Chlamdia is normally referred to as chlamydia infections in connection with the infectious agent of such Chlamydia as Chlamydia trachomatis or Chlamydophila psittaci. In the case of Chlamdia, trachomatisis a sexually transmitted disease. These are the serotypes D to K of Chlamydia that are causing the infection that causes all of conjunctivitis.

C. TRACHOMATIS

This bacterium is strictly inter-human transmission. 4% of young people at least are affected, leading some countries to a screening routine because of the cost of complications of genital infection with Chlamydia trachomatis responsible forinfertility by destroying the epithelium of the tube leading to an increase in the number of ectopic.

This infection is usually silent and only in the investigations conducted as part of a review of the infertility that infection (or at least his legacy) is discovered.

The diagnosis is greatly facilitated by the direct search of nucleic acids from bacteria by polymerase chain reaction (PCR).

Epidemiology

This is the most common sexually transmitted bacterial.

This infection is common in young sexually active. cases are more common among women 15-24 years (incidence in women 15-19 years: 1 109.1 / 100,000 inhabitants in women 20-24 years: 1 041.7 / 100,000 inhabitants). Over 50% of men and 70% of women may be asymptomatic. The prevalence reaches 5% of the population between 20 and 24 years in Great Britainone.

In symptomatic cases, the period ofincubation varies from 2 to 6 weeks, but can be longer.

Chronic symptomatic infection is possible.

Neisseria gonorrhoeae is occasionally associated with Chlamydia trachomatis, with symptoms similar, justifying a systematic combination therapy.

Manifestations Of The Disease

In both sexes, the disease can manifest as subfertility, a proctitis, a conjunctivitis, a Reiter’s syndrome.

IN WOMEN

The infection is usually asymptomatic.

It can manifest as Cervico-vaginitis as vaginal bleeding (bleeding outside the rules, leukorrhea (whitish discharge at vagina), a dysuria (difficulty in passing urine which should eliminate a urinary tract infection), a urethritis.

More rarely there may be a peri-hepatitis or syndrome Fitz-Hugh-Curtis

In Men

The infection is also frequently asymptomatic.

It can manifest as urethritis form of secretion at the tip of the penis, by dysuria, tingling in theurethra, a small red button.

There may be a orchitis-epididymitis is manifested by pain in testicles

Evolution

The spontaneous evolution of forms is often asymptomatic toward healing (as evidenced by the disappearance of any trace bacterial PCR) after a few years.

In women

The main complication is the occurrence of pelvic inflammatory disease (infection of the fallopian tubes), can cause infertility and chronic pelvic pain. It occurs in up to one third of cases and the risk of infertility affects 10-20% then. The risk of ectopic pregnancy is inconsistent among the studies, plusfour or minus.

In the newborn in a mother carrying chlamydia, may happen once conjunctivitis occurring in 20% of cases, pneumonia occurring two to three months after birth.

Diagnosis

The preferred method is the direct search of nucleic acids from bacteria by genetic amplification. It can be performed on a single stream of urine in men or women, but also on a sample at theendocervix or theurethra in men. The sample must include epithelial cells, because it is an obligate intracellular bacterium. Genital secretions may not contain a large number of these cells. In France, Social Security pays only research on one site (Do not pay a search in the urine and in a sample of the endocervix). The cost of this examination is 23 € (2005)

The serology (antibody assay) does not contribute to the diagnosis of infection at low Chlamydia trachomatis and is rarely useful in the diagnosis of pelvic infections in women

Cell culture has long been the standard method. It requires a rich sampling cell (plastic swab) and a perfect technique of sampling and transportation.

The detection of chlamydial antigens is an alternative method.

Treatment

The treatment of uncomplicated chlamydial infection is based on the prescription for antibiotics.

For treatment of urethritis, theazithromycin 1000 mg single dose (Pod Zithromax) may be prescribed. The doxycycline (100 mg for 7 days * 2), theerythromycin (1000 mg * 2 for 7 days orofloxacin (300 mg * 2 for 7 days) are alternative treatments. The first three treatments are equivalent in terms of efficiency.

Condoms are highly recommended during treatment and after 7 days or 7 days in case of single-dose treatment, 14 for treatment “classic”.

It should naturally seek out and treat partners of the last two months, and look for other sexually transmitted diseases.

The control of the healing is done by a PCR (polymerase gene) control one month after treatment, serology with no interest.

Screening

There is a policy of routine screening of Chlamydia trachomatis in the countries of northern Europe in search of Chlamydia in the urine during the university registration. In 2003, the National Agency for the Evaluation of Health (France) concludes that screening is justified even in the absence of clinical signs venereal disease clinics, anonymous testing centers and frees of AIDS, and planning centers family education and abortion clinics for women less than 25 years.