Inflammatory / infectious

Chlamydia trachomatis

Last author update: 1 October 2010
Last staff update: 13 December 2022

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PubMed search: Chlamydia trachomatis cervix

Farnaz Hasteh, M.D.
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Cite this page: Hasteh F. Chlamydia trachomatis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/cervixchlamydia.html. Accessed September 26th, 2023.
Definition / general
  • Chlamydia trachomatis is the most common sexually transmitted bacterial infection in the U.S.
  • 4 million new cases annually in US
  • Transmitted by sexual intercourse and to newborns during delivery
  • Risk factors include sexually active young women, OCP use, pregnancy
  • In gynecologic tract, affects cervix, uterus, adnexae; not vulva / vagina
  • Chlamydia trachomatis is an obligate intracellular parasite with elementary bodies (infectious but incapable of cell division) and reticulate bodies (multiply within cytoplasm, but not infectious until they transfer back into elementary bodies)
Clinical features
  • Infection is usually not associated with symptoms (Sex Health 2004;1:115)
  • Symptoms, present in 1/3, include mucopurulent cervicitis with yellow exudate
  • PID and infertility are late complications
  • Also leading cause of pneumonia and pinkeye in neonates
  • Not associated with dysplasia or cervical cancer (Diagn Cytopathol 2007;35:198)
  • Diagnose based on culture, PCR of urine or enzyme immunoassay on cervical / urethral swab (Arch Pathol Lab Med 2000;124:840)
  • Nucleic acid amplification of urine has similar sensitivity as samples from cervix or urethra (Ann Intern Med 2005;142:914)
  • Immunotypes A - C cause trachoma (chronic conjunctivitis endemic in Africa and Asia)
  • Immunotypes D - K cause genital tract infections (eMedicine: Chlamydial Genitourinary Infections)
  • Immunotypes L1 - L3 cause lymphogranuloma venereum (associated with genital ulcer disease in tropical countries)
  • Doxycycline
  • Patient and all sex partners should be treated
Microscopic (histologic) description
  • Lymphoid germinal centers (follicular cervicitis - sensitive but not specific for chlamydia), plasma cells, reactive epithelial atypia
Cytology description
  • Involvement of endocervical cells or metaplastic cells but not mature squamous cells
  • Granular cytoplasm with multiple intracytoplasmic inclusions with central small coccoid bodies
  • Targetoid inclusion within large intracytoplasmic vacuole
  • "Nebular bodies" are more specific, but are difficult to differentiate from intracytoplasmic mucin vacuoles (Diagn Cytopathol 1991;7:252)
  • Nuclear enlargement, hyperchromasia or multinucleation
  • Marked acute inflammation is common
Cytology images

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Molecular / cytogenetics description
  • Residual liquid based pap (LBP) test can be submitted for both microbiological testing (chlamydia and neisseria), as well as DNA testing for HPV (Diagn Cytopathol 2005;33:177)
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