Causes and symptoms of chlamydial conjunctivitis

Chlamydia is a common sexually transmitted disease (STD) caused by infection with the obligate intracellular bacterium Chlamydia trachomatis. Chlamydia is transmitted through sexual contact with the penis, vagina, mouth, or anus of an infected individual. It can also be transmitted from a mother with an untreated chlamydial cervical infection to her newborn during childbirth (1). 

Chlamydial infections most commonly occur in the genital area. However, chlamydia can also affect the eyes, resulting in chlamydial conjunctivitis (2). Chlamydial conjunctivitis is also known as adult inclusion conjunctivitis or swimming pool conjunctivitis (3).

How do people get chlamydial conjunctivitis?
Chlamydial conjunctivitis usually occurs through sexual contact with a person that has a genital chlamydia infection. In rare cases, an infection may be acquired from contaminated and incompletely chlorinated swimming pool water (3). Often the infection arises due to the spread of semen or vaginal fluids from an infected person to the eye (1).

Conjunctivitis can also occur due to other bacterial infections, as well as viral infections that tend to be more common than bacterial causes (4).

What are the symptoms of chlamydial conjunctivitis?
The incubation period (time from exposure to symptom appearance) is between two and 19 days. The severity of symptoms varies, but generally people present with mild symptoms that have lasted for several weeks or months. Often only one eye is affected, but symptoms can occur in both eyes for some people. The symptoms of conjunctivitis are due to inflammation of the conjunctiva (mucous membrane of the eye). Symptoms can include:

  • Bloodshot eyes
  • Watery eyes, due to overactive tear glands
  • Mucus production that sticks to and coats the eyelashes
  • Eye pain and grittiness feeling
  • Swelling and redness of the eyes
  • Eye irritation and itchiness

Severe infections may scar the conjunctiva, causing abnormalities in the tear film, or spread to the cornea of the eye (4).

Many people affected by chlamydial conjunctivitis also have symptoms of a genital infection, such as painful urination and abnormal discharge from the penis/vagina (4).

How is chlamydial conjunctivitis diagnosed?
Chlamydial conjunctivitis symptoms tend to last for several weeks and fail to clear up from topical antibiotics that are effective against other bacterial conjunctivitides (3). A clinical evaluation of symptoms, as well as laboratory testing (e.g. bacterial cultures, immunofluorescent staining, and nucleic acid detection), is generally undertaken for an accurate diagnosis (3).

How is chlamydial conjunctivitis treated?
Chlamydial conjunctivitis usually resolves spontaneously, but symptoms can last for 6-18 months before recovery (5). Oral antibiotics are required to treat chlamydial conjunctivitis, as topical antibiotics are often ineffective. Options include azithromycin, doxycycline, or erythromycin. These antibiotics also cure any concomitant genital infections (3). Sexual partners should be evaluated and treated at the same time as an infected individual.

References
1. Sexually Transmitted Disease Surveillance, 2018. CDC. [Online] October 2019. https://www.cdc.gov/std/stats18/default.htm.
2. Kalayoglu MV. (2002) Ocular chlamydial infections: pathogenesis and emerging treatment strategies. Curr Drug Targets Infect Disord, 2 (1), 85-91.
3. Adult Inclusion Conjunctivitis. MERCK MANUAL Professional Version. October 2019. https://www.merckmanuals.com/professional/eye-disorders/conjunctival-and-scleral-disorders/adult-inclusion-conjunctivitis
4. Infectious Conjunctivitis. MERCK MANUAL Consumer Version. December 2019. https://www.merckmanuals.com/home/eye-disorders/conjunctival-and-scleral-disorders/infectious-conjunctivitis
5. Yang EB, Oetting TA. (2007). Adult Chlamydial Conjunctivitis: 23-year-old male with 6-week duration of red eyes. EyeRounds.org. http://www.EyeRounds.org/cases/68-Adult-Chlamydial-Conjunctivitis-Red-Eyes-Chronic.htm.

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