Pharyngeal Infections Can Be Caused by Chlamydia trachomatis

In his "Update on Sexually Transmitted Diseases: Gonorrhea and Chlamydial Infections" (CONSULTANT, July 2006, page 901), Dr David Reitman writes that "Chlamydia trachomatis does not cause pharyngeal infections."

Yesterday, my laboratory reported to me that a pharyngeal swab tested positive for chlamydial infection (detected by DNA testing). This was not the first time I diagnosed sexually transmitted pharyngeal chlamydial infection in a patient. Readers beware: it does happen.

- Carl Stein, MHS, PA-C, AAHIVS
  San Francisco

Chlamydia trachomatis almost never causes oropharyngeal symptoms or signs of infection (unlike gonococcal pharyngitis or herpes, which can present with pain and lymphadenopathy). However, Mr Stein is correct in that pharyngeal colonization can occur. In most published series, C trachomatis colonization of the pharynx occurs so rarely that routine screening of the pharynx in sexually active patients is not recommended. In higher-risk populations (eg, males who have sex with males and/or patients who prostitute), however, screening for all sexually transmitted oropharyngeal infections is indicated. The screening media (either nucleic acid amplication tests [NAAT] or culture) must be appropriate for the oropharynx to minimize false-positive and false-negative results.

- David S. Reitman, MD
  Director of Pediatric and Adolescent Medicine
  Regional Institute for Children and Adolescents
  Rockville, Md
  Member, Division of Adolescent Medicine
  Children's National Medical Center
  Clinical Assistant Professor of Pediatrics
  George Washington University School of Medicine
  Washington, DC