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Diagnosis of Chlamydia

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Last week we repeated the first part of our discussion on chlamydial infections, and I said that it is more common than HIV and gonorrhea. We also established that women usually do not know when they have it, but it can have dire consequences. This week we will again look at these consequences.{{more}}

Urethral strictures

I hinted at the fact that chlamydial infection in men usually starts as a urethritis or inflammation of the urine passage that the men experience as burning in the pee. This urethritis, if not treated in 6-8 weeks, can cause scarring and narrowing in the urine passage. This scarring is circumferential or circular and restricts the flow of urine. Strictures are difficult to treat, especially if they are long, tight and dense (very tough, scarred tissue). They are treated initially with stretching or endoscopic opening, but eventually they will need surgery if they are not cured by the above means. I usually tell men that strictures are worse than children and mortgage; they live with you for life.

Female problems

Most women who contract chlamydia via heterosexual contact vaginally develop an infection at the mouth of the womb called a cervicitis. They, like men, can also have urine problems. Unfortunately, most women do not know that they have contracted chlamydia and so they tend to develop more complications than the men from whom they got it. Women may develop pelvic infections called PID or pelvic inflammatory disease. In this condition, the woman experiences lower abdominal pain, fever and sometimes a vaginal discharge. Even with prompt treatment, this PID may still cause scarring in the fallopian tubes and infertility. With chronic chlamydia, there is also increased risk of ectopic pregnancy due to tube scarring. Apart from tube scarring and infertility/ectopic pregnancy, PID can also cause chronic pelvic pain, painful intercourse and abscesses in the tubes and ovaries, leading to the loss of these organs at the time of surgery. I also mentioned last week that chronic chlamydial infection is one of the causes for recurrent spontaneous abortions and premature labour.

Diagnosis

In earlier times, chlamydia used to be diagnosed using the secretions from urine passage of men, urine from men and women and vaginal swab from women. These tests, even though accurate, were cumbersome and, especially in women, were not very sensitive (that is, some women with the problem were not detected). Most of the time the lab technician would look for evidence of the bacteria under the microscope. Recently, more sensitive blood tests have been developed. These look for evidence of present or previous bacterial infections. These tests are more convenient in that they are blood tests. They all try to do the same thing, which is to detect the antibody to the chlamydia in your blood. Some tests done by research labs try to detect bacterial particles. These tests are more specific but also more expensive, unlike the antibody tests which are cheaper and widely available. To recap, the cheaper, widely available blood tests are more sensitive (they can pick up any infection present); but they are not too specific (they sometime are so sensitive that they sometimes, but not often, tell you have an infection when you do not). The more expensive test does not give you a lot of these “false positives”, but they can sometimes “miss” the infections because they try to be too accurate. This happens rarely. You can differentiate your status based on your clinical symptoms, the type of antibody that is raised and the level of the raise. In difficult cases, we do serial measurements over 6-12 months. Next week I will discuss the issue of treatment using two common scenarios.

For comments or question contact:

Dr. Rohan Deshong
Tel: (784) 456-2785
email: [email protected]

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