Understanding Chlamydia Trachomatis: Clinical Manifestations and Incubation

Clinical Features. Chlamydia trachomatis is an infection that often goes unnoticed. Patients typically present asymptomatic and are only diagnosed after routine testing. Those that do have symptoms typically report an onset within two to three weeks after sexual contact. Because of the low occurrence of symptoms and the reluctance of patients to report symptoms, the incubation period is very vague with an estimate being around a few weeks. C. trachomatis grows slowly adding to the length of the incubation period.

The symptomatology of a C. trachomatis infection is often lead by complaints of yellow and purulent vaginal discharge, abnormal bleeding between periods and after sexual intercourse, and sometimes pain in the lower abdomen. Occasionally, there are urinary symptoms such as painful urination or a burning sensation when urinating, having to urinate more frequently (polyuria), or trouble urinating. Men may present with similar symptoms such as a mucus and fluid discharge from the urethra and urinary complaints. A rarer occurrence is testicular pain, tenderness, and swelling known as epididymitis. It is possible for patients to present with a rectal infection involving pain and swelling of the rectum, or even an eye infection known as conjunctivitis.

If left

untreated, C. trachomatis can spread to other areas of the reproductive system. In women, this can result in an infection of the uterus and/or fallopian tubes sometimes leading to pelvic inflammatory disease. This infection can have consequences such as infertility, ectopic pregnancy, and chronic pain. In pregnant women, C. trachomatis can spread to the infant during labor causing conjunctivitis or pneumonia. Pregnant women who are infected with C. trachomatis can also experience pre-term labor. If men do not seek treatment they may also develop pelvic inflammatory disease or epididymitis resulting in infertility. Some patients may complain of pain in the right upper quadrant which can be a symptom of a rare condition known as Fitz Hugh Curtis Syndrome, and involves inflammation of the tissue surrounding the liver.
Diagnosis. The symptomatology of a C. trachomatis infection is similar to that of many other sexually transmitted infections. A routine vaginal swab or clean-catch urine sample can diagnose an infection in women, while a urethral swab or clean-catch urine sample can diagnose an infection in men. Both tests look for the C. trachomatis bacteria in the sample. For women, these tests may be performed during an annual pap smear. It should be mentioned that these are easily performed tests and that sometimes swabs and cups may be given to the patient for collection at home. This is especially useful in teenagers who may find swabbing embarrassing and difficult.
Treatment.

C. trachomatis infections are easily treated with a course of antibiotics. According to The Centers for Disease Control, some common treatment options include: Azithromycin 1 gram orally taken in one single dose or Doxycycline 100mg. orally two times a day for a week. (CDC 2015) Azithromycin is effective in treating C. trachomatis infections because it works by binding to the 50S ribosome, which in turn stops protein synthesis. Some major adverse effects include cholestatic jaundice, angioedema, and palpitations. Doxycycline binds to the 30S ribosome, also stopping protein synthesis. Some adverse effects of Doxycycline include neutropenia, thrombocytopenia, and Stevens-Johnson

Syndrome.
Patients diagnosed with a C. trachomatis infection should avoid sexual contact for seven days after starting the antibiotic. They should be encouraged to notify any partners they have had sexual contact with so they may seek treatment. It is recommended that patients who have had previous C. trachomatis infections be tested every three months, as it is common for them to become re-infected. It should be noted that infected patients have a higher chance of contracting other sexually transmitted infections, including HIV.

References
Chlamydia - CDC Fact Sheet (Detailed). (2016, April 22). Retrieved April 28, 2016, from http://www.cdc.gov/std/chlamydia/stdfact-chlamydia-detailed.htm
Chlamydial Infections. (2015, June 04). Retrieved from http://www.cdc.gov/std/tg2015/chlamydia.htm
Lewis, S. M., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Harding, M. (2014). Chapter 53 Sexually Transmitted Infections. In Medical-surgical nursing: Assessment and management of clinical problems (9th ed., pp. 1266-1267). St. Louis, MO: Elseview Mosby.
Skidmore-Roth, L. (2015). Azithromycin, Doxycycline. In Mosby's drug guide for nursing students (11th ed.). St. Louis: Elsevier Mosby.
What is Chlamydia? | STD Symptoms, Testing and Treatment. (2014). Retrieved April 22, 2016, from https://www.plannedparenthood.org/learn/stds-hiv-safer-sex/chlamydia