According to WHO reports, the incidence of STDs are increasing in recent times and Chlamydia trachomatis is one of the pathogens which is infecting more number of individuals. There are several factors which are accumulating for the increased number of infected individuals every year, such as – changes in the behaviour of individuals for sexual selection, lack of preventive measures as well as lack of proper education. In addition to all of these factors, proper information regarding regular check-ups and sensitive detection methods are also of prime importance.
Diagnosis / Identification of the infection
There could be several kinds of detection assay possible for chlamydia identification which is broadly grouped into direct and indirect test methods. When the infection is limited to a particular area, where the sample can be taken, and direct pathogen identification methods like cell culture, Enzyme immunoassay or Nucleic acid hybridization method using Chlamydia DNA is possible. However, in the situation where infection spread to inner body areas or become chronic, indirect methods are applied which based on the identification of antibodies against chlamydia.
- Detection of chlamydia in cell culture- for the identification of the pathogen in individuals, swabs are collected from particular areas like urethra, cervix, and anal canal with a special device in clinics. Next cells are transferred to culture plates and grown with the help of a special medium for 48 to 72 hours. After the specific period cells are stained with defined dyes or antibodies which are labelled with fluorescent. If a patient sample contains the pathogen chlamydia, they can be easily visualized under microscopes.
- NAAT or nucleic acid amplification from chlamydia pathogen-Now days this test is considered to be more specific and sensitive for the detection of chlamydia. As a result, presently NAAT is considered as the gold standards method for the identification of chlamydia in suspected patients. With the help of these experiments, the presence of Chlamydia DNA is identified. In females, samples such as swab from vagina, secretions or first portion of urine (first void urine) are taken. Identification of Chlamydia in first urine is important as the pathogen concentration becomes less with increasing number of urination. For male urine sample, it seemed to most effective. When the infection spreads out to other regions including the genital part, like in anorectal, pharyngeal or eye, swabs are required to taken directly from those places. In females, menstruation does not interfere with the sample collection time. Chlamydia DNA next is extracted from the samples and detection is mostly done by PCR methods giving results in the small time frame.
iii. To initiate the treatment timely, nowadays it’s important that the testing methods should be fast as well as accurate. Although NAAT is accurate and specific there is a requirement of a laboratory and personnel to carry the material or specimen to the laboratory and the results to the patient. In this scenario, there is always a chance that the patient may not return twice to take the report and then treatment is not possible. As a result, the rate of infection goes higher among individuals. To avoid such incidents, the point of care treatment options which can be devoid of such logistics are crucial. Such treatments are currently available through rapid diagnostics tests. These kinds of tests mostly represented by chromatographic methods which can identify Chlamydia pathogen in situ from samples like genital swabs or urine.
Management of Chlamydia
To manage the widespread infection rate of chlamydia, at the beginning it’s important to establish a screening program. Such a screening program is beneficial for women to reduce the risk of PID or Pelvic inflammatory disease. For women, it’s necessary to establish screening events to initially identify the presence of Chlamydia provide prevention methods for further complications as well as give support for the partner treatment. As most of the time Chlamydia infection do not show any symptoms, thus health care providers mostly dependent on screening methods. To this end, it is advisable to start and follow an annual screening program for young sexually active women, especially in the age group under 25. Additionally, the establishment of a screening clinic for adolescents, STD clinics are highly required. Although Chlamydia is affecting both male and female individuals, however, in some circumstances like feasibility, cost-effectiveness or efficiency screening methods for a male is limited.
Consideration for diagnosis
Since 2003, the World Health Organization (WHO) has established guidelines to treat STDs including Chlamydia. These guidelines are important to give patients updated treatments for the pathogen infection which are generally coming from current pieces of evidence. WHO recommendation is required to establish a standard treatment regime which will be based on pieces of evidence. Additionally, WHO recommendation is also useful to provide country-specific support for building up national guidelines to prevent Chlamydia spreading. According to the current situation, there are nine treatment options has been provided for a different group of people like teenagers, adults, HIV positive individuals or sex workers. A specific treatment option has also been designed for pregnant women who are getting infected as well as treatment for ophthalmia neonatorum. For instances, according to WHO a single dose of azithromycin 1 g to or Doxycycline can be used at a rate of two tablets in a day for consecutive 7 days. Alternatively WHO recommends using either tetracycline, 400mg, 4 times a day for 7 days or use of erythromycin, 500mg similarly to be taken 4 times for 7 days. To increase the chance of infection control, single dose option of azithromycin should be available. In a situation where multidrug therapy is required, the first drug should be provided on the place and observation should be followed.
In general, the high rate of newly diagnosed Chlamydia infection results from reinfection because of partners does not follow the treatment or interaction with the new person who is already infected. Thus a follow-up regime following the initial treatment is highly required and clinicians must follow a retest option for the initial 12-month time frame after receiving the first treatment. Special consideration is required to take for the screening of other STDs like HIV, or syphilis in individuals having Chlamydia infection.