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Need another reason to practice safe sex? Try Chlamydia.

April 14, 2007

Frank Vasey, MD



Need another reason to practice safe sex? Try Chlamydia. Historically, this one is not as well known as herpes, gonorrhea, or syphilis but seems to be making its case here in the 21st century. Chlamydia lives inside cells making it difficult to culture, as opposed to growing readily on an agar plate. If you have sex, care for birds, or breathe, you need to know the following.

We now recognize it to be the most common STD. Annually, three to four million people acquire the disease. Most people respond to common antibiotics. You need to see your doctor if you are concerned. Remember, your sexual partner(s) need to be treated as well. The bad news is that 4% of the people who have Chlamydia do not, for unknown reasons, respond to the antibiotics.

For those who unfortunately, do not respond, your symptoms could improve but the organism is not dead. Perhaps it is hiding in one of its two forms, either the elementary or reticulate body. Think of the elementary body as a spore that cannot be killed, while the active, more alive form of the organism is called the reticulate body.

Two cousins of the Chlamydia STD are Psittacosis (Chlamydia psittaci) from sick birds and pneumonia (Chlamydia pneumonia) coughed up from people into the air. Psittacosis is a flu upper respiratory infection that can last weeks to three months. Chlamydia pneumonia is likely more common than suspected because the organism is so difficult to grow and the proteins against it (antibodies) that may also be used for diagnosis are unpredictable and non-specific. All things considered when to worry and seek medical care? Mind you some primary infections may not present with any symptoms at all!

Symptoms: MEN
1. non-specific urethritis - a fire burns when I pass water
2. epididymitis - this lump on my ball hurts
3. proctitis - my anus hurts
4. conjunctivitis - my eye is red
5. reactive arthritis (formerly called Reiter's Syndrome, but Hans Reiter was a Nazi and deserves no credit) - my joints swell up and my back is stiff every morning for an hour or two and it lasts longer than 3 hours

Symptoms: WOMEN
1. acute urethral syndrome - a fire burns when I pass water
2. bartholinitis - lumps near the opening of my vagina
3. vaginitis or cervicitis - vaginal discharge
4. endometritis - lower abdominal pain
5. salpingitis (blocked fallopian tubes) - lower abdominal pain / tubal infection / infertility / tubal pregnancy
6. conjunctivitis - my eye is red
7. perihepatitis - right upper abdominal pain
8. reactive arthritis - my joints swell up and my back is stiff every morning for an hour or two and it lasts longer than 3 hours

Just because you are worried doesn't mean you have it, as there are other causes for these symptoms. But when medical evaluation can't find a cause, and you or your sexual partner has had sex with others, ask about Chlamydia.

As a rheumatologist (arthritis specialist), we see the arthritis months to years after the primary sexual infection in our patients. The arthritis called reactive arthritis affects the spine, especially the low back, but possibly the entire spine. It affects the peripheral joints, usually in a hit-or-miss fashion, unlike rheumatoid arthritis or systemic lupus erythematosus which affects all your peripheral joints and tends to spare the low back.

My partner, John Carter, M.D., has just received a National Institute of Health (NIH) grant to study treatment with various antibiotic combinations in people with chronic reactive arthritis, perhaps from unresolved sexually transmitted Chlamydia infections as described. NIH funding is highly sought in the scientific community which emphasizes the importance of this problem, as these grants are very hard to obtain (only 12% of people who requested them were funded).The point of this essay is to increase awareness of the problems associated with untreated or uncured Chlamydia in the erudite fans of NYJSM.com.
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