Genitourinary medicine beyond sexually transmitted infections

blindness (trachoma), and in industrialized countries, as a major sexually transmitted disease pathogen and significant cause of pelvic inflammatory disease and tubal factor infertility in women. An early health promotion leaflet used the catchy title ‘Chlamydia is not a flower; it is a serious sexually transmitted disease’. So where did the word come from? The word chlamydia is derived from the ancient Greek word chlamys (modern Greek word is chlamyda) meaning cloak-like mantle, typically worn by soldiers. Early light microscopists noted that the infected cells had a large inclusion that appeared to drape from the nucleus just like a cloak (Figure 1) – hence the term chlamydia. Originally chlamydia was termed psittacosislymphogranuloma-venerum-trachoma group (PLT organisms) or the TRIC group (trachoma inclusion conjunctivitis organisms). At one time they were referred to as Bedsonia reflecting the work of Sir Samuel Bedson and colleagues in the 1930s. Chlamydia is an obligate intracellular parasite. The organisms were so small that they were filterable and that at one stage were considered as the missing link between bacteria and viruses. Chlamydiae were extremely difficult to cultivate, although the inclusions had been known about since 1910. Lindner, Halberstaedter and von Prowazak and others had seen characteristic inclusion bodies in conjunctival epithelial cells and in cells of the cervix of mothers with children suffering from inclusion blennorrhoea or from the urethra of men with non-specific urethritis. Eventually T’ang cultured the trachoma agent in the yolk sac in 1957. Tissue culture, however, became the mainstay of diagnosis in the 1980s and irradiated McCoy cells were used with the genital samples being centrifuged on to the monolayers to improve penetration. Little wonder that there has been confusion over the unusual name. According to the British Association for Sexual Health and HIV guidelines patients being treated for a chlamydial infection should be given a detailed explanation of their condition reinforced by clear and accurate written information. At the Sexual Health and HIV clinic at South Manchester, all patients are required to self-complete a short questionnaire prior to registering containing basic demographic details as well as treatment of any previous sexually transmitted infection (STI). Having noticed extreme variations in the spelling of ‘Chlamydia’, we sought to investigate this more closely. Of 440 patients who had written on the questionnaire that they had had chlamydial infection treated in the past, there were 144 different spellings of which the most common five were ‘Chlamydia’ (29%), ‘Clamidia’ (10.2%), ‘Chlamidia’ (9.7%), ‘Clymidia’ (5.4%) and ‘Clamydia’ (4.7%). There was no difference between the sexes in the proportion spelling ‘Chlamydia’ correctly (26.8% for men, 30.7% for women). These results suggest that although they were aware of having had chlamydial infection, there was a strong tendency towards spelling ‘Chlamydia’ phonetically. Of the group spelling ‘Chlamydia’ correctly, 77% self-classified themselves as ‘white-Bitish’ emphasizing the fact that English as their first language might make it easier for them to learn the correct spelling. The average age of patients in the group spelling ‘Chlamydia’ correctly was 28.5 years for women and 29 years for men. The proportion of men and women over the age of 25 years spelling ‘Chlamydia’ correctly was 82% for men and 61.5% for women (18% and 30.5%, respectively, for those under 25 years). This age difference may reflect the relative importance that the different age groups place on being diagnosed with chlamydial infection. These results emphasize just how little information younger patients actually take in when they have been told they have an STI. It supports our practice of always giving written information to take away when a diagnosis is made.