In addition, the strategy of control programmes based on screening, treatment and contact tracing is extremely costly and requires substantial societal infrastructure. This makes this approach impractical for the developing world, where the burden of disease is the greatest. Thus, development of a safe and effective vaccine is the ultimate goal in the control of Chlamydia. The relative uptake of a vaccine versus screening is difficult to quantify at present, but it is likely that a vaccine would be more widely accepted as evidenced by uptake of the HPV vaccine in settings where it is available and supported [33] and [34]. Costing of a Chlamydia vaccine is not possible at this stage.

However, based on experience from other vaccines, prices could be negotiated to levels that are cost-effective. The most important issue of all is whether find protocol a vaccine actually works, that is, has high efficacy and prevents acquisition of infection, transmitting infection or developing disease. This can only be ascertained through clinical research after the development of suitable vaccine candidate(s). With no other long-term strategy available, investment in Chlamydia vaccine design, development and evaluation is the most appropriate way forward. Our objectives in this review are to discuss infections

and diseases Autophagy screening of the genital tract caused by C. trachomatis with a focus on the complexities and challenges of chlamydial vaccine development. These include considerations such as how to; (i) better understand the range of immunological responses elicited by/to this organism, and therefore to subsequently define effective vaccine antigens and suitable biomarkers of protection, (ii) interpret the results

obtained from animal models of infection, (iii) optimally choose, combine, and present vaccine antigens (surface and/or internal antigens, mucosal adjuvants) and, (iv) interpret mathematical models to define effective vaccine goals for preventing acquisition of infection, interrupting transmission, and/or preventing tubal disease. C. trachomatis is a small (0.5 μm) bacterium that elicits inflammatory cytokine responses following infections of epithelial cells and macrophages. The complex, two-stage developmental cycle of Chlamydia is described found in Fig. 1(a). The extracellular infectious elementary bodies (EB) avoid lysosomal fusion to survive and differentiate into metabolically active reticulate bodies (RB) [35] and [36] and reviewed in [37]). The chlamydial RBs then replicate by around 500-fold, and subsequently re-differentiate into EBs inside a membrane-bound parasitophorous vacuole (“inclusion”) eventually being released by extrusion and/or cytolysis after 40–72 h to infect new cells or hosts [38]. Chlamydia can also enter a persistent growth state if exposed to molecular and cellular stresses such as inadequate antibiotic treatment or host cytokines, particularly IFN-g.