Chlamydia Trachomatis is a common sexually transmitted organism which causes a disease called Lymphogranuloma venereum.
It is mostly seen in tropical countries and affects men more than women.
It is usually, but not always, spread by sexual contact.
Chlamydia Trachomatis has been widely blamed for symptomless infections of the female genital tract like the tubes and the ovaries.
It is believed to be one of the main culprits causing infertility due to blockage of the fallopian tubes.
Incubation period of lymphogranuloma venereum is 7-14 days. In other words, it takes about 7-14 days for symptoms to appear after being infected by chlamydia trachomatis.
Chlamydia Trachomatis as seen on
a slide under the microscope
Signs and Symptoms
- Symptomless: In many patients there may be no symptoms, or, the symptoms may be so mild as to escape detection.
- General ill health: Fever and general discomfort may be present during the active stages of the disease. The infected person may suffer from tiredness, headache, bodyache and other general symptoms. This stage may even be ignored as a mild form of viral influenza.
- First vaginal sign:The first vaginal sign of infection by chlamydia trachomatis may be a small papule, pustule (blister containing pus) or an ulcer. These are usually painless and quickly heal spontaneously.
- Vaginal Discharge: Thick whitish vaginal discharge that smell foul is often present. The patient often comes to the doctor for treatment of her vaginal discharge rather than for any ulcers.
- Swellings in the groin: The infection spreads through the lymphatics to affect the tissues of the vulva as well as lymphatic glands in the groins. The glands become involved between 3-4 weeks after infection by chlamydia trachomatis. The first sign of the disease can be large, painful swellings in the groin, especially along the pantyline between the legs and the abdomen. These swellings may break down to form necrotic abscesses with a foul-smelling discharge.
- Vulval Signs: Chlamydia trachomatis may spread through the tissues of the vulva to cause thickening and ulceration of the vulva. The vulval tissues may thus feel rigid or rubbery in consistency. Sometimes, there may even be a small fenestration (hole) in the labia minora which is diagnostic of the disease.
- Involvement of the rectum: If the rectum is involved, there may be diarrhoea and passage of blood and pus from the anus.
- Infertility: Infection of the fallopian tubes may lead to scarring and blockage of the lumen of the tubes. This may pass unnoticed at the time of infection and may only be discovered at the time of investigation for infertility. According to the Indian Council for Medical Research, about 20% of all women infected with chlamydia will develop a Pelvic Inflammatory Disease (PID) and, of these, about 10% will develop a tubal factor infertility.
Diagnosis of Chlamydia Trachomatis infection
Chlamydia Trachomatis Infection can be diagnosed by two ways:
- Examination of body fluid: Samples of pus or fluids are collected from the common sites of chlamydia infection. In females, the samples are usually taken from the opening of the urethra (opening through which urine comes out), cervix, vaginal discharge, swabs from any sores or blisters and the rectum. In males, the samples are collected from the urethral opening and the rectum.
- Examination of urine: Examination of the urine for the presence of the chlamydia trachomatis organism can also be done but are less accurate than examination of body fluids.
Types of Tests:
- Antibody formation: Antibodies against chlamydia trachomatis can be detected in the blood by special tests and the diagnosis confirmed. These tests are the ELISA test (Enzyme Linked ImmunoSorbent Assay ), the DFA (Direct Fluoroscent Antibody) test and the NAAT (Nucleic Acid Amplification) test. The first two tests are also called Rapid Tests since they can show results of chlamydia infection as early as 24 hours. They are done on body fluids while the NAAT can also be done in urine.
- Chlamydia Culture: The diagnosis is by isolating and culturing chlamydia trachomatis in the laboratory. A smear is taken from a discharging lesion of the vulva or an abscess of the groin and cultured. The test is expensive and takes about 5 - 7 days to give a result.
Treatment
Chlamydia trachomatis is treated with antibiotics. Both the sexual partners should get treatment simultaneously to prevent spread from one to the other. The main antibitic pills used are:
- Azithromycin - Single Dose of 1 gm. This is a single dose therapy
- Doxycycline - Dose is 100mg twice daily for a minimum of 7 days.
- Erythromycin - Dose is 500mg twice daily for 7 days.
- Ofloxacin - Dose is 300mg twice daily for 7 days.
- Levofloxacin - Dose is 500mg twice daily for 7 days.
- Amoxycillin - 500 mg thrice daily for 7 days. This medicine is usually prescribed in pregnant women who have been infected with Chlamydia Trachomatis.
- If extensive scarring occurs, as sometimes happens, reconstructive surgery may be necessary.
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