Clinical Manifestations and Sequelae (continued)

Chlamydial Infections in Infants and Children

Infants

Conjunctivitis is the most common clinical condition resulting from perinatal transmission of chlamydia. Initial C. trachomatis infections result from exposure to the mother’s infected cervix and involve mucous membranes of the eye, oropharynx, urogenital tract, and rectum. Inclusion conjunctivitis occurs 5-14 days after delivery.

The signs range from mild scant mucoid discharge to severe copious purulent discharge, chemosis, pseudomembrane formation, erythema, friability, and edema.

Neonatal ocular prophylaxis with silver nitrate solution or antibiotic ointments for prevention of gonorrhea transmission does not prevent perinatal transmission of C. trachomatisfrom mother to infant. A chlamydial etiology should be considered for all infants aged 30 days or under who have conjunctivitis.

Chlamydial pneumonia in infants occurs 4-12 weeks after delivery. The signs are cough, congestion, and tachypnea. Infants are usually afebrile, and rales are apparent with auscultation of the lungs.

Children

Urogenital infections in pre-adolescent males and females are usually asymptomatic and can be the result of vertical transmission during the perinatal period. Genital or rectal infection can persist for as long as 2-3 years, so infection in young children may be the result of perinatally acquired infection.

However, sexual abuse is a major concern when chlamydia is detected in pre-adolescent males and females. The STD evaluation should be performed by, or in consultation with, an expert in the assessment of child sexual abuse. Only tests with high specificity should be used because of the legal and psychosocial consequences of a false-positive diagnosis.

If sexual abuse is suspected, specimens for C. trachomatis cultures should be collected from the anus of both boys and girls and from the vagina of girls. Nucleic Acid Amplification Tests (NAATs) may be an alternative ONLY if cultures are unavailable. A positive NAAT should be confirmed by a second NAAT.

Page 9 of 21