Chlamydia is a common sexually transmitted disease that remains in a person’s body for long time. The disease presents mostly as an asymptomatic one, but features of pelvic pain, mucopurulent discharge and dysuria may arise. In the case of a chronic infection the persistent inflammatory states lead to autoimmunity, uncontrolled inflammation, tissue injury and healing by fibrosis causing complications such as reactive arthritis, pelvic inflammatory disease, subfertility and preterm labor.
Chlamydia trachomatis, the causative agent, is a gram-negative spore forming bacteria which is the causative organisms for chlamydia sexually transmitted infections. Two of the three known biovars cause chlamydia sexually transmitted infection while serovars L1, L2 and L3 cause lymphogranuloma venereum; another sexually transmitted infection. The treatment for this organism involves oral doxycycline 100 mg twice daily for seven days or azithromycin 1 gram as a stat dose in most patients. The drugs control up to 98% of the infections.
In cases of chlamydia infections in pregnancy, then amoxicillin 500 mg three times a day for seven days or erythromycin 500 mg four times a day for seven days are the antibiotics of choice to ensure safety of the fetus. The patients must be retested again three or four weeks after completion of therapy to ascertain that they have been cured of the disease.
Can Chlamydia Come Back After Being Treated?
Follow-up testing for recurrence of the disease indicates that up to a third of the cases recurs even with adequate antibiotic therapy. The identification of chlamydial infections depends on the clinical presentation of the patient and the confirmatory test performed. Most of the cases seen during recurrence are asymptomatic and rely on laboratory testing using urine and vaginal swabs of female patients. The tests carried out include enzyme immunoassay and confirmatory tests done with ligase chain reaction.
Identification of the disease after a period of treatment may point towards several possible scenarios such as inadequate antibiotic use in the previous regimen, reinfection from the same partner who was not treated or infection from a new partner. This may be a source of trouble for couples with chlamydial discordance upon testing as one may accuse the other of having a sexual encounter with another infected person, which is not always the case.
Chlamydia Dormancy in the Gut
Inadequate antibiotic use and new infections do not account for all cases of recurrence leading to the theory that upon inoculation with the organism some occupy the gastrointestinal tract. The organisms may recrudescence after clearing the genital tract and the patient has stopped taking antibiotics to cause another genital tract infection that can be diagnosed as a sexually transmitted infection. It is hypothesized that chlamydia can live in your gut for up to 80 years and still retain its ability to cause disease. A higher rate of recurrence has been associated with early return to sexual activity more so with infected partners or other risky sexual behavior. It is important to note that, even recurrent cases of chlamydia infections are treatable with outcomes indicating good prognosis.
Chlamydial trachomatis sexually transmitted infection is caused by serovars Ab, B, Ba, C and D-K. The organism is a spore forming gram negative bacterium that responds well to several antibiotics such as amoxicillin, erythromycin, azithromycin and levofloxacin that have the ability to clear the sexually transmitted infection. However, the organism has a unique characteristic of occupying the gut and may remain there for up to 80 years only to get reactivated and cause a recurrent infection. Other causes of recurrence of the disease include relapse due to inadequate antibiotic use, reinfection from the same source after sexual contact or new infection from an infected person.
The disease remains treatable despite the likelihood of a recurrence. The recurrence cannot be predicted and thus, the best way of preventing it is prevention of the initial infection.
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