CHLAMYDIA TRACHOMATIS INFECTIONChlamydia trachomatis is primarily an asymptomatic infection and disease process known to contribute to widespread community transmission among unsuspecting sexual partners. Improved testing technologies in recent years have helped elucidate that the previously believed disparity between asymptomatic infection in males and females does not really exist. Males and females both have very high rates of chlamydial infections.
Among female populations screened in Florida as many as 80-85% and among males 70- 75% are asymptomatic when infected . Nationally, the reported asymptomatic rate ranges from 50-75% . Following exposure and infection, symptoms may begin within 1 to 2 weeks. Females generally present with cervicitis however urethritis is also common. Asymptomatic infection of the rectum or urethra may accompany symptomatic infection of the cervix up to 50% of the time Many women will have only mild symptoms of vaginal discharge, spotting, lower abdominal pain, or dysuria.
Infection may also present as salpingitis, endometritis, peritonitis, Bartholinitis, perihepatitis, pharyngitis, and reactive arthritis. Adults, like infants, can present with conjunctivitis and cases of myocarditis have been reported . The natural history of the infection in a nonpregnant woman is one initially of cervicitis, with ascent to cause salpingitis, sometimes having first caused endometritis en route.
Without treatment, one-fourth to one-half of women with chlamydia will go on to develop pelvic inflammatory disease (PID), involving inflammation of the endometrium, fallopian tube(s), and potential involvement of the peritoneum. Rates of identification of Chlamydia trachomatis by culture, antigen, or serology in cases of salpingitis and PID range from 5 to 55% depending on the clinic setting, geographic she, type technology and country ). The leading hypothesis for PID pathogenesis is that endometrial and Chlamydia trachomatis and Neisseria gonorrhoeae initiate tubal infection. Then secondary groups of anaerobic and aerobic bacteria may invade to contribute to the inflammatory disease process .
CHLAMYDIA INFECTION DIAGNOSISReported recovery from women examined by laparoscopy has ranged from 10% to 80%, with secondary bacteria recovered much less frequently. More often in clinically milder or "silent PID," chlamydia is recovered or there is immunologic evidence of recent infection with Chlamydia trachomatis . Tubal scarring and development of tubal infertility follow the acute or silent PID. This same scarring can set the stage for later life threatening ectopic pregnancy events. Moore and Cates (1990) suggest that infertility may follow either acute or clinically detected PID and silent salpingitis. They and others provide ample evidence to suggest that the majority of tubal factor infertility follows events of silent salpingitis, in women who report no history of PID but demonstrate serologic evidence of prior chlamydial infection .
In contrast the Womer-Hanssen (1995) in- depth study using laproscopy and questionnaires suggests that 'silent' PID is secondary to the failure of the medical community to elicit more complete information from a patient regarding their menstrual history, abdominal pain, and episodes of infection.
Studies conducted among pregnant women have identified rates of less than 6% to close to 33% infected depending on the age, clinic setting, and area of residence. Allaire and others found a rate of 14.8% among a high-risk indigent obstetric population using both rNA hybridization and enzyme immunoassay