Clinical Case Study Two

Chlamydial Infection

Case Presentation

Cory, a nineteen year old college student, has been experiencing some pain for the last couple of days during urination. On one occasion, he observed a small amount of yellowish discharge from the tip of his penis. He realized his symptoms could indicate a sexually transmitted disease and figured that he must have contracted it from his girlfriend Julie. Cory and Julie had been seeing each other for about 3 months and had just recently become sexually intimate. Julie assured Cory that she had been faithful to him for the entire time that they had been together. Cory questioned whether Julie was being honest with him, but also had the feeling that Julie was wondering if he had been unfaithful to her.

Cory went to the college health center and provided a urine sample that would be used to test for sexually transmitted disease. He returned the following day to find that he had tested positive for chlamydial infection. Cory was referred to a doctor at the clinic who gave him a prescription for an antibiotic that he was to take for seven days. The doctor inquired about Cory's sexual activities and Cory explained the situation with his girlfriend. Cory explained to the doctor that Julie must be lying to him about not having sex with anyone since first dating him. The doctor explained to Cory that most women with chlamydial infections do not have symptoms and furthermore, that Julie could have contracted the disease before she and Cory began seeing each other.

The doctor told Cory he was very concerned about Julie's health because undiagnosed chlamydial infection in women can lead to pelvic inflammatory disease. He explained that pelvic inflammatory disease is a cause of infertility and one of the leading causes of pregnancy related death. The doctor was adamant that Julie should inform other sex partners of her infection.

Case Background

Chlamydial infection is caused by Chlamydia trachomatis, an obligate intracellular bacterial pathogen. The pathogen occurs in two forms, an infective form and a reproductive form. The infective form invades a body cell and then differentiates into a reproductive form. The reproductive form is noninfective and resides inside of a body cell, producing new infective cells.

Chlamydial infection is the most common form of sexually transmitted disease in the United States with three million new cases reported each year. As many as 85 percent of infected women and 40 percent of infected men are without symptoms. If not treated, 20 to 40 percent of women who have chlamydial infection develop pelvic inflammatory disease. Pelvic inflammatory disease can cause chronic pelvic pain and scarring of reproductive structures. It also accounts for 15 percent of all cases of female infertility and is a primary cause of ectopic pregnancy.

1		Why did the doctor advise Julie to inform past sexual partners of her infection?
2		Describe the pathway followed by a secondary oocyte and zygote from ovulation to implantation.

Define the following terms.

3		Ectopic pregnancy
4		Tubal pregnancy

Answer the following questions.

5		Why would pelvic inflammatory disease increase the risk of tubal pregnancy?
6		Why is Chlamydia trachomatis described as an obligate intracellular bacterial pathogen?