Disease Process The pathogenesis of colds is still sketchy. The virus is deposited in the nasopharynx, where it moves to the adenoids and a rich bed of viral receptors. An inflammatory reaction is evoked, resulting in vasodilation, mucus production, coughing, and sneezing about 16 hours after initial infection. The virus spreads to the ciliated epithelial cells in the nasal passages, and symptoms continue for 4 to 10 days. The virus is active for about 3 weeks and may affect the trachea and bronchi, particularly in individuals with chronic respiratory disease.

Symptoms Typical symptoms include nasal congestion and discharge, sore throat, sneezing, coughing, headache, and fatigue. Febrile reactions occur in infants and young children but are uncommon in older children and adults.

Potential Complications The most common complications are the secondary overlay of a bacterial infection with purulent sinusitis or otitis media and the triggering of bronchospasms in persons with asthma.

Diagnostic Tests The diagnosis is made by clinical examination, while ruling out secondary bacterial sinusitis, otitis media, and streptococcal pharyngitis.

Treatments

Surgery
None.

Drugs
Acetaminophen analgesics for headache, nasal sprays for decongestion, saline gargle or topical anesthetics for sore throat; no aspirin for infants or children; no antibiotics.

General
Rest for comfort and to minimize spread; good handwashing and careful handling of items in the environment to minimize viral contact by others; adequate fluids for hydration.

Disease Process After intimate contact with an infected individual, the Chlamydia bacterium attaches to and is then ingested by the columnar epithelial cells in various receptacle sites, where it multiplies in the host cell. Common sites are the urethra and prostate in men and the urethra and cervix in women. The rectum and pharynx are sites for both genders. Sites for infants and children include the conjunctivae and respiratory tract.
The pathogenesis after this point is unclear, but most likely an immune response is triggered, producing a patchy, inflammatory response in the submucosa. This is spread by the lymphatics to such sites as the epididymis in men and the fallopian tubes in women. Inflammatory exudate is eventually replaced by fibrous tissue, leading to strictures in the urethra, epididymis, and fallopian tubes and scarring of the conjunctivae.
Lymphogranuloma venereum produces a localized, nodular lesion that spreads regionally via the lymph system (primarily the inguinal nodes), producing other nodular lesions, which mat together and form large abscesses. If the condition is left untreated, abscesses form throughout the lymph system and often rupture through epithelial surfaces, creating draining sinuses and fistulas.

Symptoms Manifestations vary, depending on the mucous membrane initially involved and the infecting strain of C. trachomatis.

Urethritis/cervicitis
Often asymptomatic; urinary pain and frequency; scanty mucoid urethral discharge (men), mucopurulent vaginal discharge (women); pain in scrotum with epididymitis; flank tenderness with salpingitis

Lymphogranuloma
Early sign is lesion on penis, labia, vagina, cervix, or rectum; men then have lymphadenopathy; systemic signs include fever, chills, severe headache

Pharyngeal infection
Asymptomatic or sore throat; red, dry tongue

Rectal infection
Bloody diarrhea, purulent discharge

Trachoma and conjunctivitis
Purulent discharge from eyes

Potential Complications Complications from untreated disease include urethral and rectal strictures, pelvic inflammatory disease, sterility, fistulas, elephantiasis, blindness, and pneumonia.

Diagnostic Tests The primary diagnostic tools are a clinical examination with a history of exposure to an infected partner or multiple partners, and a culture of exudate that tests positive for C. trachomatis.

Treatments

Surgery – None.

Drugs
Antiinfective drugs sensitive to C. trachomatis following treatment guidelines for type and dosage issued by the Centers for Disease Control and Prevention.

General
Cautioning patient to refrain from sexual activity until he or she is free of disease, and tracing of all potentially exposed sex partners; screening of high-risk populations to treat infected individuals and reduce the reservoir; information about STDs.