Speaker 1: In high school. I heard the rumors and saw the
Speaker 1: writings on bathroom walls of the quote dirty people who
Speaker 1: slept around and got STIs like the clap. I never
Speaker 1: wanted to be like them, and I thought I was
Speaker 1: better than them for being quote cleaner and selective about
Speaker 1: whom I was seeing. I thought I was doing everything right,
Speaker 1: So you can imagine my surprise when my senior year
Speaker 1: of high school, my then partner and I tested positive
Speaker 1: for chlamythia. I was shocked and confused, wondering how it
Speaker 1: had happened. I felt ashamed and dirty, angry both at
Speaker 1: myself and my partner. Thoughts like I'll never have sex
Speaker 1: again and my life is over flashed through my head.
Speaker 1: I even blamed the person my ex contracted it from.
Speaker 1: I felt betrayed by my partner, thinking how could you
Speaker 1: do this to me? But after a conversation with my doctor,
Speaker 1: who was very familiar with these cases, my assumptions about
Speaker 1: the disease were thrown out the window and replaced with
Speaker 1: a new understanding. A simple round of antibiotics and we'd
Speaker 1: both be fine. I felt the stigma had dropped, and
Speaker 1: I wasn't shy to tell my story to let others
Speaker 1: in the same boat know that it isn't the end
Speaker 1: of the world, and that you are not defined by
Speaker 1: a diagnosis. I was proud to handle it the way
Speaker 1: I did. Then college came, and it followed me. I
Speaker 1: hooked up with a person who turned cold towards me.
Speaker 1: Days later, I knew something was off, and I asked
Speaker 1: them about it. They told me they heard about my past.
Speaker 1: They said that they had heard quote something about chlamydia
Speaker 1: and it scared them. They were ashamed for being intimate
Speaker 1: with me as someone who was once diagnosed with this infection.
Speaker 1: They thought I was dirty and that it made them
Speaker 1: dirty too. The feeling of rejection cut deep, and I
Speaker 1: begged him to keep his voice down. Doing what I could,
Speaker 1: I told him some of the facts. I knew how
Speaker 1: men are usually asymptomatic, how antibiotics are used to treat it,
Speaker 1: condoms are one method of prevention, and how it can
Speaker 1: increase the risk of pelvic inflammatory disease in women. Still,
Speaker 1: I was so angry and shocked that this had happened.
Speaker 1: Of course they didn't know better, but maybe they should have.
Speaker 1: I was upset both for the judgments they made about me,
Speaker 1: but also anyone who had been diagnosed with an STI.
Speaker 1: I thought to myself, why am I to blame? Why
Speaker 1: not my male partners? Why not the disease itself? What
Speaker 1: blame is there to be had? Anyway? I have learned
Speaker 1: my lesson that what matters in sexual intimacy is not
Speaker 1: rumors and history, but who someone is at their core,
Speaker 1: and whether or not their values and understanding of the
Speaker 1: world aligns with yours. What's important is mutual respect and
Speaker 1: open and healthy communication. STIs can happen to you virtually anyone,
Speaker 1: and your value as a person has nothing to do
Speaker 1: with your sexual health. You are not a diagnosis. I
Speaker 1: feel like that is just such an important message, right
Speaker 1: like you are not a die diagnosis.
Speaker 2: You are not your diagnosis. It's my favorite. I had
Speaker 2: a whole pairagraph at the beginning of my notes that's
Speaker 2: all about why it's so important that we talk about chlamydia,
Speaker 2: because it is so common and we need to reduce
Speaker 2: the stigma. So I love that first hand account.
Speaker 1: Thank you. Yeah. So that story was sent in by
Speaker 1: one of our listeners, and I, yeah, I just want
Speaker 1: to say a huge thank you to both this listener
Speaker 1: and also to everyone who has ever submitted a first
Speaker 1: hand account because it is a really vulnerable position to
Speaker 1: be in, right, Like you're kind of bearing your soul
Speaker 1: talking about your experiences something very personal to you, and
Speaker 1: that's difficult to do. And I just want to acknowledge
Speaker 1: that and say thank you, and also that it's so
Speaker 1: wonderful and impactful, because I feel like it really drives
Speaker 1: home that like, these diseases do happen, These things happen
Speaker 1: to people who are living their everyday lives. And yeah,
Speaker 1: I think it just sort of reinforces once again, you
Speaker 1: are not a diagnosis. Yeah. Yeah, Hi, I'm Erin Welsh
Speaker 1: and I'm Erin on an updike and this is this
Speaker 1: podcast will Kill You.
Speaker 2: Welcome to Chlamydia.
Speaker 1: Welcome. Yeah, this is an interesting one because it's sort
Speaker 1: of like a two for the price of one episode.
Speaker 2: I would call it even two point five, as you'll
Speaker 2: hear in the biology.
Speaker 1: Yeah, I'm very intrigued by that. So is it a
Speaker 1: certain time of evening the time it's quarantine time?
Speaker 2: According to I'm actually wearing a watch today.
Speaker 1: You are what are we drinking this week?
Speaker 2: Erin, We're drinking Happy as a clam get it clamydia?
Speaker 1: Yeah, c h L A M. Yeah, and in a
Speaker 1: happy as a clam is of course clamato. How could
Speaker 1: we resist at tequila? And basically it's your standard bloody mary,
Speaker 1: but with tequila instead of vodka. And yes, we do
Speaker 1: know that we made a bloody mary for typhoid, but
Speaker 1: it's with clamado, so it's with coronato and it's with
Speaker 1: tequila instead of vodka. So hopefully that's different enough.
Speaker 2: And in any case, we'll post the full recipe for
Speaker 2: the quarantine and the non alcoholic clamado based plus e
Speaker 2: verrita on our website, This podcast would Kill You dot
Speaker 2: Com and all of our social media channels.
Speaker 1: On our website, you can find all sorts of things
Speaker 1: like transcripts, sources for all of our episodes. You can
Speaker 1: find links to music by Bloodmobile. You can find links
Speaker 1: to our bookshop dot org affiliate account. You can find
Speaker 1: links to merch and Patreon. Probably a few more things
Speaker 1: that I'm forgetting, but you know that's enough.
Speaker 2: Check it out, check it there.
Speaker 1: And just real quick, I wanted to mention again that
Speaker 1: if you have a first hand account that you might
Speaker 1: be willing to share on the podcast, please shoot us
Speaker 1: a message on the contact us form on our website
Speaker 1: or send us an email at this podcast will Kill
Speaker 1: You dot com. I'm also putting it on my to
Speaker 1: do list to create like an FAQ or like a
Speaker 1: first hand account link, so that maybe things will be
Speaker 1: set up more easily on the website and you can
Speaker 1: get more information.
Speaker 2: Oh well, then shall we dive into this episode.
Speaker 1: Let's do it right after this shortbreak.
Speaker 2: Is that how you would say that chlamydia chlamydia with
Speaker 2: an E at the end?
Speaker 1: Yeah?
Speaker 2: Sure, Chlamydia are gram negative obligately intracellular bacteria, of which
Speaker 2: there are several different species, and they infect a pretty
Speaker 2: wide range of hosts and within those hosts a wide
Speaker 2: range of body sites. So we'll talk in this episode
Speaker 2: about different tissue tropisms, which we've talked about before, but
Speaker 2: that essentially just means which cell types these intracellular bacteria
Speaker 2: like to infect. There are two major species of chlamydia
Speaker 2: that infect humans. Primarily, that is Chlamydia pneumonia, which causes
Speaker 2: pneumonia so it infects our respiratory tract, and Chlamydia trachomitis,
Speaker 2: which is really the subject of today's episode. But other
Speaker 2: species can cause respiratory or eurogenital or chloacal or conjunctival
Speaker 2: infections in mice, birds, cats, pigs, marsupial snakes, turtles, guinea pigs, koalas,
Speaker 2: and probably other animals that I didn't mention, and some
Speaker 2: of these other species just as like a fun side note.
Speaker 2: For example, Chlamydia citassi, if I'm saying that right, is
Speaker 2: often a zoonotic pathogen that can cause disease in humans.
Speaker 2: It causes a disease called cydycosis, but it's primarily a
Speaker 2: bacteria of I believe birds. Anyways, all of that to
Speaker 2: say that today we're focusing on one species of chlamydia,
Speaker 2: and that is Chlymydia trachomitis. This is a human specific bacterium.
Speaker 2: But there are at least thirteen, maybe nineteen different erra VARs,
Speaker 2: and these seri VARs cause different diseases kind of a
Speaker 2: number of them. Let's get into it. Err of rs A, B,
Speaker 2: and C cause an infection of the eyes that's called trachoma,
Speaker 2: which can lead to scarring and blindness and is a
Speaker 2: really important major cause of blindness in many parts of
Speaker 2: the world. Cerr of rs D through K cause what
Speaker 2: most of our listeners are probably familiar with as chlamydia,
Speaker 2: the sexually transmitted infection, and then the L SERR of rs,
Speaker 2: of which there are several cause another sexually transmitted infection
Speaker 2: called Lymphogranuloma veneerum. Oh, so it's like three different seer
Speaker 2: of R groups that cause three different types of diseases.
Speaker 2: More or less there's some nuance there. So what I'm
Speaker 2: going to do here is take a pretty big picture
Speaker 2: view and talk about what all Chlamydia trachomatis has in common,
Speaker 2: and then will go over the kind of different presentations
Speaker 2: of those diseases. Because it turns out, even though each
Speaker 2: ser of R like infects different tissues and maybe causes
Speaker 2: slightly different diseases, there's a lot of similarities in terms
Speaker 2: of the basic biology of how this pathogen works.
Speaker 1: That's so interesting that there are like distinct seri of VARs. Yeah,
Speaker 1: the differences among these SERR VARs Are they genetic? Is
Speaker 1: it just how they act? Is it expression?
Speaker 2: Like?
Speaker 1: What is the origin of those differences? Yeah?
Speaker 2: Oh, it's a good question, Aaron. I wish I had
Speaker 2: a good answer for you. Oh I don't. And that's
Speaker 2: not to say that it might be that a good
Speaker 2: answer exists out there better than what I can explain it.
Speaker 2: But what it really comes down to at a very
Speaker 2: basic level is differences in tropism. So the different serr
Speaker 2: of vrs have a tendency to infect different tissue types,
Speaker 2: and that probably is based on some specifics of their genetics. Okay,
Speaker 2: but as we'll see, especially the classically sexually transmitted zero
Speaker 2: vrs D through K actually have a fairly wide tropism.
Speaker 2: So it's also differences in just the kind of epidemiology
Speaker 2: of where you find them and who tends to be
Speaker 2: infected and things like that.
Speaker 1: Fascinating. I want to know so much more about tishoot tropism,
Speaker 1: So let's get start happy.
Speaker 2: Wouldn't that be fun? So Chlamydia, like I said, it's
Speaker 2: an obligate intracellular bacterium, so it can't replicate without entering
Speaker 2: a host cell. Chlamydia bacteria are kind of fun. They
Speaker 2: have two different parts to their life stage. One is
Speaker 2: a kind of sporelike infectious form called an elementary body,
Speaker 2: and that's what actually infects our cells. And once these
Speaker 2: bacteria actually enter our cells, they actually differentiate into an
Speaker 2: active form that replicates prolifically. And then we'll transition back
Speaker 2: into the infectious elementary body to leave our cells and
Speaker 2: go on and infect more cells.
Speaker 1: Interesting and yeah, so you mentioned that this was a
Speaker 1: spore like condition. What does that mean exactly?
Speaker 2: It means that they are hardy, and they are not
Speaker 2: extremely metabolically active. They're not completely inactive, but they don't
Speaker 2: replicate and they're not very active, and they're a little
Speaker 2: bit hardier than most bacteria.
Speaker 1: How hardy are we talking? What's the environmental durability of it?
Speaker 2: I didn't see how long the environmental durability is. It's
Speaker 2: not like a true spore. It's not like drying and
Speaker 2: surviving on surfaces. It's not anthrax. No, no, good question.
Speaker 2: So chlamydia, all of the different sera VARs of Chlmydia
Speaker 2: trichomitis is transmitted generally by direct contact with secretions. And
Speaker 2: what secretions depend on what tissue we're talking about, but
Speaker 2: in general, Chlamydia trichomitis has the ability to infect any
Speaker 2: of our mucous membranes. So anywhere that you have wet,
Speaker 2: vulnerable epithelial cells, you could get infected. That means eyes, nose, throat, penis,
Speaker 2: vagina anus primarily, and associated structures and like I kind
Speaker 2: of touched on a lot. The different err of rs
Speaker 2: have different tissue tropisms. So cerr vrs A, B, and
Speaker 2: C tend to like the epithelial cells of our eyes
Speaker 2: and our nose. That's their preferred tissue tropism. That's where
Speaker 2: they do the best d through K most often infect
Speaker 2: our genital tract, but can also absolutely cause infection in
Speaker 2: eyes or throat. And then the l zer of rs,
Speaker 2: the ones that I think we think of the least often.
Speaker 2: They also tend to be sexually transmitted, so primarily infect
Speaker 2: the anogenital region. But what's really different about the l
Speaker 2: serra rs is they have a tendency to invade past
Speaker 2: just that epithelial cell layer and cause a much deeper infection,
Speaker 2: which I think is fascinating and really does set them
Speaker 2: apart from the other seer.
Speaker 1: Of rs interesting. And so the deeper tissues that it invades,
Speaker 1: what are those deeper tissues made of?
Speaker 2: Oh, great question. It tends to invade into the lymph nodes.
Speaker 2: And we'll talk a little bit more about that when
Speaker 2: I talk specifically about lymphogranuloma veneerum. I know I can see.
Speaker 1: Your face, yeah, okay.
Speaker 2: But despite those differences at pretty much all of the
Speaker 2: sites of infection. One thing that chlamydia does across all
Speaker 2: serr of rs is it induces a pretty intense inflammatory
Speaker 2: reaction from us. And so what we'll see when we
Speaker 2: talk about the different symptoms is that while those symptoms
Speaker 2: are going to vary, of course depend on what tissues infected,
Speaker 2: depending on which mucous membrane is exposed, the inflammatory reaction
Speaker 2: itself is universal, and as we talked about in our
Speaker 2: endometriosis episode, that inflammatory reaction that our body generates can
Speaker 2: often result in scarring, and this scarring can have chronic
Speaker 2: or long term consequences. And that's across the board regardless
Speaker 2: of tissue type. So when we talk about chlamydia, there's
Speaker 2: always the acute initial infection, but then there's also the
Speaker 2: potential for this inflammation to cause scarring that can cause
Speaker 2: more permanent or progressive damage.
Speaker 1: I find that really intriguing because, as I'll briefly touch on,
Speaker 1: these microbes have been evolving with humans for ever forever,
Speaker 1: So it seems like that would be that it would
Speaker 1: be selected for to have not so much of an
Speaker 1: inflammatory response or not cause so much inflammation either from
Speaker 1: the human side or the bacterial side.
Speaker 2: Well, what's interesting is that, yes, this is a pathogen
Speaker 2: that's been with us for a very long time. This
Speaker 2: is a pathogen that actually has a really intimate relationship
Speaker 2: with our cells and with our immune response. So what
Speaker 2: it actually tends to do is block a lot of
Speaker 2: pro apoctotic So it blocks a lot of processes that
Speaker 2: just straight up kill infected cells, because that's what our
Speaker 2: body usually does when it recognizes an infected cell, is
Speaker 2: just kill it. And instead, what chlamydia tends to do
Speaker 2: is modulate progression through the cell cycle in a way
Speaker 2: to try and promote chlamydia's own growth and survival for
Speaker 2: as long as possible. So I suspect that the inflammatory
Speaker 2: response is more of a like a last ditch, like,
Speaker 2: let's do what we can. So it's this constant battle
Speaker 2: between this bacteria that's inside of our cells and our
Speaker 2: body trying as best it can to fight it off,
Speaker 2: but then causing damage in the process.
Speaker 1: Gotcha, Yeah, do our bodies clear chlamydia infection on their own?
Speaker 2: Excellent question? They absolutely can, yes.
Speaker 1: Okay, And so does the inflammatory response then vary substantially
Speaker 1: from person to person, And like the tendency to scar
Speaker 1: and stuff like that. Probably, yeah, okay, what factors might
Speaker 1: contribute to that?
Speaker 2: Oh, Aaron, whenever we ask about host factors, my answer.
Speaker 1: Is great question, fair, we gotta have.
Speaker 2: Angie Rasmussen back on to I heard. No, that's a
Speaker 2: really good question though, But yes, it presumably definitely would
Speaker 2: very person to person. What those factors may be is
Speaker 2: probably the subject of an intense amount of research.
Speaker 1: All right.
Speaker 2: So that was chlmydia in general. So now let's kind
Speaker 2: of go through the different sea of rs and sites
Speaker 2: of infection to understand what these diseases actually look like.
Speaker 2: So cerra vrs, A, B, and C cause trachoma. A
Speaker 2: lot of listeners may have never heard of trachoma, even
Speaker 2: though it is one of the most common causes of
Speaker 2: infectious blindness worldwide. But these serr rs are generally transmitted
Speaker 2: from person to person by direct contact from eye and
Speaker 2: nose secretions. So think rub your eye on your hand
Speaker 2: and then touch somebody else, or you know, you're nuzzling
Speaker 2: with your baby, snuggling with your kid and you get
Speaker 2: their goopy eyes and nose all over you, or you're
Speaker 2: sharing a towel. It can also be transmitted by I
Speaker 2: seeking flies. Although the relative importance of I seeking flies
Speaker 2: and all of these various modes of transmission, it's a
Speaker 2: little bit like we don't know which is the most important.
Speaker 2: But anyways, as an acute infection, an initial infection these
Speaker 2: err rs are of Chlamydia trachomatis cause a mucopurulent conjunctivitis,
Speaker 2: so an infection of the eye and the conjunctiva, and
Speaker 2: it generally is self limited, like you asked aaron, it
Speaker 2: usually resolves. However, reinfection, especially in children, is incredibly common
Speaker 2: in endemic areas, and so trichoma. The disease that results
Speaker 2: is the result of either longitudinal, continued active infection, which
Speaker 2: can also occur if you don't completely clear it, or
Speaker 2: chronic inflammation that results because of repeated infection, and this
Speaker 2: inflammation can actually persist even after infection is resolved. And
Speaker 2: in either case, whether it's a you know, continual infection
Speaker 2: or continual reinfection with inflammation, it results in significant scarring
Speaker 2: to the eye and to the cornea. So it tends
Speaker 2: to be young children who are infected frequently and recurrently,
Speaker 2: but this scarring takes place over the course of decades,
Speaker 2: and what really happens is that the scarring it causes
Speaker 2: the upper eyelid to kind of turn inward, which then
Speaker 2: eventually progresses to something called trichiasis, which is when the
Speaker 2: eyelashes in turn and begin rubbing against the eye like sorry,
Speaker 2: I know, eyes are difficult.
Speaker 1: Eyes are difficult. It is that. Yeah, I saw a
Speaker 1: lot of pictures and descriptions in the books that I read,
Speaker 1: and it it sounds so like painful and so painful,
Speaker 1: horrifically uncomfortable. That is, yes, it's yeah, yeah.
Speaker 2: Exactly like you. I think we've all had the sensation
Speaker 2: of having an eyelash stuck in your eye, right, imagine it,
Speaker 2: all of them, all of them, and always like you.
Speaker 2: It's not like you can just take it out. It's
Speaker 2: it's the way that your eyelid has turned. And so this,
Speaker 2: in addition to being incredibly incredibly uncomfortable, this constant rubbing
Speaker 2: actually leads to additional scarring of the cornea and this
Speaker 2: is what leads to blindness, gotcha. And so the prevalence
Speaker 2: of scarring and blindness in adults relates to their exposure
Speaker 2: as children, which is kind of an important like public
Speaker 2: health concept because it's an acute infection that then causes
Speaker 2: this chronic disease in chronic scarring.
Speaker 1: Right, it helps with who to target to disrupt this
Speaker 1: cycle of transmission, chain of transmission yet exactly.
Speaker 2: And it really has to be a kind of multi
Speaker 2: tiered approach because you have to both, you know, prevent
Speaker 2: the disease in children and treat the disease in children,
Speaker 2: but then you also have to be able to deal
Speaker 2: with the after effects of the chronic infection in adults.
Speaker 2: So that's trichoma. Next to go into the chlamydia that
Speaker 2: everyone is probably more familiar with, and that is servrs
Speaker 2: D through K sexually transmitted chlamydia. So these are the
Speaker 2: SERI VARs that tend to cause anogenital infections. So in
Speaker 2: people with a penis, chlamydia loves to infect the cells
Speaker 2: that line the urethra. Inflammation in this area is going
Speaker 2: to cause a urethritis, inflammation of the urethra. Often it's
Speaker 2: called non gonococcal urethritis, which I think is just so
Speaker 2: silly because it just means like, well, it's not gonorrhea.
Speaker 1: I have a little section about that, so I can't wait.
Speaker 1: You'll understand where it came from and why why people
Speaker 1: start using it in the first place.
Speaker 2: I can't in people with a penis that this urethritis
Speaker 2: can also be complicated by epididymitis, which is inflammation of
Speaker 2: the epididymis, which is where sperm are stored and transported
Speaker 2: in the testicles. And one thing that's really important to
Speaker 2: know is that even in this population, when it's a
Speaker 2: penile infection, thirty to fifty percent of the time it's
Speaker 2: completely asymptomatic. So someone is not going to know that
Speaker 2: they're infected and potentially infectious.
Speaker 1: Right.
Speaker 2: If someone is going to become symptomatic, then the symptoms
Speaker 2: usually are like a pain or burning when you pee
Speaker 2: because of that inflammation, or maybe a little bit of
Speaker 2: clear or white discharge. In people with a CERFX, seventy
Speaker 2: to ninety percent of the time infection is entirely asymptomatic.
Speaker 1: It's so interesting that it's a different rate of asymptomatic,
Speaker 1: Like why is that?
Speaker 2: Well, I think it's largely because the symptoms that you're
Speaker 2: having from a urethritis are the pain and burning with
Speaker 2: urination because you have urine passing over these inflamed cells.
Speaker 2: But with a serviceitis, which is inflammation of the cervix,
Speaker 2: which is the most common place that you're going to
Speaker 2: have infection in someone with a CERFX. In a sexually
Speaker 2: transmitted chlamydia infection, the cervix is pretty high up in
Speaker 2: the vagina, and so even if you do have that
Speaker 2: mucopurulent discharge, which is what you may have, you might
Speaker 2: not notice. It might not be painful, you might not
Speaker 2: have any other symptoms, and so you can have things
Speaker 2: like a little bit of bleeding after intercourse or if
Speaker 2: you did like a speculum exam, you might see the
Speaker 2: cervix look a little bit swollen or have a little
Speaker 2: bit of bleeding if you did a swab, but you
Speaker 2: might not feel that necessarily or notice it in terms
Speaker 2: of symptoms. That makes sense.
Speaker 1: That makes sense. Yeah.
Speaker 2: Interesting, Now if a person with a cervix can also
Speaker 2: have a urethritis, right, because the urethra is really really
Speaker 2: close to the vaginal opening, and that might be more
Speaker 2: likely to be symptomatic. But you might think it's a
Speaker 2: UTI or a bladder infection, right because the symptoms are
Speaker 2: going to be similar.
Speaker 1: What about the anus.
Speaker 2: The anus absolutely can be infected and it may or
Speaker 2: may not be symptomatic. We'll talk more about the anus
Speaker 2: in a little bit. Don't worry, I won't leave out
Speaker 2: the anus.
Speaker 1: Perfect good. I'm relieved.
Speaker 2: Now I want to focus on the cervix for a
Speaker 2: little bit longer because one of the things that makes
Speaker 2: chlamydia infection especially dangerous considering how often it's asymptomatic, is
Speaker 2: that with a cervical infection, if it's untreated about twenty
Speaker 2: to forty percent of the time, that infection can progress
Speaker 2: upwards through the endometrio canal. Because this is a bacteria
Speaker 2: that's spreading from cell to cell, it can spread through
Speaker 2: the uterus and up into the cells that line the
Speaker 2: Phillipian tubes. So it can cause an endometritis, which is
Speaker 2: inflammation of the endometrium the cells that line the uterus,
Speaker 2: or a salpingitis, which is inflammation of those Filipian tubes.
Speaker 2: And if an infection ascends into the uterus and the
Speaker 2: Philippian tubes, that can become a persistent infection known as
Speaker 2: pelvic inflammatory disease. And that inflammation, just like it can
Speaker 2: happen in the eyes with the trichoma serre of ours,
Speaker 2: can cause a lot of scarring over time, and this
Speaker 2: scarring is a big risk factor for both infertility as
Speaker 2: well as ectopic pregnancy, which can be a life threatening emergency.
Speaker 1: So I have a few questions. Number one, can you
Speaker 1: talk a little bit more about pelvic inflammatory disease? What
Speaker 1: that is?
Speaker 2: Yeah, Pelvic inflammatory disease is when a bacterial infection spreads
Speaker 2: up into the uterus and the Filippian tubes. So it's
Speaker 2: very often caused by chlamydia, but it can also be
Speaker 2: caused by gonorrhea, which I think we talked about in
Speaker 2: our gonerhea episode. Or it can be caused by a
Speaker 2: number of other bacteria, just bacteria generally bacteria.
Speaker 1: Yeah, okay, okay. And then another question is about ectopic pregnancy.
Speaker 1: Why is that? Why is that associated with chlamydia infection?
Speaker 1: That has ascended great.
Speaker 2: Question because that inflammation can cause scarring in the Filippian
Speaker 2: tubes such that even though sperm might be able to
Speaker 2: make it through the Filippian tube to fertilize the egg,
Speaker 2: the egg can't make it back through the Filippian tube
Speaker 2: to be able to implant, or all the way through
Speaker 2: the Philippian tube to be able to implant safely in
Speaker 2: the uterus, So it implants ectopically, which just means outside
Speaker 2: of the uterus.
Speaker 1: Okay, Yeah, So in terms of infertility, what is the
Speaker 1: process by which this inflammation from chlamydia causes infertility. Is
Speaker 1: it sort of certain steps or is it multiple steps
Speaker 1: or is it just like the general inflammation.
Speaker 2: Yeah, it's so the general inflammation and the scarring that
Speaker 2: occurs because of that inflammation.
Speaker 1: Gotcha.
Speaker 2: It's not like something that happens overnight or over the
Speaker 2: course of even you know, a few days. This is
Speaker 2: the result of a long standing, untreated infection or repeated
Speaker 2: infection that's untreated in general, similar to trachoma in.
Speaker 1: That way, right right.
Speaker 2: Chlamydia can also lead to infection in a newborn during delivery.
Speaker 2: Most commonly affects the eyes and causes a conjunctivitis or
Speaker 2: can descend the respiratory tract and cause a pneumonia. So
Speaker 2: this is really a very versatile bacteria.
Speaker 1: So the one that can cause a pneumonia in newborns
Speaker 1: is not chlamydia pneumonia, but chlamydia.
Speaker 2: I mean, chlamydia pneumonia could also cause pneumonia tiborns, but normally, yeah,
Speaker 2: Chlamydia trichomatis. If someone is infected during delivery and delivers vaginally,
Speaker 2: then the baby could become colonized and therefore chlamydia trichomtis pneumonia.
Speaker 1: Wow okay, yeah, yeah, very versatile really is.
Speaker 2: Now the L serra VARs we haven't even touched on,
Speaker 2: so I'll breeze through it really quickly. But these are
Speaker 2: the ones that cause lymphogranuloma veneerum. This is a disease
Speaker 2: that tends to be more deeply invasive than the other
Speaker 2: seri VARs. So they establish an infection not just in
Speaker 2: the epithelial cells of say the cervix or the urethra
Speaker 2: or the anus, but they infect cells deeper in our
Speaker 2: submucosa and then are able to disseminate through our lymphatics
Speaker 2: to our lymph nodes and cause a more systemic infection. Now,
Speaker 2: what's interesting about this especially is that it used to
Speaker 2: be considered a relatively rare disease in high income countries
Speaker 2: and classically was described as like a painless ulcer followed
Speaker 2: by lymph node swelling, et cetera. But over the last
Speaker 2: few decades has become a much more common pathogen that
Speaker 2: more predominantly affects the anogenital region and can cause significant
Speaker 2: inflammation in the rectum. In people that are having receptive
Speaker 2: anal sex.
Speaker 1: Interesting.
Speaker 2: Yeah, And of course the other SERI VARs of chlamydiatrochomitis
Speaker 2: can also infect the anal region, but this specific zero
Speaker 2: type seems to really like the anal region and can
Speaker 2: cause a more disseminated infection. So it can cause things
Speaker 2: like recto bleeding, pain, a mucoid discharge. It can cause
Speaker 2: something called tinismus, which is this horrible sensation that you
Speaker 2: have to have a bowel movement even when your rectum
Speaker 2: is empty. So it can cause a lot of muscle
Speaker 2: spasm and be really painful. So the symptoms can actually
Speaker 2: be confused with inflammatory bowel disease because these symptoms really overlap.
Speaker 2: Huh h.
Speaker 1: And is this just because it has a tendency to
Speaker 1: invade more deeply and so like the infection itself is
Speaker 1: just more exactly intense and almost systemic kind.
Speaker 2: It is, and it is it's harder to treat. It
Speaker 2: needs a longer course of antibiotics.
Speaker 1: Okay, exactly, Yeah.
Speaker 2: I swear I'm almost done. But there's like one more
Speaker 2: thing I can't not talk about, and that is that
Speaker 2: chlamyty infection can also cause what's known as a reactive arthritis, oh,
Speaker 2: which happens weeks later after an infection, and it can
Speaker 2: cause arthritis, so pain in the joints and inflammation in
Speaker 2: the fluid in your joints, and also a conjunctivitis, which
Speaker 2: is fascinating, Like, how did the inflammation make it all
Speaker 2: the way up to your eye after just a urethral infection.
Speaker 2: I don't know the answer to that. We don't know
Speaker 2: the answer to that. It's really unclear if this reactive
Speaker 2: arthritis is caused by a persistent chlamidial infection or if
Speaker 2: it's caused by just our immune response causing this inflammation
Speaker 2: that that becomes more widespread. Chlamydia is not the only
Speaker 2: cause of reactive arthritis. Salmonella, Camplobacter your senia, a lot
Speaker 2: of other bacteria are also associated with reactive arthritis. But
Speaker 2: one of the pepers that I read said that up
Speaker 2: to four percent of people with an acute Chlamydia trichomitis
Speaker 2: infection go on to develop reactive arthritis, which is way
Speaker 2: higher than I thought.
Speaker 1: Yeah, okay, questions. This is for all serovars of Chlymydia trichomtis.
Speaker 2: I think it's mostly d through K but I don't
Speaker 2: think that it's impossible that any of the serra VARs
Speaker 2: could potentially cause.
Speaker 1: This, Okay, And would this happen even if you go
Speaker 1: on a course of antibiotics and clear the infection that.
Speaker 2: Way, great question. I think yes, potentially.
Speaker 1: Okay, So this is like the chlamydia trichomitis is no
Speaker 1: longer there, but your body is still reacting to something.
Speaker 2: Well, yes, but the bacteria are often able to be
Speaker 2: recovered from synovial fluid in people with reactive arthritis, but
Speaker 2: it's unclear whether they are active infectious bacteria or not. Remember,
Speaker 2: there are multiple stages of the life cycle of chlamydia,
Speaker 2: and whether or not antibiotics are effective in treatment is
Speaker 2: really up for debate right now. So it's unclear. It's
Speaker 2: one of these areas that, much like so many you know,
Speaker 2: chronic and autoimmune inflammatory conditions, again, is ripe for research
Speaker 2: because we just don't really understand this reaction.
Speaker 1: How long does it last?
Speaker 2: I think it tends to resolve even without treatment, within
Speaker 2: at least a few months.
Speaker 1: Okay, Yeah, fascinating.
Speaker 2: It is really interesting. And I mean that's chlmydia trichomitis
Speaker 2: in not quite a nutshell but like maybe several like puts, yeah,
Speaker 2: a back of peanuts, or like boiled.
Speaker 1: Peanuts where you have like five sometimes in a shell.
Speaker 2: Yeah, you know, I don't eat hot boiled peanuts.
Speaker 1: That's true. That's true.
Speaker 2: I mean I've eating peanuts.
Speaker 1: Hot boil peanuts are the best though. Yeah.
Speaker 2: Well, anyways, it is still a treatable infection. All of
Speaker 2: the different serra VARs are treatable, which is great, and
Speaker 2: it's all with the same antibiotics, either doxy cycling or
Speaker 2: as a thermycin of course longer for the more deeper infection.
Speaker 2: Like I mentioned, antibiotic resistance, it's a thing. It's a thing,
Speaker 2: and that is part of why it used to be
Speaker 2: that in the US, sexually transmitted lamydia was treated with
Speaker 2: one time dose of az atherrmycin. But now there's more
Speaker 2: data that shows that actually curates are better with doxycycling,
Speaker 2: even though it's a longer course it's seven days. So yeah,
Speaker 2: antibiotic resistance is definitely a thing. I think it's not
Speaker 2: yet as severe as say, with gonorrhea, but let's hope
Speaker 2: we don't get there.
Speaker 1: Yeah, I was gonna say, just wait, just wait.
Speaker 2: So yeah, any other questions I don't know if I
Speaker 2: answered any of your questions adequately.
Speaker 1: You did, No, I feel like I feel like I'm
Speaker 1: all set for now, but I'm gonna keep thinking in
Speaker 1: the back of my head as I tell you the history.
Speaker 2: Can you please I want to know all about it.
Speaker 1: Yeah, I'll take a quick break and then I'll get
Speaker 1: into it. Just like with the biology section, I feel
Speaker 1: like we can split the history of chlamydia trachomitis into
Speaker 1: multiple parts as well, but in this case, I'm going
Speaker 1: to do it in two parts based on its name.
Speaker 1: So there's what we can think of as the chlamydia
Speaker 1: part of the story, So that's what I'm calling the
Speaker 1: disease as an STI, like the pathogen as an STI.
Speaker 1: And then there's the trachomatis or trachoma part of the story,
Speaker 1: So the bacteria as the cause of this ie infection,
Speaker 1: the severe chronic eye infection. Yeah, and that's kind of
Speaker 1: how I decided to approach this history, except for the
Speaker 1: fact that I am going to be giving trachoma more
Speaker 1: airtime than chlamydia as an STI, partly because and I
Speaker 1: was a bit surprised to find this that trachoma has
Speaker 1: a much deeper and a much more extensive history than
Speaker 1: Chlmytia as an STI, because that was really only recognized
Speaker 1: as an STI fairly recently. Really yeah, which, of course
Speaker 1: it doesn't mean that it only emerged as an STI recently,
Speaker 1: but in terms of like clinical recognition, yes, huh yeah,
Speaker 1: so kind of like you did. I'm gonna start with
Speaker 1: the evolutionary history overall, and then I'm going to go
Speaker 1: into tracoma and then talk a bit at the end
Speaker 1: about chlamydia. So I'm going to call this the trachomitus
Speaker 1: chlamydia approach. I love it, thank you. For quite a while,
Speaker 1: people thought that chlamydia were mainly mammalian pathogens, infecting mammals
Speaker 1: and a few other animals intracellularly. But then in the
Speaker 1: late nineteen nineties, some researchers observed chlamydia acting as endosymbions
Speaker 1: inside free living amibe. They're not in the same genus like,
Speaker 1: for instance, one is called parachlamydia, but they are related
Speaker 1: to these intracellular pathogens. Okay, okay, yeah, And this showed
Speaker 1: that not only are chlamydia way more diverse than people
Speaker 1: previously thought, but also much older, like seven hundred million
Speaker 1: years old. Oh that's yeah, But we're not going to
Speaker 1: go through all seven hundred million years of history. Let's
Speaker 1: kind of get to where the human chlamydia specific strains
Speaker 1: or species that were interested in, right, So chlamydia trichomitis,
Speaker 1: essentially the strains of chlamydia that cause eye infections apparently
Speaker 1: diverged from the strains that caused genital infections around two
Speaker 1: million to five million years ago, which is around the
Speaker 1: time that Homo habilis and Homo erectus evolved. So these
Speaker 1: guys have been with us for you know, like we said,
Speaker 1: as long as we've been human, yeah, forever, And ancient
Speaker 1: writings further confirmed that. So now is where I switched
Speaker 1: to focus on tricoma. Okay, So, even though tracoma has
Speaker 1: probably always impacted humans, the transition to larger settlements and
Speaker 1: decreased mobility would have provided more opportunities for the infection
Speaker 1: to spread to more people, both within communities and also
Speaker 1: along trade routes. And its widespread prevalence is it's evident
Speaker 1: in the fact that trachoma is described in so many
Speaker 1: ancient texts, like so many really, Yeah, let's go through
Speaker 1: a few of these early mentions, starting with the more
Speaker 1: vague mentions and then getting more specific. There's a description
Speaker 1: from sometime during twenty six hundred to twenty seven hundred
Speaker 1: BCE about an emperor in China undergoing surgery for trachiasis.
Speaker 1: And there are inscriptions of eye disorders found on animal
Speaker 1: bones and tortoise shells from around eleven hundred to sixteen
Speaker 1: hundred BCE. And there are also bronze age appellation forceps
Speaker 1: used for removing eyelashes found in Sumeria from around twenty
Speaker 1: six hundred BCE.
Speaker 2: Wow.
Speaker 1: Yeah. The first specific references to trachoma come from around
Speaker 1: four hundred and twenty to five hundred and eighty one
Speaker 1: BCE in China, and in these references, trachoma is described
Speaker 1: with terms including quote pepper seed like lesions and quote
Speaker 1: milk like granules and copper. Octopus and garlic rubbed on
Speaker 1: the eyelids was a commonly recommended treatment. Then we have
Speaker 1: writings from Sushruda from the seven hundreds BCE, who is
Speaker 1: an ancient Indian physician and surgeon that I've mentioned on
Speaker 1: the podcast at least a few times, like I think
Speaker 1: many times. Specifically, actually look this up in our diabetes, rabies,
Speaker 1: and organ transplantation episodes.
Speaker 2: For example, that you looked it up.
Speaker 1: I did, I did so. Sushrudo wrote about how the
Speaker 1: inner eyelid gets rough and thick, and how the eyelashes
Speaker 1: can grow inward, and how your eyelid can also turn
Speaker 1: inwards and cause slashes to rub against your eye. It's
Speaker 1: like pretty like spot on tracot right, the early history
Speaker 1: of tracoma. Honestly, it reads like who's who of the
Speaker 1: early medical texts, because up next is our old friend,
Speaker 1: the ebers Papyrus.
Speaker 2: I was hoping you'd say that.
Speaker 1: Of course I was going to say that. So into
Speaker 1: this classic text, which is from around the fifteen fifties
Speaker 1: BCE or so, we've got lots and lots of different
Speaker 1: treatments for eye disorders, including onions, gazelle excrement applied to
Speaker 1: the eye with a vulture feather oh wow, and appellation,
Speaker 1: followed by the application of lizard or bat blood okay. Interestingly,
Speaker 1: both Plato and Aristotle suggested that tracoma was contagious, with
Speaker 1: Aristotle going so far as to suggest that you could
Speaker 1: get it just by looking at someone who had it.
Speaker 1: Oh yes, but it would take it quite a long time,
Speaker 1: of course, before they were vindicated in this belief. And
Speaker 1: we have another friend yet who is joining us, which
Speaker 1: is Hippocrates and the Hippocratic texts. Yep. And in these
Speaker 1: texts there are descriptions of the fig like appearance of
Speaker 1: the upper lid and intern lashes, and also some suggestions
Speaker 1: that the condition could be prevented by avoiding the cold
Speaker 1: winds from the north and the warm winds from the south,
Speaker 1: which like, what winds are you left with?
Speaker 2: But just avoid all winds, avoid all winds. You can
Speaker 2: have an easterly breeze. That would be fine, Okay.
Speaker 1: Yeah, yeah. But also I really love these treatments. Drinking wine,
Speaker 1: bathing yep, I'm down for that, purging nope, blood letting nope,
Speaker 1: or applying a cleansing medication to the affected area.
Speaker 2: Okay, yeah, we've got some decent ones in there.
Speaker 3: Yeah.
Speaker 1: And of course there were also surgical procedures that were
Speaker 1: recommended to treat tricoma in these texts. In the first
Speaker 1: century CE, the ancient Greek physician Diascorides was the first
Speaker 1: to use the word trachoma, meaning roughness, to describe the condition,
Speaker 1: and a little over one hundred years later, Galen described
Speaker 1: the four stages of trachoma. I mean I could, honestly,
Speaker 1: I could go on and on this entire episode, just
Speaker 1: like listing these other ancient texts that have references to tracoma,
Speaker 1: like those by Avicenna and Alcohol the Ophthalmologist, among others.
Speaker 1: And also like you know that I would love to
Speaker 1: get into some of these, you know, these incredibly varied
Speaker 1: treatments used egg, white mouse, ear, frog's blood, the bile
Speaker 1: of a goat, et cetera. But even without doing that,
Speaker 1: even without going further down this like rabbit hole of
Speaker 1: like ancient texts and tracoma, I feel like it has
Speaker 1: given us a pretty good sense of how widespread and
Speaker 1: devastating a problem this was.
Speaker 2: Yeah, I honestly had no idea. I mean, it makes
Speaker 2: sense even now, like looking at the distribution and how
Speaker 2: many people are still at risk and affected, like it
Speaker 2: makes sense. But I never realized.
Speaker 1: That, yeah, me either at all. I really thought before
Speaker 1: researching this episode, this is going to be an STI
Speaker 1: history where I'm going to talk about like when people
Speaker 1: realized chlamydia was different than gonnerhea et cetera, et cetera.
Speaker 1: And then I realized like this is really fascinating and important,
Speaker 1: and it just gets more so because if you thought
Speaker 1: it was widespread in the ancient world, of course, it's
Speaker 1: only going to get more widespread as global population increase,
Speaker 1: mobility increase, and so on. Yeah, so I'm going to
Speaker 1: mention one more thing and kind of like olden times
Speaker 1: before jumping all the way ahead to the eighteen hundreds. Okay, So,
Speaker 1: during the Crusades in like eleven hundred to twelve hundred CE,
Speaker 1: a ton of crusaders and pilgrims that were venturing to
Speaker 1: the Holy Lands, and many of them came back with tracoma,
Speaker 1: one of them possibly being Saint Francis of Assisi, who
Speaker 1: was actually blind at his death in twelve twenty six.
Speaker 2: I'm loving this.
Speaker 1: All right, So now let's get to the eighteen hundreds.
Speaker 1: And why the eighteen hundreds, you might ask. So from
Speaker 1: the ancient times to then, of course, tracoma was around,
Speaker 1: It was written about, it was described, it made an impact.
Speaker 1: But also it was kind of used sometimes as a
Speaker 1: catch all term as this umbrella term to describe both
Speaker 1: the acute phase and the chronic phase. More eye infections
Speaker 1: caused by other pathogens it was not really featured as
Speaker 1: sporadically or studied very intensively. But all of that would
Speaker 1: change around the early eighteen hundreds, and the reason for
Speaker 1: that change is, of course, war, specifically the Napoleonic Wars.
Speaker 1: Poor Napoleon has been featured on this podcast for way
Speaker 1: like so many times, for all of the disastrous campaigns
Speaker 1: where he was just basically his army was wiped out
Speaker 1: by various diseases. Right all the way back in season one,
Speaker 1: we're talked about him in yellow Fever. In our Typhus episode,
Speaker 1: we talked about how an unbelievably huge number of his
Speaker 1: soldiers died from Typhus while trying to march up to Russia.
Speaker 1: But with Trachoma and Napoleon, we find ourselves not in
Speaker 1: Russia or Hispaniola, but rather in Egypt. From seventeen ninety
Speaker 1: eight to eighteen fifteen, Napoleon decided to wage a series
Speaker 1: of campaigns basically all over the place to try to
Speaker 1: gain more control over the European continent, largely by disrupting
Speaker 1: British colonial and Econo rule. That was his aim. In
Speaker 1: July seventeen ninety eight, Napoleon landed near Alexandria Egypt, and
Speaker 1: then he and around forty thousand French troops marched to Cairo.
Speaker 1: And the purpose of the Egypt invasion, from what I
Speaker 1: can tell, was essentially to establish a foothold in the
Speaker 1: region so that they could try to disrupt one of
Speaker 1: the main sources of British economic power, India, by driving
Speaker 1: the British out of that subcontinent. So they were like,
Speaker 1: all right, we're going to set up shop in Egypt
Speaker 1: and then from here we're going to just get like
Speaker 1: we're going to defeat the British. Okay, it also came
Speaker 1: with the plus of establishing French trade in the region.
Speaker 1: Not long after they arrived in Egypt, however, Napoleon's troops
Speaker 1: began to experience many of the illnesses you'd expect a
Speaker 1: traveling army to dysentery, excessive dehydration, and also eye infections.
Speaker 1: By late September, the prevalence of eye infections or inflammation
Speaker 1: had grown enormously. For example, in one battalion of three
Speaker 1: hundred soldiers, one hundred and twenty five had ie inflammation
Speaker 1: severe enough that they were effectively blind wow and had
Speaker 1: to rely on their unaffected comrades to point their guns
Speaker 1: in the right direction from the trenches.
Speaker 2: Oh dear, mm hmm.
Speaker 1: And the high prevalence in this battalion doesn't really seem
Speaker 1: like a one off, because in an expedition in October
Speaker 1: seventeen ninety eight, fourteen hundred French soldiers developed ophthalmia out
Speaker 1: of three thousand, so nearly half wow. And the condition
Speaker 1: was not restricted to just the French soldiers fighting, but
Speaker 1: also the people they were fighting against, namely Turkish and
Speaker 1: British troops, although Turkish troops later switched sides and fought
Speaker 1: against the British. So everyone was affected essentially, is what
Speaker 1: I'm trying to say. And the British army seemed especially
Speaker 1: affected by eye inflammation after around March of eighteen oh one.
Speaker 1: One report from the time described how out of an
Speaker 1: eight thousand person division, sixteen hundred soldiers developed ophthalmia in
Speaker 1: September and October, and one hundred and fifty eight became
Speaker 1: blind just like a lot. That's a lot of people.
Speaker 1: Napoleon's invasion of Egypt marked a turning point in the
Speaker 1: history of tracoma because it led to huge amount of
Speaker 1: interest in the disease, especially from military physicians, and it
Speaker 1: also led to the infection spreading much more widely. When
Speaker 1: these British and French troops returned to Europe from Egypt,
Speaker 1: many of them brought tracoma back with them, and basically
Speaker 1: everywhere they traveled on their journey home, tracoma followed. For instance,
Speaker 1: French troops landing in Sicily in eighteen oh one on
Speaker 1: their way back from Egypt kicked off an epidemic of
Speaker 1: trachoma that didn't peak until twelve years later. Just rose
Speaker 1: and rose and rose. Yeah, oh my gosh. This time
Speaker 1: of the Napoleonic Wars and really in the years after
Speaker 1: was a period of great upheaval and mobility across huge
Speaker 1: parts of Europe, and trachoma was, you know, was not
Speaker 1: alone in this. It was just one of the diseases
Speaker 1: that took advantage of this disruption and widespread travel. Tracoma
Speaker 1: moved from Sicily to Hungary, France, the Netherlands, Germany, Russia
Speaker 1: and on and on and on essentially everywhere, and it
Speaker 1: especially became a fixture in armies. Ophthalmia first showed up
Speaker 1: in the Russian army in eighteen eighteen, and within twenty
Speaker 1: years nearly eighty thousand Russian soldiers had been affected. Thousands
Speaker 1: of soldiers in the Dutch and Belgian armies became blind
Speaker 1: or partially blind. And during the Crimean War, so like
Speaker 1: eighteen sixty one to eighteen sixty seven or so quote,
Speaker 1: four percent of all disability in the army was due
Speaker 1: to ophthalmia and five percent of the total discharges were
Speaker 1: because of blindness, although these rates were approximately half what
Speaker 1: they had been in the eighteen thirties. Wow yeah, So
Speaker 1: ten percent of the discharges being due to blindness in
Speaker 1: the army, Wow yeah. And so you know, doctors, military
Speaker 1: doctors and also civilian doctors had plenty on their hands
Speaker 1: in terms of trachoma, And as you might expect, one
Speaker 1: of the things in the front of everyone's mind was
Speaker 1: how to control or prevent this disease, which, in the
Speaker 1: years before germ theory was tangled up with a debate
Speaker 1: on whether tracoma was contagious or not. Was it warm
Speaker 1: rains or cool nights, was it a dusty atmosphere or
Speaker 1: a cold wind that led to outbreaks, or was it
Speaker 1: the sharing of hand basins, not washing regularly, sharing towels,
Speaker 1: not cleaning bedding, or not using pillowcases, etc. And in reality,
Speaker 1: it was kind of a little bit of both, because
Speaker 1: you know, having access to clean your face or not
Speaker 1: sharing towels one big part of it, and some environmental
Speaker 1: factors playing another part through seasonal changes in fly prevalence,
Speaker 1: for instance. While some doctors continued to work on the
Speaker 1: control aspects of trachoma, others began to concentrate and specialize
Speaker 1: on how to treat the condition. The author of the
Speaker 1: book that I read for this compared tracoma to Helen
Speaker 1: of Troy, but rather than ships, tracoma was the disease
Speaker 1: that launched a thousand hospitals. I loved that by the
Speaker 1: mid to late eighteen hundreds, tracoma was a pervasive problem
Speaker 1: everywhere and it wasn't limited to just the military. Entire
Speaker 1: hospitals and medical visions were created to treat it. And
Speaker 1: trachoma also played a big role in making ophthalmology a
Speaker 1: specialization and profession in itself, rather than it being just
Speaker 1: a part of generalist care. Like generalists who have an
Speaker 1: interest in ophthalmology.
Speaker 2: Wow, that's I had no idea.
Speaker 1: I know, the history of trachoma is so much deeper
Speaker 1: than I realized, and it's also just I really find
Speaker 1: it interesting to think about the origins of different specialties
Speaker 1: and specializations in medicine.
Speaker 2: Oh my gosh, I know.
Speaker 1: Yeah. Governments established tracoma schools attended by children who had
Speaker 1: tricoma or other eye conditions because, like you said, it
Speaker 1: was so prevalent among children, and it also became a
Speaker 1: notifiable disease in many places. By the second half of
Speaker 1: the eighteen hundreds, researchers had fully established that trachoma was
Speaker 1: indeed contagious, even if they wouldn't discover the causative agent
Speaker 1: until in nineteen oh seven. But knowing that trachoma was
Speaker 1: caused by an intracellular bacterium didn't stop people from characterizing
Speaker 1: the epidemiology of the disease. Familial transmission was common, children
Speaker 1: under seven had the highest prevalence, seemed to be strongly
Speaker 1: correlated with access to sanitation and clean water, and it
Speaker 1: seemed to be most prevalent among low income households. And
Speaker 1: of course these last two characteristics, so low income households
Speaker 1: plus lack of access to sanitation or hygiene practices, these
Speaker 1: marked the disease as a social status indicator, similar to
Speaker 1: many other diseases that we've talked about on the podcast before, tuberculosis, hookworm, trachoma.
Speaker 1: These were the diseases that the poor brought upon themselves
Speaker 1: just by being poor. That was like the narrative, right,
Speaker 1: These diagnoses became wrapped up in a person's identity, labeling
Speaker 1: them unclean.
Speaker 2: I feel like that's still the problem with tracoma and
Speaker 2: why we don't know anything about it.
Speaker 1: Absolutely. Absolutely. Although some control strategies for tracoma involved providing
Speaker 1: care to people who had the disease, many of them
Speaker 1: focused more on limiting the spread of the disease to
Speaker 1: wealthier populations. Right. It wasn't so much let's manage and
Speaker 1: stop the cycle of transmission. It was like, let's keep
Speaker 1: the cycle of transmission over there and not let it
Speaker 1: spill into here.
Speaker 2: Yeah, which is not only cruel, it's also ineffective.
Speaker 1: It truly, truly is. So. It seems unclear whether or
Speaker 1: not tracoma had been present in the US prior to
Speaker 1: the arrival of Europeans in the fourteen hundreds and fifteen hundreds,
Speaker 1: but in any case, the late eighteen hundreds saw a
Speaker 1: similar increase in tracoma in the US that the rest
Speaker 1: of the world was experiencing, and this rise in cases
Speaker 1: was blamed on immigration. Throughout this time and into the
Speaker 1: early nineteen hundreds, millions of people were leaving their homeland,
Speaker 1: which was often somewhere in Europe, to travel to the
Speaker 1: US and try to find more opportunities, or be with
Speaker 1: their family, or escape some of the horrible situations that
Speaker 1: were happening, like famine, many many, many different reasons. And
Speaker 1: I'm not going to go in depth about the immigration
Speaker 1: politics of this time because I don't know enough about
Speaker 1: it and there's probably better podcasts and resources out there,
Speaker 1: but I will say that as immigration increased in the
Speaker 1: late decades of the eighteen hundreds, so did resentment and
Speaker 1: anti immigration sentiments, which eventually led to policies aimed at
Speaker 1: reducing immigration by especially targeting people that they didn't want
Speaker 1: to admit into the country, for instance the Chinese Exclusion
Speaker 1: Act of eighteen eighty two, or other laws or acts
Speaker 1: that prevented people from being admitted if they had certain disease,
Speaker 1: including but not limited to, epilepsy, quote insanity, tuberculosis, cholera, typhus, ringworm,
Speaker 1: and trichoma. In eighteen ninety seven, the US Surgeon General
Speaker 1: called trachoma quote a dangerous contagious disease, and instructed medical
Speaker 1: officers to examine all immigrants. The examination process itself was
Speaker 1: painful and not at all sanitary, which probably led to
Speaker 1: further spread of trachoma. You're like, let me check your eyes. Okay, next,
Speaker 1: let me check your eyes. Oh you have tracoma. Oh
Speaker 1: let me check the next person's eyes.
Speaker 2: Yeah.
Speaker 1: If you were suspected to have trachoma, the officer would
Speaker 1: mark a big chalk tea on your shirt and you
Speaker 1: were sent to the contagious disease hospital to wait it
Speaker 1: out to see whether you had acute conjunctivitis or if
Speaker 1: it was tricoma. And if it was tracoma, that was
Speaker 1: bad news. Over ninety five percent of those with tracoma
Speaker 1: were deported. Whoam. And if you were fortunate enough to
Speaker 1: be in the five percent not deported, you could remain
Speaker 1: in the US in hospital for treatment, but that usually
Speaker 1: took about six months. Whoa huh, because remember this is
Speaker 1: all pre any sort of effective right antibiotics? Antibiotics. Yeah.
Speaker 1: In nineteen oh two, the US ramped up their restrictions
Speaker 1: against tracoma by placing a one hundred dollars fine on
Speaker 1: every shipping company per tracoma case brought to the US.
Speaker 1: So then these companies started to do like port of
Speaker 1: origin screening sites, and these additional restrictions led to tracoma
Speaker 1: becoming one of the main reasons that prospective immigrants were rejected.
Speaker 1: Let me read you some numbers to give you a
Speaker 1: sense of just how much tracoma played a role in immigration. Quote,
Speaker 1: between eighteen ninety seven and nineteen twenty four, some twenty
Speaker 1: one million, seven hundred and fifty eight thousand, eight hundred
Speaker 1: and seventy five immigrants were examined and thirty three thousand,
Speaker 1: eight hundred and forty seven were debarred because of tracoma.
Speaker 1: So it would be zero point sixteen percent. Wow. Another quote,
Speaker 1: it was common to have two to five percent of
Speaker 1: prospective immigrations rejected. Eighty five percent of those rejections were
Speaker 1: due to tracoma.
Speaker 2: I wow.
Speaker 1: I know you would think that, based on how seriously
Speaker 1: the US was taking tracoma in the context of like
Speaker 1: immigration stuff, that there would be almost no tracoma in
Speaker 1: the country. Right.
Speaker 2: Oh, you'd think, right, I think right, it's logical.
Speaker 1: Oh, of course that's not true, though. The first detailed
Speaker 1: look at tracoma in the US came out around nineteen eleven.
Speaker 1: That year, a physician from Lexington, Kentucky, released a report
Speaker 1: that showed just how prevalent tracoma was, especially in eastern
Speaker 1: Kentucky and across rural Appalachia through to Kansas and Oklahoma.
Speaker 1: Rates of tracoma in these regions were comparable to or greater,
Speaker 1: much greater than many of the countries from which people
Speaker 1: were emigrating. For instance, Native Americans were among those most impacted,
Speaker 1: with an average prevalence rate of twenty three percent, but
Speaker 1: it gets worse. In some Native American boarding schools in Oklahoma,
Speaker 1: that number would shoot up to a horrific ninety two percent.
Speaker 1: Ninety two percent, yeah, oh my. This report did kind
Speaker 1: of awaken public health officials to the tremendous issue that
Speaker 1: tracoma already posed in parts of the US, and so
Speaker 1: they created tricoma hospitals and state specific control programs, and
Speaker 1: over the early nineteen hundreds, especially the nineteen thirties and
Speaker 1: the nineteen forties, trachoma did sharply decline in the US
Speaker 1: and in many countries in Europe where it had been
Speaker 1: prevalent essentially countries that were like higher income countries, And
Speaker 1: I think it's not the easiest thing to tease out
Speaker 1: exactly why this decline occurred and how much these treatment
Speaker 1: centers contributed versus infrastructural improvements in things like sanitation and
Speaker 1: clean water that made it possible for people to regularly
Speaker 1: practice like these hygiene practices that would help them keep
Speaker 1: their face clean, et cetera. Based on the timing of
Speaker 1: the declines, it's possible that antibiotics like sulfonamides played a role,
Speaker 1: but if they did, I have to feel like it
Speaker 1: was a fairly minor one, since the decrease seemed to
Speaker 1: happen in many places long before the widespread introduction of
Speaker 1: these antibiotics.
Speaker 2: Which is really interesting in the context of current events.
Speaker 1: It certainly is. Yeah, yeah, this is such a good
Speaker 1: illustration of how disease prevalence can be reduced through changes
Speaker 1: in infrastructure rather than just treatment alone. And I think
Speaker 1: it also shows that treatment alone is never going to
Speaker 1: be sufficient.
Speaker 2: Nail head.
Speaker 1: But as usual, this decline in tracoma was not universal,
Speaker 1: nor did it happen evenly across the landscape. In the US,
Speaker 1: for example, tracoma persisted in many Native American communities through
Speaker 1: the nineteen eighties, and in Australia it continues to be
Speaker 1: a problem in indigenous communities, and there are many regions
Speaker 1: around the world that still have high rates of tracoma,
Speaker 1: which I know you'll talk more about, Aaron. Wasn't really
Speaker 1: until the mid nineteen hundreds that international organizations like the
Speaker 1: WHO started tracoma control programs for some low and middle
Speaker 1: income countries, and they set an elimination goal only in
Speaker 1: the mid nineteen nineties, which, honestly, it really surprised me
Speaker 1: after reading about this history, where I was like, wait,
Speaker 1: it's preventable, it's treatable, and it also has an absolutely
Speaker 1: enormous impact on quality of life.
Speaker 3: Yep.
Speaker 1: So I've almost gotten all the way to the end
Speaker 1: of the tracoma history part without even talking about the
Speaker 1: causative agent really and like how it was identified and
Speaker 1: who discovered it and so on. And one of the
Speaker 1: reasons for that is, like I said earlier, knowing exactly
Speaker 1: what caused this condition didn't seem to be necessary to
Speaker 1: stop the cycle of transmission and reduce prevalence in some places.
Speaker 1: But what the identification of chlamydia trachomatists did was allow
Speaker 1: people to distinguish trachoma from other acute types of eye inflammation,
Speaker 1: enabled them to see which treatments might work best, and
Speaker 1: also let them look for other ways that this bacterium
Speaker 1: could infect humans, such as genitally genitals. So let's go
Speaker 1: back in time to one chlamydia trichomitis was first identified.
Speaker 1: The late decades of the eighteen hundreds could be considered
Speaker 1: the heyday of germ theory. People were identifying bacterial or
Speaker 1: parasitic causes of diseases left and right. I mean really, like,
Speaker 1: can you imagine the dissertation would be like I looked
Speaker 1: in this person's boogers and I found this boom give
Speaker 1: me a science or nature of paper. I don't think
Speaker 1: they existed back then, but in theory, in theory, yeah.
Speaker 1: And so when a disease existed that a bacterium or
Speaker 1: parasite wasn't easily like or readily identified, it wasn't like, oh,
Speaker 1: this must not be infectious. It was often assumed that
Speaker 1: it was a transmissible, filterable agent aka a virus, and
Speaker 1: trichoma fell into this category at first, of course, until
Speaker 1: nineteen o seven, when Halberstetter and von Prowseek used a
Speaker 1: special stain to visualize the bacteria in trichoma, but they
Speaker 1: didn't realize at that time that it was bacteria they
Speaker 1: were seeing. They thought it was intracellular protozoa that appeared
Speaker 1: to cloak the nucleus of the cells they infected, which
Speaker 1: gave rise to the name climytozoa, after the Greek word
Speaker 1: for cloak.
Speaker 2: Oh, that's fun.
Speaker 1: Yeah, And of course it was later changed to chlamydia
Speaker 1: once people realized that they were not protozoa but bacteria. So,
Speaker 1: now that people had found what caused trachoma, did that
Speaker 1: mean that they would also be able to link it
Speaker 1: to the genital infection? Not exactly. If you think back
Speaker 1: to our Gonerhea episode, I think I mentioned how I
Speaker 1: didn't check my notes prior to the identification of the
Speaker 1: Gonerhea bacteria. It's hard to tease a part which historical
Speaker 1: descriptions of genital infections are actually gonerrhea versus something else
Speaker 1: based on symptoms alone, and the identification of Nicia Gonereea
Speaker 1: allowed people to finally say this is definitely gonerreea, which
Speaker 1: also meant that they could say, well, I don't know
Speaker 1: what this is, but it's certainly not gonereea, and we
Speaker 1: can't treat it with the same things as we do gonoreea.
Speaker 1: And so this is how non gonococcal urethritis or non
Speaker 1: specific urethritis became a diagnosis. It was this diagnosis of
Speaker 1: exclusion that makes sense. People did look for the cause
Speaker 1: of non ganacoccal urethritis, which I'm just gonna call n
Speaker 1: GU moving forward, But one problem was that it wasn't
Speaker 1: just one thing causing it. Right later research has shown
Speaker 1: that it can be caused by chamydia trichomitus, mycoplasma, genitalium trichomonas,
Speaker 1: among others, but people didn't know it was like all
Speaker 1: of these things could cause it at that time. Yeah,
Speaker 1: So if you're a researcher, let's say you're like digging
Speaker 1: in some secretions and trying to find out what the
Speaker 1: cause of this infection was, and you're like, I think
Speaker 1: I found it. I got it, And then you go
Speaker 1: over to a friend, take your little horse and buggy,
Speaker 1: go over to your friend and you say, I think
Speaker 1: I found it. Do you see it in your secretions?
Speaker 1: And he goes, no, I don't, this is something totally different.
Speaker 1: So you didn't get the right one right.
Speaker 2: You just feel really bad about yourself, feel like every
Speaker 2: my experiment failed right.
Speaker 1: And you're like, I'm leaving academia, and I'm not. I
Speaker 1: can't do this anymore. I quit.
Speaker 2: I'm going to make a podcast. Sorry, that was funny.
Speaker 1: That was really good. But researchers did try to minimize
Speaker 1: this confusion about what caused NGU by seeing if they
Speaker 1: could distinguish among different types of NGU. Okay, how long
Speaker 1: was the incubation period, what were the symptom, how long
Speaker 1: did they last? Things like that. And one of these
Speaker 1: people who was trying to characterize ngu's was named Ludwig.
Speaker 1: And I don't know how you pronounce this name, but
Speaker 1: I'm very excited about it because it is spelled wae lscch,
Speaker 1: which is very close to Welsh, and so I'm just
Speaker 1: going to call him Ludwig Welsh. And he described a
Speaker 1: quote rare form of NGU that had an incubation period
Speaker 1: of ten to fourteen days. The course of the disease
Speaker 1: was mild but long, and it was difficult to treat
Speaker 1: using the antibiotics of the day. Additional work also showed
Speaker 1: that the mucous membrane in cases of Welsh erythritis, as
Speaker 1: it would be called, was reddened with soft multiple infiltrates
Speaker 1: quote like the nodules in tracoma. Interesting, people had made
Speaker 1: a possible connection with the tracoma agent and genital infections
Speaker 1: before this. One gruesome experiment even involved taking material from
Speaker 1: people's genitals who had NGU and then applying that to
Speaker 1: the eyes of monkeys, and sure enough they developed an
Speaker 1: eye infection. There's definitely no io Cook approval on that one,
Speaker 1: for sure, no. But it seems like the tracoma agent
Speaker 1: was just a tricky bug to work with, and it
Speaker 1: was hard to know what it was or what it
Speaker 1: wasn't responsible for, including trachoma because there was still some
Speaker 1: debate about that, and also there was no ability at
Speaker 1: the time to culture it. And even with well scheerithritis,
Speaker 1: sometimes people saw chlamydia in the scrapings of infected tissue
Speaker 1: under the scope and other times they didn't, but the
Speaker 1: link seemed strong enough for at least one researcher to
Speaker 1: suggest that this well scheerythritis was quote a genital tricoma.
Speaker 1: The debate continued for decades, but in the nineteen thirties,
Speaker 1: American ophthalmologist Philip Thiguson drew a link between neonatal ocular
Speaker 1: infection and being exposed to genital infection during birth, and
Speaker 1: later that decade he also showed that trachoma could be
Speaker 1: treated with sulfonamides, which was actually a pretty huge, pretty
Speaker 1: huge deal at the time. After the introduction of penicillin
Speaker 1: in the nineteen forties, which could be used to treat
Speaker 1: gonorrhea but not ngus, interest in NGU and the possible
Speaker 1: link between trachoma and genital infection increased even more. But
Speaker 1: the real turning point for both trachoma and chlamydia would
Speaker 1: come about in nineteen fifty seven. Earlier, when I said
Speaker 1: that scientists thought that trachoma could be caused by a virus,
Speaker 1: they weren't actually that far off right. Chlamydia trichomatis acts
Speaker 1: like a virus in many ways, and this similarity to viruses,
Speaker 1: where they have to basically hijack a host sales machinery
Speaker 1: to replicate it kept researchers from being able to culture
Speaker 1: them for fifty years after their initial identification.
Speaker 2: Wow fifty years, Yeah, it's a long time, and that
Speaker 2: made it.
Speaker 1: Really difficult to fully characterize the bacterium, see its life cycles,
Speaker 1: and see like where it was involved. In nineteen fifty seven,
Speaker 1: Tang fey Fan, along with a research team, was able
Speaker 1: to culture the bacteria in a chick embryo. This was
Speaker 1: a huge breakthrough because it allowed people to culture large
Speaker 1: amounts of these bacteria, which led to careful characterization of
Speaker 1: its infection cycle, diagnostic tests, exploration into vaccines, antibiotic sensitivity testing,
Speaker 1: and so on. And two years after chlamydia could finally
Speaker 1: be cultured, it was isolated after delivery from both the
Speaker 1: cervix as well as the eyes of the infant who
Speaker 1: had inclusion conjunctivitis. People were finding more and more chlamydia
Speaker 1: in genital infections, and by nineteen sixty five, the number
Speaker 1: of cases of NGU, many of which were chlamydia, possibly
Speaker 1: most of which finally surpassed that of gonorrhea in the US,
Speaker 1: really illustrating how important it was to be able to
Speaker 1: distinguish among these NGU infections right. It was no longer
Speaker 1: enough to just say there ngu, that's NGU. Finally, chlamydia
Speaker 1: as an STI became a clinical entity in the nineteen
Speaker 1: seventies w I no and even then it would be
Speaker 1: another ten or more years before it became a notifiable
Speaker 1: disease in some places. In the nineteen eighties is when
Speaker 1: people started to discuss the possible ties between chlamydia and
Speaker 1: public inflammatory disease and infertility, and it seems like around
Speaker 1: the time of that research is when chlamydia began to
Speaker 1: be labeled as a disease of promiscuity, especially promiscuous women,
Speaker 1: which is really no different from how women were viewed
Speaker 1: historically as the sources of STIs, but not people who
Speaker 1: needed to be treated themselves, right.
Speaker 2: Which is I can't even tell you how frustrating, especially
Speaker 2: in the context of chlamydia today. But anyways, that's my
Speaker 2: personal high horse and I'll step off.
Speaker 1: No, it is really frustrating, especially when you read these
Speaker 1: descriptions of treatment that we're not that old, right from
Speaker 1: the seventies to eighties, and the way that they describe
Speaker 1: treatment is that in order to reduce chlamydia in men,
Speaker 1: we should prescribe antibiotics in women. Oh and I guess
Speaker 1: it'll treat them too.
Speaker 2: That's fascinating because I literally just read a paper that
Speaker 2: was like, what if we actually screen men, can we
Speaker 2: reduce the rates in women? Because we still aren't screening.
Speaker 1: We still aren't screening, Are you serious?
Speaker 2: Yeah? And people with a penis that is still not
Speaker 2: recomend for general spreading.
Speaker 1: It's wow.
Speaker 3: Yeah, And the link between infertility and chlamydia seemed to
Speaker 3: be used to push this like judgmental, moralistic narrative where
Speaker 3: infertility was the punishment for being promiscuous, the world was
Speaker 3: witnessing a silent but deadly epidemic of infertility. Oh god,
Speaker 3: things like that, and all during this cases of chlamydia
Speaker 3: did seem to be on the rise, although it was
Speaker 3: only routinely included in STI statistics in the US and
Speaker 3: Europe starting in nineteen ninety.
Speaker 1: So I realized this was kind of just like a
Speaker 1: brief foray into these two different diseases with very distinct
Speaker 1: histories and social impacts. And I could have probably spent
Speaker 1: an episode on each of them had we known, had
Speaker 1: we known, But I think that what they both show
Speaker 1: us going back to kind of like the theme I
Speaker 1: feel like for this episode is how easy it can
Speaker 1: be for a diagnosis to become wrapped up in someone's
Speaker 1: identity and how important it is that we don't let
Speaker 1: that happen. Yeah. So Aaron, I would love for you
Speaker 1: to tell me more about where we stand with chlamydia
Speaker 1: and trachoma today.
Speaker 2: I can't wait to right after this break. When it
Speaker 2: comes to trachoma, this remains the most common infectious cause
Speaker 2: of blindness worldwide.
Speaker 1: Yeah, it's it's really common.
Speaker 2: It's really common. It's responsible for blindness or visual impairment
Speaker 2: in almost two million people, which is about one point
Speaker 2: four percent of all blindness worldwide, and globally, an estimated
Speaker 2: one hundred and thirty six million people in forty four
Speaker 2: countries across the globe live in tricoma endemic areas and
Speaker 2: are therefore at risk of infection, which is a lot
Speaker 2: of human beings. Yeah. Yeah, And like you kind of mentioned, Aaron,
Speaker 2: the World Health Organization, the World Health Assembly, has targets
Speaker 2: for like global elimination, which sounds so great. But the
Speaker 2: initial target date was twenty TWENTYMWOMPOM, so the new target
Speaker 2: is twenty thirty.
Speaker 1: How are we doing with that target?
Speaker 2: By the way, well, I actually have some great news
Speaker 2: on that front, thanks for asking. As of March seventh,
Speaker 2: twenty twenty two, fourteen countries have newly reported achieving elimination goals.
Speaker 2: So I feel like that's something worth celebrating.
Speaker 1: That's huge.
Speaker 2: Yeah, that's very big. Unfortunately, the COVID pandemic put a
Speaker 2: very big damper on public health efforts. In twenty twenty,
Speaker 2: half as many people received corrective surgery to treat trachiasis
Speaker 2: and reduce the progression of visual impairment, and way less
Speaker 2: than half as many people as in twenty nineteen received
Speaker 2: antibiotic prophile axis or treatment. So that's a big bummer.
Speaker 2: But we're still at least seeing progress in a lot
Speaker 2: of places, so that's really good.
Speaker 1: That's great.
Speaker 2: Yeah, And like we kind of talked about before, the
Speaker 2: strategies to kind of treat this, I'll post the World
Speaker 2: Health organizations like information for people who want to read more.
Speaker 1: But it is a very.
Speaker 2: Multi tiered approach, which I think is important. Not only
Speaker 2: do they target inf structure to be able to increase
Speaker 2: access to clean water and sanitation, which is going to
Speaker 2: be able to reduce the spread of infection, it also
Speaker 2: includes antibiotic treatment in mass antibiotic campaigns, especially in hyper
Speaker 2: endemic areas, because this does tend to be a disease
Speaker 2: that in certain areas will be at really really high prevalence,
Speaker 2: and then in other areas will be at much lower prevalence,
Speaker 2: so mass antibiotic campaigns and then also surgical correction to
Speaker 2: be able to reduce the progression of disease in people
Speaker 2: who already had it as children.
Speaker 1: Where are some of these hyperendemic regions? Like, how is
Speaker 1: this distributed across the globe?
Speaker 2: Great question? So across the globe, it's the most economically
Speaker 2: disadvantaged and rural areas of Africa, Central and South America, Asia, Australia,
Speaker 2: and the Middle East. So the kind of most economically disadvantaged, poorest,
Speaker 2: most rural regions that tend to be the most hyperendemic.
Speaker 1: Gotcha.
Speaker 2: In terms of the STI chlamydia, we are talking about
Speaker 2: the most common bacterial sexually transmitted infection. Yeah, the most
Speaker 2: common one. The most recent studies that I read estimated
Speaker 2: a global incidence of one hundred thirty one million new
Speaker 2: cases every year. That's a lot of cases, a lot
Speaker 2: of humans, with an estimated global prevalence of around four
Speaker 2: percent or so three point eight to four point two
Speaker 2: of people with a cervix so a cervical infections and
Speaker 2: anywhere from just under three percent to about seven percent
Speaker 2: were the estimates that I saw of people with a penis.
Speaker 2: Surprisingly to no one, we don't have as good of
Speaker 2: data on penile urethral infections because most countries do not
Speaker 2: universally screen people with a penis for infection the way
Speaker 2: that they do screen young adult people with a cervix universally,
Speaker 2: which is again something that I hope will change in
Speaker 2: the next coming years. And importantly, it does tend to
Speaker 2: be young adults age eighteen to twenty six tend to
Speaker 2: have the highest prevalence. So overall it's probably close to
Speaker 2: three to four percent of the population adult population infected
Speaker 2: at any given time. Got that's a lot of humans.
Speaker 2: And in the US as of twenty nineteen, there were
Speaker 2: over one point eight million cases reported annually. And if
Speaker 2: you look just at the highest risk group that we
Speaker 2: screen that we have good data on, that is people
Speaker 2: age fifteen to twenty four with a cervix, the annual
Speaker 2: incidence is over three thousand, seven hundred cases per one
Speaker 2: hundred thousand people. Okay, that is incredibly common.
Speaker 1: It's very common.
Speaker 2: So I feel like one of the things that I
Speaker 2: hope that these numbers really highlight and kind of going
Speaker 2: back to what you were talking about, Aaron, about how
Speaker 2: chlamydia infection has been used in the past to like
Speaker 2: have a lot of shame and stigma specifically associated with it.
Speaker 2: This is an incredibly common infection. It is not something
Speaker 2: that only a certain type of people can have, or
Speaker 2: only a certain type of people are going to be
Speaker 2: at risk for. When we're talking about sexually transmitted bacterial
Speaker 2: infection as common as this, anyone having sexual contact of
Speaker 2: any kind is going to be at some risk of infection.
Speaker 2: People having multiple different kinds of sex or sex with
Speaker 2: multiple people, of course, are going to have a higher risk.
Speaker 2: But whether you're having any type of sex with one
Speaker 2: person or multiple people, things like using condoms can decrease
Speaker 2: our risk getting tested, getting treated. Talking about this infection
Speaker 2: and making it less shameful so that we have an
Speaker 2: awareness about it is the way that we reduce this infection.
Speaker 2: Because it's not that it's inherently bad or shameful to
Speaker 2: get a sexually transmitted infection, but they can be really serious,
Speaker 2: and we have ways to reduce the risk and to
Speaker 2: be able to treat these infections. So I think that's
Speaker 2: really important.
Speaker 1: Yeah, that was really well said. I agree with I
Speaker 1: agree with that.
Speaker 2: Thanks, And speaking of prevention, what about vaccines Arin.
Speaker 1: What about vaccines erin, Yeah, we don't have one yet yet.
Speaker 2: I read a really interesting paper that was looking at
Speaker 2: all chlamydias and over the last seventy years there have
Speaker 2: been at least two hundred and twenty different vaccine trials,
Speaker 2: and in the last ten years alone, there's been an
Speaker 2: average of twelve vaccine studies per year on chlamydia, which
Speaker 2: is like one a month, so that's thrilling. Not all
Speaker 2: of these studies have been on our friend chlymydia trachomitis.
Speaker 2: A lot have also been on species affecting koalash that's
Speaker 2: a spoiler. So far, still no vaccine, but of course
Speaker 2: lots of people doing fantastic research to get us closer.
Speaker 1: Speaking of fantastic people doing research to get us closer
Speaker 1: to a chlamydia vaccine, uh huh. I am very excited
Speaker 1: for a next week's bonus episode when I get to
Speaker 1: chat with not one but two researchers working on chlamydia
Speaker 1: in domestic animals and wildlife, including Kowalas doctor Martina Yelochnik
Speaker 1: and doctor Sam Phillips, both from the University of the
Speaker 1: Sunshine Coast in Queensland, Australia will be joining me to
Speaker 1: talk about other chlamydia species of wildlife or veterinary health importance.
Speaker 1: We'll be talking about how these infections have led to
Speaker 1: declines in certain animal populations, as well as the latest
Speaker 1: news regarding a chlamythia vaccine for koalas. So make sure
Speaker 1: you don't miss it, because it's going to be great.
Speaker 2: I can't I really can't wait. That's chlamydia and trachoma.
Speaker 1: Yeah, this was a very packed full episode. Yeah.
Speaker 2: Yeah, that's a good way to say it.
Speaker 1: Uh. Should we round it out with some sources?
Speaker 2: We sure ought to.
Speaker 1: I had a few, But what I really want to
Speaker 1: highlight R two one is a book called Trachoma by
Speaker 1: Hugh Taylor, and that is a fantastic overview of everything Tracoma.
Speaker 1: And then for chlamydia, there is a chapter by war
Speaker 1: Boys from twenty nineteen called Chlamydia A Disease without a History.
Speaker 2: I read a lot of papers for this since there
Speaker 2: was so many different aspects of it, So I'm not
Speaker 2: gonna specifically shout out any in particular, but suffice to say,
Speaker 2: if you want more details on the specific immunology and
Speaker 2: cell biology, path of physiology of Clamydia trachomatis. I've got
Speaker 2: papers for you if you want more details on reactive arthritis,
Speaker 2: got a couple of papers for you. You want more
Speaker 2: on those seventy years of vaccine research? Oh, I got it.
Speaker 1: More on tracoma.
Speaker 2: It's there. Check out our website This podcast will Kill
Speaker 2: You dot com and you'll find a list of every
Speaker 2: single source from this episode and all of our episodes.
Speaker 2: There's like ninety something.
Speaker 1: Yeah, there's ninety something. Thank you again so very much
Speaker 1: to the listener who sent in their first hand account
Speaker 1: for this episode. Again, we really appreciate your willingness to
Speaker 1: put yourself out there and be vulnerable.
Speaker 2: Yeah, thank you. And thank you also to Bloodmobile for
Speaker 2: providing the music for this episode and all of our episodes.
Speaker 1: And thank you to exactly Right Listen, follow and leave
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Speaker 2: And thank you to you listeners. We really appreciate you listening,
Speaker 2: and we hope that you liked this episode.
Speaker 1: We do, and a special thank you also to our
Speaker 1: wonderful generous patrons. We love you well. Until next time,
Speaker 1: wash your hands.
Speaker 2: You filthy animals.
Speaker 1: Oh buba buba bubo
Speaker 2: Oh