Chlamydia trachomatis - Clinical manifestation, Trachoma, LGV, Conjunctivitis, Pneumonia, NGU, Transmission

Clinical Manifestation of Chlamydia trachomatis

The clinical manifestations of Chlamydia trachomatis include:

1. Trachoma

2. Lymphogranuloma venereum (LGV)

3. Ocular LGV

4. Acute inclusion conjunctivitis

5. Neonatal conjunctivitis

6. Infant pneumonia

7. Urogenital infection

8. Non-Gonococcal Urethritis (NGU)

The clinical syndromes of Chlamydia trachomatis along the route of transmission are listed in the table below.

Trachoma

Trachoma, caused by Chlamydia trachomatis, is a communicable disease caused by serovars A, B, Ba, and C. It is acquired by contact with infected secretions on towels or fingers or by flies. Early symptoms include irritation and itching of eyes and eyelids and discharge.

The infection progresses slowly with increased eye pain, blurred vision, and photophobia. Repeated infection results in scarring of inner eyelids (eyelids turn in toward the eye-entropion followed by eyelashes-trichiasis). This results in scratching and rubbing of the cornea.

The combined effect of damage to the cornea, and inflammation results in ulceration, scarring, and loss of vision (complication).

Lymphogranuloma venereum (LGV)

STI caused by Chlamydia trachomatis serovars L1, L2, L2b, L3. It affects the cervix, urethra, salpinges, and epididymis and is called lymphogranuloma venereum (LGV). The incubation period varies from 1-4 weeks.

Symptoms of LGV

Primary stage

• the brief appearance of a small, painless papule/ulcerative lesion on external genitalia or site of infection. In females, the fourchette, and cervix may also be infected and in males, the penis may be infected. The rectum may be infected in homosexuals.

• the absence of pain in ulcers differentiates them from painful ulcers in HSV and syphilis.

Secondary stage

• acute lymphadenitis

• In males, inguinal lymph nodes are enlarged (swollen), matted (fused) together, fluctuant (lymph nodes are filled with pus), and fixed to the skin forming a large area of groin swelling called a bubo.

• In females, intrapelvic and pararectal lymph nodes are swollen. During this stage, the infection may become systemic causing fever, chills, and joint pain, or may spread locally causing granulomatous proctitis.

• Anorexia, headache, and myalgia are other manifestations

Tertiary/chronic stage

• occurs more in women than men

• results in:

  • general hyperplasia (a congenital condition where adrenal gland hormone production)

  • rectogenital fistulae (abnormal connection)

  • rectal stricture

  • draining sinuses

  • genital elephantiasis

  • strictures (abnormal narrowing of a body passage)

Ocular LGV

Ocular LGV, caused by Chlamydia trachomatis, results in Pasiraud’s oculogenital conjunctivitis. It is characterized by inflammation of the conjunctiva associated with periauricular, submandibular, and cervical lymphadenopathy.

Acute inclusion conjunctivitis

Acute inclusion conjunctivitis occurs in both sexually active adults and newborns. It results from infection with Chlamydia trachomatis strains associated with genital infection (a, B, Ba, and D-K).

Infection is acquired from contaminated genital secretions that get into the eyes via fingers, during birth, in swimming pools and hot tubs (which are poorly chlorinated) sharing eye makeup, etc.

It does not lead to blindness in adults or newborns. Clinical manifestations include:

• swollen eyes

• purulent discharge

• hyperemia (an increase in blood flow to tissue)

• papillary hypertrophy

• follicular conjunctivitis

• uniocular and biocular red eye-make

If left untreated, the disease may progress to keratitis and iritis.

Neonatal conjunctivitis

Neonatal conjunctivitis is a neonatal form of inclusion conjunctivitis caused by Chlamydia trachomatis. They acquire infection from the infected birth canal. The incubation period is around 5-12 days. Clinical syndromes include:

• swelling of the infant's eyelids

• hyperemia

• purulent discharge

If left untreated, it can lead to conjunctival scarring and corneal vascularization.

Infant pneumonia

Infant pneumonia, with the causative agent as Chlamydia trachomatis_, is seen in infants between 4-16 weeks of age. It is the most common cause of pneumonia in newborns. The incubation period is around 2-3 weeks after birth.

The defining characteristics include rhinitis with cough and wheezing. Perinatally acquired infection may persist in the nasopharynx, urogenital tract, or rectum for more than two years.

Urogenital infection

Among patients with urogenital infection, 80% of females and 50% of males are asymptomatic and serve as large reservoirs. If symptoms present then unusual discharge and pain or burning sensation. Chlamydia trachomatis causes:

• urethritis (non-gonococcal)

• cervicitis

• artholinitis

• proctitis

• salpingitis (infection of the fallopian tube)

• epididymitis

• acute urethral syndrome

• endometritis

Ascending infection can result in PID, chronic pelvic pain, and pyelonephritis, and serotype C may develop cervical cancer (6-5 times risk high).

PID can cause infertility and ectopic pregnancies. In a single episode, 10% of women become infertile because of tubal occlusion. Risk increases with each additional episode.

Non-Gonococcal Urethritis (NGU)

The incubation period of Non-Gonococcal Urethritis (NGU) is around 7-14 days. The symptoms of the disease caused by Chlamydia trachomatis include:

• dysuria

• mid-cycle bleeding

• irritation of urethra

• mucopurulent discharge

• inflammation of urethra

In females, the disease may progress to PID.