Chlamydia trachomatis aka: The Silent Disease

1. Chlamydia trachomatisaka: The Silent Disease Presented By: Tony Anderson & Jeffrey Pounds

2. Species Information Family: Chlamydiaceae Genus: Chlamydia Species: C. trachomatis

3. What is Chlamydia trachomatis? C. trachomatis is a eukaryotic gram-negative bacteria. It is a parasitic organism because it cannot generate it�s own media to live, it requires other cells to live in. It has two shapes, cocci and rod shaped, it can be one of two shapes based on the stage the organism is in. It is about 0.3 um in diameter. It is classified as a gram negative organism in that it contains an outer lipopolysaccharide membrane, but it lacks peptidoglycan in its cell wall.

4. Growth Life cycle consist of two stages 1) Elementary body, this is the dispersal form, it is found similar to a spore, it is in the stage when outside of the cell, it can induce it�s on endocytosis upon exposure to target cells. It prevents phagolysomial fusion, which then allows for intercellular survival of the bacteria.

5. Growth (continued) 2) The second phase is the reticulate body, it is the result that occurs when the elementary body germinates inside of the endsome of a target cell. The reticulate body divides through binary fusion in about 2 to 3 hours per generation, and it incubates anywhere from 7-21 days in the host. This stage contains no cell wall making it look like part of the cell, so it is virtually invisible to the body�s natural immune system.

7. How is it diagnosed? The bacteria are too tiny to be seen with an ordinary microscope and must be grown in tissue culture cells or detected with fluorescent antibodies. The only way to fully determine if you have Chlamydia is to get tested. Clinics used to have to swab the cervix for females and scrape cells out of the urethra for males. This was very uncomfortable and a painful process. Since then a new procedure called Ligase chain reaction (LCR) has been created, this can easily identify the primers in the DNA of the bacteria, it is a lot less invasive and can be done by just testing the urine. Diagnosis is dependent on an adequate sample being obtained. If it is a urine sample, it is ideal to have held urine in the bladder for 2-3 hours before it is taken, It is the first 10-20m of urine that are required not the usual mid-stream sample that is used to test for cystitis. Diagnosis is dependent on an adequate sample being obtained. If it is a urine sample, it is ideal to have held urine in the bladder for 2-3 hours before it is taken, It is the first 10-20m of urine that are required not the usual mid-stream sample that is used to test for cystitis.

10. Transmission It is transmitted from penetrative sexual contact. Contact needs to be made between any of the special membranes of the eye, throat, anus, or genitalia.

11. How infectious is it? After just one time of unprotected sex with an infected person, about 10% of people will catch the bacteria. The reason that it is such an epidemic is due to it�s ability to hide inside the cells of the genital tract in both men and women, and can then be passed on in new relationships leaving both partners completely unaware.

12. Virulence factors There are many factors that contribute to the pathogenicity of C. trachomatis. Colonies form after the bacteria attaches to the sialic acid receptors in any of the contact sites. It also has a unique cell wall structure, that inhibits phagolysomial fusion in phagocytes. The cell wall contains a lipopolysaccharide membrane which classifies it as a Gram-negative organism but it lacks a peptidoglycan in its cell wall. To make up for this it has a cysteine �rich protein layer that is equivalent to the peptidoglycan layer, this unique structure allow for intracellular division and extracellular survival.

14. Who does it infect Everyone, it is the most common bacterial sexually transmitted infection affection millions of people worldwide. Over the past 10 years Chlamydia infections doubled to over 1,000,000 cases in the USA and continues to rise, it is now the highest ever nationally recorded disease in any year, with over 1 million new cases reported every year. It is most common in sexually active teenagers from ages of 16 to 19, and is very prevalent in women because of the lack of symptoms.

15. Chlamydia � Rates by state: United States and outlying areas, 2008

16. Chlamydia � Rates by county: United States, 2008

17. Chlamydia � Rates by region: United States, 1999�2008

18. What does it effect? In women the infection can vary between having absolutely no symptoms at all, to having a severe illness associated with long-term complication, in particular a women�s fertility. Women who don�t have symptoms can still be experiencing the ongoing damage to the fallopian tubes, and certain women would not know this until years later. The bacteria can start in the womb and travel up through the fallopian tubes causing what is known as Pelvic Inflammatory disease. This can cause severe fertility issues in women.

20. What does it affect? (continued) In about 70% of men they display no symptoms. When affected, men with signs or symptoms might have a discharge from their penis or a burning sensation when urinating. Men might also have burning and itching around the opening of the penis. Men or women who have receptive anal intercourse may acquire Chlamydia infection in the rectum, which can cause rectal pain, discharge, or bleeding. Chlamydia can also be found in the throats of women and men having oral sex with an infected partner. Mention how the bacteria sometime causes no symptoms because of the fact that is doesn�t always cause cell death.Mention how the bacteria sometime causes no symptoms because of the fact that is doesn�t always cause cell death.

21. Complications For women the biggest complication is the Pelvic Inflammatory disease (PID), it causes inflammation or endometritis, which causes damage to the reproductive organs. There is also risk that comes with the inflammation of the other glands and ducts in the lower vagina. Women also can experience a spread of the bacteria to the liver, which causes inflammation at the liver edge and the surrounding lining of the abdomen. This results from the spread of the Chlamydia from the fallopian tubes and up through the abdominal lining.

23. Complications (continued) Men also experience inflammation of the reproductive organs, Although it does not cause as much destruction in male reproductive system as it does in the female reproductive system, it is still unclear how much damage this actually causes. In both sexes C. trachomatis can cause reactive Arthritis, it affect the larger joints of the body and occurs several weeks after infection.

24. Vaccines At this time there is no vaccine available for this organism. The organism�s growth requirements make it very hard for it to researched and examined inside of a laboratory setting. It can only grow in tissue media, and a lot of media is required to acquire a small sample of the organism.

25. Prevention Wear condoms Limit the number of sexual partners Practice monogamy Public awareness campaigns Making sure health care providers are more aware of and recognize the symptoms of Chlamydia. Most Chlamydia infections look like bladder infections.

26. Treatment Chlamydia can be easily treated and cured with antibiotics. A single dose of azithromycin or a week of doxycycline (twice daily) are the most commonly used treatments. Tetracycline, chloramphenicol, rifampicin, and fluroquinones can also be used. Pregnant women are advised to take erythromycin for the infection All sex partners should be evaluated, tested, and treated. Persons with chlamydia should abstain from sexual intercourse until they and their sex partners have completed treatment, otherwise re-infection is possible.

27. References Barnes, R.C. (1990). Infections Caused by Chlamydia trachomatis Chapter 6 in Morse, et al, Sexually Transmitted Diseases. J.B. Lippincott. Philadelphia The Boston Women's Health Collective (1992). The New Our Bodies Ourselves. New York: Simon and Schuster. CDC. Recommendations for the Prevention and Management of Chlamydia trachomatis Infections. MMWR 1993; 42 (RR-12). Coghlan, Andy (1996). Shapely Vaccine Targets Chlamydia. New Scientist. 152: 18. Hatch, Thomas P. (1996). Disulfide Cross-Linked Envelope Proteins: the Functional Equivalent of Peptidoglycan in Chlamydia? Journal of Bacteriology. 178: 1-5. Hillis, Susan et al. (1995). Impact of a Comprehensive Chlamydia Prevention Program in Wisconsin. Family Planning Perspectives. 27: 108-111. Madigan, Michael, Martinko, John, and Jack Parker (1997). Brock's Biology of Microorganisms. eighth edition. New Jersey: Prentice Hall.