Chlamydiose

This article treats only infection caused by “ Chlamydia trachomatis”

One usually indicates under the term of chlamydiose the genital infections in connection with the infectious agent Chlamydia trachomatis. They are the Sérotype S D with K of the Chlamydia trachomatis which are responsible for infections sexually transmissible. This bacterium is with strict inter-human transmission. Same the sérotypes of chlamydia trachomatis can cause Conjonctivite S.

4% of the young people at least are reached, leading certain countries to make a systematic Dépistage because of the costs of the complications of the genital infection with Chlamydia trachomatis responsible for Infertilité by destruction of the epithelium of the horn involving an increase in the number of extra-uterine pregnancies.

This infection is generally quiet and it is not that during the investigations carried out within the framework of an assessment of an infertility that this infection (or at least its after-effects) is discovered.

Fortunately, for a few years the diagnosis has been largely facilitated by the direct research of the nucleic acid of the bacterium by genic amplification (PCR).

Epidemiology

It is most frequent of the infections sexually transmissible Bactérie.

This infection is frequent at the young credits sexually:

the cases are most numerous among women from 15 to 24 years (incidence among women from 15 to 19 years: 1 109,1/100 000 inhabitants; among women from 20 to 24 years: 1 041,7/100 000 inhabitants).
at the men, of many cases is not diagnosed.

More than 50% of the men and 70% of the women can be asymptomatic.
At the symptomatic cases, the incubation period varies between 2 and 6 weeks, but it can be longer.
Neisseria gonorrhoeae is occasionally associated with Chlamydia trachomatis .
a symptomatic chronic infection is possible.
generally Reaches a young credit sexually old of less than 25 years

Clinical signs

At the man

Secretion at the end of the Rod.
Dysurie
Feeling of tingling on the level of the Urethra
Pains with the Testicle S

small red button

At the woman

generally asymptomatic Infection
genital Flow with the curdled milk aspect and yeast odor
Dysurie after having eliminated a urinary Infection
low abdominal Pains
abnormal vaginal Bleedings
Dyspareunie deep
Pains during the rules

Manifestations of the disease

Women

Cervicite
high genital Infection
Urethritis
Perish-hepatitis

Men

Men and women

Rectite
Conjunctivitis
Syndrome of Reiter
venereal Lymphogranulome

Complications

At the woman

high genital Infection being able to involve the sterility or of the extra-uterine pregnancies
chronic pelvic Pain
Syndrome of Reiter

At the newborn in an expectant mother carrying chlamydiose

Conjunctivitis occurring in 20% of the case
Pneumonia occurring two to three months after the birth

At the man

Fall of the Fertility.
Syndrome of Reiter
Orchite and épididymite

Diagnosis

Method of choice: Direct research of the nucleic acids of the bacterium by genetic amplification.

Can be practiced on a simple jet of Urine at the man or at the woman
Can be also made on a taking away on the level of the Endocol or Urètre at the man.
the sample must include epithelial cells, because it is an obligatory intracellular bacterium. Genital secretions can not contain a great number of these cells.
In France, the S.S refunds only research on one site (does not refund a research in the urines and in a taking away of the endocol). The cost of this examination is of 23 € (2005)

Other methods

Serology

does not contribute to the diagnosis of the low infections with Chlamydia trachomatis .
Is seldom useful in the diagnosis of the pelvic infections at the woman

Cellular culture

remained a long time the method of reference
Nécessite a taking away rich in cell (plastic flue brush)
Absolue need for a perfect technique of taking away and transport

Detection of the chlamydial antigens

Treatments

The treatment of the noncomplicated chlamydiose rests on:

Treatment of choice

Azithromycine 1000 Mg in single catch (Zithromax Monodose)

Alternatives

Doxycycline 100 Mg * 2 during 7 days
Érythromycine 1000 Mg *2 during 7 days (less effective)
Ofloxacine 300 Mg * 2 during 7 days (expensive Treatment)

Monitoring

Preventive during the treatment and 7 days after, is 7 days in the event of monodose treatment, 14 for a " treatment; classique"
Research and treatment of partners the last two month old
PCR (genic amplification) of control of the cure one month after the end of the treatment
Serology without interest

Prevention

Existence of systematic policy of tracking of the Chlamydia trachomatis in the countries of Northern Europe by research of the chlamydia in the urines at the time of the university inscription
In 2003, the National agency for the evaluation of health concludes that tracking is justified even in the absence of clinical signs the dispensaries antivénériens, the public health clinics free anonymity and of the AIDS, the centers of planning and family education and the centers of I.V.G among women of less than 25 years.

Photographs

See too

venereal Lymphogranulomatosis or Disease of Nicolas Favre due to the sérotypes L1 L2 and L3

More images are available in our database images

Sources

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