Consult the medical resource doctors trust

UpToDate is one of the most respected evidence-based medical information resources in the world, used by over 400,000 doctors and thousands of patients to find answers to medical questions.

  • Content written by a faculty of over 4,000 physicians from leading medical institutions
  • Unbiased: free of advertising or pharmaceutical funding
  • Evidence-based treatment recommendations
  • Continuously updated to incorporate new medical findings

Related articles

Genital Chlamydia trachomatis infections in women

INTRODUCTION

Chlamydia trachomatis is the most common bacterial agent of sexually transmitted genital infections. A significant proportion of patients are asymptomatic, thereby providing an ongoing reservoir for infection. In infants born to mothers through an infected birth canal, conjunctivitis and pneumonia can occur. These syndromes are caused by the C. trachomatis serovars B and D through K. The L serovars cause lymphogranuloma venereum, a genital ulcer syndrome. (See "Lymphogranuloma venereum".)

The microbiology, pathophysiology, epidemiology and clinical genital C. trachomatis infections in women, including during pregnancy, will be reviewed here. Pelvic inflammatory disease, lymphogranuloma venereum, genital chlamydia infections in men, and endemic trachoma, an ocular infection caused by serovars A to C that is spread by direct contact and seen commonly in the developing world, are discussed separately. (See "Clinical features and diagnosis of pelvic inflammatory disease" and "Lymphogranuloma venereum" and "Genital Chlamydia trachomatis infections in men" and "Epidemiology, diagnosis, and management of trachoma".)

MICROBIOLOGY

C. trachomatis is a small gram-negative bacterium with unique biologic properties that distinguish it from all other living organisms. It is an obligate intracellular parasite that has a distinct life-cycle that consists of two major phases:

  • The small elementary bodies attach and penetrate into cells, changing into the metabolically active form, called the reticulate body, within six to eight hours (picture 1). These forms create large inclusions within cells.
  • The reticulate bodies then reorganize into small elementary bodies, and within two to three days the cell ruptures, releasing newly formed elementary bodies. Release of the elementary bodies initiates the replicative process, since this is the form which can infect new epithelial cells. The long growth cycle explains why prolonged courses of treatment are necessary.

Chlamydia cannot be cultured on artificial media; traditionally tissue culture has been required to established a diagnosis. Rapid and inexpensive screening tests are now available. (See "Screening for Chlamydia trachomatis".)

» To continue reading this article you need to login or subscribe.

Ready to join over 400,000 satisfied users? Subscribe to read this article and others like it.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use (click here) ©2010 UpToDate, Inc.
References
Top
  1. Debattista, J, Timms, P, Allan, J, Allan, J. Immunopathogenesis of chlamydia trachomatis infections in women. Fertil Steril 2003; 79:1273.
  2. Lampe, MF, Wong, KG, Stamm, WE. Sequence conservation in the major outer membrane protein gene among Chlamydia trachomatis strains isolated from the upper and lower urogenital tract. J Infect Dis 1995; 172:589.
  3. Stothard, DR, Boguslawski, G, Jones, RB. Phylogenetic analysis of the Chlamydia trachomatis major outer membrane protein and examination of potential pathogenic determinants. Infect Immun 1998; 66:3618.
  4. Pal, S, Barnhart, KM, Wei, Q, et al. Vaccination of mice with DNA plasmids coding for the Chlamydia trachomatis major outer membrane protein elicits an immune response but fails to protect against a genital challenge. Vaccine 1999; 17:459.
  5. Su, H, Raymond, L, Rockey, DD, et al. A recombinant Chlamydia trachomatis major outer membrane protein binds to heparan sulfate receptors on epithelial cells. Proc Natl Acad Sci U S A 1996; 93:11143.
  6. Rund, S, Lindner, B, Brade, H, Holst, O. Structural analysis of the lipopolysaccharide from Chlamydia trachomatis serotype L2. J Biol Chem 1999; 274:16819.
  7. Ingalls, RR, Rice, PA, Qureshi, N, et al. The inflammatory cytokine response to Chlamydia trachomatis infection is endotoxin mediated. Infect Immun 1995; 63:3125.
  8. Wyrick, PB, Knight, ST, Paul, TR, et al. Persistent chlamydial envelope antigens in antibiotic-exposed infected cells trigger neutrophil chemotaxis. J Infect Dis 1999; 179:954.
  9. Ito, JI, Lyons, JM. Role of gamma interferon in controlling murine chlamydial genital tract infection. Infect Immun 1999; 67:5518.
  10. Igietseme, JU, Ananaba, GA, Bolier, J, et al. The intercellular adhesion molecule type-1 is required for rapid activation of T helper type 1 lymphocytes that control early acute phase of genital chlamydial infection in mice. Immunology 1999; 98:510.
  11. Persson, K, Osser, S, Birkelund, S, et al. Antibodies to Chlamydia trachomatis heat shock proteins in women with tubal factor infertility are associated with prior infection by C. trachomatis but not by C. pneumoniae. Hum Reprod 1999; 14:1969.
  12. Peterson, EM, Cheng, X, Motin, VL, de la, Maza LM. Effect of immunoglobulin G isotype on the infectivity of Chlamydia trachomatis in a mouse model of intravaginal infection. Infect Immun 1997; 65:2693.
  13. LaVerda, D, Albanese, LN, Ruther, PE, et al. Seroreactivity to Chlamydia trachomatis Hsp10 correlates with severity of human genital tract disease. Infect Immun 2000; 68:303.
  14. Su, H, Morrison, R, Messer, R, et al. The effect of doxycycline treatment on the development of protective immunity in a murine model of chlamydial genital infection. J Infect Dis 1999; 180:1252.
  15. Webster, LA, Greenspan, JR, Nakashima, AK, Johnson, RE. An evaluation of surveillance for Chlamydia trachomatis infections in the United States,1987-1991. MMWR Morb Mortal Wkly Rep 1993; 42 (SS-3):21.
  16. Centers for Disease Control, Division of Sexually Transmitted Diseases. 1997 Annual Report.
  17. Quinn, TC, Zenilman, J, Rompalo, A. Sexually transmitted diseases: advances in diagnosis and treatment. Adv Intern Med 1994; 39:149.
  18. Alexander, LA, Cates, JR, Herndon, N, Ratcliff, JM. Sexually Transmitted Diseases in America. Kaiser Family Foundation, Menlo Park, CA. December 1998.
  19. Miller, WC. Prevalence of chlamydial and gonococcal infections among young adults in the United States. JAMA 2004; 291:2229.
  20. Chlamydia trachomatis genital infections--United States, 1995. MMWR Morb Mortal Wkly Rep 1997; 46:193.
  21. Gaydos, CA, Howell, MR, Pare, B, et al. Chlamydia trachomatis infections in female military recruits. N Engl J Med 1998; 339:739.
  22. Cook, RL, St. George, K, Lassak, M, et al. Screening for Chlamydia trachomatis infection in college women with a polymerase chain reaction assay. Clin Infect Dis 1999; 28:1002.
  23. Burstein, GR, Waterfield, G, Joffe, A, et al. Screening for gonorrhea and chlamydia by DNA amplification in adolescents attending middle school health centers. Opportunity for early intervention. Sex Transm Dis 1998; 25:395.
  24. Neu, NM, Grumet, S, Saiman, L, et al. Genital chlamydial disease in an urban, primarily Hispanic, family planning clinic. Sex Transm Dis 1998; 25:317.
  25. Datta, S, Sternberg, M, Johnson, R, et al. Gonorrhea and Chlamydia in the United States among persons 14 to 39 years of age, 1999 to 2002. Ann Intern Med 2007; 147:89.
  26. Sturm-Ramirez, K, Brumblay, H, Diop, K, et al. Molecular epidemiology of genital Chlamydia trachomatis infection in high-risk women in Senegal, West Africa. J Clin Microbiol 2000; 38:138.
  27. Kilmarx, PH, Black, CM, Limpakarnjanarat, K, et al. Rapid assessment of sexually transmitted diseases in a sentinel population in Thailand: prevalence of chlamydial infection, gonorrhoea, and syphilis among pregnant women--1996. Sex Transm Infect 1998; 74:189.
  28. Warszawski, J, Meyer, L, Weber, P. Criteria for selective screening of cervical Chlamydia trachomatis infection in women attending private gynecology practices. Eur J Obstet Gynecol Reprod Biol 1999; 86:5.
  29. Parish, WL, Laumann, EO, Cohen, MS, et al. Population-based study of chlamydial infection in china: a hidden epidemic. JAMA 2003; 289:1265.
  30. Stamm, WE, Koutsky, LA, Benedetti, JK, et al. Chlamydia trachomatis urethral infections in men. Prevalence, risk factors, and clinical manifestations. Ann Intern Med 1984; 100:47.
  31. Immunization of health-care workers: recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR Recomm Rep 1997; 46:1.
  32. Recommendations for the prevention and management of Chlamydia trachomatis infections, 1993. Centers for Disease Control and Prevention. MMWR Recomm Rep 1993; 42:1.
  33. Phillips, RS, Hanff, PA, Holmes, MD, et al. Chlamydia trachomatis cervical infection in women seeking routine gynecologic: Criteria for selected testing. Am J Med 1989; 86:515.
  34. Stamm, WE, Mardh, PA. Chlamydia trachomatis. In: Sexually transmitted diseases, Holmes, KK, Mardh, PA, Sparling, PF, Wiesner, PJ (Eds), 2nd ed. McGraw-Hill, New York; 1990:917.
  35. Stergachis, A, Scholes, D, Heidrich, FE, et al. Selective screening for Chlamydia trachomatis infection in a primary care population of women. Am J Epidemiol 1993; 138:143.
  36. Lin, JS, Donegan, SP, Heeren, TC, et al. Transmission of Chlamydia trachomatis and Neisseria gonorrhoeae among men with urethritis and their female sex partners. J Infect Dis 1998; 178:1707.
  37. Vogels, WH, van Voorst Vader, PC, Schroder, FP. Chlamydia trachomatis infection in a high-risk population: Comparison of polymerase chain reaction and cell culture for diagnosis and follow-up. J Clin Microbiol 1993; 31:1103.
  38. Burstein, GR, Gaydos, CA, Diener-West, M, et al. Incident Chlamydia trachomtis infections among inner-city adolescent females. JAMA 1998; 280:521.
  39. Laga, M, Manoka, A, Kivuvu, M, Malele, B. Non-ulcerative sexually transmitted diseases as risk factors for HIV-1 transmission in women: results from a cohort study. AIDS 1993; 7:95.
  40. Kilmarx, PH, Limpakarnjanarat, K, Mastro, TD, et al. HIV-1 seroconversion in a prospective study of female sex workers in northern Thailand: Continued high incidence among brothel-based women. AIDS 1998; 12:1889.
  41. Geisler, WM, Wang, C, Morrison, SG, et al. The Natural History of Untreated Chlamydia trachomatis Infection in the Interval Between Screening and Returning for Treatment. Sex Transm Dis 2008; 35:119.
  42. Stamm, WE, Holmes, KK. Chlamydia trachomatis infections of the adult. In: Sexually Transmitted Diseases (2nd ed), Holmes KK, Mardh, PA, Sparling, PF, et al (Eds), McGraw-Hill Inc, New York 1990. p.181.
  43. McCormack, WM, Rosner, B, McComb, DE, et al. Infection with Chlamydia trachomatis in female college students. Am J Epidemiol 1985; 121:107.
  44. Johnson, BA, Poses, RM, Fortner, CA, et al. Derivation and validation of a clinical diagnostic model for chlamydial cervical infection in university women. JAMA 1990; 264:3161.
  45. Jacobson, DL, Peralta, L, Graham, NM, Zenilman, J. Histologic development of cervical ectopy: relationship to reproductive hormones. Sex Transm Dis 2000; 27:252.
  46. Anttila, T, Saikku, P, Koskela, P, et al. Serotypes of Chlamydia trachomatis and risk for development of cervical squamous cell carcinoma. JAMA 2001; 285:47.
  47. Cates, W Jr, Wasserheit, JN. Genital chlamydial infections: epidemiology and reproductive sequelae. Am J Obstet Gynecol 1991; 164:1771.
  48. Tubal infertility: serologic relationship to past chlamydial and gonococcal infection. World Health Organization Task Force on the Prevention and Management of Infertility. Sex Transm Dis 1995; 22:71.
  49. Cook, RL, Hutchison, SL, Ostergaard, L, et al. Systematic review: noninvasive testing for Chlamydia trachomatis and Neisseria gonorrhoeae. Ann Intern Med 2005; 142:914.
  50. Quinn, TC, Welsh, L, Lentz, A, et al. Diagnosis by AMPLICOR PCR of Chlamydia trachomatis infection in urine samples from women and men attending sexually transmitted disease clinics. J Clin Microbiol 1996; 34:1401.
  51. Jespersen, DJ, Flatten, KS, Jones, MF, Smith, TF. Prospective comparison of cell cultures and nucleic acid amplification tests for laboratory diagnosis of Chlamydia trachomatis Infections. J Clin Microbiol 2005; 43:5324.
  52. Workowski, KA, Berman, SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep 2006; 55:1.
  53. LaMontagne, DS, Fenton, KA, Randall, S, et al. Establishing the National Chlamydia Screening Programme in England: results from the first full year of screening. Sex Transm Infect 2004; 80:335.
  54. Greer, L, Wendel, GD Jr. Rapid diagnostic methods in sexually transmitted infections. Infect Dis Clin North Am 2008; 22:601.
  55. Mahilum-Tapay, L. New point of care Chlamydia Rapid Test--bridging the gap between diagnosis and treatment: performance evaluation study. BMJ 2007; 335:1190.
  56. Sabido, M, Hernandez, G, Gonzalez, V, et al. Clinic-based evaluation of a rapid point-of-care test for detection of Chlamydia trachomatis in specimens from sex workers in Escuintla, Guatemala. J Clin Microbiol 2009; 47:475.
  57. Addiss, DG, Vaughn, ML, Ludka, D, et al. Decreased prevalence of Chlamydia trachomatis infection associated with a selective screening program in family planning clinics in Wisconsin. Sex Transm Dis 1993; 20:28.
  58. Scholes, D, Stergachis, A, Heidrich, FE, et al. Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection. N Engl J Med 1996; 334:1362.
  59. Howell, MR, Quinn, TC, Gaydos, CA. Screening for Chlamydia trachomatis in asymptomatic women attending family planning clinics. A cost-effectiveness analysis of three strategies. Ann Intern Med 1998; 128:277.
  60. Rosenbaum, S. Negotiating the new health system: purchasing publicly accountable managed care. Am J Prev Med 1998; 14:67.
  61. Miller, WC. Screening for chlamydial infection: are we doing enough?. Lancet 2005; 365:456.
  62. Drugs for sexually transmitted infections. Treat Guidel Med Lett 2007; 5:81.
  63. Foglia, G, Rhodes, P, Goldberg, M, St Louis, ME. Completeness of and duration of time before treatment after screening women for Chlamydia trachomatis infections. Sex Transm Dis 1999; 26:421.
  64. Drugs for sexually transmitted infections. Treat Guidel Med Lett 2004; 2:67.
  65. Lau, CY, Qureshi, AK. Azithromycin versus doxycycline for genital chlamydial infections: a meta-analysis of randomized clinical trials. Sex Transm Dis 2002; 29:497.
  66. Wang, SA, Papp, JR, Stamm, WE, et al. Evaluation of antimicrobial resistance and treatment failures for Chlamydia trachomatis: a meeting report. J Infect Dis 2005; 191:917.
  67. Erbelding, EJ, Zenilman, JM. Toward better control of sexually transmitted diseases. N Engl J Med 2005; 352:720.
  68. Golden, MR, Whittington, WL, Handsfield, HH, et al. Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection. N Engl J Med 2005; 352:676.
  69. Khan, A, Fortenberry, JD, Juliar, BE, et al. The prevalence of chlamydia, gonorrhea, and trichomonas in sexual partnerships: implications for partner notification and treatment. Sex Transm Dis 2005; 32:260.
Genital Chlamydia trachomatis infections in women