Clinical Review Lesson of the week

A family cluster of Chlamydia trachomatis infection

BMJ 2001; 322 doi: (Published 16 June 2001) Cite this as: BMJ 2001;322:1473
  1. C Thompson, consultant in genitourinary medicine (,
  2. M Macdonald, consultant ophthalmologista,
  3. S Sutherland, consultant virologistb
  1. a Fife Acute Hospitals NHS Trust, Victoria Hospital, Kirkcaldy, KY2 5AH
  2. b Department of Medical Microbiology, University of Edinburgh Medical School, Edinburgh, EH8 9AG
  1. Correspondence to:
  • Accepted 10 July 2000

Prepubertal chlamydial infection may indicate sexual abuse and requires sensitive multiagency management of the family

Chlamydia trachomatis is the commonest curable sexually transmitted pathogen in the United Kingdom. Chlamydial infection is often asymptomatic and therefore underdiagnosed as there is no routine screening surveillance outside departments of genitourinary medicine. The true prevalence of chlamydial infection in the general population is currently unknown, but it is estimated to be as high as 10% in people under 20. Untreated carriers may present with complications of infection—salpingitis, possibly resulting in pelvic pain and tubal pregnancy or infertility in women and epidydimo-orchitis in men.1 Babies can acquire the infection at birth if their mother's cervix is infected2; this results in neonatal ophthalmia or pneumonitis, or both, and in nasopharyngeal and genital tract colonisation. The case we report raises the possibility that vertical transmission of vaginal chlamydial infection can remain asymptomatic for as long as six years.

Case report

A 6 year old girl was referred to an ophthalmologist because her eye was red and sticky and the condition had failed to respond to fucithalmic drops. The uniocular conjunctival injection, thickening, and follicle formation seen at examination suggested chlamydial infection. A swab from the eye was positive for C trachomatis by enzyme immunoassay testing (Syva Microtrak, Syva, CA) confirmed by direct immunofluorescence.3 The symptoms and signs resolved with topical tetracycline ointment.

The mode of transmission of infection was a source of concern. Three possibilities were considered: recent acquisition resulting from child sexual abuse, fomite contamination from another household member, and latent …

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