Last time we talked about trichonomiasis, a sexually transmitted infection (STI) that often produces no symptoms. Chlamydia is another STI that often causes no symptoms, at least initially. We shall investigate this condition this week and then move to topics other than STIs next time.
This infection is usually caused in humans by the bacterium Chlamydia trachomatis and is found only in humans. Unlike trichomoniasis, women are more often asymptomatic than are men. Estimates are that around 75% of women present with no symptoms whislt around 50% of men do have symptoms, almost the opposite from our infection of the week last time.
Although this is a serious subject, let us keep it a bit light. After the fold in a song by Todd Rundgren called “You Left me Sore”. Although most likely written about gonorrhea, it is still apt in this case.
By the way, this is from his wonderful album, Something/Anything?. I highly recommend this record.
In any event, chlamydia is a serious infection, with the potential to cause significant harm to both sexes and to neonates. It is also very common, with 1,244,180 new cases reported to CDC according to CDC’s website. That is a lot of cases. Note that this number is much more precise than the between 3.5 and 7 million new cases for trichomoniasis. The reason is that chlamydia is a reportable infection, meaning that physicians have to report infections to their state health department, which in turn must report them to CDC. Thus, we have a much better handle of infection rates and outcomes. However, that figure is certainly a lowball, because asymptomatic people are not diagnosed and thus not reported. CDC estimates that the real figure is around 2.8 million new infections. Also, if antibiotics are given without tests, the diagnostic is for a nonspecific urinary tract infection (UTI) and these cases are not reported, either.
Symptoms, when present, in women consist usually of an abnormal discharge and possibly burning when urinating. That is, when only the cervix and urethra are involved. It can spread further up the reproductive tract to the Fallopian tubes and MAY produce symptoms such as backache of abdominal pain.
In men, the main symptoms are burning during urination and a penile discharge. However, remember that only around half of men and only around one quarter of women display symptoms.
Complicating the situation, unlike trichonomiasis, chlamydia can exist in other regions of the body. Throat infections are very common, as are anal infections. In females it is possible to self infect the anus from vaginal sources. Thus it is possible to spread chlamydia by conventional heterosexual sex, heterosexual or homosexual oral sex, and heterosexual or homosexual anal sex.
The health effects of chlamydia can be much more serious than those of trichomoniasis. A common result of chlamydial infections in women is pelvic inflammatory disease, (PID), that can have extremely serious outcomes. PID can be caused by many organisms, but those caused by chlamydia are particularly of concern because very often there is no pain involved even though extremely serious tissue damage (irreversible damage, in fact) is being caused.
PID is not usually life threatening, but it can be (we shall get to that later). However, PID may cause so much scarring of the Fallopian tubes that infertility can happen because the tubes are no longer large enough in diameter for an ovum to be conducted to the uterus. Normally, this just causes infertility, but you have to remember that a spermatozoon is much smaller than an ovum, so if one happens to travel up to where the ovum is “stuck”, it can impregnate the ovum in the Fallopian tube. If not detected, this can be a life threatening condition, called an ectopic pregnancy, because the Fallopian tube finally ruptures from the growth of the embryo. Normally ectopic pregnancies are very painful, but sometimes the embryo can develop to a large enough size to cause a rupture. The only treatment for an ectopic pregnancy is immediate removal of the embryo before rupture of the tube occurs. It is estimated that betwixt a quarter and half a million cases of PID are caused by chlamydia annually in the US alone.
Now, here is an interesting question for those states pondering “personhood from conception” laws. If such a law were in force, the embryo, even there is zero chance of it surviving after it kills the mother from a Fallopian tube rupture and subsequent fatal hemorrhage, could not be removed for risk of the medical practitioner being prosecuted. This is just one scenario that can result from those ill conceived laws.
In men, further infection beyond the urethra is uncommon, but there are known cases of epididymitis, an inflammation of the epididymis, the structure in the scrotum where spermatozoa are stored. This can lead to sterility in men. There is also some evidence that chlamydia can cause inflammation of the prostate. I have not seen any evidence linking chlamydia to cancer, but any time chronic inflammation is present, I think of a possible connexion. CDC estimates that about a quarter of a million cases of epididymitis are caused by this infection annually in the US>
As I mentioned earlier, sexual contact is the only mode of transmission, and I strongly suspect that digital contact, along with oral sex and intercourse are transmission pathways. However, there is a strong possibility that a pregnant woman will pass chlamydia to her child during vaginal childbirth. Apparently the bacterium does not cross the placenta, so a Caesarian delivery can prevent infection of the baby. CDC guidelines recommend that all pregnant women be screened for chlamydia and treated with antibiotics if positive.
Interestingly, females below the age of 25 seem to be more susceptible to chlamydia that other populations. This is thought to be due to the fact that the cells in the cervices in this group are still immature, and are more easily infected with the bacterium.
Chlamydia infections in infants are most common in the lungs, causing pneumonia, and the eyes, causing conjunctivitis. Those conditions can cause death and blindness, respectively, but are easily controlled in modern situations with antibiotic treatment. In the undeveloped world, this infection (called trachoma) accounted for 15% of blindness 15 or so years ago, but aggressive antibiotic treatment, spearheaded by the World Health Organization (WHO) has reduced this greatly. The WHO have a goal for eradication by the end of this decade.
In rare cases, this infection can lead to a rather severe arthritis, more commonly in young males. Sometimes it never goes away, even after the infection is eradicated. It is not caused exclusively by chlamydia, but that is a common trigger. It is linked to a specific gene that gets activated by an infection, triggering an autoimmune response where joint cartilage gets attacked. Although not common, it can be devastating.
Chlamydia is easy to diagnose, but since it often produces no symptoms it is often not suspected. There are DNA based tests that are extremely sensitive and specific, and in my opinion, like I mentioned last week, that all women be screened for it during routine Pap smears. Except for the ones regarding reporting, since chlamydia is already reportable, the same recommendations that I offered for trichomoniasis last week hold for chlamydia in the link above about trichomoniasis. CDC recommends such screening in females 25 years of age and younger. I think this a bit too low an age cutoff, but that is just my opinion.
Once diagnosed, treatment consists of antibiotics. The recommended regimen is a single oral dose of azithromycin at one gram. This is 97% effective, according to CDC, and the sexual partners of the woman should get the same regimen. Abstention from sexual activity for seven days is essential. There are other regimens that are also effective, such as doxycycline at 100 mg twice a day for seven days. Followup is recommended at three months to assure that reinfection has not occurred. I particularly like the single dose regimens because the practitioner can actually observe the entire treatment regimen. Even the most conscientious patients sometimes forget a dose of medication.
Obviously, prevention is a better solution than treatment, but prevention is not always possible. Either total abstinence from sex (including digital and oral) or a committed, absolutely monogamous relationship with a person known not to be infected is also pretty much a sure thing, but it is always possible that the partner in whom one has absolute trust may be hiding secrets. There is some evidence that latex male condoms are of some benefit for preventing the spread of the infection, but this is not a panacea. However, since this bacterium can thrive in any mucus membrane, even an act as simple as wiping an eye with a finger containing the bacterium can transfer the infection. I certainly realize that people are going to have sex, but minimizing the risk for transmission is still important. It is known that persons infected with chlamydia are more susceptible to other STIs.
Here is a map from CDC about infection rates. These are actual numbers (since this is a reportable infection) for the various states and territories. I find it very strange that the states that are perceived to be the most conservative and evangelical also have the highest rates of infection, whilst heathen California has one of the lowest. Go figure!
While we are talking pictures, here is a link to a number of them. I found them way too graphic for this piece, but if you are of strong constitution I leave the link for you.
Well, you have done it again! You have wasted many more einsteins of perfectly good photons reading this infected piece. And even though Newt Gingrich realizes that he has zero chance to become president one day when he reads me say it, I always learn much more than I could possibly hope to teach writing this series, so please keep those comments, questions, corrections, and other feedback coming. Tips and recs are also welcome. I shall hang around tonight as long as comments warrant, and shall return tomorrow around 9:00 PM Eastern for Review Time.
Warmest regards,
Doc
Crossposted at
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good medicine?
Warmest regards,
Doc