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 Manifestations

• Presentation varies by serovar

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

Urethritis

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

Fitz-Hugh-Curtis syndrome

• Liver capsular inflammation, possibly autoimmune

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