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  • Writer's pictureShruti GOCHHWAL


Chlamydiae are small obligate intracellular(can reproduce only inside the cells) microorganisms that preferentially infect squamocolumnar cells(a type of cells found in the body). They include the genera Chlamydia(Chlamydia trachomatis) and Chlamydophila(Chlamydophila pneumoniae and Chlamydophila psittaci).

Chlamydia trachomatis is responsible for causing multiple infections like-

  1. Trachoma- Serious eye disease endemic in Africa and Asia characterized by chronic conjunctivitis which can lead to blindness.

  2. Genital tract infections

  3. Lymphogranuloma venereum is associated with genital ulcer disease in tropical countries.

Chlamydia infects the squamocolumnar junction in the ectocervix found in young sexually active females. It invokes the production of antibodies in the form of IgA, IgM, and IgG. Chlamydiae has a life cycle adaptive to both intracellular and extracellular environments but can reproduce only in the intracellular environment as it requires the energy of the host cell(ATP) to do so.

The bacterium usually spreads through the sexual route thus called STD. An infected male has a 25% chance per sexual encounter of transmitting the infection to an uninfected female. The transmission rate from mother to newborn is about 50-60% primarily causing conjunctivitis. The incubation period of the disease is 1-3 weeks. Around 50% of infected males and 80% of infected females are asymptomatic. Among the symptomatic ones most commonly seen include mucopurulent cervicitis in females and urethritis in males and rarely Pelvic inflammatory disease in females and epididymitis in males. The co-infection of chlamydia and gonorrhea is most common.

Specific risk factors seen for chlamydial infection include-

  1. Multiple sexual partners history

  2. Age 15-24 years

  3. Poor socioeconomic conditions

  4. History of previous STD


Keys to the management of chlamydial infection include-

  1. Arriving at a correct diagnosis

  2. Ensuring patient compliance

Undiagnosed chlamydia can progress to pelvic inflammatory diseases which may lead to relative or absolute infertility. Many times STDs are misdiagnosed as a case of Urinary tract infection and only later understood therefore safeguarding, and additional testing against this is required.

Adolescents are at high risk for non-compliance with treatment especially if the patient is attempting to keep information away from parents. Single-dose, in-office treatment is being used to improve compliance and confidentiality. Partner treatment is crucial for the prevention of reinfection.


Chlamydiae are susceptible to antibiotics that interfere with DNA and protein synthesis that include tetracyclines, macrolides, and quinolones. CDC recommends azithromycin and doxycycline as first-line drugs for the treatment of chlamydial infection. Medical treatment with these agents is 95% effective. Alternative agents include erythromycin, levofloxacin, and ofloxacin.

Treatment for uncomplicated genital tract infection has been doxycycline 100 mg orally twice daily for 7 days. However, high single-dose azithromycin is equally effective, keeping in mind that the FDA had released a warning in 2013 against azithromycin notorious for causing potentially life-threatening arrhythmias. Therefore patients with known QT interval abnormality on ECG should take doxycycline instead.

Treatment for upper genital tract complications must be vigorously sought out because of potential complications. Inadequately treated PID can lead to sepsis, infertility, and chronic pelvic pain. Management of PID should always be three-pronged and directed against C trachomatis, N gonorrhoeae, and anaerobic bacteria. It is divided into 2 categories

  1. Outpatient PID- Initial single-dose intramuscular therapy with a second or third-generation cephalosporin plus 14 days of doxycycline with or without metronidazole twice daily for 14 days

  2. Inpatient PID- Iv infused cephalosporin along with a 14-day course of doxycycline.

Treatment is also indicated for sexual partners of the index case if the time of the last sexual encounter was within 60 days of onset and it should be considered for longer periods for the last sexual partner.


Follow-up culture is not recommended after azithromycin or doxycycline therapy but retesting is recommended at 3 months after therapy because of the high risk of reinfection in women and men. Patients should abstain from sexual intercourse till completion of their and their partner’s treatment.

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