Chlamydia

young couple in bed, being intimateChlamydia (“kla-MID-ee-uh”) is a curable sexually transmitted infection
(STI), which is caused by bacteria called Chlamydia trachomatis. You
can get genital chlamydial infection during oral, vaginal, or anal sexual
contact with an infected partner. It can cause serious problems in men and
women, such as penile discharge and infertility respectively, as well as in
newborn babies of infected mothers.

Chlamydia is one of the most widespread bacterial STIs in the United States.
The Centers for Disease Control and Prevention (CDC) estimates that more than 3
million people are infected each year.

WHAT ARE THE SYMPTOMS OF CHLAMYDIA?

Chlamydia bacteria live in vaginal fluid and in semen. Chlamydia is sometimes
called the “silent” disease because you can have it and not know it. Symptoms
usually appear within 1 to 3 weeks after being infected. Those who do have
symptoms may have an abnormal discharge (mucus or pus) from the vagina or penis
or experience pain while urinating. These early symptoms may be very mild.

The infection may move inside your body if it is not treated. Bacteria can
infect the cervix, fallopian tubes, and urine canal in women, where they can
cause pelvic inflammatory disease (PID). In men the bacteria can cause
epidydimitis (inflammation of the reproductive area near the testicles). PID and
epidydimitis are two very serious illnesses.

C. trachomatis also can cause inflammation of the rectum and lining
of the eye (conjunctivitis or “pink eye”). The bacteria also can infect the
throat from oral sexual contact with an infected partner.

HOW IS CHLAMYDIA DIAGNOSED?

Chlamydia is easily confused with gonorrhea because the symptoms of both
diseases are similar and the diseases can occur together, though rarely.

The most reliable ways to find out whether the infection is chlamydia are
through laboratory tests.

• The usual test is for a health care provider to collect a sample of fluid
from the vagina or penis and send it to a laboratory that will look for the
bacteria.

• The other test looks for bacteria in a urine sample and does not require a
pelvic exam or swabbing of the penis, and results are available within 24
hours.

HOW IS CHLAMYDIA TREATED?

If you are infected with C. trachomatis, your health care provider
will probably give you a prescription for an antibiotic such as azithromycin
(taken for one day only) or doxycycline (taken for 7 days). Or, you might get a
prescription for another antibiotic such as erythromycin or ofloxacin.

Health care providers may treat pregnant women with azithromycin or
erythromycin, or sometimes, with amoxicillin. Penicillin, which health care
providers often use to treat some other STIs, won’t cure chlamydial
infections.

If you have chlamydia, you should

• Take all your medicine, even after symptoms disappear, for the amount of
time prescribed

• Go to your health care provider again if your symptoms do not disappear
within 1 to 2 weeks after finishing the medicine

• Tell your sex partners that you have chlamydia so they can be tested and
treated, if necessary

You also should not have sexual intercourse until your treatment is completed
and successful.

HOW CAN CHLAMYDIA BE PREVENTED?

The surest way to avoid transmission of STIs is to not have sexual contact or
to be in a long-term mutually monogamous relationship with a partner who has
been tested and is not infected.

You can reduce your chances of getting chlamydia or giving it to your partner
by using male latex condoms correctly every time you have sexual
intercourse.

Health experts recommend chlamydia screening annually for all sexually active
women 25 years of age and younger. Health care experts also recommend an annual
screening test for older women with risk factors for chlamydia (a new sex
partner or many sex partners). In addition, all pregnant women should have a
screening test for chlamydia.

If you experience genital symptoms like burning while urinating or have a
discharge, you should see your health care provider immediately.

WHAT ARE THE COMPLICATIONS OF CHLAMYDIA?

Each year up to 1 million women in the United States develop PID, a serious
infection of the reproductive organs. As many as half of all cases of PID may be
due to chlamydial infection, and many of these women don’t have symptoms. PID
can cause scarring of the fallopian tubes, which can block the tubes and prevent
fertilization from taking place. Researchers estimate that 100,000 women each
year become infertile because of PID.

In other cases, scarring may interfere with the passage of the fertilized egg
to the uterus during pregnancy. When this happens, the egg may attach itself to
the fallopian tube. This is called ectopic or tubal pregnancy. This very serious
condition results in a miscarriage and can cause death of the mother.

In men, untreated chlamydial infections may lead to pain or swelling in the
scrotal area. This is a sign of inflammation of the epididymis. Though
complications in men are rare, infection could cause, pain, fever, and
sterility.

CAN CHLAMYDIA AFFECT A NEWBORN BABY?

A baby who is exposed to C. trachomatis in the birth canal during
delivery may develop an eye infection or pneumonia. Symptoms of conjunctivitis,
which include discharge and swollen eyelids, usually develop within the first 10
days of life.

Symptoms of pneumonia, including a cough that gets steadily worse and
congestion, most often develop within 3 to 6 weeks of birth. Health care
providers can treat both conditions successfully with antibiotics. Because of
these risks to the newborn, many providers recommend that all pregnant women get
tested for chlamydia as part of their prenatal care.

RESEARCH

Scientists are looking for better ways to diagnose, treat, and prevent
chlamydia. NIAID-supported scientists recently determined the genetic code or
sequence for C. trachomatis. The sequence represents an encyclopedia of
information about the organism. This accomplishment will give scientists
important information as they try to develop a safe and effective vaccine.

Developing topical microbicides (preparations that can be inserted into the
vagina to prevent infection) that are effective and easy for women to use is
also a major research focus.

MORE INFORMATION

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TTY
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Genital Herpes

couple appearing to have an argumentAlternative Names

Herpes – genital; Herpes simplex – genital; Herpesvirus 2; HSV-2

Definition

Genital herpes is a sexually transmitted viral infection affecting the skin
of the genitals.

Causes

Herpes is caused by two viruses:

– Herpes simplex virus type 1 (HSV-1)
– Herpes simplex virus type 2
(HSV-2)

HSV-1, the virus responsible for common cold sores, can be transmitted
through fluids from the mouth. It is responsible for some cases of genital
herpes cases. HSV can spread from the mouth to the genitals during oral sex.

HSV-2 causes most of the genital herpes cases. HSV-2 can be spread through
secretions from the mouth or genitals.

Herpes simplex virus (HSV) is spread from one person to another by
skin-to-skin contact. The virus is shed from visible sores, blisters, or a rash
during outbreaks, but can also be shed from the affected area between outbreaks
of symptoms.

HSV is transmitted to the area of skin with which it comes into contact.
There are also some cases by which other types of contact can spread HSV. For
example, a variant of herpes, known as herpes gladiatorum, can be passed on
during body contact sports, such as wrestling.

Because the virus is transmitted through secretions from the mouth or genital
tissue (mucosa), common sites of infection in men include:

– Anus
– Inner thighs
– Scrotum
– Shaft and head of the penis

Common sites of infection in women include:

– Anus
– Cervix
– Inner thighs
– Labia
– Vagina

The mouth can also be a site of infection in both sexes.

Research suggests that the virus can be transmitted even when there are no
symptoms present, so that a sexual partner without obvious genital herpes sores
can still transmit the illness. In fact, asymptomatic spread may actually
contribute more to the spread of genital herpes than do active sores.

Symptoms

For people with no prior contact with HSV-1 or HSV-2, initial infection
involves both whole body (systemic) and local symptoms.

Generalized symptoms include:

– Decreased appetite
– Fever
– Malaise
– Muscle aches

Local symptoms include repeated eruptions of small, painful blisters filled
with clear, straw-colored fluid on the genitals, around the rectum, or covering
nearby areas of skin. Before these blisters appear, the person may experience
increased skin sensitivity, tingling, burning, itching, or pain at the site
where the blisters will appear.

When the blisters break, they leave shallow ulcers that are very painful.
These ulcers eventually crust over and slowly heal over 7 – 14 days.

Enlarged and tender lymph nodes in the groin may accompany an outbreak. Women
also may develop vaginal discharge and painful urination. Men can develop
painful urination if the lesion is near the opening of the urethra.

Once a person is infected, the virus hides within nerve cells, making it
difficult for the immune system to find and destroy it. Within the nerve cells,
the virus can remain dormant for a long period of time, which is called
“latency.”

The infection can reactivate at any time, at which point painful blisters
again cover the genitals, anus, inner thigh, or mouth. A variety of events can
trigger latent infection to become active, including:

– Fatigue
– Mechanical irritation
– Menstruation
– Stress

Attacks can recur as seldom as once per year, or so often that the symptoms
seem continuous. Recurrent infections in men are generally milder and shorter in
duration than those in women.

Exams and Tests

– Viral culture of blister fluid from lesion is positive for herpes simplex
virus. The herpes simplex virus can grow within 2 – 3 days.
– PCR from the
blister fluid detects small amounts of DNA and can tell whether the herpes virus
is present in the blister.
– Tzanck test of skin lesion may show results
consistent with herpes virus infection. This test involves staining human cells
within the blister fluid with a dye. If the cells from the fluid contain viral
particles, they become visible. However, the test cannot determine which strain
of virus is in the blister.

Recently developed antibody tests can determine whether a person has HSV-1 or
HSV-2. These tests can also tell if a person has ever been exposed to either of
these strains in the past (IgG test) or was just recently exposed to one of them
(IgM test).

Treatment

Genital herpes cannot be cured. However, antiviral treatment can relieve the
symptoms. Medication can quickly relieve the pain and discomfort during an
outbreak, and can shorten healing time. Medications have been shown to speed
healing and relieve symptoms in first attacks more than in recurrent episodes of
genital HSV-1 and HSV-2 infections.

If necessary, patients can use daily suppressive therapy, which may reduce
the frequency of recurrence in patients with frequent genital herpes
outbreaks.

For maximum benefit during recurrences, start therapy as soon as the
tingling, burning, or itching begins, or as soon as you notice blisters.

Possible side effects from herpes medications include:

– Fatigue
– Headache
– Nausea and vomiting
– Rash
– Seizures

– Tremor

Some people need medication through a vein (intravenous) for severe herpes
infections that can involve the brain, eyes, and lungs. These complications
sometimes develop in people with a compromised immune system.

Warm baths may relieve the pain of genital lesions. Gentle cleansing with
soap and water is recommended. If you develop a secondary infection of the skin
lesions by bacteria, you can use a topical or oral antibiotic.

Support Groups

See: Herpes genital – support group

Outlook (Prognosis)

Once you are infected, the virus stays in your body for the rest of your
life. Some people never have another episode, and others have frequent
recurrences. In most recurrences, no obvious trigger is identified. Many people,
however, find that attacks of genital herpes occur with the following
conditions:

– Fatigue
– General illness (from mild illnesses to serious conditions,
such as operations, heart attacks, and pneumonia)
– Immunosuppression due to
AIDS or medication such as chemotherapy or steroids
– Menstruation

Physical or emotional stress
– Trauma to the affected area, including sexual
activity

In people with a normal immune system, genital herpes remains a localized and
bothersome infection, but is rarely life-threatening.

Possible Complications

Various complications are associated with herpes infection. The herpes virus
is of special significance to women because research has found that it can cause
cancer of the cervix. The risk increases when HSV is present in combination with
human papilloma virus (HPV), the virus responsible for genital warts
(condyloma).

For pregnant women, HSV-1 or HSV-2 on the outside of the genitals or in the
birth canal is a threat to