Chlamydia trachomatis

Microbiology

• Small, obligate intracellular Gram-negative coccobacillus
  • Very difficult to Gram stain due to lack of peptidoglycan in cell wall
• Two forms exist:
  • Elementary body (EB): spore-like form than can survive short times outside the body
  • Reticulate body (RB): replicative form
• Virulence factors include lipopolysaccharide (LPS)

Clinical Presentations

• Presentation varies by serovar

Syndrome	Serovars
Urethritis, PID, neonatal infection	D to K
Trachoma (chronic conjunctivitis)	A to C
Lymphogranuloma venereum (LGV)	L1 to L3

Urethritis

• In men, most are symptomatic
  • Incubation or 7 to 21 days in men
  • Purulent urethritis
• In women, often asymptomatic

Fitz-Hugh-Curtis syndrome

• Inflammatory ?autoimmune liver capsular inflammation

Diagnosis

• Urine NAAT ~80% sensitive
• Self-collected vaginal swab better
• MD-collected cervical swab best (90+%)
• No more serology!

Management

• For serovars L1-L3 (LGV): treat for 21 days
• In pregnant women, azithromycin is best