Chlamydia

Chlamydia is a bacterial-borne sexually transmitted disease that has been known to humankind for a long time: the first reference dates back to about 1550 B.C. and appears in the Ebers Papyrus, a collection of medical and mystical knowledge preserved at the University of Leipzig.

To find an in-depth definition of the disease, however, we have to wait until 60 A.D., when the physician and botanist Dioscorides Pedanius, who lived in imperial Rome under Nero, reported his observation of a man suffering from redness, granulation, and a strong burning sensation caused by an infection that culminated in the loss of his eyesight.

Over the centuries, the disease was attributed to parasites and later to viruses until the second half of the twentieth century, when subsequent research with modern instrumentation revealed many bacterial-like features, confirming the origin of the disease.

CAUSES

Chlamydia trachomatis is responsible for the disease, an obligate intracellular bacterium (which can, therefore, only reproduce within a host cell). Five species are known to be responsible for different infections:

• Chlamydia trachomatis
• Chlamydia pneumoniae
• Chlamydia psittaci (bird to human)
• Chlamydia suis (porcine pathogen)
• Chlamydia muridarum (mouse pathogen)

While pneumoniae and psittaci lead to the origin of pulmonary forms of infection, trachomatis is responsible for eye inflammation and particularly sexually transmitted diseases (STDs).

TRANSMISSION

Transmission occurs primarily by sexual contact, with the exchange of fluids between an infected person and a healthy one, which can also occur indirectly through, for example, hands or sex toys.

Vertical transmission from mother to child during delivery can also occur. In contrast, cases of transmission during pregnancy and postpartum are rare.

GEOGRAPHICAL DISTRIBUTION

This disease is present all over the world. The numbers are particularly high in the United States, with 1,500,000 infected in 2015, but there is also a steady increase in Europe, particularly in the 20-24 age group.

SYMPTOMS

Although Chlamydia Trachomatis is often asymptomatic or with vague symptoms, so it is also called Silent Epidemic, it develops several manifestations in individuals that if left untreated can result in serious consequences.

Trachomatis infection has an incubation period of 7 to 21 days after infection and does not provide immunity against subsequent reinfection.

In women, cervicitis with stringy mucus discharge, irritation, bleeding, and sometimes urethritis with pyuria and dysuria are found. In some cases, it can also travel from the cervix to the Fallopian tube and give rise to pelvic inflammatory disease that can result in infertility (PID).

Pregnant women can transmit the infection during delivery, and in newborns it can cause conjunctivitis and/or neonatal pneumonia.

In men, however, Trachomatis presents as urethritis, irritation, itching and discharge, sometimes pain and enlargement of the testicles.

In the case of anal intercourse, the infection can spread to the rectum. This spread causes inflammation of the rectum characterized by intense pain, bleeding, and mucopurulent discharge. Chlamydia Trachomatis can also result in painful pharyngitis in cases of oral transmission.

People who are infected with this STD, definitely have a higher chance than those who are not infected of acquiring and transmitting HIV.

DIAGNOSIS

Genito-urinary infections from Chlamydia Trachomatis account for about 50 percent of nongonococcal urethritis. It is diagnosed by molecular laboratory tests that rely on amplification of nucleic acids with endocervical, urethral, vaginal, rectal, oral swabs or in urine samples.

In case of a positive test, it is also advisable to undergo serological testing for HIV and other STDs. Again in case of positivity, it is appropriate to extend testing to the sexual partner.

TREATMENT

Therapy for Trachomatis is antibiotic and involves oral azithromycin or doxycycline. Alternatively, levofloxacin or erythromycin, again orally. Sexual partners should also be treated and the test repeated 3 months after therapy.

In pregnant women, azithromycin is used and repeated 4 weeks after the end of treatment. It is necessary to abstain from sexual intercourse until one week after the end of therapy.

PREVENTION

Prevention relies like other STDs on the use of condoms, as there is no targeted vaccine. Spermicides and bactericidal agents, as well as intravaginal devices, are not a means of combating any sexually transmitted diseases. The only prevention is the use of condoms in vaginal, oral, and anal intercourse and avoiding risky intercourse or when the state of health of the partner is unknown.

In countries at high risk for Trachomatis or Lymphogranuloma Venereum (in order the United States and Eastern Europe for the former and Africa, India, and Southeast Asia for the latter), intercourse with locals should be avoided unless protected.

In case of positivity, abstinence until negativization will prevent transmission of the infection. After returning from a trip if you have had unprotected intercourse of any kind with local people, you should be checked for Trachomatis even if no symptoms are detected, given the large number of asymptomatic infections.

The above also applies to mild symptoms such as burning, difficulty urinating, pain and swelling in the scrotum, and in women vaginal discharge, bleeding, dyspareunia (pain during sexual intercourse). Always remember that international travel facilitates the rapid spread of sexually transmitted diseases globally.

Bibliografia

Linee guida OMS “Treatment of Chlamydia Trachomatis” (2017)

1. “Le infezioni sessualmente trasmesse. Come riconoscerle e prevenirle” (2018)
2. “The impact of Chlamydia Trachomatis infection on sperm parameters and male fertility: A comprehensive study”
3. “Magazine” Fondazione Umberto Veronesi 2019
4. “La diagnostica delle infezioni sessuali” Idelson Gnocchi (2014)