Spectrum of Disease

As previously mentioned, infection with C. trachomatis can lead to several different clinical syndromes. These infections are summarized in Table 46-2.

Trachoma. Trachoma is manifested by a chronic inflammation of the conjunctiva and remains a major cause of preventable blindness worldwide. As the infection progresses, the conjunctiva becomes scarred, which causes distortion of the eyelids such that the eyelashes become misdirected and turn in. The eyelashes then mechanically damage the cornea, resulting in ulceration, scarring, and visual loss.

Lymphogranuloma Venereum. Lymphogranuloma venereum (LGV) is a sexually transmitted disease that is unusual in Europe and North America but relatively frequent in Africa, Asia, and South America, The disease is characterized by a primary genital lesion at the initial infection site, which lasts a short time. This lesion is often small and may be unrecognized, especially bj female patients. The second stage, acute lymphadenitis, often involves the inguinal lymph nodes, causing thefr? to enlarge and become matted together, forming a largg area of groin swelling, or bubo. During this stage, infection may become systemic and cause fever or may spread locally, causing granulomatous proctitis. In a few patients (more women than men), the disease pron gresses to a chronic third stage, causing the development of genital hyperplasia, rectal fistulas, rectal stricture, draining sinuses, and other manifestations.

Diagnosis of LGV is established by the isolation of an LGV strain from a bubo or other infected site. However, organism recovery rates of only 24% to 30?L are reported. An intradermal skin test of LGV antigen, . Frei's test, lacks sensitivity in early LGV and lads specificity later, because Frei's antigen is only a genus*! specific antigen. Moreover, the Frei's test can remain positive for many years, limiting its usefulness.

Oculogenital Infections. C. trachomatis can cause an acute inclusion conjunctivitis in adults. These infections are associated with a purulent discharge. In contrast to trachoma, inclusion conjunctivitis does not lead to blindness in adults (or newborns).

C. trachomatis infections have surpassed gonococcal* infections as a cause of sexually transmitted disease in the United States. Similar to gonococci, C. trachomatis is a^ cause of urethritis, cervicitis, bartholinitis, proctitis, salpingitis, epididymitis, and acute urethral syndrome in women. In the United States, 60% of cases of nongonococcal urethritis are caused by chlamydiae. Both chlamydiae and gonococci are m^jor causes of PID, contributing significandy to the rising rate of infertility and ectopic pregnancies in young women. After only one episode of PID, as many as 10% of women may become infertile because of tubal occlusion. The risk increases drama*! tically with each additional episode.

Many genital chlamydial infections in both sexes are asymptomatic or not easily recognized by clinical criteria; asymptomatic carriage in both men and women may persist, often for months. As many as 25% of men and 70% to 80% of women identified as having chlamydial genital tract infections have no symptoms. Of „Significance, these asymptomatic infected individuals serve as a large reservoir to sustain transmission within a community.

Perinatal Infections. Approximately one fourth to half of infants born to women infected with C. trachomatis develop inclusion conjunctivitis. Usually, the incubation period is 5 to 12 days from birth, but may be as late as 6 weeks. Although most develop inclusion conjunctivitis, about 10% to 20% of infants develop pneumonia. Of significance, perinatally acquired C. -—trachomatis infection may persist in the nasopharynx, urogenital tract, or rectum for more than 2 years.

Bacterial Vaginosis Facts

Bacterial Vaginosis Facts

This fact sheet is designed to provide you with information on Bacterial Vaginosis. Bacterial vaginosis is an abnormal vaginal condition that is characterized by vaginal discharge and results from an overgrowth of atypical bacteria in the vagina.

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