Chlamydia and Gonorrhea Research Paper
Chlamydia affects approximately 3-4 million people annually in the US, making it the most prevalent sexually transmitted bacterial infection. Moreover, it is the leading cause of infertility, ectopic pregnancy, and pelvic inflammatory disease (PID) among women. In men, chlamydia may become the reason of sterility and is frequently associated with prostate and testicular infections. Chlamydia often co-exists with gonorrhea. In the US, nearly 0.7 million cases of gonorrhea infections are documented annually. Gonorrhea has been linked to infertility, ectopic pregnancy, and PID among women, as well as prostate and testicular infections among men. This paper discusses various aspects associated with chlamydia and gonorrhea, including diagnosing, prevalence, treatment choices, education plan, and follow-up.
Method of Diagnosing Chlamydia and Gonorrhea
The diagnosing of chlamydia entails taking swabs (from cervix and inside of penis) and urine test (Geisler). For women, the physicians take swabs from cervix to collect a discharge sample for antigen testing or culture growing to detect the presence of the Chlamydia trachomatis. It might done in the course of a regular Pap test. Some women prefer taking swabs on their own, which has been reported to have the same diagnostic value as swabs performed by doctors (Taylor & Haggerty). Screening and diagnosing of chlamydia is relatively simple. For men, a slim swab is inserted into the penis to obtain a urethra sample. Sometimes, the anus swabs might be taken. Urine testing entails conducting a laboratory analysis of the urine sample to ascertain the presence of chlamydia (Geisler). It is imperative for the urine sample to be collected at least two hours after the previous urination.
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The analysis of the specimen obtained using swabs and urine samples for chlamydial infection has evolved since the 1990s to 2006 (Geisler). The nucleic acid amplification tests (NAAT), such as the DNA strand displacement amplification (SDA), transcription mediated amplification (TMA), and the polymerase chain reaction (PCR) are presently the standard methods used for analyzing the samples of chlamydia. For example, NAAT might be considered for analyzing swab samples obtained from the urethra (men) or cervix (women) (Mayor, Roett, & Uduhiri). The test can also be performed on voided urine or self-collected vaginal swabs. Geisler reports that NAAT has a sensitivity of approximately 90 percent coupled with a specificity of 99 percent irrespective of whether the sample is urine or a cervical specimen. Among women who show negative results of the urine test after being tested for chlamydia, a successive swab obtained from the cervix yields positive tests in approximately 2 percent of cases (Geisler). Presently, NAAT is approved for use only in the process of testing urogenital samples.
However, research indicates that it might offer reliable test results when rectal samples are used. Due to improvements in the accuracy, the convenience of managing specimen, and ease with which individuals can be screened, NAAT has substituted the use of culture and non-amplified probe tests for chlamydial detection. In their turn, the non-amplified probe tests are comparatively insensitive, resulting in only successful detections of 60-80 percent of cases and usually providing false positives (Taylor & Haggerty). However, culture is still useful in particular situations and is presently the only approved method for analyzing non-genital samples.
Chlamydia is often tightly connected to gonorrhea
Prior studies have reported that chlamydia co-exists with gonorrhea in approximately 40-50% of cases (Mayor et al.). An implication of this observation is that testing for chlamydia should always be accompanied by a diagnosing for gonorrhea. The samples for diagnosing gonorrhea are collected in the same way as it is done for chlamydia, namely taking swabs (urethral and cervical) and urine specimen (Mayor et al.). Conventionally, the diagnosing of gonorrhea was performed using gram stain (identifying the genetic material from the bacteria causing the disease) and culture (growing the bacteria). Nevertheless, novel PCR methods are becoming increasingly common. Other tests for diagnosing gonorrhea include DNA amplification and DNA probe techniques (Geisler). Although these tests are relatively expensive when compared to cultures, they often produce more accurate and rapid test results.
A general recommendation is that individuals diagnosed with gonorrhea should be tested for other sexually transmitted illnesses, such as human immunodeficiency virus (HIV) and syphilis at the same time (Taylor & Haggerty). Moreover, Geisler recommends regular screening even when one does not show any symptoms of the disease. Additionally, screening should be performed approximately two weeks after a suspected exposure in order for testing to be accurate. In addition, repeated testing is recommended 3-4 months after diagnosing and treatment (Geisler).
Sexually transmitted infections (STIs) are still a significant public health concern in the US. Estimates by the Centers for Disease Control (CDC) indicate approximately 19 million new STI infections annually (CDC). In 2009, there were at least 1.5 million of gonorrhea and chlamydia patients reported to the CDC, which makes these two STIs the most prevalently reported infectious illnesses in the US. These two STI are most common among young women (20-24 years) and adolescent girls (19-19 years) (CDC). Consequently, in 2009, they recorded the largest number of chlamydia and gonorrhea cases reported to the CDC. This trend can be attributed to a number of factors. Some of them are explained by the fact that females have a higher risk of STIs relative to males and the higher rates of STI screening (CDC).
Of the two diseases, chlamydia is the most prevalent in the US, with CDC documenting more than 1.2 million cases (1,244,180) in 2009. It is the largest number of cases ever to be documented by CDC for any disease. Chlamydia particularly affects young girls and women representing different minority groups aged less than 26 years (CDC). In 2009, the cases of gonorrhea documented by CDC amounted of 301,174, which denoted a decline of 10% compared to 2008 (CDC). In 2014, the CDC documented 1.4 million chlamydia cases (546.1 per 100000 population), which was an increase by 2.8 percent in comparison with 2013 (CDC). The number of gonorrhea cases documented in 2014 was 350,062 (111.7 per 100,000 population) (CDC). From these trends, it is evident that the prevalence of chlamydia and gonorrhea in the US is increasing, which is further worsening the STI epidemic. Such situation calls for better methods of diagnosing, treating, and preventing these diseases.
The treatment of gonorrhea and chlamydia is based on the CDC guidelines (Workowski). The infected individual and his/her sexual partner(s) should be treated immediately. Taking the prescribed medication is also an essential requirement for effective treatment of these STIs. The guidelines also provide information that any sexual partner of a person diagnosed with gonorrhea or/and chlamydia during the previous sixty days should undergo evaluation, testing, and treatment as well (Workowski). Moreover, even in instances when the last sexual contact occurred more than sixty days prior to diagnosis, that sexual partner should be assessed and subsequently treated. The CDC also recommends abstaining from all sexual contacts during the treatment as it reduces the risk of re-exposure and the need for retreatment (Workowski).
The two most important considerations in managing chlamydia outlined by Workowski include ensuring correct diagnosis and treatment compliance as treating chlamydia requires antibiotics. The medications recommended by CDC as the first-line treatment for chlamydia are doxycycline and azithromycin, which have been found to be effective in 95 percent of cases (Workowski). Alternative medications for chlamydia include ofloxacin, levofloxacin, and erythromycin (LeFevre).
For the case of gonorrhea, after diagnosis has been established, the physician must decide whether to hospitalize the patient or provide outpatient treatment. Male patients with genital infection are usually treated as outpatients. Nevertheless, some complications, such as gonococcal arthritis or disseminated gonococcal infection might become the reason for hospitalization (LeFevre). For female patients, the decisions to hospitalize or provide outpatient treatment is relatively difficult due to the higher complications risks. Moreover, as a result of high noncompliance rates, poor follow-up, and the possibility of reinfection, some authors recommend hospitalizing female patients, particularly adults, in instances of such complications occurrence as PID (Taylor & Haggerty).
Similarly to chlamydia, gonorrhea can be treated using antibiotics (LeFevre). Early diagnosing of gonorrhea might require using a single antibiotic. Nevertheless, due to the resistance of cephalosporin, the CDC recommends treating gonorrhea using a dual therapy of azithromycin and ceftriaxone, which should be administered on the same day, at the same time, and under close supervision (Workowski). Moreover, since chlamydia and gonorrhea may occur simultaneously, the CDC recommends treating people suffering from both diseases using a regime that targets both illnesses (Workowski), which further supports the use of dual treatment with azithromycin included.
Education Plan and Patient Follow-up Regarding Diagnosis
The education plan for people diagnosed with gonorrhea and chlamydia consists of two components, including responsible sexual behavior and risks associated with unprotected sex.
Responsible Sexual Behavior Education
The first component entails discussions connected to safe sex practices with individuals suspected of having these two STIs (Henderson, Raine, Schalet, Blum, & Harper). A proper education plan for preventing chlamydia and gonorrhea is more effective when compared to issuing simplistic instructions focusing on avoiding sex. Studies show unchanged STI rates among teenagers who participate in campaigns focusing on sex abstinence only (Stanger-Hall & Hall). Moreover, such teenagers tend to acquire oral and anal infections instead of the vaginal ones due to the perception that only vaginal sex leads to transmitting diseases (Stanger-Hall & Hall). Consequently, it is imperative for the clinicians to emphasize that infections can also be transmitted via anal or oral sex.
Nevertheless, the clinicians should not educate patients on responsible sexual practices based on their personal moral or religious views (Walker & Sweet). It is caused by the fact that patients might have different views, especially teenagers, who are fascinated by experimentation. Whereas the most effective approach to prevent STI is abstaining from sex, it is usually unrealistic, particularly among the teenagers. Stanger-Hall & Hall state that 88 percent of teenagers who practiced abstinence being at middle and high school levels still practiced premarital sex. In addition, teenagers are more likely to engage in riskier, unprotected sex practices due to their lack of knowledge (Stanger-Hall & Hall). Whereas abstinence should be highlighted as the best option, a more realistic expectation is to abstain from engaging in sex with individuals who are suspected or known to have STI until they finish their treatment. In this regard, it is imperative for clinicians to educate patients on the importance of knowing the sexual history of their partners (Walker & Sweet).Moreover, practicing protected sex can be recommended as an alternative for those patients who consider abstinence as an unrealistic expectation.
Educating Patients on the Risks of Unprotected Sex
The second aspect of the education plan is to inform patients on the mode of infection transmission, as well as the adverse effects associated with the recurrent of infections on their fertility (Walker & Sweet). Moreover, it is imperative to counsel patients regarding the complication risks associated with these STIs, as well as the risk of suffering from other related diseases. Henderson et al. recommend to instruct patients in a necessity to make their sexual partners ask for apt assessment and treatment. It is also important to emphasize to patients the importance of avoiding sexual contacts until they finish their medication and until their partners are also assessed and, if necessary, properly treated.
It is also essential to counsel patients regarding the additional risks associated with practicing unprotected sex, such as acquiring more lifelong or serious diseases, such as HIV, hepatitis B, herpes, as well as unwanted pregnancies (Henderson et al.). In addition, Walker & Sweet recommend addressing the emotional aspects associated with sexual relationships, particularly among adolescent girls. It is caused by the emotional vulnerability of teenage girls, since they are sexually mature, although are not yet ready to exhibit emotional input.
Reducing the risk of reinfection of chlamydia and gonorrhea requires issuing prescription both for patients and their sexual partners. It is referred to as patient-delivered partner therapy or expedited partner therapy. Alternatively, the clinicians can contact their patients’ sexual partners directly to provide treatment devoid of examination (Taylor & Haggerty). Some states have prohibited patient-delivered partner therapy; hence, it is important for the clinicians to consult the CDC prior to embarking on the given follow-up approach. The CDC has guidelines developed for patient-delivered partner treatment, which include providing treatment instructions, outlining suitable health warnings, specifying general health warnings, and issuing statements aimed at recommending sex partners of a sick person to seek for personal medical assessment (Workowski). Patient-delivered partner therapy reduces the risk of repeated diagnosing with gonorrhea at follow-up by nearly 50% (Jotblad et al.).
Retesting the individuals diagnosed with chlamydia and gonorrhea should be done within 3-6 months following the treatment, irrespective of partner treatment (LeFevre). It is caused by the high reinfection rates during the first six months following treatment. LeFevre further recommends retesting pregnant women within 3-6 months as well. Just like any other case of STIs, gonorrhea and chlamydia increase possibility of HIV spreading. Thus, treating gonorrhea reduces HIV spreading, as well as consequent disease transmissions (Walker & Sweet). Additionally, all patients testing positive for chlamydia and gonorrhea should be examined for other STIs, including HIV and syphilis.
Gonorrhea and chlamydia are a significant public issue in the US with at least 1.5 million new infections detected annually. These STIs are predominantly common among teenage girls and young women. The diagnosis of chlamydia and gonorrhea involves swabbing samples from the cervix (women) and urethra (men). Urine samples can also be analyzed to detect the presence of bacteria associated with the two STIs. These samples can be analyzed using nucleic acid amplification tests, such as SDA, TMA, and PCR. When treating chlamydia and gonorrhea, emphasis should be placed on ensuring correct diagnosing and treatment compliance. The two STIs can be treated using antibiotics with the dual therapy recommended for cases of co-infections. Patient education and follow-up are also important components of preventing reinfections and further spread of chlamydia and gonorrhea. The emphasis of patient education should be placed on responsible sexual behavior and risks associated with engaging in unprotected sex. Finally, follow-up should be performed using patient-delivered partner therapy to help reduce the reinfection risk.