Chlamydia trachomatis infections--a major concern for reproductive health. Where do we stand regarding epidemiology, pathogenesis, diagnosis and therapy?

The current article deals with the problem of distinguishing between relapse and reinfection of genital chlamydial infections due to the chronic character of such infections. The problem of detecting and treating chlamydial pelvic inflammatory disease is considered. Factors that may affect the clinical presentation of such infections, such as hormonal therapy, are also highlighted. Observations on novel manifestations of Chlamydia trachomatis infections, such as spontaneous abortion, prematurity and intrauterine infections as well as a statistical correlation of a certain serovar to cervical cancer, are described. The representivity of the data on infections with C. trachomatis monitored in national surveillance programs is questioned. The paper also elaborates on which type of sample, sample site and detection method may be optimal for the diagnosis of such infections in women. Whether to screen at clinics and self-sampling at home of specimens from an index case and a sexual partner to be mailed to a laboratory for testing is discussed. Whether or not females are more susceptible to genital chlamydial infections and their sequelae than males is also discussed. The effectiveness of recommended antibiotic regimens is considered, e.g. in relation to the recent detection of the existence of strains of C. trachomatis that show heterotypic resistance to drugs commonly used for their treatment.