**2.2** *Chlamydia trachomatis*

CT is the agent of the most common bacterial STI worldwide, with a significant clinical, economic, and public health impact [21]. This bacterial sexually transmitted infection is responsible for lymphogranuloma venerum (LGV). Some chlamydial infections may occur without clinical symptoms. Individuals with LGV commonly present with tender inguinal or femoral lymph nodes, which are mostly unilateral. Sometimes, an ulcer which is mostly self-limiting may occur at the site of the infection. Often, these lesions would have disappeared by the time the infected individual is seeking care in the hospital. The prevalence of CT in pregnancy in developing countries is between 7 and 31%. In sub-Saharan Africa, the prevalence of CT among high-risk groups in the 1980s was 2–25% while among the low-risk groups in the same period was 2–29% [22–25]. The prevalence of the organism among high-risk groups in the 1990s was 2–13% and among the low-risk group in the same period was 4–18% [22–25]. This high prevalence is occurring in places where we have a paucity of manpower and equipment for the treatment of patients with the resultant morbidity and mortality associated with the disease.

A definitive LGV diagnosis can be made only with LGV-specific molecular testing (e.g., PCR-based genotyping). These tests can differentiate LGV from non-LGV CT in rectal specimens. However, these tests are not widely available, and results are not typically available in a time frame that would influence clinical management. Therefore, diagnosis is based on clinical suspicion, epidemiologic information, and a CT Nucleic acid Amplification Test (NAAT) at the symptomatic anatomic site, along with the exclusion of other etiologies for proctocolitis, inguinal lymphadenopathy, or genital, oral, or rectal ulcers [26, 27]. Genital or oral lesions, rectal specimens, and lymph node specimens (i.e., lesion swab or bubo aspirate) can be tested for CT by NAAT or culture. NAAT is the preferred approach for testing because it can detect both LGV strains and non-LGV CT strains [28]. Therefore, all persons presenting with proctocolitis should be tested for CT with a NAAT performed on the rectal specimen. The facilities and personnel for these services are unavailable to most persons in the resource-limited settings who require these tests. This is due to poverty, ignorance, and poor governance.

For the treatment of CT cervicitis, the CDC recommends oral Doxycycline 100 milligram orally twice daily for 7 days. For individuals who are at risk for gonorrhea or who live in communities where gonorrhea is prevalent, treatment with potent antibiotics for the causative organism—*Neisseria gonorrhea* (NG)—may be considered. Alternatively, a single dose of oral Azithromycin 1 g may be used for the CT infection. The CDC recommended regimen for chlamydial infection among adolescents and adults includes (a) oral Doxycycline 100 mg twice daily for 1 week (b) oral Azithromycin 1 g in a single dose (c) oral Levofloxacin 500 mg once daily for 1 week. The recommended regimen for chlamydial infection during pregnancy includes oral Azithromycin 1 g in a single.
