CHLAMYDIA

Disusun Oleh :

PPDS I OBSTETRI & GINEKOLOGI

dr. Antonius Budi Giri B(S5011202010)
dr. Andy Wijaya(S501202008)
dr. Muhamad Nasrudin (S501202045)
dr. John Arianto Sondakh(S501202037)
dr. Yusri (S501202077)
dr. Kautsar Heridho (S501202038)
dr. Ika Wiraswesty(S501202034)
dr. Fajar Alam Sukma Raharja(S501202024)
dr. Rinaldi Yudhistira. (S501202059)
dr. Supatmi. (S501202065)
PRODI KEDOKTERAN KELUARGA MINAT BIOMEDIK
PROGRAM PASCA SARJANA UNIVERSITAS SEBELAS MARET
SURAKARTA
2012

Chlamydia Curriculum

Epidemiology

Chlamydia Rates, Selected Counties, 2007

U.S.
New Mexico
Cibola
Lea
McKinley
Bernalillo
Curry
Roosevelt
Chaves
San Juan
Quay
San Miguel
Rio Arriba
Luna

Includes counties
reporting at least
50 cases

Estimated Rate per 100,000 population

STD Program

Data as of 7/15/08

Chlamydia Rates, by Race/Ethnicity, 2007

5th in the
U.S.

Note: 12% of cases

have Unknown
Race/Ethnicity
STD Program

Estimated Rate per 100,000 population

Data as of 7/15/08

ChlamydiaRates by Age and Sex, United

States, 2009
Men
3,800

Rate (per 100,000 population)

3,040

2,280

1,520

760

0
13.8

760
Age 0
1014
127.9

Women
1,520

1519

735.5

1,234.0

3034

286.0

511.7

141.3

3539

81.9

4044

36.0

4554

32.0

11.0

5564

9.1

2.9
219.8

65+
Total

3,800

3,273.9

2529

573.3

3,040

3,329.3

2024

1,120.6

2,280

205.8
88.4

2.1
593.4

ChlamydiaRates by Sex, United States,

19902009
Rate (per 100,000 population)
600
Men
Women
Total

500
400
300
200
100
0

1990

1992

1994

1996

1998

2000

2002

2004

2006

Year

NOTE: As of January 2000, all 50 states and the District of Columbia had regulations that
required chlamydia cases to be reported.

2008

ChlamydiaRates by Region, United States,

20002009
Rate (per 100,000 population)
500
400
300
200

West
Midwest
Northeast
South

100
0

2000

2001

2002

2003

2004

Year

2005

2006

2007

2008

2009

ChlamydiaPrevalence by Age Group and

Race/Ethnicity, National Health and Nutrition
Examination Survey,
19992002
Prevalance, %
16
Non-Hispanic Whites
Non-Hispanic Blacks
Mexican-Americans

12

1419

2029

3039

Age
NOTE: Error bars indicate 95% confidence intervals.
SOURCE: Datta SD, Sternberg M, Johnson RE, Berman S, Papp JR, McQuillan G, et al. Gonorrhea
and chlamydia in the United States among persons 14 to 39 years of age, 1999 to 2002. Ann
Intern Med. 2007;147(2):89-96.

Sumber: Ditjen PP & PL Kemenkes RI.

Chlamydia Curriculum

Epidemiology

Risk Factors

Adolescence
New or multiple sex partners
History of STD infection
Presence of another STD
Oral contraceptive user
Lack of barrier contraception
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Chlamydia Curriculum

Epidemiology

Transmission
Transmission is sexual or vertical
Highly transmissible
Incubation period 7-21 days
Significant asymptomatic reservoir exists in
the population
Re-infection is common
Perinatal transmission results in neonatal
conjunctivitis in 30%-50% of exposed babies
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Chlamydia Curriculum

Pathogenesis

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Chlamydia Curriculum

Source: California STD/HIV Prevention Training Center

Pathology

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The Chlamydial Lifecycle

The Chlamydial inclusion

membrane

Proteins to be studied

Im are seeking to confirm that these are localized to the inclusion membrane
and to examine their interactions with human proteins.

Hydrophilicity plots provide evidence that these proteins are

localized to the inclusion membrane.

GPIC 425

GPIC 426

Primers were designed for Ct 58, CWL 369, GPIC 425, and GPIC 426. They were ordered from SigmaGenosys and used to amplify portions of these genes from genomic DNA via PCR. Gel electrophoresis
was used to determine that they had worked and fragments corresponding to the size of the target
sequence were extracted from the gel with a QIAGEN gel extraction kit.
Ct58

CWL369

Ladder

GPIC425 Ladder GPIC426

The expression vector

PCR screen of transformed E. coli colonies

426

425

369

58

I ligated the digested plasmid (P-Mal C2) with the targeted gene fragments
and then transformed E. coli with the result. I screened for successful
transformation with LB Ampicillin plates and then ran a PCR screen on the
colonies. True positives were found for all but GPIC 426.

Chlamydia Curriculum

Clinical Manifestations

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Chlamydia Curriculum

Clinical Manifestations

Clinical Syndromes Caused by C. trachomatis

Local Infection

Complication

Sequelae

Men

Conjunctivitis
Urethritis
Prostatitis

Reiters syndrome
Epididymitis

Chronic arthritis
(rare)
Infertility (rare)

Women

Conjunctivitis
Urethritis
Cervicitis
Proctitis

Infertility
Endometritis
Ectopic pregnancy
Salpingitis
Chronic pelvic pain
Perihepatitis
Chronic arthritis
Reiters syndrome
(rare)

Infants

Conjunctivitis
Pneumonitis
Pharyngitis
Rhinitis

Chronic lung
disease?

Rare, if any
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Chlamydia Curriculum

Clinical Manifestations

C. trachomatis Infection in Men

UrethritisOne cause of non-gonococcal
urethritis (NGU)
Majority (>50%) asymptomatic
Symptoms/signs if present: mucoid or clear
urethral discharge, dysuria
Incubation period unknown (probably 5-10 days
in symptomatic infection)
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Chlamydia Curriculum

Clinical Manifestations

C. trachomatis Infections in
Women
Cervicitis
Majority (70%-80%) are asymptomatic
Local signs of infection, when present, include:
Mucopurulent endocervical discharge
Edematous cervical ectopy with erythema and friability

Urethritis
Usually asymptomatic
Signs/symptoms, when present, include dysuria,
frequency, pyuria
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Chlamydia Curriculum

Clinical Manifestations

Normal Cervix

Source: STD/HIV Prevention Training Center at the University of

Washington/Claire E. Stevens

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Chlamydia Curriculum

Clinical Manifestations

Chlamydial Cervicitis

Source: STD/HIV Prevention Training Center at the University of

Washington/Connie Celum and Walter Stamm

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Chlamydia Curriculum

Clinical Manifestations

Cervicitis

Source: St. Louis STD/HIV Prevention Training Center

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Chlamydia Curriculum

Clinical Manifestations

C. trachomatis Complications
in Women
Pelvic Inflammatory Disease (PID)
Salpingitis
Endometritis

Perihepatitis (Fitz-Hugh-Curtis Syndrome)

Reiters Syndrome

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Chlamydia Curriculum

Diagnosis

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Chlamydia Curriculum

Diagnosis

Testing Technologies
Culture
Non-culture tests
Nucleic Acid Amplification Tests (NAATs)
Non-Nucleic Acid Amplification Tests (NonNAATs)
Serology

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Chlamydia Curriculum

Diagnosis

Culture

Historically the gold standard

Variable sensitivity (50%-80%)
High specificity
Use in legal investigations
Not suitable for widespread screening

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Chlamydia Curriculum

Diagnosis

NAATs
NAATs amplify and detect organismspecific genomic or plasmid DNA or
rRNA
FDA cleared for urethral swabs from
men/women, cervical swabs from
women, and urine from both

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Chlamydia Curriculum

Diagnosis

NAATs
Commercially available NAATs include:
Becton Dickinson BDProbeTec
Gen-Probe AmpCT, Aptima
Roche Amplicor

Significantly more sensitive than other

tests

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Chlamydia Curriculum

Diagnosis

Non-NAATs
Direct fluorescent antibody (DFA)
Detects intact bacteria with a fluorescent antibody
Variety of specimen sites
Can be used to determine quality of endocervical
specimens

Enzyme immunoassay (EIA)

Detects bacterial antigens with an enzyme-labeled
antibody

Nucleic acid hybridization (NA probe)

Detects specific DNA or RNA sequences of C.
trachomatis and N. gonorrhoeae
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Chlamydia Curriculum

Diagnosis

NAATs
Commercially available NAATs include:
Becton Dickinson BDProbeTec
Gen-Probe AmpCT, Aptima
Roche Amplicor

Significantly more sensitive than other

tests

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Chlamydia Curriculum

Diagnosis

Serology
Rarely used for uncomplicated
infections (results difficult to interpret)
Criteria used in LGV diagnosis
Complement fixation titers >1:64
suggestive
Complement fixation titers > 1:256
diagnostic
Complement fixation titers < 1:32 rule out
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Chlamydia Curriculum

Patient Management

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Chlamydia Curriculum

Management

Treatment of Uncomplicated
Genital Chlamydial Infections
CDC-recommended regimens
Azithromycin 1 g orally in a single dose, OR
Doxycycline 100 mg orally twice daily for 7 days
Alternative regimens
Erythromycin base 500 mg orally 4 times a day for 7 days,
OR
Erythromycin ethylsuccinate 800 mg orally 4 times a day for
7 days, OR
Ofloxacin 300 mg orally twice a day for 7 days, OR
Levofloxacin 500 mg orally once a day for 7 days
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Chlamydia Curriculum

Management

Treatment of Chlamydial Infection

in Pregnant Women
CDC-recommended regimens
Erythromycin base 500 mg orally 4 times a day for 7 days, OR
Amoxicillin 500 mg orally 3 times a day for 7 days

Alternative regimens
Erythromycin base 250 mg orally 4 times a day for 14 days, OR
Erythromycin ethylsuccinate 800 mg orally 4 times a day for 7
days, OR
Erythromycin ethylsuccinate 400 mg orally 4 times a day for 14
days, OR
Azithromycin 1 g orally (single dose)
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Chlamydia Curriculum

Prevention

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Chlamydia Curriculum

Prevention

Why Screen for Chlamydia?

Screening can reduce the incidence of
PID by more than 50%.
Most infections are asymptomatic.
Screening decreases the prevalence of
infection in the population and reduces
the transmission of disease.

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Chlamydia Curriculum

Prevention

Screening Recommendations:
Non-pregnant Women
Sexually active women age 25 years and under
should be screened annually.
Women >25 years old should be screened if risk
factors are present.
Repeat screening of women 3-4 months after
treatment for C. trachomatis infection, especially
adolescents.
Repeat screening of all women treated for C.
trachomatis when they next present for care.
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Chlamydia Curriculum

Prevention

Screening Recommendations:
Pregnant Women
Screen all pregnant women at the first
prenatal visit.
Pregnant women aged <25 years and
those at increased risk for chlamydia
should be screened again in the third
trimester.

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