Essay Sample on Chlamydia Trachomatis Infection

Introduction

The Chlamydiaceae family comprise of Chlamydia psittac, Chlamydia pneumoniae, and Chlamydia trachomatics as the key pathogenic species. Chlamydiae are metabolically deficient in their capacity to produce ATP and amino acids. Furthermore, they are energy parasites, therefore, need an exogenous energy source that they derived from the hosting cells. However, Chlamydia trachomatis infection is one of the prominent infection that is transmitted sexually in both Europe and the U.S (Centers for Disease Control and Prevention, 2018). In the U.S. alone, approximately 1,758,668 cases were discovered from different states (Centers for Disease Control and Prevention, 2018). It was also approximated that over 2.86 million infections occur per year. It additionally causes trachoma, that is a contagious eye infection that contributes to most of the blindness cases in the world. Contagious eye infection is mainly prevalent among the poor population living in developing countries. Among women, it is primarily caused by reinfections, urethritis, and asymptomatic cervicitis. In untreated instances, Chlamydia trachomatis may develop into pelvic inflammatory diseases abbreviated as PID as well as sequelae, for example, chronic pelvic pain, infertility, and ectopic pregnancy. It contributes to non-gonococcal urethritis abbreviated as NGU in men. It is, however, asymptomatic in both genders. Therefore, the main aim of this brochure is to review the disease and pathogen identification, signs and symptoms, virulence factors and pathogenesis, and epidemiology as well as diagnosis, treatment, prevention, and current research on Chlamydia trachomatis to understand how to treat and prevent it.

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Disease and Pathogen Identification

According to Gunn and Lofstedt (2016), the order of Chlamydia trachomatis is Chlamydiales, and its family is Chlamydiaceae, while its genus is chlamydia. It also an obligate intracellular bacterium that has outer and inner membranes resembling other Gram-negative bacteria though it does not have peptidoglycans even though it has genes required for their synthesis (Gunn & Lofstedt, 2016). Furthermore, its organisms possess prokaryotic ribosomes, RNA, and DNA. Chlamydia trachomatis is able to produce lipids, nucleic acids, and protein though they need amino acids, which it is unable to produce. Therefore, it must obtain it from the host cell.

Chlamydia trachomatis has a biphasic life cycle, where the initial form is the elemental body abbreviated as E.B. that is extremely infectious. However, it cannot divide nor replicate. It is required to infiltrate through the eukaryotic cell to remain in its life cycle as the second form, known as the non-infectious reticular body abbreviated as R.B.

Signs and Symptoms

It is recognized as a ‘silent’ infection since the majority of the individuals are asymptomatic and do not show abnormal physical assessment results. The projection of individuals infected by Chlamydia trachomatis and develop symptoms differ depending on the study methodology and setting. For example, two published surveys, which integrated modeling methodology to resolve the limitations of prevalence researchers, projected that approximately 10% of men and only 5-30% of women that had laboratory-verified chlamydial infection developed symptoms (Centers for Disease Control and Prevention, 2018). Its incubation period is poorly described. Nevertheless, provided the significantly sluggish replication cycle of the organism, it is impossible to see symptoms until a few weeks after the exposure among individuals who develop them.

In women, it first infects the cervix, which resulting in signs and symptoms of cervicitis, such as easily induced endocardial bleeding and mucopurulent endocardial discharge (Wiesenfeld et al., 2005). In some cases, the urethra may cause urethritis’ signs and symptoms such as urinary frequency dysuria and pyuria. It may spread to the upper reproductive tract such as fallopian tubes and uterus, leading to pelvic inflammatory diseases that may be either asymptomatic or acute with normal pelvic pain or abdominal symptoms, alongside signs of adnexal tenderness and motion tenderness on assessment.

In symptomatic men, they have urethritis that has a watery or mucoid urethral dysuria and discharge. The majority of the infected men develop epididymitis that may be or not have symptomatic urethritis. It presents with swelling, tenderness, unilateral testicular pain.

Virulence Factors and Pathogenesis

Chlamydia trachomatis has a distinct biphasic developmental cycle. Its E.B. infects the eukaryotic host cells. It is able to live outside the host cell for some time. Besides, it transforms into a metabolically active as well as a dividing form that is the R.B.

However, the growth cycle of Chlamydia trachomatis takes place in three stages. In the initial stage, the infectious E.B.s link themselves to the host cells. Virulence factors, for example, the PmpD, OmcB, MOMP, and glycosaminoglycan, have been projected as ligands and adhesins, particularly for receptor interactions. A recent survey reveals that the membrane of the host protein disulfide isomerase (PDI) aims the outer membrane of the cross-linked E.B. proteins. It furthermore links with Chlamydia trachomatis associated with the human endometrial epithelial cells, which backs its role in E.B. entry (Vasilevsky et al., 2014). There exits various process for ensuring chlamydia entry, but its route relies on chlamydia species or aspects of the host cell form that is being entered. Nevertheless, regardless of cell species or type, the unifying characteristic of E.B. entry is the Rac1-dependent actin conversion that occurs at the site of the attachment.

In the second stage, the membrane of the host cell surrounds the E.B. to make the inclusion body. The Chlamydia trachomatis proteins are injected in the inclusion body membrane and join with the cell vesicles of the host that encompasses the required nutrients for replication. Within 48-72 hours of the replication cycle, several R.B.s transits to E.B.s. Despite the accumulation of around 750 infectious E.B.s with the addition, the host cells experience a little disruption (Favaroni, 2017). In the host cell, the E.B. maintains in the membrane-lined phagosome, which fails to fuse with the lysosome of the host cell. Moreover, while inside the cells, Chlamydia trachomatis avoids intracellular innate immunity, hinders apoptosis, and evades endogenous stress mechanisms. Therefore, R.B. and CPAF protease concealed in the cytoplasm destroys cytoskeletal components and synthesizes intermediate filament proteins primarily to ensure the time it is exposed to intracellular innate immune processes and stabilize the inclusion bodies (Favaroni, 2017).

The third stage starts around 48 hours after infection. They release cytolysis or through the extrusion of the entire inclusion leaving the host cell intact. The E.B.s must exit the cell after the developmental cycle to trigger consequent rounds of infection. Egress may happen through cell lysis. It is prosperous and allows the organism to trigger significantly silent chronic infection.

Epidemiology

It is a leading contributor of sexually transmitted bacterial organisms globally that significantly causes both socioeconomic burden and morbidity. In the U.S. alone, approximately 1,244,180 cases of Chlamydia trachomatis were received by the CDC, which had an occurrence of 409.2 in every 100,000 individuals (Centers for Disease Control and Prevention, 2018). Nonetheless, it is essential to note that majority of the infections are not identified because of the underreporting, incomplete screening coverage, and asymptomatic aspect of the ailment. For example, from 2001 to 2002, a sample population of around 14,300 youths aged between 18 to 26 years, revealed a general prevalence of Chlamydia trachomatis of 4.19%. It also expressed that women had a high potential of being infected compared to men (Centers for Disease Control and Prevention, 2018).

Furthermore, the percentage of chlamydia trachomatis new cases is increasing annually, particularly since 2008 (Estcourt et al., 2017). This may be attributed to a high number of transmission as well as the increased employment of more sensitive diagnostic methods, particularly the molecular diagnosis that has resulted in the enhancement in sensitivity of around 10-30%. Besides, genital infection primarily affects women aged between 15 to 25 years, who represent approximately 75% of the cases where among them, nearly 50-80% are asymptomatic (Estcourt et al., 2017). Individuals interned in prisons, people with promiscuous behavior, people with new sex partners, and sex workers are the most vulnerable population to the Chlamydia trachomatis (Khan et al., 2009). Therefore, these are the individuals who represented the biggest number in the statistics presented above.

Diagnosis, Treatment, Prevention, and Current Research

According to Mayo Clinic (2020), CDC suggests the diagnosis of Chlamydia trachomatis for:

• Sexually active women below 25 years, the rate of infections is high among them and, therefore, recommends an annual screening test. They suggest that is one should be tested every year, particularly when one has a new sex partner.
• Individuals with different sex partners or those who do not often use condoms, undergoing recurrent chlamydia screenings are necessary.
• Pregnant women should be diagnosed with Chlamydia trachomatis in their initial prenatal exam. Where one has a high infection risk, for example, as a result of changing sex partners, they should be retested later during their pregnancy.

However, diagnosis and screening for Chlamydia trachomatis are typically simple. The tests encompass:

• A urine test where urine is examined in the lab to identify infection presence
• A swab is undertaken for women where the physician performs it from the cervix discharge primarily for antigen examination for chlamydia. It can be performed during a routine Pap test. However, most women choose to swab their vaginas themselves. In men, physicians put a slim swab in their penis to obtain a sample from their urethra, but in some instances, they may swab the anus.
• It is also recommended that individuals diagnosed with Chlamydia trachomatis should be reexamined every three months. For the general public, they should be tested yearly.

One of the most effective techniques for treating Chlamydia trachomatis is through antibiotics. A one-time dose is provided where one is required to take medication daily or at different times per day for 5-10 days. In the majority of the cases, Chlamydia trachomatis resolves within two weeks, when one should refrain from sex. It is also required that the other sexual partner should undergo treatment even though they reveal no signs and symptoms. If not, Chlamydia trachomatis may be transmitted back and forth. It is, however, essential to note that having undergone Chlamydia trachomatis treatment before does not stop one from being infected again.

The most effective approach to preventing Chlamydia trachomatis is refraining from sexual activities. If this is not possible, people should:

• Utilize either female polyurethane or male latex condom in every sexual contact. If used appropriately, condoms decrease though they do not eliminate the possibility of the infection.
• Evade douching that reduces the number of good bacteria within the vagina, which upsurge the potential of Chlamydia trachomatis infection.
• Undergo regular screenings, particularly where they are sexually active and with more than one partner. They should communicate with their doctors concerning how recurrent they should be diagnosed with Chlamydia trachomatis, among other sexually transmitted diseases.