eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Chlamydial Infections

Author: Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Coauthor(s): Marc James Grella, MD, Clinical Instructor, Department of Pediatrics, Massachusetts General Hospital
Contributor Information and Disclosures

Updated: Jan 21, 2009

Introduction

Background

Chlamydia infection can cause disease in many organ systems. The most frequent disease caused by Chlamydia trachomatis is a sexually transmitted infection (STI) that affects the cervix, urethra, salpinges, uterus, nasopharynx, and epididymis. C trachomatis infection causes other diseases, including conjunctivitis, pneumonia or pneumonitis, afebrile pneumonia syndrome (in infants born vaginally to infected mothers), Fitz-Hugh-Curtis syndrome (inflammation of the liver capsule), and trachoma, the world's leading cause of acquired blindness, which is spread from eye-to-hand-to-eye and caused by serotypes A, B, and C.

Chlamydophila pneumoniae infection is spread via respiratory droplets and causes pharyngitis, bronchitis, and pneumonia. Chlamydophila psittaci infection is spread by bird droppings and aerosols and causes psittacosis. These infections are not discussed in this article.

Pathophysiology

C trachomatis is an obligate intracellular bacterium that infects the urethra and cervix. The bacterium is usually spread through sexual activity and can be vertically spread, causing conjunctivitis and pneumonia in newborns (see Afebrile Pneumonia Syndrome). If untreated, genital disease can progress to epididymitis in males and upper genital tract disease in females. Chlamydia infects columnar epithelial cells, which places the adolescent female at particular risk of infection because of the presence of the squamocolumnar junction on the ectocervix present until early adulthood.

An infected male has a 25% chance per sexual encounter of transmitting the infection to an uninfected female. The transmission rate from infected mother to newborn is 50%, causing conjunctivitis (most cases) or pneumonia (10-20%). The incubation period is 1-5 weeks compared with 0-2 weeks for Neisseria gonorrhoeae infection, which is the most significant STI in the differential diagnosis of conjunctivitis in newborns.

Frequency

United States

More than 3 million episodes of chlamydia are reported each year, making it the most prevalent STI. Sexually active female populations average carriage rates of about 20%. Many patients are asymptomatic. The incidence rate is 2-3 times that of N gonorrhoeae.

Mortality/Morbidity

Deaths are rare and are caused by progression to salpingitis and tuboovarian abscess with rupture and peritonitis. The most significant morbidity occurs when repeated episodes of chlamydia lead to obstruction and scarring of the fallopian tubes, resulting in partial or total sterility. Chlamydia is an indirect cause of mortality from ectopic pregnancies.1 Mortality due to ectopic pregnancy is probably more common than is death due to tuboovarian abscess.

Race

Chlamydia is more common in blacks, Hispanics, and Native Americans in the United States. Variability in socioeconomic groups may explain racial differences because of the lack of ability to obtain adequate health care.

Sex

The male-to-female ratio is 1:1.

Age

Chlamydia is most prevalent in persons aged 15-24 years.

Clinical

History

The following may be noted in patients with chlamydial infection:

  • Females
    • Dysuria
    • Vaginal discharge
    • Abnormal vaginal bleeding (postcoital or unrelated to menses)
    • Dyspareunia
    • History of sexual activity without condoms or condom failure
    • Proctitis, rectal discharge, or both in cases of receptive anal intercourse
    • Slow onset and progression of lower abdominal pain
  • Males
    • Dysuria
    • Urethral discharge
    • History of sexual activity without condoms or condom failure
    • Proctitis, rectal discharge, or both in cases of receptive anal intercourse
  • Newborns
    • Symptoms of pneumonia begin in children aged 1-3 months, and symptoms of conjunctivitis develop in children aged 1-2 weeks.
    • Cough and fever can occur in pneumonia (although the classic description is afebrile).
    • Eye discharge, eye swelling, or both develop in conjunctivitis.
    • The mother is diagnosed with or suspected of having a chlamydial infection during pregnancy.

Physical

  • Females
    • Cervical discharge, urethral discharge (usually thin, mucoid), or both
    • Cervical friability (easy bleeding on manipulation)
    • Cervical motion tenderness
    • Adnexal fullness/tenderness, associated with progression to pelvic inflammatory disease (PID)
    • Lower abdomen tender to palpation
  • Males
    • Urethral discharge (elicited by having examiner or patient milk the urethra)
    • Dysuria
  • Newborns
    • Fever, cough, wheezing, and crackles in pneumonia
    • Conjunctival erythema, mucoid discharge, and/or periorbital swelling in conjunctivitis

Causes

Risk factors include the following:

  • Age 15-24 years
  • Multiple sex partners
  • Unprotected intercourse (without condoms)
  • History of current or past sexually transmitted infection (STI)
  • Homelessness
  • Exchange of sex for drugs or money

More on Chlamydial Infections

Overview: Chlamydial Infections
Differential Diagnoses & Workup: Chlamydial Infections
Treatment & Medication: Chlamydial Infections
Follow-up: Chlamydial Infections
Multimedia: Chlamydial Infections
References
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References

  1. Bakken IJ. Chlamydia trachomatis and ectopic pregnancy: recent epidemiological findings. Curr Opin Infect Dis. Feb 2008;21(1):77-82. [Medline].

  2. Chernesky M, Freund GG, Hook E 3rd, Leone P, D'Ascoli P, Martens M. Detection of Chlamydia trachomatis and Neisseria gonorrhoeae infections in North American women by testing SurePath liquid-based Pap specimens in APTIMA assays. J Clin Microbiol. Aug 2007;45(8):2434-8. [Medline].

  3. CDC. Update to CDC's Sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR [serial online]. Apr 13 2007;56(14):332-336. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5614a3.htm?s_cid=mm5614a3_e.

  4. 2004 Canadian sexually transmitted infections surveillance report. Can Commun Dis Rep. May 2007;33 Suppl 1:1-69. [Medline].

  5. American Academy of Pediatrics. 2006 Red Book: Report of the committee on infectious diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006:249-57.

  6. Anschuetz GL, Beck JN, Asbel L, Goldberg M, Salmon ME, Spain CV. Determining Risk Markers for Gonorrhea and Chlamydial Infection and Reinfection Among Adolescents in Public High Schools. Sex Transm Dis. Sep 22 2008;[Medline].

  7. Azenabor AA, Kennedy P, Balistreri S. Chlamydia trachomatis infection of human trophoblast alters estrogen and progesterone biosynthesis: an insight into role of infection in pregnancy sequelae. Int J Med Sci. 2007;4(4):223-31. [Medline].

  8. Bandea CI, Koumans EH, Sawyer MK, et al. Evaluation of the rapid BioStar OIA assay for detection of Chlamydia trachomatis in adolescent women. J Clin Microbiol. Nov 12 2008;[Medline].

  9. Baud D, Regan L, Greub G. Emerging role of Chlamydia and Chlamydia-like organisms in adverse pregnancy outcomes. Curr Opin Infect Dis. Feb 2008;21(1):70-76. [Medline].

  10. Behrman RE. Nelson's textbook of pediatrics. Philadelphia, Pa: WB Saunders; 1992:536-7.

  11. Biro FM. Adolescents, sexual activity, and sexually transmitted infections. J Pediatr Adolesc Gynecol. Aug 2007;20(4):219-20. [Medline].

  12. Blake DR, Kearney MH, Oakes JM, et al. Improving participation in Chlamydia screening programs: perspectives of high-risk youth. Arch Pediatr Adolesc Med. Jun 2003;157(6):523-9. [Medline].

  13. Blake DR, Lemay CA, Indurkhya A. Correlates of readiness to receive Chlamydia screening among 2 populations of youths. Arch Pediatr Adolesc Med. Nov 2007;161(11):1088-94. [Medline].

  14. CDC. Sexually transmitted diseases treatment guidelines, 2006. Centers for Disease Control and Prevention. MMWR Recomm Rep [serial online]. Aug 4 2006;55(RR-11):1-94. [Medline]. Available at http://www.cdc.gov/std/treatment/2006/rr5511.pdf.

  15. Chiaradonna C. The Chlamydia cascade: enhanced STD prevention strategies for adolescents. J Pediatr Adolesc Gynecol. Oct 2008;21(5):233-41. [Medline].

  16. Cusini M, Boneschi V, Arancio L, et al. Lymphogranuloma Venereum: the Italian experience. Sex Transm Infect. Nov 26 2008;[Medline].

  17. Darville T. Chlamydia trachomatis infections in neonates and young children. Semin Pediatr Infect Dis. Oct 2005;16(4):235-44. [Medline].

  18. Fisman DN, Spain CV, Salmon ME, Goldberg M. The Philadelphia High-School STD Screening Program: key insights from dynamic transmission modeling. Sex Transm Dis. Nov 2008;35(11 Suppl):S61-5. [Medline].

  19. Freeto JP, Jay MS. "What's really going on down there?" A practical approach to the adolescent who has gynecologic complaints. Pediatr Clin North Am. Jun 2006;53(3):529-45, viii. [Medline].

  20. Gambhir M, Basanez MG, Turner F, Kumaresan J, Grassly NC. Trachoma: transmission, infection, and control. Lancet Infect Dis. Jun 2007;7(6):420-7. [Medline].

  21. Gaydos CA. Nucleic acid amplification tests for gonorrhea and chlamydia: practice and applications. Infect Dis Clin North Am. Jun 2005;19(2):367-86, ix. [Medline].

  22. Geisler WM. Management of uncomplicated Chlamydia trachomatis infections in adolescents and adults: evidence reviewed for the 2006 Centers for Disease Control and Prevention sexually transmitted diseases treatment guidelines. Clin Infect Dis. Apr 1 2007;44 Suppl 3:S77-83. [Medline].

  23. Glasier A, Gulmezoglu AM, Schmid GP, et al. Sexual and reproductive health: a matter of life and death. Lancet. Nov 4 2006;368(9547):1595-607. [Medline].

  24. Haggerty CL, Ness RB. Newest approaches to treatment of pelvic inflammatory disease: a review of recent randomized clinical trials. Clin Infect Dis. Apr 1 2007;44(7):953-60. [Medline].

  25. Hammerschlag MR. Chlamydia trachomatis and Chlamydia pneumoniae infections in children and adolescents. Pediatr Rev. Feb 2004;25(2):43-51. [Medline].

  26. Heath PT. Epidemiology and bacteriology of bacterial pneumonias. Paediatr Respir Rev. Mar 2000;1(1):4-7. [Medline].

  27. Hughes G, Simms I, Leong G. Data from UK genitourinary medicine clinics, 2006: a mixed picture. Sex Transm Infect. Oct 2007;83(6):433-5. [Medline].

  28. Hwang L, Shafer MA. Chlamydia trachomatis infection in adolescents. Adv Pediatr. 2004;51:379-407. [Medline].

  29. Jalal H, Stephen H, Bibby DF, Sonnex C, Carne CA. Molecular epidemiology of genital human papillomavirus and Chlamydia trachomatis among patients attending a genitourinary medicine clinic - will vaccines protect?. Int J STD AIDS. Sep 2007;18(9):617-21. [Medline].

  30. Joesoef MR, Kahn RH, Weinstock HS. Sexually transmitted diseases in incarcerated adolescents. Curr Opin Infect Dis. Feb 2006;19(1):44-8. [Medline].

  31. Kelly P, Koh J. Sexually transmitted infections in alleged sexual abuse of children and adolescents. J Paediatr Child Health. Jul-Aug 2006;42(7-8):434-40. [Medline].

  32. Klovstad H, Aavitsland P. Chlamydia Trachomatis Infections in Norway, 1986 to 2006, Surveillance Data. Sex Transm Dis. Oct 10 2008;[Medline].

  33. Kohlberger P, Bancher-Todesca D. Bacterial colonization in suspected sexually abused children. J Pediatr Adolesc Gynecol. Oct 2007;20(5):289-92. [Medline].

  34. Kropp RY, Latham-Carmanico C, Steben M, Wong T, Duarte-Franco E. What's new in management of sexually transmitted infections? Canadian Guidelines on Sexually Transmitted Infections, 2006 Edition. Can Fam Physician. Oct 2007;53(10):1739-41. [Medline].

  35. Kucinskiene V, Sutaite I, Valiukeviciene S, et al. Prevalence and risk factors of genital Chlamydia trachomatis infection. Medicina (Kaunas). 2006;42(11):885-94. [Medline].

  36. Kumar S, Hammerschlag MR. Acute respiratory infection due to Chlamydia pneumoniae: current status of diagnostic methods. Clin Infect Dis. Feb 15 2007;44(4):568-76. [Medline].

  37. Lee S, Alemayehu W, Melese M, et al. Chlamydia on children and flies after mass antibiotic treatment for trachoma. Am J Trop Med Hyg. Jan 2007;76(1):129-31. [Medline].

  38. Lee SR, Chung JM, Kim YG. Rapid one step detection of pathogenic bacteria in urine with sexually transmitted disease (STD) and prostatitis patient by multiplex PCR assay (mPCR). J Microbiol. Oct 2007;45(5):453-9. [Medline].

  39. Majeroni BA, Ukkadam S. Screening and treatment for sexually transmitted infections in pregnancy. Am Fam Physician. Jul 15 2007;76(2):265-70. [Medline].

  40. Malik AI, Huppert JS. Interval to treatment of sexually transmitted infections in adolescent females. J Pediatr Adolesc Gynecol. Oct 2007;20(5):275-9. [Medline].

  41. Manhart LE, Golden MR, Marrazzo JM. Expanding the spectrum of pathogens in urethritis: implications for presumptive therapy?. Clin Infect Dis. Oct 1 2007;45(7):872-4. [Medline].

  42. Marrazzo JM, Martin DH. Management of women with cervicitis. Clin Infect Dis. Apr 1 2007;44 Suppl 3:S102-10. [Medline].

  43. McClean H, Carne C, Bunting P, et al. UK National Audit of chlamydial infection management in sexual health clinics. case notes audit: demography, diagnosis and treatment. Int J STD AIDS. Jul 2008;19(7):469-72. [Medline].

  44. McClean H, Carne C, Bunting P, et al. UK National Audit of chlamydial infection management in sexual health clinics. case notes audit: information-giving, partner notification and follow-up. Int J STD AIDS. Jul 2008;19(7):473-6. [Medline].

  45. McCormack WM. Pelvic inflammatory disease. N Engl J Med. Jan 13 1994;330(2):115-9. [Medline].

  46. Mecaskey JW, Knirsch CA, Kumaresan JA, Cook JA. The possibility of eliminating blinding trachoma. Lancet Infect Dis. Nov 2003;3(11):728-34. [Medline].

  47. Miller CA, Tebb KP, Williams JK, Neuhaus JM, Shafer MA. Chlamydial screening in urgent care visits: adolescent-reported acceptability associated with adolescent perception of clinician communication. Arch Pediatr Adolesc Med. Aug 2007;161(8):777-82. [Medline].

  48. Miller KE. Diagnosis and treatment of Chlamydia trachomatis infection. Am Fam Physician. Apr 15 2006;73(8):1411-6. [Medline].

  49. Miller WC, Zenilman JM. Epidemiology of chlamydial infection, gonorrhea, and trichomoniasis in the United States--2005. Infect Dis Clin North Am. Jun 2005;19(2):281-96. [Medline].

  50. Mollen CJ, Pletcher JR, Bellah RD, Lavelle JM. Prevalence of tubo-ovarian abscess in adolescents diagnosed with pelvic inflammatory disease in a pediatric emergency department. Pediatr Emerg Care. Sep 2006;22(9):621-5. [Medline].

  51. Olshen E, Shrier LA. Diagnostic tests for chlamydial and gonorrheal infections. Semin Pediatr Infect Dis. Jul 2005;16(3):192-8. [Medline].

  52. Peeling RW, Mabey D, Herring A, Hook EW 3rd. Why do we need quality-assured diagnostic tests for sexually transmitted infections?. Nat Rev Microbiol. Dec 2006;4(12):909-21. [Medline].

  53. Richardus JH, Gotz HM. Risk selection and targeted interventions in community-based control of chlamydia. Curr Opin Infect Dis. Feb 2007;20(1):60-5. [Medline].

  54. Risser WL, Bortot AT, Benjamins LJ, et al. The epidemiology of sexually transmitted infections in adolescents. Semin Pediatr Infect Dis. Jul 2005;16(3):160-7. [Medline].

  55. Rours IG, Hammerschlag MR, Ott A, De Faber TJ, Verbrugh HA, de Groot R. Chlamydia trachomatis as a cause of neonatal conjunctivitis in Dutch infants. Pediatrics. Feb 2008;121(2):e321-6. [Medline].

  56. Schaeffer A, Henrich B. Rapid detection of Chlamydia trachomatis and typing of the Lymphogranuloma venereum associated L-Serovars by TaqMan PCR. BMC Infect Dis. Apr 30 2008;8:56. [Medline].

  57. Skinner SR, Parsons A, Kang M, Williams H, Fairley C. Sexually transmitted infections. Initiatives for prevention. Int J Adolesc Med Health. Jul-Sep 2007;19(3):285-94. [Medline].

  58. Summaries for patients. Gonorrhea and chlamydia in the United States among persons 14 to 39 years of age. Ann Intern Med. Jul 17 2007;147(2):I22. [Medline].

  59. Summaries for patients. Screening for chlamydial infection: recommendations from the U.S. Preventive Services Task Force. Ann Intern Med. Jul 17 2007;147(2):I44. [Medline].

  60. Walker CK, Wiesenfeld HC. Antibiotic therapy for acute pelvic inflammatory disease: the 2006 Centers for Disease Control and Prevention sexually transmitted diseases treatment guidelines. Clin Infect Dis. Apr 1 2007;44 Suppl 3:S111-22. [Medline].

  61. Waugh M. Sexually transmitted infections-microbial infections, 2007 update. Skinmed. Sep-Oct 2007;6(5):242-4. [Medline].

  62. Webley WC, Tilahun Y, Lay K, et al. Rate of Chlamydia trachomatis and Chlamydia pneumoniae in paediatric respiratory infections. Eur Respir J. Nov 14 2008;[Medline].

  63. Wright HR, Taylor HR. Clinical examination and laboratory tests for estimation of trachoma prevalence in a remote setting: what are they really telling us?. Lancet Infect Dis. May 2005;5(5):313-20. [Medline].

  64. Wright HR, Turner A, Taylor HR. Trachoma. Lancet. Jun 7 2008;371(9628):1945-54. [Medline].

  65. Zar HJ. Neonatal chlamydial infections: prevention and treatment. Paediatr Drugs. 2005;7(2):103-10. [Medline].

  66. Centers for Disease Control and Prevention. Chlamydia screening among sexually active young females enrollees of health plans - United States, 2000-2007. MMWR Weekly. April 17, 2009;58(14):362-365. [Full Text].

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Further Reading

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Keywords

chlamydial infection, chlamydia, bronchitis, conjunctivitis, dyspareunia, dysuria, ectopic pregnancy, epididymitis, Fitz-Hugh-Curtis syndrome, lymphogranuloma venereum, LGV, pelvic inflammatory disease, PID, pharyngitis, pneumonia, pneumonitis, proctitis, salpingitis, sexually transmitted disease, STD, sexually transmitted infection, STI, trachoma, tuboovarian abscess, upper genital tract disease, urethritis, urinary tract infection, UTI, cervicitis, C hlamydia, Chlamydia trachomatis, C trachomatis

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Contributor Information and Disclosures

Author

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; sanofi pasteur Honoraria Speaking and teaching

Coauthor(s)

Marc James Grella, MD, Clinical Instructor, Department of Pediatrics, Massachusetts General Hospital
Marc James Grella, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Medical Association, and Massachusetts Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Ashir Kumar, MBBS, MD, FAAP, Professor, Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University; Consulting Staff, Department of Pediatrics, EW Sparrow Hospital
Ashir Kumar, MBBS, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association of Physicians of Indian Origin, American Federation for Clinical Research, American Society for Microbiology, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Mark R Schleiss, MD, American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota School of Medicine
Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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