 2015;70(5):1290-7.
WHO. Chlamydia, 2023. Available at: https://www.who.int/newsroom/factsheets/detail/chlamydia. Accessed on 20 February 2024.
Zhang W, Wong CKH, Xin Y, Fong DYT, Wong JYH. A Web-Based Sexual Health Intervention to Prevent Sexually Transmitted Infections in Hong Kong: Model-Based Cost-Effectiveness Analysis. J Med Internet Res. 2023;25:e45054.