WEBVTT - Ep 94 Chlamydia: Double Trouble 0:00:02.080 --> 0:00:05.000 In high school. I heard the rumors and saw the 0:00:05.000 --> 0:00:09.600 writings on bathroom walls of the quote dirty people who 0:00:09.720 --> 0:00:14.160 slept around and got STIs like the clap. I never 0:00:14.200 --> 0:00:16.319 wanted to be like them, and I thought I was 0:00:16.360 --> 0:00:20.439 better than them for being quote cleaner and selective about 0:00:20.480 --> 0:00:23.680 whom I was seeing. I thought I was doing everything right, 0:00:24.360 --> 0:00:27.400 So you can imagine my surprise when my senior year 0:00:27.440 --> 0:00:30.600 of high school, my then partner and I tested positive 0:00:30.880 --> 0:00:35.920 for chlamythia. I was shocked and confused, wondering how it 0:00:36.000 --> 0:00:40.599 had happened. I felt ashamed and dirty, angry both at 0:00:40.640 --> 0:00:44.800 myself and my partner. Thoughts like I'll never have sex 0:00:44.840 --> 0:00:49.040 again and my life is over flashed through my head. 0:00:49.400 --> 0:00:52.200 I even blamed the person my ex contracted it from. 0:00:52.880 --> 0:00:55.600 I felt betrayed by my partner, thinking how could you 0:00:55.720 --> 0:00:59.200 do this to me? But after a conversation with my doctor, 0:00:59.440 --> 0:01:03.560 who was very familiar with these cases, my assumptions about 0:01:03.560 --> 0:01:06.360 the disease were thrown out the window and replaced with 0:01:06.400 --> 0:01:10.479 a new understanding. A simple round of antibiotics and we'd 0:01:10.520 --> 0:01:13.679 both be fine. I felt the stigma had dropped, and 0:01:13.720 --> 0:01:16.560 I wasn't shy to tell my story to let others 0:01:16.600 --> 0:01:18.880 in the same boat know that it isn't the end 0:01:18.880 --> 0:01:21.560 of the world, and that you are not defined by 0:01:21.600 --> 0:01:25.039 a diagnosis. I was proud to handle it the way 0:01:25.080 --> 0:01:29.920 I did. Then college came, and it followed me. I 0:01:29.959 --> 0:01:32.800 hooked up with a person who turned cold towards me. 0:01:33.080 --> 0:01:36.560 Days later, I knew something was off, and I asked 0:01:36.560 --> 0:01:40.360 them about it. They told me they heard about my past. 0:01:41.120 --> 0:01:45.240 They said that they had heard quote something about chlamydia 0:01:45.480 --> 0:01:48.880 and it scared them. They were ashamed for being intimate 0:01:48.920 --> 0:01:51.920 with me as someone who was once diagnosed with this infection. 0:01:52.440 --> 0:01:54.559 They thought I was dirty and that it made them 0:01:54.640 --> 0:01:58.680 dirty too. The feeling of rejection cut deep, and I 0:01:58.800 --> 0:02:02.200 begged him to keep his voice down. Doing what I could, 0:02:02.280 --> 0:02:04.680 I told him some of the facts. I knew how 0:02:04.760 --> 0:02:09.040 men are usually asymptomatic, how antibiotics are used to treat it, 0:02:09.560 --> 0:02:12.280 condoms are one method of prevention, and how it can 0:02:12.400 --> 0:02:16.720 increase the risk of pelvic inflammatory disease in women. Still, 0:02:16.840 --> 0:02:19.640 I was so angry and shocked that this had happened. 0:02:20.080 --> 0:02:22.440 Of course they didn't know better, but maybe they should have. 0:02:22.760 --> 0:02:25.720 I was upset both for the judgments they made about me, 0:02:26.040 --> 0:02:29.320 but also anyone who had been diagnosed with an STI. 0:02:29.880 --> 0:02:32.560 I thought to myself, why am I to blame? Why 0:02:32.600 --> 0:02:36.160 not my male partners? Why not the disease itself? What 0:02:36.360 --> 0:02:39.920 blame is there to be had? Anyway? I have learned 0:02:39.919 --> 0:02:43.440 my lesson that what matters in sexual intimacy is not 0:02:43.600 --> 0:02:47.440 rumors and history, but who someone is at their core, 0:02:47.720 --> 0:02:50.520 and whether or not their values and understanding of the 0:02:50.520 --> 0:02:55.680 world aligns with yours. What's important is mutual respect and 0:02:55.840 --> 0:03:01.440 open and healthy communication. STIs can happen to you virtually anyone, 0:03:01.960 --> 0:03:04.400 and your value as a person has nothing to do 0:03:04.480 --> 0:03:54.680 with your sexual health. You are not a diagnosis. I 0:03:54.720 --> 0:03:58.040 feel like that is just such an important message, right 0:03:58.120 --> 0:04:00.560 like you are not a die diagnosis. 0:04:00.840 --> 0:04:04.000 You are not your diagnosis. It's my favorite. I had 0:04:04.040 --> 0:04:07.760 a whole pairagraph at the beginning of my notes that's 0:04:07.840 --> 0:04:11.840 all about why it's so important that we talk about chlamydia, 0:04:12.000 --> 0:04:14.440 because it is so common and we need to reduce 0:04:14.440 --> 0:04:17.320 the stigma. So I love that first hand account. 0:04:17.360 --> 0:04:20.200 Thank you. Yeah. So that story was sent in by 0:04:20.200 --> 0:04:22.360 one of our listeners, and I, yeah, I just want 0:04:22.360 --> 0:04:25.719 to say a huge thank you to both this listener 0:04:25.880 --> 0:04:28.599 and also to everyone who has ever submitted a first 0:04:28.600 --> 0:04:31.960 hand account because it is a really vulnerable position to 0:04:32.080 --> 0:04:34.080 be in, right, Like you're kind of bearing your soul 0:04:34.200 --> 0:04:38.000 talking about your experiences something very personal to you, and 0:04:38.360 --> 0:04:41.120 that's difficult to do. And I just want to acknowledge 0:04:41.120 --> 0:04:44.479 that and say thank you, and also that it's so 0:04:45.200 --> 0:04:48.640 wonderful and impactful, because I feel like it really drives 0:04:48.680 --> 0:04:51.839 home that like, these diseases do happen, These things happen 0:04:51.920 --> 0:04:55.760 to people who are living their everyday lives. And yeah, 0:04:55.760 --> 0:04:58.040 I think it just sort of reinforces once again, you 0:04:58.080 --> 0:05:03.200 are not a diagnosis. Yeah. Yeah, Hi, I'm Erin Welsh 0:05:03.240 --> 0:05:06.240 and I'm Erin on an updike and this is this 0:05:06.279 --> 0:05:07.880 podcast will Kill You. 0:05:08.000 --> 0:05:09.520 Welcome to Chlamydia. 0:05:09.880 --> 0:05:16.120 Welcome. Yeah, this is an interesting one because it's sort 0:05:16.120 --> 0:05:18.560 of like a two for the price of one episode. 0:05:18.920 --> 0:05:21.440 I would call it even two point five, as you'll 0:05:21.480 --> 0:05:22.400 hear in the biology. 0:05:22.920 --> 0:05:30.800 Yeah, I'm very intrigued by that. So is it a 0:05:30.839 --> 0:05:35.720 certain time of evening the time it's quarantine time? 0:05:35.839 --> 0:05:38.160 According to I'm actually wearing a watch today. 0:05:38.600 --> 0:05:43.280 You are what are we drinking this week? 0:05:43.400 --> 0:05:50.160 Erin, We're drinking Happy as a clam get it clamydia? 0:05:50.880 --> 0:05:54.760 Yeah, c h L A M. Yeah, and in a 0:05:54.880 --> 0:06:00.640 happy as a clam is of course clamato. How could 0:06:00.680 --> 0:06:06.760 we resist at tequila? And basically it's your standard bloody mary, 0:06:06.800 --> 0:06:11.320 but with tequila instead of vodka. And yes, we do 0:06:11.520 --> 0:06:15.359 know that we made a bloody mary for typhoid, but 0:06:15.440 --> 0:06:18.640 it's with clamado, so it's with coronato and it's with 0:06:18.960 --> 0:06:22.120 tequila instead of vodka. So hopefully that's different enough. 0:06:22.400 --> 0:06:25.159 And in any case, we'll post the full recipe for 0:06:25.240 --> 0:06:29.280 the quarantine and the non alcoholic clamado based plus e 0:06:29.360 --> 0:06:32.200 verrita on our website, This podcast would Kill You dot 0:06:32.240 --> 0:06:34.279 Com and all of our social media channels. 0:06:34.680 --> 0:06:38.200 On our website, you can find all sorts of things 0:06:38.920 --> 0:06:43.160 like transcripts, sources for all of our episodes. You can 0:06:43.200 --> 0:06:46.720 find links to music by Bloodmobile. You can find links 0:06:46.760 --> 0:06:50.839 to our bookshop dot org affiliate account. You can find 0:06:50.920 --> 0:06:54.240 links to merch and Patreon. Probably a few more things 0:06:54.240 --> 0:06:56.640 that I'm forgetting, but you know that's enough. 0:06:56.960 --> 0:06:58.599 Check it out, check it there. 0:07:00.080 --> 0:07:03.080 And just real quick, I wanted to mention again that 0:07:03.240 --> 0:07:05.280 if you have a first hand account that you might 0:07:05.320 --> 0:07:08.640 be willing to share on the podcast, please shoot us 0:07:08.680 --> 0:07:11.160 a message on the contact us form on our website 0:07:11.360 --> 0:07:13.280 or send us an email at this podcast will Kill 0:07:13.320 --> 0:07:15.320 You dot com. I'm also putting it on my to 0:07:15.360 --> 0:07:18.400 do list to create like an FAQ or like a 0:07:18.440 --> 0:07:21.240 first hand account link, so that maybe things will be 0:07:21.480 --> 0:07:23.200 set up more easily on the website and you can 0:07:23.240 --> 0:07:24.120 get more information. 0:07:25.160 --> 0:07:29.720 Oh well, then shall we dive into this episode. 0:07:29.920 --> 0:07:32.120 Let's do it right after this shortbreak. 0:08:01.200 --> 0:08:04.240 Is that how you would say that chlamydia chlamydia with 0:08:04.280 --> 0:08:05.120 an E at the end? 0:08:05.240 --> 0:08:05.960 Yeah? 0:08:06.000 --> 0:08:13.840 Sure, Chlamydia are gram negative obligately intracellular bacteria, of which 0:08:13.880 --> 0:08:18.720 there are several different species, and they infect a pretty 0:08:18.760 --> 0:08:23.280 wide range of hosts and within those hosts a wide 0:08:23.400 --> 0:08:27.040 range of body sites. So we'll talk in this episode 0:08:27.200 --> 0:08:31.840 about different tissue tropisms, which we've talked about before, but 0:08:31.920 --> 0:08:36.800 that essentially just means which cell types these intracellular bacteria 0:08:36.920 --> 0:08:41.760 like to infect. There are two major species of chlamydia 0:08:41.800 --> 0:08:47.800 that infect humans. Primarily, that is Chlamydia pneumonia, which causes 0:08:48.120 --> 0:08:54.040 pneumonia so it infects our respiratory tract, and Chlamydia trachomitis, 0:08:54.080 --> 0:08:58.800 which is really the subject of today's episode. But other 0:08:58.840 --> 0:09:05.760 species can cause respiratory or eurogenital or chloacal or conjunctival 0:09:05.880 --> 0:09:13.920 infections in mice, birds, cats, pigs, marsupial snakes, turtles, guinea pigs, koalas, 0:09:13.920 --> 0:09:17.400 and probably other animals that I didn't mention, and some 0:09:17.440 --> 0:09:20.280 of these other species just as like a fun side note. 0:09:20.360 --> 0:09:24.560 For example, Chlamydia citassi, if I'm saying that right, is 0:09:24.800 --> 0:09:28.480 often a zoonotic pathogen that can cause disease in humans. 0:09:28.520 --> 0:09:31.960 It causes a disease called cydycosis, but it's primarily a 0:09:32.000 --> 0:09:36.920 bacteria of I believe birds. Anyways, all of that to 0:09:37.000 --> 0:09:40.599 say that today we're focusing on one species of chlamydia, 0:09:40.640 --> 0:09:46.000 and that is Chlymydia trachomitis. This is a human specific bacterium. 0:09:46.600 --> 0:09:54.559 But there are at least thirteen, maybe nineteen different erra VARs, 0:09:56.240 --> 0:10:01.080 and these seri VARs cause different diseases kind of a 0:10:01.200 --> 0:10:04.839 number of them. Let's get into it. Err of rs A, B, 0:10:05.000 --> 0:10:09.120 and C cause an infection of the eyes that's called trachoma, 0:10:09.640 --> 0:10:13.280 which can lead to scarring and blindness and is a 0:10:13.320 --> 0:10:16.640 really important major cause of blindness in many parts of 0:10:16.679 --> 0:10:21.800 the world. Cerr of rs D through K cause what 0:10:22.040 --> 0:10:25.840 most of our listeners are probably familiar with as chlamydia, 0:10:26.240 --> 0:10:30.680 the sexually transmitted infection, and then the L SERR of rs, 0:10:30.880 --> 0:10:35.240 of which there are several cause another sexually transmitted infection 0:10:35.800 --> 0:10:42.160 called Lymphogranuloma veneerum. Oh, so it's like three different seer 0:10:42.200 --> 0:10:46.199 of R groups that cause three different types of diseases. 0:10:46.320 --> 0:10:50.120 More or less there's some nuance there. So what I'm 0:10:50.160 --> 0:10:52.200 going to do here is take a pretty big picture 0:10:52.320 --> 0:10:56.760 view and talk about what all Chlamydia trachomatis has in common, 0:10:57.400 --> 0:11:00.880 and then will go over the kind of different presentations 0:11:00.920 --> 0:11:04.439 of those diseases. Because it turns out, even though each 0:11:04.720 --> 0:11:08.280 ser of R like infects different tissues and maybe causes 0:11:08.320 --> 0:11:12.559 slightly different diseases, there's a lot of similarities in terms 0:11:12.600 --> 0:11:15.320 of the basic biology of how this pathogen works. 0:11:15.960 --> 0:11:20.960 That's so interesting that there are like distinct seri of VARs. Yeah, 0:11:21.120 --> 0:11:26.240 the differences among these SERR VARs Are they genetic? Is 0:11:26.280 --> 0:11:28.800 it just how they act? Is it expression? 0:11:28.880 --> 0:11:29.000 Like? 0:11:29.120 --> 0:11:32.679 What is the origin of those differences? Yeah? 0:11:32.880 --> 0:11:34.960 Oh, it's a good question, Aaron. I wish I had 0:11:35.000 --> 0:11:41.200 a good answer for you. Oh I don't. And that's 0:11:41.200 --> 0:11:43.439 not to say that it might be that a good 0:11:43.480 --> 0:11:47.200 answer exists out there better than what I can explain it. 0:11:47.800 --> 0:11:50.800 But what it really comes down to at a very 0:11:50.800 --> 0:11:54.960 basic level is differences in tropism. So the different serr 0:11:54.920 --> 0:11:58.720 of vrs have a tendency to infect different tissue types, 0:11:58.760 --> 0:12:03.760 and that probably is based on some specifics of their genetics. Okay, 0:12:04.720 --> 0:12:09.000 but as we'll see, especially the classically sexually transmitted zero 0:12:09.080 --> 0:12:12.360 vrs D through K actually have a fairly wide tropism. 0:12:12.520 --> 0:12:15.840 So it's also differences in just the kind of epidemiology 0:12:15.920 --> 0:12:17.680 of where you find them and who tends to be 0:12:17.720 --> 0:12:19.040 infected and things like that. 0:12:19.760 --> 0:12:23.480 Fascinating. I want to know so much more about tishoot tropism, 0:12:23.679 --> 0:12:25.160 So let's get start happy. 0:12:25.240 --> 0:12:29.559 Wouldn't that be fun? So Chlamydia, like I said, it's 0:12:29.600 --> 0:12:34.679 an obligate intracellular bacterium, so it can't replicate without entering 0:12:34.720 --> 0:12:39.040 a host cell. Chlamydia bacteria are kind of fun. They 0:12:39.080 --> 0:12:43.040 have two different parts to their life stage. One is 0:12:43.240 --> 0:12:47.679 a kind of sporelike infectious form called an elementary body, 0:12:48.520 --> 0:12:52.160 and that's what actually infects our cells. And once these 0:12:52.200 --> 0:12:56.560 bacteria actually enter our cells, they actually differentiate into an 0:12:56.679 --> 0:13:02.120 active form that replicates prolifically. And then we'll transition back 0:13:02.200 --> 0:13:05.800 into the infectious elementary body to leave our cells and 0:13:05.840 --> 0:13:08.440 go on and infect more cells. 0:13:08.440 --> 0:13:11.080 Interesting and yeah, so you mentioned that this was a 0:13:11.200 --> 0:13:15.240 spore like condition. What does that mean exactly? 0:13:15.520 --> 0:13:18.600 It means that they are hardy, and they are not 0:13:18.920 --> 0:13:23.480 extremely metabolically active. They're not completely inactive, but they don't 0:13:23.559 --> 0:13:26.840 replicate and they're not very active, and they're a little 0:13:26.880 --> 0:13:29.920 bit hardier than most bacteria. 0:13:29.960 --> 0:13:33.480 How hardy are we talking? What's the environmental durability of it? 0:13:33.640 --> 0:13:37.160 I didn't see how long the environmental durability is. It's 0:13:37.200 --> 0:13:40.480 not like a true spore. It's not like drying and 0:13:40.520 --> 0:13:44.240 surviving on surfaces. It's not anthrax. No, no, good question. 0:13:45.840 --> 0:13:49.520 So chlamydia, all of the different sera VARs of Chlmydia 0:13:49.559 --> 0:13:55.640 trichomitis is transmitted generally by direct contact with secretions. And 0:13:55.800 --> 0:14:00.680 what secretions depend on what tissue we're talking about, but 0:14:00.880 --> 0:14:05.319 in general, Chlamydia trichomitis has the ability to infect any 0:14:05.440 --> 0:14:09.080 of our mucous membranes. So anywhere that you have wet, 0:14:09.440 --> 0:14:17.520 vulnerable epithelial cells, you could get infected. That means eyes, nose, throat, penis, 0:14:17.720 --> 0:14:24.600 vagina anus primarily, and associated structures and like I kind 0:14:24.600 --> 0:14:26.760 of touched on a lot. The different err of rs 0:14:26.800 --> 0:14:30.760 have different tissue tropisms. So cerr vrs A, B, and 0:14:30.840 --> 0:14:34.440 C tend to like the epithelial cells of our eyes 0:14:34.520 --> 0:14:38.120 and our nose. That's their preferred tissue tropism. That's where 0:14:38.160 --> 0:14:43.360 they do the best d through K most often infect 0:14:43.360 --> 0:14:47.560 our genital tract, but can also absolutely cause infection in 0:14:47.680 --> 0:14:51.600 eyes or throat. And then the l zer of rs, 0:14:51.840 --> 0:14:55.040 the ones that I think we think of the least often. 0:14:56.680 --> 0:14:59.960 They also tend to be sexually transmitted, so primarily infect 0:15:00.080 --> 0:15:03.880 the anogenital region. But what's really different about the l 0:15:03.960 --> 0:15:07.040 serra rs is they have a tendency to invade past 0:15:07.160 --> 0:15:11.400 just that epithelial cell layer and cause a much deeper infection, 0:15:11.600 --> 0:15:15.480 which I think is fascinating and really does set them 0:15:15.520 --> 0:15:17.080 apart from the other seer. 0:15:17.000 --> 0:15:22.400 Of rs interesting. And so the deeper tissues that it invades, 0:15:22.480 --> 0:15:24.960 what are those deeper tissues made of? 0:15:25.360 --> 0:15:28.720 Oh, great question. It tends to invade into the lymph nodes. 0:15:28.840 --> 0:15:30.520 And we'll talk a little bit more about that when 0:15:30.560 --> 0:15:34.720 I talk specifically about lymphogranuloma veneerum. I know I can see. 0:15:34.560 --> 0:15:37.520 Your face, yeah, okay. 0:15:37.920 --> 0:15:43.280 But despite those differences at pretty much all of the 0:15:43.320 --> 0:15:47.040 sites of infection. One thing that chlamydia does across all 0:15:47.120 --> 0:15:51.200 serr of rs is it induces a pretty intense inflammatory 0:15:51.280 --> 0:15:55.160 reaction from us. And so what we'll see when we 0:15:55.200 --> 0:15:58.080 talk about the different symptoms is that while those symptoms 0:15:58.120 --> 0:16:01.520 are going to vary, of course depend on what tissues infected, 0:16:01.600 --> 0:16:06.760 depending on which mucous membrane is exposed, the inflammatory reaction 0:16:06.960 --> 0:16:10.720 itself is universal, and as we talked about in our 0:16:10.800 --> 0:16:16.000 endometriosis episode, that inflammatory reaction that our body generates can 0:16:16.040 --> 0:16:20.360 often result in scarring, and this scarring can have chronic 0:16:20.520 --> 0:16:24.200 or long term consequences. And that's across the board regardless 0:16:24.200 --> 0:16:28.240 of tissue type. So when we talk about chlamydia, there's 0:16:28.320 --> 0:16:32.160 always the acute initial infection, but then there's also the 0:16:32.160 --> 0:16:35.440 potential for this inflammation to cause scarring that can cause 0:16:35.480 --> 0:16:37.440 more permanent or progressive damage. 0:16:38.640 --> 0:16:43.880 I find that really intriguing because, as I'll briefly touch on, 0:16:44.600 --> 0:16:50.920 these microbes have been evolving with humans for ever forever, 0:16:51.640 --> 0:16:54.400 So it seems like that would be that it would 0:16:54.400 --> 0:16:57.160 be selected for to have not so much of an 0:16:57.200 --> 0:17:01.320 inflammatory response or not cause so much inflammation either from 0:17:01.360 --> 0:17:03.880 the human side or the bacterial side. 0:17:04.080 --> 0:17:08.200 Well, what's interesting is that, yes, this is a pathogen 0:17:08.200 --> 0:17:10.840 that's been with us for a very long time. This 0:17:10.920 --> 0:17:14.280 is a pathogen that actually has a really intimate relationship 0:17:14.359 --> 0:17:18.000 with our cells and with our immune response. So what 0:17:18.080 --> 0:17:21.080 it actually tends to do is block a lot of 0:17:21.960 --> 0:17:25.280 pro apoctotic So it blocks a lot of processes that 0:17:25.400 --> 0:17:28.719 just straight up kill infected cells, because that's what our 0:17:28.720 --> 0:17:31.720 body usually does when it recognizes an infected cell, is 0:17:31.800 --> 0:17:35.480 just kill it. And instead, what chlamydia tends to do 0:17:35.600 --> 0:17:40.320 is modulate progression through the cell cycle in a way 0:17:40.359 --> 0:17:44.080 to try and promote chlamydia's own growth and survival for 0:17:44.119 --> 0:17:47.720 as long as possible. So I suspect that the inflammatory 0:17:47.760 --> 0:17:51.600 response is more of a like a last ditch, like, 0:17:51.800 --> 0:17:54.880 let's do what we can. So it's this constant battle 0:17:55.000 --> 0:17:58.400 between this bacteria that's inside of our cells and our 0:17:58.440 --> 0:18:00.760 body trying as best it can to fight it off, 0:18:00.760 --> 0:18:02.400 but then causing damage in the process. 0:18:03.160 --> 0:18:09.280 Gotcha, Yeah, do our bodies clear chlamydia infection on their own? 0:18:09.320 --> 0:18:12.120 Excellent question? They absolutely can, yes. 0:18:12.359 --> 0:18:16.600 Okay, And so does the inflammatory response then vary substantially 0:18:16.640 --> 0:18:18.960 from person to person, And like the tendency to scar 0:18:19.080 --> 0:18:23.720 and stuff like that. Probably, yeah, okay, what factors might 0:18:23.760 --> 0:18:24.480 contribute to that? 0:18:24.640 --> 0:18:28.960 Oh, Aaron, whenever we ask about host factors, my answer. 0:18:28.600 --> 0:18:33.400 Is great question, fair, we gotta have. 0:18:33.359 --> 0:18:39.159 Angie Rasmussen back on to I heard. No, that's a 0:18:39.200 --> 0:18:42.800 really good question though, But yes, it presumably definitely would 0:18:42.960 --> 0:18:47.439 very person to person. What those factors may be is 0:18:47.720 --> 0:18:50.159 probably the subject of an intense amount of research. 0:18:52.680 --> 0:18:53.000 All right. 0:18:53.080 --> 0:18:56.400 So that was chlmydia in general. So now let's kind 0:18:56.400 --> 0:18:59.119 of go through the different sea of rs and sites 0:18:59.160 --> 0:19:02.480 of infection to understand what these diseases actually look like. 0:19:03.840 --> 0:19:07.800 So cerra vrs, A, B, and C cause trachoma. A 0:19:07.800 --> 0:19:11.440 lot of listeners may have never heard of trachoma, even 0:19:11.480 --> 0:19:14.119 though it is one of the most common causes of 0:19:14.160 --> 0:19:19.600 infectious blindness worldwide. But these serr rs are generally transmitted 0:19:19.640 --> 0:19:23.240 from person to person by direct contact from eye and 0:19:23.280 --> 0:19:27.600 nose secretions. So think rub your eye on your hand 0:19:27.680 --> 0:19:30.760 and then touch somebody else, or you know, you're nuzzling 0:19:30.840 --> 0:19:33.600 with your baby, snuggling with your kid and you get 0:19:33.640 --> 0:19:36.280 their goopy eyes and nose all over you, or you're 0:19:36.280 --> 0:19:39.879 sharing a towel. It can also be transmitted by I 0:19:40.119 --> 0:19:45.479 seeking flies. Although the relative importance of I seeking flies 0:19:45.600 --> 0:19:47.960 and all of these various modes of transmission, it's a 0:19:48.000 --> 0:19:50.400 little bit like we don't know which is the most important. 0:19:50.760 --> 0:19:57.200 But anyways, as an acute infection, an initial infection these 0:19:57.359 --> 0:20:03.240 err rs are of Chlamydia trachomatis cause a mucopurulent conjunctivitis, 0:20:03.280 --> 0:20:07.320 so an infection of the eye and the conjunctiva, and 0:20:07.400 --> 0:20:11.119 it generally is self limited, like you asked aaron, it 0:20:11.240 --> 0:20:19.080 usually resolves. However, reinfection, especially in children, is incredibly common 0:20:19.240 --> 0:20:23.879 in endemic areas, and so trichoma. The disease that results 0:20:24.080 --> 0:20:28.800 is the result of either longitudinal, continued active infection, which 0:20:28.840 --> 0:20:32.480 can also occur if you don't completely clear it, or 0:20:33.160 --> 0:20:39.000 chronic inflammation that results because of repeated infection, and this 0:20:39.160 --> 0:20:45.320 inflammation can actually persist even after infection is resolved. And 0:20:45.480 --> 0:20:49.040 in either case, whether it's a you know, continual infection 0:20:49.359 --> 0:20:55.440 or continual reinfection with inflammation, it results in significant scarring 0:20:55.800 --> 0:20:59.440 to the eye and to the cornea. So it tends 0:20:59.480 --> 0:21:02.879 to be young children who are infected frequently and recurrently, 0:21:03.240 --> 0:21:06.240 but this scarring takes place over the course of decades, 0:21:07.720 --> 0:21:12.040 and what really happens is that the scarring it causes 0:21:12.080 --> 0:21:15.720 the upper eyelid to kind of turn inward, which then 0:21:15.880 --> 0:21:19.639 eventually progresses to something called trichiasis, which is when the 0:21:19.680 --> 0:21:24.879 eyelashes in turn and begin rubbing against the eye like sorry, 0:21:24.920 --> 0:21:26.160 I know, eyes are difficult. 0:21:26.359 --> 0:21:30.040 Eyes are difficult. It is that. Yeah, I saw a 0:21:30.080 --> 0:21:33.400 lot of pictures and descriptions in the books that I read, 0:21:33.440 --> 0:21:38.120 and it it sounds so like painful and so painful, 0:21:38.240 --> 0:21:42.160 horrifically uncomfortable. That is, yes, it's yeah, yeah. 0:21:41.880 --> 0:21:44.920 Exactly like you. I think we've all had the sensation 0:21:45.000 --> 0:21:48.000 of having an eyelash stuck in your eye, right, imagine it, 0:21:48.440 --> 0:21:51.240 all of them, all of them, and always like you. 0:21:51.359 --> 0:21:53.359 It's not like you can just take it out. It's 0:21:53.400 --> 0:21:57.480 it's the way that your eyelid has turned. And so this, 0:21:57.920 --> 0:22:03.480 in addition to being incredibly incredibly uncomfortable, this constant rubbing 0:22:03.600 --> 0:22:07.120 actually leads to additional scarring of the cornea and this 0:22:07.200 --> 0:22:11.800 is what leads to blindness, gotcha. And so the prevalence 0:22:11.960 --> 0:22:16.840 of scarring and blindness in adults relates to their exposure 0:22:16.960 --> 0:22:20.119 as children, which is kind of an important like public 0:22:20.160 --> 0:22:24.520 health concept because it's an acute infection that then causes 0:22:24.560 --> 0:22:27.240 this chronic disease in chronic scarring. 0:22:27.640 --> 0:22:29.920 Right, it helps with who to target to disrupt this 0:22:30.280 --> 0:22:33.200 cycle of transmission, chain of transmission yet exactly. 0:22:33.240 --> 0:22:35.200 And it really has to be a kind of multi 0:22:35.240 --> 0:22:38.560 tiered approach because you have to both, you know, prevent 0:22:38.640 --> 0:22:41.840 the disease in children and treat the disease in children, 0:22:41.880 --> 0:22:43.440 but then you also have to be able to deal 0:22:43.480 --> 0:22:46.399 with the after effects of the chronic infection in adults. 0:22:47.480 --> 0:22:53.760 So that's trichoma. Next to go into the chlamydia that 0:22:53.800 --> 0:22:57.520 everyone is probably more familiar with, and that is servrs 0:22:57.600 --> 0:23:02.840 D through K sexually transmitted chlamydia. So these are the 0:23:02.840 --> 0:23:07.000 SERI VARs that tend to cause anogenital infections. So in 0:23:07.080 --> 0:23:11.320 people with a penis, chlamydia loves to infect the cells 0:23:11.320 --> 0:23:15.280 that line the urethra. Inflammation in this area is going 0:23:15.320 --> 0:23:20.440 to cause a urethritis, inflammation of the urethra. Often it's 0:23:20.480 --> 0:23:23.679 called non gonococcal urethritis, which I think is just so 0:23:23.840 --> 0:23:26.080 silly because it just means like, well, it's not gonorrhea. 0:23:27.080 --> 0:23:30.880 I have a little section about that, so I can't wait. 0:23:31.080 --> 0:23:35.160 You'll understand where it came from and why why people 0:23:35.200 --> 0:23:36.359 start using it in the first place. 0:23:36.880 --> 0:23:42.119 I can't in people with a penis that this urethritis 0:23:42.160 --> 0:23:46.080 can also be complicated by epididymitis, which is inflammation of 0:23:46.119 --> 0:23:49.680 the epididymis, which is where sperm are stored and transported 0:23:49.680 --> 0:23:52.879 in the testicles. And one thing that's really important to 0:23:52.920 --> 0:23:55.879 know is that even in this population, when it's a 0:23:56.320 --> 0:24:01.160 penile infection, thirty to fifty percent of the time it's 0:24:01.200 --> 0:24:05.439 completely asymptomatic. So someone is not going to know that 0:24:05.520 --> 0:24:07.840 they're infected and potentially infectious. 0:24:08.400 --> 0:24:08.600 Right. 0:24:09.440 --> 0:24:12.840 If someone is going to become symptomatic, then the symptoms 0:24:12.920 --> 0:24:15.720 usually are like a pain or burning when you pee 0:24:15.760 --> 0:24:18.280 because of that inflammation, or maybe a little bit of 0:24:18.359 --> 0:24:24.640 clear or white discharge. In people with a CERFX, seventy 0:24:24.760 --> 0:24:29.280 to ninety percent of the time infection is entirely asymptomatic. 0:24:30.320 --> 0:24:36.080 It's so interesting that it's a different rate of asymptomatic, 0:24:36.200 --> 0:24:37.000 Like why is that? 0:24:37.320 --> 0:24:41.680 Well, I think it's largely because the symptoms that you're 0:24:41.720 --> 0:24:44.760 having from a urethritis are the pain and burning with 0:24:44.880 --> 0:24:49.240 urination because you have urine passing over these inflamed cells. 0:24:49.640 --> 0:24:53.040 But with a serviceitis, which is inflammation of the cervix, 0:24:53.080 --> 0:24:56.359 which is the most common place that you're going to 0:24:56.400 --> 0:25:00.439 have infection in someone with a CERFX. In a sexually 0:25:00.520 --> 0:25:05.280 transmitted chlamydia infection, the cervix is pretty high up in 0:25:05.320 --> 0:25:08.040 the vagina, and so even if you do have that 0:25:08.240 --> 0:25:12.440 mucopurulent discharge, which is what you may have, you might 0:25:12.440 --> 0:25:15.639 not notice. It might not be painful, you might not 0:25:15.720 --> 0:25:20.080 have any other symptoms, and so you can have things 0:25:20.200 --> 0:25:23.840 like a little bit of bleeding after intercourse or if 0:25:23.880 --> 0:25:26.800 you did like a speculum exam, you might see the 0:25:26.840 --> 0:25:29.560 cervix look a little bit swollen or have a little 0:25:29.600 --> 0:25:34.639 bit of bleeding if you did a swab, but you 0:25:34.720 --> 0:25:38.720 might not feel that necessarily or notice it in terms 0:25:38.760 --> 0:25:40.119 of symptoms. That makes sense. 0:25:40.320 --> 0:25:41.280 That makes sense. Yeah. 0:25:41.560 --> 0:25:44.800 Interesting, Now if a person with a cervix can also 0:25:44.920 --> 0:25:48.200 have a urethritis, right, because the urethra is really really 0:25:48.240 --> 0:25:50.600 close to the vaginal opening, and that might be more 0:25:50.680 --> 0:25:53.320 likely to be symptomatic. But you might think it's a 0:25:53.640 --> 0:25:57.280 UTI or a bladder infection, right because the symptoms are 0:25:57.280 --> 0:25:58.000 going to be similar. 0:25:58.520 --> 0:25:59.680 What about the anus. 0:26:00.280 --> 0:26:05.520 The anus absolutely can be infected and it may or 0:26:05.520 --> 0:26:08.240 may not be symptomatic. We'll talk more about the anus 0:26:08.359 --> 0:26:13.400 in a little bit. Don't worry, I won't leave out 0:26:13.400 --> 0:26:13.920 the anus. 0:26:14.240 --> 0:26:15.800 Perfect good. I'm relieved. 0:26:17.320 --> 0:26:19.520 Now I want to focus on the cervix for a 0:26:19.520 --> 0:26:22.200 little bit longer because one of the things that makes 0:26:22.280 --> 0:26:28.280 chlamydia infection especially dangerous considering how often it's asymptomatic, is 0:26:28.320 --> 0:26:32.719 that with a cervical infection, if it's untreated about twenty 0:26:32.760 --> 0:26:36.320 to forty percent of the time, that infection can progress 0:26:36.480 --> 0:26:40.560 upwards through the endometrio canal. Because this is a bacteria 0:26:40.600 --> 0:26:44.280 that's spreading from cell to cell, it can spread through 0:26:44.320 --> 0:26:46.520 the uterus and up into the cells that line the 0:26:46.600 --> 0:26:50.639