Case Study Week 10
Patient is a 21-year-old female with no medical history. She reports vaginal discomfort and
discharge for approximately 3 days. She is sexually active and has a new partner within the
last 2 months. She denies fever, nausea or severe pain. The only medication the patient is
taking is birth control.
DIAGNOSTIC:
Cervical swab PCR test is positive for chlamydia trachomatis
Urinalysis –
Color – yellow
Clarity – clear
pH – 7.0
Blood – negative
Nitrites – negative
Leukocytes – negative
POC Pregnancy – neg
Questions:
1. Describe the pathophysiologic process of chlamydia, including the two forms,
intracellular development, and immune evasion.
2. Explain the host’s response to the infection, including pathogen recognition
receptors and proinflammatory cytokines.
3. Explain the risk factors for STDs.
4. Explain the potential complications of Chlamydia.

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1. Pathophysiologic Process of Chlamydia

Chlamydia trachomatis is an obligate intracellular bacterium, meaning it must live and replicate inside host cells. It has a unique biphasic life cycle consisting of two forms:

Elementary Body (EB): This is the infectious, extracellular form. It is metabolically inactive but can survive outside host cells. EBs attach to epithelial cells in the genitourinary tract and are taken up by endocytosis.
Reticulate Body (RB): Once inside the host cell, EBs convert into RBs, which are metabolically active and replicate by binary fission within a specialized vacuole called an inclusion. After replication, RBs condense back into EBs, which are then released to infect neighboring cells.

Immune Evasion:
Chlamydia avoids immune detection by:

Inhibiting phagosome-lysosome fusion in host cells
Altering host cell apoptosis pathways
Modulating the host immune response to avoid rapid clearance, thereby promoting chronic infection and tissue damage.

2. Host Response to the Infection

The host detects Chlamydia trachomatis through Pathogen Recognition Receptors (PRRs) such as Toll-like Receptors (TLRs) (especially TLR2 and TLR4) on epithelial and immune cells. These receptors recognize components of the bacterial cell wall (e.g., lipopolysaccharide and heat shock proteins).

Upon recognition:

The innate immune system initiates a response with the release of proinflammatory cytokines, including:
- Interleukin-1 (IL-1)
- Interleukin-6 (IL-6)
- Tumor Necrosis Factor-alpha (TNF-α)
- Interleukin-8 (IL-8), which recruits neutrophils

This response helps control the infection but also contributes to tissue inflammation and damage, especially in the reproductive tract.

3. Risk Factors for STDs

Key risk factors for sexually transmitted diseases (STDs), including Chlamydia, include:

Age: Adolescents and young adults (particularly under age 25) are at higher risk.
New or multiple sexual partners: Increases exposure risk.
Unprotected sex: Lack of condom use significantly raises infection risk.
Inconsistent screening and lack of treatment: Many STDs, including chlamydia, are asymptomatic.
Low socioeconomic status and limited access to healthcare: Reduces screening and treatment opportunities.
History of previous STIs: Increases susceptibility to reinfection.
Substance use: Impaired judgment can lead to risky sexual behaviors.

4. Potential Complications of Chlamydia

If left untreated, Chlamydia trachomatis can lead to several significant health issues, particularly in females:

Pelvic Inflammatory Disease (PID): Ascending infection can damage the uterus, fallopian tubes, and ovaries.
Infertility: Resulting from tubal scarring and obstruction due to chronic inflammation.
Ectopic Pregnancy: Tubal damage increases the risk of embryo implantation outside the uterus.
Chronic Pelvic Pain: Due to long-term tissue inflammation and scarring.
Perihepatitis (Fitz-Hugh–Curtis syndrome): A rare complication involving liver capsule inflammation.
Increased HIV susceptibility: Due to compromised mucosal barriers and immune activation.
Neonatal complications (if pregnant): Including conjunctivitis and pneumonia in newborns.

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