Chlamydial pharyngitis?

Head and Neck Manifestations of Lymphogranuloma Venereum

Lymphogranuloma venereum (LGV)—caused by Chlamydia trachomatis serovars L1, L2, or L3—rarely occurs in the United States. The disease clinically manifests in three stages: primary, secondary, and tertiary. The primary manifestation, a self-limited genital ulcer at the site of inoculation, often is absent by the time the patient seeks medical attention. The most common clinical manifestation of LGV is evident in its secondary stage: unilateral tender inguinal and/or femoral lymphadenopathy. However, proctocolitis or inflammatory involvement of perirectal or perianal lymphatic tissues resulting in fistulas and strictures may also occur. The diagnosis of LGV is usually made serologically and by exclusion of other causes of inguinal lymphadenopathy or genital ulcers. Doxycycline is the preferred treatment; it cures the infection and prevents ongoing tissue damage. This case highlights an unusual manifestation of LGV infection—cervical lymphadenopathy following suspected oropharyngeal infection with C trachomatis. Head and neck manifestations of LGV may become an increasing problem in the future if sexual practices such as orogenital contact become more widespread.

Oral Chlamydia trachomatis in patients with established periodontitis

Periodontitis is considered a consequence of a pathogenic microbial infection at the periodontal site and host susceptibility factors. Periodontal research supports the association of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, and Bacteroides forsythus, and periodontitis; however, causality has not been demonstrated. In pursuit of the etiology of periodontitis, we hypothesized that the intracellular bacteria Chlamydia trachomatis may play a role. As a first step, a cross-sectional study of dental school clinic patients with established periodontitis were assessed for the presence of C. trachomatis in the oral cavity, and in particular from the lining epithelium of periodontal sites. C. trachomatis was detected using a direct fluorescent monoclonal antibody (DFA) in oral specimens from 7% (6/87) of the patients. Four patients tested positive in specimens from the lining epithelium of diseased periodontal sites, one patient tested positive in healthy periodontal sites, and one patient tested positive in the general mucosal specimen. In conclusion, this study provides preliminary evidence of C. trachomatis in the periodontal sites. Planned studies include the use of a more precise periodontal epithelial cell collection device, the newer nucleic acid amplification techniques to detect C. trachomatis, and additional populations to determine the association of C. trachomatis and periodontitis.

Oral manifestations of selected sexually related conditions

The incidence of certain microbial infections occurring in the oropharynx is well documented, but infection by other pathogens, although highly probable, has not been established with certainty. Considerable recent interest in the incubation period of various infections and improved community surveillance programs combine to ascribe infection to specific incidents. It is prudent for health care personnel to acknowledge the presence of many sexually transmitted diseases in the oropharynx and consider them in the differential diagnosis of many well-established conditions.

Value of screening for oro-pharyngeal Chlamydia trachomatis infection

AIMS

To determine whether oro-pharyngeal colonisation by Chlamydia trachomatis occurs in patients at risk of genital chlamydia infection; to determine whether screening pharyngeal specimens by polymerase chain reaction (PCR) increases detection of C trachomatis compared with isolation and the immune dot blot test; and to correlate the detection of C trachomatis and Neisseria gonorrhoeae in the pharynx with a history of oro-genital contact.

METHODS

Thirteen homosexuals and 11 heterosexuals were included in the study. Urogenital and pharyngeal specimens were tested for C trachomatis and N gonorrhoeae using standard clinical diagnostic procedures. Two different PCR methodologies were also used to detect C trachomatis in the pharyngeal specimens. Results were correlated with the mode of sexual practice.

RESULTS

Oro-genital sexual contact was practised by 64.9% (72/111) of heterosexuals in addition to penetrative penovaginal intercourse. Additionally, 62.1% (77/124) of all patients did not use any form of barrier protection. Of those who admitted to oro-genital sexual contact, 17.6% of patients with a genital chlamydial infection and 36.4% of those with genital gonorrhoea also had asymptomatic pharyngeal colonisation. C trachomatis was detected in three of 124 (2.4%) pharyngeal specimens by PCR which were reported as negative by chlamydial culture; one was positive by the immune dot blot test.

CONCLUSION

The majority of patients practised unprotected oro-genital contact and significant pharyngeal colonisation by C trachomatis and N gonorrhoeae occurred if genital infection was present. Despite the use of PCR in a population at high risk of sexually transmitted disease, the prevalence of chlamydia in the pharynx was very low. This indicates that transmission of C trachomatis to the oro-pharynx does not pose a serious health risk and that screening of patients for oro-pharyngeal C trachomatis is not worthwhile.

Prolonged and recurrent tonsillitis associated with sexually transmitted Chlamydia trachomatis

Chlamydia trachomatis is a common sexually transmitted pathogen. We describe six cases of tonsillitis associated with sexually transmitted C. trachomatis infection. The organism was isolated from tonsillar crypts in all patients, and from uro-genital swabs in five of the six patients. In three partners of the patients, C. trachomatis infection of the uro-genital organ was assessed. They all had a history of orogenital sexual intercourse prior to the illness.

Frequency of Chlamydia trachomatis as the cause of pharyngitis

We evaluated the incidence of Chlamydia trachomatis as the etiologic agent of uncomplicated pharyngitis by the cell culture procedure recommended by the Centers for Disease Control, Atlanta, Ga., and by the MicroTrak direct immunofluorescent stain (Syva Co., Palo Alto, Calif.) for elementary bodies on throat swabs collected from 126 symptomatic patients. Of the 126 cultures, 8% were positive for group A beta-hemolytic streptococci. Of 126 chlamydia cultures, none was positive. The MicroTrak test gave one borderline positive result. In contrast to a previously published report that C. trachomatis is the most frequent nonviral cause of adult pharyngitis (A. L. Komaroff, M. D. Aronson, T. M. Pass, C. T. Ervin, and W. T. Branch, Jr., Science 222:927-929, 1983), our data indicated an infection rate of less than 1%.

Role of Chlamydia trachomatis in acute pharyngitis in young adults

It has recently been suggested that Chlamydia trachomatis may be a common cause of acute pharyngitis in adults. In a prospective investigation of 95 college students with acute pharyngitis, C. trachomatis was not isolated from any pharyngeal cultures. Further investigations are needed to better define the role of C. trachomatis in upper respiratory tract infections.

Variations of palatal erythema secondary to fellatio

Mucosal alterations in fellatio may appear as a submucosal hemorrhage which now exhibits a distinctive enough clinical picture that histologic examination is not needed. The occurrence in male subjects has not been stressed in the literature but must be a consideration when palatal hemorrhage is noted. Fellatio should also be considered in patients with palatal mucositis and Candida albicans should be definitely ruled out as the causative factor in these cases. Cytologic or histologic examination should be done and microscopic examination of the submitted tissue should be extensive to find organisms which may be present only in small numbers.

Chlamydial infection in homosexual men. Frequency of isolation of Chlamydia trachomatis from the urethra, ano-rectum, and pharynx

Urethral, rectal, and pharyngeal material from 150 men who had had exclusively homosexual contact and who consecutively attended a sexually transmitted diseases clinic was cultured for Chlamydia trachomatis. The organism was isolated from at least one site in 15 (105) patients. The isolation rates from the urethra, rectum, and pharynx were 6 . 7%, 4%, and 1 . 3% respectively.

Epidemiology of infection by serotypes D to K of chlamydia trachomatis

Non-specific urethritis (NSU) is a sexually transmitted disease; 50% of cases are due to Chlamydia trachomatis, so that this is the commonest sexually transmitted infection in the developed world. Chlamydial infection is now readily diagnosable and the evidence increasingly suggests that it is underdiagnosed. Chlamydial conjunctivitis (in the newborn baby or the adult) in the developed world is a complication of sexually transmitted genital infection by C trachomatis and it indicates a large reservoir of such infections. Because of the association of sexually transmitted diseases, systemic treatment for such chlamydial conjunctivitis should not be given until full genital and serological investigators have been carried out. Chlamydial infection causes serious complications (that were formerly often thought to be gonococcal), such as epididymitis in young men and salpingitis on young women. It may cause local complications in the eye of the newborn baby and even pneumonia in babies and fatal endocarditis in adults. The diagnosis of NSU should lead to the correct treatment of the male patient and of his sexual partners. It is the promiscuous woman, who does not have a regular sexual partner to report back to her that he has NSU, who is at particular risk of undiagnosed chlamydial infection. Routine genital investigations for chlamydia are particularly indicated in her case. Following the parallel of gonorrhoea, it seems that the use of contact tracers may be an effective method for controlling chlamydial infection.

The rôle of Chlamydia trachomatis in genital-tract and associated diseases

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