Chlamydia is a gram-negative, non-motile and coccoid bacteria that acts as a parasite of eukaryotes. The organism is obligate intracellular with no energy synthesizing molecules (ATP) as it lacks the biosynthetic and metabolic pathways. Its interdependence with the host makes it to be mistaken to be a virus. The virion structure of Chlamydia consists of a combination of proteins, RNA and DNA (Byrne, 2010). Moreover, the iodine stain makes the bacterial sample to be more distinct while under Electron microscope analysis.

Virulence factors

Virulence factors are the substances produced by the microorganisms to help in attachment to various surfaces. Chlamydia lacks muramic acid in its cell wall, a characteristic which increases its resistance to antibiotics of the lactam group. To explain this factor, the antibiotics of this group majorly disrupt any typical cell wall with muramic acid included. Moreover, the bacterial cell wall contains lipopolysaccharides that react against the host’s immune system to cause damage. Chlamydia binds sialic acid receptors embedded in the mucous membrane once inside the host. Too important to note, is the antigen variation factor contained by the bacteria which is known to have 15 serotypes (Byrne, 2010).

Immunity

The immune system response to chlamydia infections is local and involves relocation of the white blood cells to the infection sites. Additionally, the immune system response plays a vital role in secretion of cytokines and chemokines that are pro-inflammatory in nature. Similarly, the immune cells produce reactive oxygen species that initiate chronic inflammation. Consequently, cell proliferation occurs due to long-term inflammation that could lead to cancer. The autoimmune systems stimulation is directly linked to the long-term inflammation. In light to this, the individual recovering from the multi-drug resistant strain of the bacterium escapes future reinfection. Additionally, the B cells and the CD4+ T cells play a significant role in offering immunity to susceptible individuals (Redgrave & McLaughlin, 2014).

Infectious disease information

The conditions that result to the Chlamydial disease infection include; unprotected oral, vaginal and anal sex with infected individuals. Similarly, mothers have high chances to transmit the disease to their infants during pregnancy, nursing or labor. This is due to failure to adhere to prenatal and postnatal clinical procedures.

Notably, chlamydial infections cause infection of the eye called Trachoma that consequently leads to scarring of the conjunctiva. Additionally, it affects both the vagina and the penis. However, some cases of chlamydial infections affect the throat therefore resulting to blockage of breathing pathways. To sum up all these, the outlined infections damage the ocular system, reproductive system, and upper respiratory systems.

Many detrimental complications arise if chlamydia is left untreated at the early stages. In women, Pelvic Inflammatory Disease (PID) develops and affects the uterus, oviduct and ovaries (Byrne, 2010).In regard to this, there are increased cases of ectopic pregnancies in such women and increased prevalence of infertility.

In men, Urethritis and epididymitis come up in cases of failure to clinically address the situation. However, the infants suffer the most since they can develop pneumonia and can easily result in death. Principally, untreated chlamydial infections cause reactive arthritis to both the women and men groups. The above mentioned infections are therefore chronic in nature and most times they can be fatal. Notably, Chlamydia is one of the most serious opportunistic disease to people with HIV/AIDS.

Epidemiology

The life cycle of the chlamydia bacterium is as outlined below:

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The elementary body (EB) is majorly found in secretions and is infectious and small in size. The EB attaches onto cells such as urethral or endocervical cells and enters them. Consequently, this elementary body replicates to induce an immune response that leads to scarring or damage to the site that is infected. Furthermore, this cell transforms into reticulate body within 8 hours. The reticulate body therefore multiply within an inclusion (an isolated area in the cell).Some of the reticulate bodies change back to elementary bodies within 24 hours. Finally, the elementary bodies are transmitted to the adjacent cells through bursting of the cell wall.

Hypothetical situation of a chlamydia patient

A person infected with the multi-drug resistant strain of Chlamydia suffers a lot from developed complications. Depending on the level of severity, such complications result to infertility in both men and women. For example, a promiscuous marriage partner heightens the spread of chlamydia to an innocent partner. In regard to this, the disease presents itself more on these people because they frequently use antibiotics and they are likely to develop resistance. Furthermore, blunt natural immunity develop due to frequent screening done to these patients and this leads to reinfection. It is therefore important to notify the partner in any cases of infection so that immediate preventive measures can be taken. Alternatively, a patient should use a protective barrier during coitus or otherwise abstain.

The signs and symptoms experienced by both male and female patients are outlined as follows: In cases of a female patient; the disease is characterized by foully and yellowish vaginal discharge, increased urge to urination together with burning sensation, abdominal pain, and pains during coitus. Similarly, in men, watery or milky penile discharge with pus is evident, burning sensation and pain during urination alongside swollen testicles. The patient’s condition that led to the infection by the chlamydial disease was unprotected sex with the infected marriage partner. In regard to this, the severe complications experienced by the patient prompted the couple to seek medical attention.

Moreover, the clinical indicators of chlamydial infection consist of visual indicators such as opaque cervical discharge, easily induced bleeding and endocervical discharge in a female patient. However, the clinic gave a prevalence of 6.3% of chlamydial infections (Berntsson & Tunbäck, 2013).

Case study

Ms F, a 23 years old college student was worried about following her situation that she only came to notice as a surprise. Ms F observed that she had vaginal discharge coupled with irritation, en effect that had occurred for three days. Notably, the discharge was watery, slight, and clear with no other abnormal bleeding. Having changed her partner three months ago, she did her best to seek advice from a medical doctor. Ms F uses combined contraceptives and as a result, she not use condoms.

Upon undertaking medical checking, Ms F only noteworthy results was that her cervix easily bled when swabbed. Two swabs were taken from her endocervix, urethra, and the posterior fornix. The doctor carried out both plastic shafted chlamydia swab and the standard cotton swab. Laboratory reports after a few days reported the detection of chlamydia. As a result of this, she was referred to seek attention from a nearby sexually transmitted disease clinic.

Prevention

There has never been a childhood vaccine against chlamydia after failure of the first attempted vaccine. To expound on this, the first vaccine seemed to have severe negative effects to humans that prompted the scientists to drop the idea. Predictably, vaccine usage predisposed the individuals to be more susceptible to chlamydia. Consequently, the popularity of the vaccine development came to a halt (Brandie & Haggerty, 2011). Otherwise, the subsequent experiments have been done on mouse models as an indication of the resurrection of the invention idea.

Measures that can be implemented to prevent transmission.

Proper usage of barrier contraceptives such as female and male condoms significantly reduce the exchange of fluids with an infected partner during copulation. Additionally, ensuring screening of the partners while abstaining during the treatment period is core to prevent transmission of chlamydia. Furthermore, maintenance of proper hygiene such as proper washing of hands helps to avoid transfer of bacteria to the eyes. Notably, people who use sex toys are advised to maintain privacy as sharing them accelerate the spread of the disease .More importantly, mothers should frequent the hospital for pre-natal care during their pregnancy periods lest they transmit it to their babies (Brandie & Haggerty, 2011).

Treatment

Usually, the class of antibiotics termed as Macrolides act as chemotherapeutic agents in the treatment of Chlamydia. One of the most effective antibiotics of this class is Azithromycin. Its mechanism of action involve inhibiting chlamydia growth by disrupting the protein synthesis. In addition, it prevents mRNA translation by binding to the 50s ribosomal subunits of the bacteria. Azithromycin is efficacious because in cases of chronic inflammatory disorder, it exerts immunomodulatory effects on the patient. Moreover, it is broad spectrum and the host responses modulation features make it more efficacious. Most important is its guaranteed safety and effectiveness towards the pregnant women.

Other therapeutic agents involve the tetracycline group such as doxycycline. This group is also broad spectrum in nature and contain bacteriostatic action. Secondly, the quinolones group consist of ciprofloxacin among many others and are also broad spectrum. Majorly, this group act on systemic infections and play a significant role in cases of failure of macrolides’ and Tetracycline’s therapy (Bhengraj et al., 2010).

Clinical relevance

Too important to note is that Chlamydia trachomatis is one of the multi-drug resistant strain that is so hard to control. In regard to this, reinfection is common to a patient who in the first instance was exposed to strains of Chlamydia trachomatis. This strain is a known health-related issue due to its recorded simple screening tests and predicted asymptomatic infections. In light of this, the health-based researchers attempt to develop the nucleic acid amplification technology majorly for detection of such multi-drug resistant strains. Notably, the persons who are sexually active populations are prone to Chlamydia trachomatis (Bhengraj et al., 2010).This strain has a historical background of usage of fluoroquinolones, tetracycline and macrolides groups of drugs. However, the reports show that some have indicated resistance even though the clinical relevance about this is still unidentified.

References

Berntsson, M., & Tunbäck, P. (2013). Clinical and microscopic signs of cervicitis and urethritis: correlation with Chlamydia trachomatis infection in female STI patients. Acta Dermatol-venereological, 93(2), 230-233.

Bhengraj, A. R., Vardhan, H., Srivastava, P., Salhan, S., & Mittal, A. (2010). Decreased susceptibility to azithromycin and doxycycline in clinical isolates of Chlamydia trachomatis obtained from recurrently infected female patients in India. Chemotherapy, 56(5), 371-377.

Brandie, T., Haggerty, C.(2011).Management of C.trachomatis genital tract infection: Screening and treatment challenges.info drug resist,4:19-29

Byrne, G. I. (2010). Chlamydia trachomatis strains and virulence: rethinking links to infection prevalence and disease severity. The Journal of infectious diseases, 201(Supplement_2), S126-S133

Redgrave, K. A., & McLaughlin, E. A. (2014). The role of the immune response in Chlamydia trachomatis infection of the male genital tract: a double-edged sword. Frontiers in immunology, 5, 534.

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