Chlamydia

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Genital chlamydia (pronounced kla-mid-ee-uh) is the most frequently reported bacterial sexually transmitted disease (STD) in the United States today. It occurs most frequently among teenagers and young adults, according to the American Social Health Association (ASHA). In fact, among females, the highest rates of chlamydia occurred in girls aged 15 to 19 in 2007. Overall, according to the Centers for Disease Control and Prevention (CDC), an estimated 2,291,000 Americans between the ages of 14 and 39 are infected with chlamydia, which is caused by the bacterium Chlamydia trachomatis.

Initially, the bacteria invade cells lining the endocervix (the opening to the uterus). As it spreads into the reproductive tract, it can eventually lead to infertility, ectopic pregnancy and chronic pelvic pain. It has been estimated that chlamydia causes no symptoms in three of every four infected women and in half of all men. It is sometimes called a "silent" disease. Because chlamydia is usually silent but can lead to serious complications, such as infertility, routine annual screening of all sexually active young women 25 years and younger is recommended.

Chlamydia is so common in young women that, by the time they reach age 30, it is estimated that half of sexually active women have evidence of having had the disease at some time during their lives. In fact, ASHA says that an estimated one in 10 teenage girls tests positive for chlamydia.

When diagnosed, chlamydia is easily treated and cured. Left untreated, it can lead to significant medical problems for women, one of the most serious being pelvic inflammatory disease (PID). PID is a generic term indicating various inflammatory disorders of the upper genital tract, including endometritis and tubo-ovarian abscess. Acute PID can be difficult to diagnose. Its signs and symptoms vary widely, and many women have only subtle symptoms.

Risk Factors for PID

• previous episodes of PID or STDs

• multiple sex partners or a partner with multiple sex partners

• being under age 25

• douching

• using an intrauterine device (IUD)

Chlamydia infection is one of the most common causes of PID. It has been estimated that up to 40 percent of women with untreated chlamydia will develop PID. About one out of five persons with PID will become infertile. Other potential complications include chronic pelvic pain and life-threatening ectopic pregnancy, which is a leading cause of pregnancy-related deaths for American women in the first trimester. Chlamydia screening sexually active women under 25 years old is cost effective because it can prevent serious reproductive complications, such as infertility, ectopic pregnancy and chronic pelvic pain.

Chlamydia also can harm a newborn by causing serious eye and lung infections. Chlamydia also can cause proctitis (inflamed rectum) and conjunctivitis (inflammation of the eye lining). Chlamydia can infect the throat as a result of oral sex with an infected partner, but most throat infections are asymptomatic. If a chlamydia-related throat infection does produce symptoms, they may include soreness and redness of the throat or mouth.

Chlamydia and HIV

The consequences of chlamydia are not limited to pregnancy. Research has shown that women infected with chlamydia are up to five times more likely to acquire HIV if exposed to the virus. The reason for the increased risk may be that chlamydia causes a spike in the number of white blood cells at the site of infection. Some of these immune system cells, while needed to fight the infection, also happen to be the main target for HIV.

Chlamydia and Cervical Cancer

Some studies have shown an increased risk of cervical cancer in women who have had chlamydia. A study published in the January 2001 issue of the Journal of the American Medical Association (JAMA) suggested that certain strains of Chlamydia trachomatis may increase the risk of cervical cancer in infected women. Although infections with cancer-causing strains of human papillomavirus (HPV) remain the prime cause of cervical cancer, infection with certain subtypes of Chlamydia trachomatis may contribute to that risk, according to the study.

In 1993, Congress set aside funds to begin a national STD-related infertility prevention program that has led to significant increases in chlamydia screening. As a result, more public and private health care professionals have been screening young women. Because most young women still are not tested, health officials estimate that the actual number of infections is much higher. Reported cases for women greatly exceed those for men. The reasons for this are unclear, yet it may be that fewer men are screened routinely for chlamydia, often presenting for screening only when they have symptoms.

Fortunately, increased awareness of the seriousness of chlamydia has put pressure on health care professionals to offer regular screening to younger women. Some states now require insurance companies to cover the cost of chlamydia screening. In the year 2000, chlamydia was added to the list of performance measures for the Healthcare Effectiveness Data and Information Set, known by its acronym HEDIS. This tool rates how well managed care organizations perform on a variety of clinical measures, including prevention efforts for breast cancer, controlling blood cholesterol levels and childhood immunizations. While this step will not make chlamydia screening mandatory, managed care organizations will be evaluated on how well they meet the established guideline of offering yearly chlamydia testing to sexually active women between ages 15 and 25 years.

Chlamydia in Pregnancy

A small percentage of pregnant women are infected with chlamydia. Transmission to the newborn results from exposure to the mother's infected cervix during birth. All women should be screened for chlamydia as part of routine prenatal care. Infants with chlamydia may be born prematurely. They also may experience eye inflammation (conjunctivitis) and breathing problems. Chlamydia infection also can involve the oropharynx, genital tract and rectum. Infection sometimes can cause pneumonia during an infant's first months. Recommended treatment for neonatal chlamydia is erythromycin base divided in four daily doses for 14 days.