Pathogenesis: C. trachomatis is a gram-negative obligate intracellular bacterium. It is unique in that it has no ability, or only limited ability, to produce its own adenosine triphosphate (ATP) energy source. This inability to create a steady source of energy forces the bacterium to reside within a host cell. The infectious form of the bacterium, called the elementary body, gains entry into a host cell. Within the cell, it forms a larger, actively reproducing reticulate body. The reticulate body undergoes binary fission to produce progeny (elementary bodies), which are then released from the cell to infect other cells or hosts.
Histology: A skin biopsy of a primary ulcer of LGV shows epithelial necrosis with a mixed, nonspecific inflammatory infiltrate. There are no pathognomonic histological findings in LGV. A tissue culture (McCoy cell culture) is the only reliable means of diagnosis. The finding of iodine-staining, glycogen-containing inclusion bodies is sensitive and specific for the presence of C. trachomatis. Various serological tests are available, but they cannot reliably differentiate between past and present disease.
Treatment: The routine application of erythromycin to the eyes of newborns has dramatically decreased the risk of trachoma. LGV is treated with oral antibiotics in the tetracycline or erythromycin class. All sexual partners should also be treated, even if they do not exhibit overt signs of disease.
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