Chlamydia Trachomatis Infection
Chlamydial infections—including urethritis in men and urethritis and cervicitis in women—are linked to the organism C. trachomatis. Trachoma inclusion conjunctivitis, a chlamydial infection that rarely occurs in the United States, is a leading cause of blindness in Third World countries. Lymphogranuloma venereum, a rare disease in the United States, is also caused by C. trachomatis. (See Lymphogranuloma venereum.)
Causes
Transmission of C. trachomatis primarily follows vaginal or rectal intercourse or oral-genital contact with an infected person. Because symptoms of chlamydial infection commonly appear late in the course of disease, sexual transmission of the organism typically occurs unknowingly. Children born to mothers who have chlamydial infections may contract associated conjunctivitis, otitis media, and pneumonia during passage through the birth canal.
Lymphogranuloma VenereumA rare disease in the United States, lymphogranuloma venereum is caused by serovars L1, L2, or L3 of C. trachomatis. The most common clinical manifestation of lymphogranuloma venereum among heterosexuals, especially male patients, is enlarged inguinal lymph nodes (usually unilateral). These nodes may become fluctuant, tender masses. Regional nodes draining the initial lesion may enlarge and appear as a series of bilateral buboes. Untreated buboes may rupture and form sinus tracts that secrete a thick, yellow, granular discharge.
Women and homosexually active men may have proctocolitis or inflammatory involvement of perirectal or perianal lymphatic tissues, resulting in fistulas and strictures.
By the time most patients seek treatment, the self-limited genital ulcer that sometimes occurs at the inoculation site is no longer present. The diagnosis usually is made serologically and by excluding other causes of inguinal lymphadenopathy or genital ulcers.
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