Identification

The Chlamydia trachomatis infection is one of the most common sexually transmitted bacterial infections (STIs), especially in young women, to which most of the time the infection is asymptomatic. ^[1]***. Chlamydia. Sexually transmitted diseases surveillance. 2014

Up to 70% of sexually active women with chlamidian infection are asymptomatic. ^[2]***. Chlamydia. Sexually transmitted diseases surveillance. 2014` Repeated infections with Chlamydia may cause sterility both in female and male. ^[3]***. STDs during Pregnancy – CDC Fact Sheet (Detailed). Centers for Disease Control and Prevention. 2016

The female infection in the genital area is manifested as a cervical infection (in the cervix = Cervix).^[4]***. Pelvic Inflammatory Disease (PID) – CDC Fact Sheet. Centers for Disease Control and Prevention. 2017

 

Clinical manifestations in women include:^[5]***. Chlamydia. Sexually transmitted diseases surveillance. 2014(-)

• Purulent leakage in small or moderate quantities,
• Burning sensation at urination,
• Pruritus (itching) urethral
• Sterility.

The untreated infection leads to pelvic inflammatory disease, which is an important cause of infertility, chronic pelvic pain and ectopic pregnancy.^[6]***. Chlamydia. Sexually transmitted diseases surveillance. 2014(*)

To the pregnant woman:

• During pregnancy the chlamidian infection may cause abortion, premature rupture of membranes and premature birth ^[7]Popa GL, Popa MI. Microbiologie Medicala. 2008.
• In genitally infected pregnant women with Chlamydia the infection may be transmitted to the newborn during childbirth, causing conjunctivitis or pneumonia ^[8]/***. Chlamydia. Sexually transmitted diseases surveillance. 2014..

Diagnosis

Tests for the identification of Chlamydia infection should be considered in people who have had partners with this infection, whether they have suggestive symptoms or are asymptomatic ^[9]Meyer T. Diagnostic Procedures to Detect Chlamydia trachomatis Infections. Microorganisms. 2016;25(4):1-10. The diagnosis of chlamidian infection has undergone considerable changes in recent years as a result of the occurrence of tests that are carried out by molecular biology ^[10].Meyer T. Diagnostic Procedures to Detect Chlamydia trachomatis Infections. Microorganisms. 2016;25(4):1-10.

The diagnostic methods are direct and indirect ^[11]Popa GL, Popa MI. Microbiologie Medicala. 2008`’..

Direct Diagnostic Methods:

• It is used in particular in the diagnosis of infections localized to the lower genital tract (cervicitis) by detecting antigens using a ELISA type technique; are not as sensitive as molecular tests (but are commonly used) ^[12]Meyer T. Diagnostic Procedures to Detect Chlamydia trachomatis Infections. Microorganisms. 2016;25(4):1-10..`.. Classical cultivation is carried out only in reference laboratories and is not made for the current diagnosis ^[13]Meyer T. Diagnostic Procedures to Detect Chlamydia trachomatis Infections. Microorganisms. 2016;25(4):1-10..-..
• Molecular tests using the gene amplification technique (PCR, Polimerase Chain reaction) are of the most faithful, specific and sensitive, but are expensive and involve external quality control, strictly ^[14]Meyer T. Diagnostic Procedures to Detect Chlamydia trachomatis Infections. Microorganisms. 2016;25(4):1-10’|..

 Indirect diagnostic methods:

• Include the detection of anti-Chlamydia antibodies trachomatis, being indicated in particular in the case of chronic or invasive infections and complications ^[15]Meyer T. Diagnostic Procedures to Detect Chlamydia trachomatis Infections. Microorganisms. 2016;25(4):1-10./.
• It is considered that the presence of IgM and IgA anti-Chlamidian antibodies suggests acute infection, and the presence of IgG types can be met in chronic infections, but also after healing ^[16]Meyer T. Diagnostic Procedures to Detect Chlamydia trachomatis Infections. Microorganisms. 2016;25(4):1-10.//..

Effects of Infection on the fetus:

• Premature birth,
• Fetus born dead,
• Miscarriage
• Low birth weight ^[17]Andrews WW et al. The Preterm Prediction Study: association of second-trimester genitourinary chlamydia infection with … birth. Am J Obstet ...continue

       Manifestations of the Chlamydia infection in the newborn:

• Ocular infections – Periodic ophtalmia neonatorum
• Pulmonary infections ^[18]***.. STDs during Pregnancy – CDC Fact Sheet (Detailed). Centers for Disease Control and Prevention. 2016

Diagnosis of Newborn

• It is performed in newborns with conjunctivitis or/and mothers infected with Chlamydia ^[19]***. Chlamydial Infections – 2015 STD Treatment Guidelines. Centers for Disease Control and Prevention. 2015.
• In the case of ocular infection immunofluorescence or PCR tests are performed from conjunctival secretion ^[20]***.Chlamydial Infections – 2015 STD Treatment Guidelines. Centers for Disease Control and Prevention. 2015(*).
• In the case of pulmonary infection, immunofluorescence or PCR tests are performed from nasopharyngeal secretion or tracheo-bronchial aspirate ^[21]***.. Chlamydial Infections – 2015 STD Treatment Guidelines. Centers for Disease Control and Prevention. 2015.

 

The infectious agent

            Chlamidiile are increasingly recognized as being involved in sexually transmitted infections, ocular and pulmonary infections in the infant, resulting from maternal genital infection ^[22] Popa GL, Popa MI. Microbiologie Medicala. 2008.

Chlamidiile that can cause human infection are classified in ^[23]. Popa GL, Popa MI. Microbiologie Medicala. 2008:

• Chlamydia Trachomatis,
• Chlamydia pneumoniae,
• Chlamydia Psittaci.

 

Chlamydia trachomatis, is one of the genus chlamydia species, a binding intracellular bacterium, which exhibits two morphological forms, the infectious particle and the elemental Corpusculul ^[24].. Popa GL, Popa MI. Microbiologie Medicala. 2008. Chlamydia Trachomatis includes serotypes that determine trachomul, genital infections, pneumonia in infants but also other serotypes that determine Limfogranulomul Venerian ^[25] Popa GL, Popa MI. Microbiologie Medicala. 2008./.. The D-K serotypes of Chlamydia Trachomatis are responsible for the infection transmitted to perinatal in the newborn ^[26]Schachter J. C. trachomatis- Infectious Disease and Antimicrobial Agents. Antimicrobe. 2016.

 

Chlamydia pneumoniae causes respiratory diseases, including “atypical” pneumonia and appears to be involved in the impaired coronary artery ^[27]Joshi R et al. Chlamydophila pneumoniae infection and cardiovascular disease. N Am J Med Sci. Wolters Kluwer — Medknow Publications; martie ...continue.

 Chlamydia Psittacii determines psittacosis in humans and can be transmitted by inhaling dry secretions from infected birds, poultry (parrots, macaws and Cockatieli) and poultry (turkeys and Ducks) ^[28]Popa GL, Popa MI. Microbiologie Medicala. 2008./~.

 

Incidence and prevalence

The incidence of cases of infection with Chlamydia trachomatis is on the rise, the number of cases reported in the USA reaching from 191,000 in 2004 to 385,000 in 2013 ^[29]Meyer T. Diagnostic Procedures to Detect Chlamydia trachomatis Infections. Microorganisms. 2016;25(4):1-10.!. At European level, an increase in the number of cases reported since the year 2004 ^[30]European Centre for Disease Prevention and Control. Guidance on chlamydia control in Europe. Stock ECDC. Björn Herrmann; 2016 is also observed.  The actual number of cases is likely higher than that reported, the main reasons for which it is not known its true value being, the following ^[31]Meyer T. Diagnostic Procedures to Detect Chlamydia trachomatis Infections. Microorganisms. 2016;25(4):1-10.;:

1. Lack of diagnosis and proper reporting,

2. High percentage of asymptomatic cases ^[32]Meyer T. Diagnostic Procedures to Detect Chlamydia trachomatis Infections. Microorganisms. 2016;25(4):1-10/ .

Source

In the case of Chlamydia trachomatis the source is strictly human, being the only species of this kind that infects only man ^[33]Schachter J. C. trachomatis- Infectious Disease and Antimicrobial Agents. Antimicrobe. 2016..

Method of transmission

The infection with Chlamydia trachomatis occurs by sexual contact ^[34]***. STD Facts – Chlamydia. Centers for Disease Control and Prevention. 2015. Persons who have been infected and treated may be reinfected ^[35]***.. STD Facts – Chlamydia. Centers for Disease Control and Prevention. 2015. Infected pregnant women may transmit the newborn infection at birth by exposing it at the time of passing through the infected cervix ^[36]***. STD Facts – Chlamydia. Centers for Disease Control and Prevention. 2015./.

Risk groups

Susceptibility is general, any sexually active person may become infected ^[37]***. Detailed STD Facts – Chlamydia. Centers for Disease Control and Prevention. 2016. In the absence of a long-term immunities and after treatment, the reinfection may take place ^[38]***.. Detailed STD Facts – Chlamydia. Centers for Disease Control and Prevention. 2016. A larger number of cases are observed in the age group 14-24 years ^[39]*** Detailed STD Facts – Chlamydia. Centers for Disease Control and Prevention. 2016./..

Infection and reinfection are influenced by several factors ^[40]***Detailed STD Facts – Chlamydia. Centers for Disease Control and Prevention. 2016.;.:

• Number of sexual partners,
• Ectopic pregnancies in young women,
• Factors that may increase susceptibility to infection.

Cellular immune response immunity is specific for each infectant serotype ^[41]*** Detailed STD Facts – Chlamydia. Centers for Disease Control and Prevention. 2016.//..

Incubation period

The incubation period of the Chlamydia infection is not clearly defined, but taking into account the low multiplier rate, symptoms may occur after 7-14 days after infectant contact ^[42]*** Detailed STD Facts – Chlamydia. Centers for Disease Control and Prevention. 2016,!.

Infectiousness Period

The infectiousness period is not clearly delineated, being stretched over several months, with some authors stating that it may take until the infection is treated/cured ^[43]*** Detailed STD Facts – Chlamydia. Centers for Disease Control and Prevention. 2016./|.. The untreated infection most often becomes chronic in a few months ^[44]Popa GL, Popa MI. Microbiologie Medicala. 2008|~. relapses, Re-infections are common ^[45]*** STD Facts – Chlamydia. Centers for Disease Control and Prevention. 2015|~|..

Prophylaxis

 

The primary prevention of this infection can be achieved through health education. The best method is abstinence to the moment of marriage and when there is only one partner/partner, healthy. If this recommendation is respected, moral precepts or realizeaă a proper sexual education and promotion of condom use can be reduced/eliminated all sexually transmitted infections and not just Chlamydia spp infections. ^[46]European Centre for Disease Prevention and Control. Guidance on chlamydia control in Europe. Stock ECDC. Björn Herrmann; 2016~. Through information programmes at population or individual level, discussions with the patient/patient should be transmitted to attempt changes in risk behaviour which could lead to a decrease in transmission ^[47].European Centre for Disease Prevention and Control. Guidance on chlamydia control in Europe. Stock ECDC. Björn Herrmann; 2016.

Secondary prevention includes detecting and treating infected people.

• Detection can be achieved by testing people with suggestive or asymptomatic symptoms ^[48]..European Centre for Disease Prevention and Control. Guidance on chlamydia control in Europe. Stock ECDC. Björn Herrmann; 2016. Asymptomatic persons who should be tested are primarily contacţii, partners of sick people and people at risk of illness, due to their behaviour ^[49]European Centre for Disease Prevention and Control. Guidance on chlamydia control in Europe. Stock ECDC. Björn Herrmann; 2016/'. The detection of cases can be performed during clinical consultations and during the anamnesis being suggested either by certain symptoms or by the presence of risk factors ^[50]European Centre for Disease Prevention and Control. Guidance on chlamydia control in Europe. Stock ECDC. Björn Herrmann; 2016.;..

• Patients with a positive result should be treated. All sexual partners of the positive patient are required to be informed, tested and treated (as appropriate) ^[51]*** Chlamydia. Sexually transmitted diseases surveillance. 2014`’~.

• An effective method of reducing reinfectărilor is the annual screening of sexually active adolescents; The test can be done noninvasively using as a urine-investigating product.

To prevent the spread, infection but also important side effects, CDC (Centers for Disease Control and Prevention) recommends that all women sexually active, younger than 25 years of age participate in the annual screening for infection Chlamydia ^[52]*** Chlamydia. Sexually transmitted diseases surveillance. 2014`’~-.

 

Lung X-ray is recommended at the age of three weeks and again after 12-18 weeks of life to exclude subclinical chlamidiene pneumonia ^[53]European Centre for Disease Prevention and Control. Guidance on chlamydia control in Europe. Stock ECDC. Björn Herrmann; 2016//. in the newborn mother with untreated Chlamydia genital infection.

 

Vaccination

There is no vaccine for these conditions.

 

Birth to female genitally infected with Chlamydia

There are no special recommendations, but caesarean birth significantly reduces the risk of child transmission ^[54]European Centre for Disease Prevention and Control. Guidance on chlamydia control in Europe. Stock ECDC. Björn Herrmann; 2016./`'.

 

Breastfeeding

There are no special recommendations

 

Treatment

In the adult with genital infection, the administration of doxycycline per bone 100 mg twice daily for 7 days is the classic treatment ^[55]*** Chlamydial Infections – 2015 STD Treatment Guidelines. Centers for Disease Control and Prevention. 2015.!.. Other alternatives are azithromycin and erythromycin ^[56]*** Chlamydial Infections – 2015 STD Treatment Guidelines. Centers for Disease Control and Prevention. 2015(-).

In infants, erythromycin is the recommended medicine ^[57]*** Chlamydial Infections – 2015 STD Treatment Guidelines. Centers for Disease Control and Prevention. 2015(*).

In pregnancy, pregnant women with chlamidiană infection are recommended azithromycin per bone, one gram at a single dose ^[58]*** Chlamydial Infections – 2015 STD Treatment Guidelines. Centers for Disease Control and Prevention. 2015//~.

To underline the importance of concomitant treatment of both spouses/partners.

Bibliography

1. ***. Chlamydia. Sexually transmitted diseases surveillance. 2014
2. ***. STDs during Pregnancy-CDC Fact Sheet (detailed). Centers for Disease Control and Prevention. 2016
3. ***. Pelvic Inflammatory Disease (PID)-CDC Fact Sheet. Centers for Disease Control and Prevention. 2017
4. Popa GL, Palm MI. Medical Microbiology. 2008
5. Meyer T. Diagnostic procedures to Detect Chlamydia trachomatis infections. Microorganisms. 2016; 25 (4): 1-10
6. Andrews WW, Goldenberg RL, Mercer B, et al. The Preterm prediction Study: Association of second-trimester genitourinary chlamydia infection with subsequent spontaneous preterm birth. I have J Obstet Gynecol. 2000; 183 (3): 662-8
7. ***. Chlamydial infections-2015 STD Treatment Guidelines. Centers for Disease Control and Prevention. 2015
8. Schachter J. C. Trachomatis-Infectious Disease and Antimicrobial agents. Antibacterial. 2016.9. Joshi R, Khandelwal B, Joshi D, Gupta OP. Chlamydophila pneumoniae infection and cardiovascular disease. N Am J Med Sci. Wolters Kluwer–Medknow publications; March 2013; 5 (3): 169-81
9. European Centre for Disease Prevention and Control. Guidance on Chlamydia control in Europe. Stock ECDC. Björn Herrmann; 2016
10. ***. STD Facts-Chlamydia. Centers for Disease Control and Prevention. 2015
11. ***. Detailed STD Facts-Chlamydia. Centers for Disease Control and Prevention. 2016