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Initially regarded as a virus, due to its nature as an obligate cellular parasite, in 1966, observation with an electron microscope revealed it to have not only DNA and RNA, but also ribosomes and a membrane typical of bacteria.
Chlamydia trachomatis infection affects only humans and is transmitted through vaginal, anal and oral sex, through contact with genital mucous secretions or through the semen of an infected person.
Sexual habits therefore play a decisive role in the incidence of infection.
Particularly at risk are young adults and sexually active adolescents who do not use barrier methods of contraception (such as condoms), who tend to change sexual partners frequently and who have multiple partners.
Chlamydia is called a silent infection. According to a surveillance-sentinel system of sexually transmitted infections, based on the diagnoses made by a network of public specialist centres and coordinated by the Istituto Superiore di Sanità, more than one third of carriers are asymptomatic and, among these, the largest proportion are women and, among women, non-pregnant women.
However, it is more likely to be estimated that those affected but asymptomatic are more than 50%.
When Chlamydia becomes symptomatic, usually 1-3 weeks after infection, the clinical picture that most frequently presents itself in both sexes is urethritis, characterised by urinary burning and frequent and painful urination.
In men it may manifest itself as a urethral discharge of variable colour, ranging from white to light grey; in a limited number of cases an acute inflammation of the epididymis appears with pain and testicular swelling.
In women, the infection, even when symptomatic, may be more subtle and present with the characteristics of a common bacterial vaginitis, with vaginal discharge of the yellowish leucorrhoea type, sometimes associated with burning and with possible postcoital and/or intermenstrual bleeding.
In order to make a diagnosis, it is necessary to undergo a test that involves taking a small amount of material from the area to be tested (cervix, vagina, penis, anus) with a cotton swab, which is then sent to a laboratory for analysis.
If infection is present, the test is positive even in the absence of symptoms. The test must be performed following symptoms of urethritis, which manifests itself in women, with unusual vaginal discharge or bleeding, accompanied by burning and pain during sexual intercourse, and in men, with urethral burning and greyish-white discharge from the penis.
In some, not uncommon cases, the clinical picture is much more nuanced and subtle: minor discomfort such as itching or mild burning referred to the tip of the penis and urethra. These symptoms are often mistakenly attributed to chronic abacterial prostatitis and therefore treated incorrectly.
The suspicion of chlamydia infection is especially well-founded if the symptoms occur after recent sexual intercourse with a new partner.
The spread of the germ to neighbouring organs can cause serious complications. In women, the inflammation can spread to the tubes and the peritoneum causing so-called ‘pelvic inflammatory disease (PID)’, which can cause permanent damage to the reproductive system, such as tubal closure (resulting in sterility), risk of uterine pregnancy, abdominal adhesions and chronic pelvic pain.
In men, the most frequent complication is the onset of a chronic inflammatory process in the epididymis, a small duct where the sperm produced by the testicle are stored and preserved. The outcome of the infection is fibrosis of the duct, with obstruction and consequent sterility.
Chlamydia infection is treated with antibiotics to which the germ is very sensitive.
Several antibiotics are used in the treatment and all are equally effective.
The drug of first choice is azithromycin. In the case of uncomplicated acute episodes, a single dose of antibiotic is sufficient. The same treatment must be followed by the partner.
It is advisable to avoid sexual intercourse for at least three weeks after the end of therapy.
Cure does not make one immune: new relapses are possible.
Therefore, more attention must be paid to prevention.
Prevention consists of correct sexual behaviour: a mutually monogamous relationship and/or the use of barrier contraceptive methods, such as condoms, significantly reduce the risk of infection.
Screening, i.e. the search for Chlamydia in asymptomatic individuals, is recommended annually in people under the age of 25, especially if they are at risk and after unprotected intercourse with a new partner.
Although Chlamydia infection is believed to be responsible for premature rupture of membranes, preterm delivery and low birth weight of the foetus, prenatal screening is not recommended for all women, as there is insufficient evidence of its usefulness.
Clinically, however, it is recommended at the first visit for pregnant women with recognised risk factors (under 25 years of age, sexual promiscuity, new partner or multiple partners), possibly to be repeated in the third trimester if risky behaviour in the couple has been detected.
The first choice drug compatible with pregnancy is erythromycin, to be administered for 5-7 days.
It is advisable to extend the therapy to the partner and to recommend the use of condoms in intercourse up to the birth.
Chlamydia can be transmitted to the unborn child during birth. Infection in the newborn child manifests itself in the form of conjunctivitis, present in around 50-70% of newborns, or pneumonia, present in 30% of cases.
Fortunately, if treated promptly, both infections resolve successfully.
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