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General Considerations

Chlamydia trachomatis is responsible for a wide spectrum of clinical disease, particularly in the genital tract. Despite the availability of effective antimicrobial therapy and improved preventive efforts, genital chlamydial infections remain a worldwide public health concern, and the World Health Organization estimates that 90 million new cases occur worldwide each year. Genital chlamydial infection remains the most commonly reported bacterial sexually transmitted disease (STD) in the United States, producing an estimated four million new infections each year, according to the Centers for Disease Control and Prevention (CDC).

From the time genital chlamydial infections first became a reportable disease in the United States in 1986, a greater number of cases have been reported in women versus men, a finding that has been attributed to emphasis on chlamydial screening in women. Chlamydia causes significant morbidity, especially in women, who can develop upper genital tract infection (pelvic inflammatory disease [PID]), which can lead to chronic pelvic pain, tubal abscesses, ectopic pregnancy, and infertility; chlamydia is the leading preventable cause of infertility worldwide. Genital chlamydia can also increase the risk of acquisition and transmission of HIV.

Among the many risk factors for genital chlamydial infection, age is the strongest risk factor, with CDC surveillance studies demonstrating the highest chlamydial prevalence occurring in men and women younger than 25 years of age. A history of prior chlamydial infection is another strong predictor for current chlamydial infection. The majority of chlamydial infections in men and women are asymptomatic; therefore, the diagnosis of infection relies on identification of the organism through diagnostic testing. The availability of highly sensitive nucleic acid amplification tests (NAATs) should help to facilitate both improved rates of diagnosis and more widespread chlamydial screening, because such tests can be performed on noninvasively collected specimens (eg, urine and self-collected vaginal swabs). However, many barriers to screening exist, including lack of patient access to health care providers and lack of routine chlamydial testing in many medical settings.

Current management of genital chlamydial infection relies on effective antimicrobial therapy for infected patients and their sex partners, and routine rescreening 3 months after treatment. Although antimicrobial resistance in chlamydial infections has not been a major concern to date, evidence is building that suggests this may be a future problem. Recurrence of chlamydial infection in women is common, and the CDC recommends retesting at approximately 3 months following therapy. Development of an effective chlamydial vaccine is one of the priorities for the prevention and control of chlamydia, but efforts to date have been hindered by an incomplete understanding of the human host immune response to C trachomatis.