[1] Chlamydia Flashcards
What is chlamydia?
A sexually transmitted infection caused by the Chlamydiae bacteria
What type of bacteria are Chlamydiae?
Small, obligate intracellular gram -ve bacteria
What cells are infected by Chlamydiae bacteria?
Human columnar and transitional epithelium
What type of Chlamydiae causes chlamydia most often?
Chlamydia trachomatis
What types of infections are caused by Chlamydia trachomatis?
- Ocular infection
- Genitourinary infections
- Proctitis
- Sexually acquired reactive arthritis
What can cause varying patterns of disease in chlamydia?
Different serological variants of C. trachomatis
What serological variants of C. trachomatis are responsible for GU infection?
Types D-K
How common is chlamydia compared to other STI’s?
It is the most commonly diagnosed STI in the UK
How common is chlamydia in terms of causing infertility?
It is the most common cause of preventable infertility worldwide
In what group of people is chlamydia most common?
Sexually active people under the age of 25
What percentage of cases of chlamydia occur in under 25’s?
75%
What percentage of people between 15-24 are infected with chlamydia?
1.5-10%
How many new cases of chlamydia occur each year worldwide?
131 million
What proportion of chlamydia cases are asymptomatic?
The majority
What are the risk factors for chlamydia?
- Age <25
- Partner +ve for chlamydia
- 2 or more sexual partners in preceding year
- Recent change in sexual partner
- Lack of consistent use of condoms
- Non-barrier contraception
- Infection with another STI
- Poor socio-economic status
- Genetic predisposition
How are most cases of chlamydia detected?
During screening or investigations for other GU illness
What are the symptoms seen in women with chlamydia?
- Vaginal discharge
- Dysuria
- Vague lower abdo pain
- Fever
- Intermenstrual or postcoital bleeding
- Deep dyspareunia
What are the two common presentations of chlamydia in men?
- Classical urethritis
- Epididymo-orchitis
What are the symptoms of classical urethritis in men with chlamydia?
- Dysuria
- Urethral discharge
What are the symptoms of epididymis-orchitis in men with chlamydia?
- Unilateral testicular pain
- Swelling (with or without)
What could be possible presentations of chlamydia in both sexes?
- Young adults with reactive arthritis
- Upper abdominal pain due to perihepatitis
- Proctitis with mucopurulent discharge
What is Reiter’s syndrome? (Shouldn’t really use this anymore)
A triad of urethritis, arthritis and conjunctivitis that can be triggered by chlamydial infections
What is upper abdominal pain due to perihepatitis a feature of?
Fits-Hugh Curtis Syndrome
When may proctitis with mucopurulent discharge be a feature of chlamydia?
Due to rectal chlamydia following anal intercourse
What are the signs of chlamydia in women?
- Friable, inflamed cervix
- Mucopurulent endocervical discharge
- Abdominal tenderness
- Pelvic adnexal tenderness on bimanual palpation
- Cervical excitation
What are the signs of chlamydia in men?
- Epididymal tenderness
- Mucoid or mucopurulent discharge
- Perineal fullness due to prostatitis
What are the differentials for chlamydia?
- Gonorrhoea
- Trichomonas vaginalis
- UTI
- Bacterial vaginosis
- Endometriosis
- Urethral/vaginal foreign body
- Periurethral abscess
What test can identify chlamydia?
Nuclei acid amplification tests
How are samples for nucleic acid amplification tests obtained in suspected chlamydia?
- Vulvovaginal swab in women
- First catch urine specimen in men
How is a vulvovaginal swab for chlamydia performed?
- Swab inserted about 5cm into vagina and rotated gently for 10-30 seconds
How is a first catch urine specimen for chlamydia taken?
- Should not have passed urine for last hour
- Catch first 20ml of sample
What are the criteria for testing for chlamydia?
- Symptoms of infection
- Sexual partners of people suspected for chlamydia
- All sexually active people under 25 annually (more often if changed partner)
- People under 25 who have been treated in last 3 months
- People who have concerns of exposure
- All women for TOP
- All those in GUM clinic
- Women being fitted with IUD and at risk of UTI
What does management of chlamydia include?
- Antibiotics
- Screening for other STI’s
- Partner notification
What is the first line treatment for uncomplicated chlamydia?
- Single dose of 1g azithromycin
What is an alternative to single dose treatment for chlamydia?
Doxycycline 100mg BD for 7 days
If doxycycline and azithromycin are contraindicated what can be given for chlamydia?
- Erythromycin 500mg BD for 10-14 days
What antibiotics should be given for chlamydia in pregnancy?
- Azithromycin 1g
- Erythromycin 500mg QDS for 7 days or BD for 14 days
When is test of cure advised in chlamydia?
- Pregnancy
- Persistent symptoms
- Non-compliance
- Re-exposed
When should test of cure be performed if required?
At least 3 weeks after treatment
What could cause a second positive result after chlamydia treatment?
- Poor adherence
- Re-infection
- Inadequacy of treatment
- False positive
When should a person detected positive on screening for chlamydia have a re-test?
3 months later
What is the ‘look back’ period for contact tracing in a male with urethral symptoms of chlamydia?
- 4 weeks prior to symptoms
- All contacts since symptoms
What is the ‘look back’ period for contact tracing in asymptomatic and non-urethral symptoms of chlamydia in men and women?
6 months
What should at-risk contacts be offered in chlamydia?
- Informed of risk
- Offered treatment
- Contact tracing
- STI testing
How can partners of individuals be informed of risk of chlamydia?
- By index patient (patient referral)
- By HCP (provider referral)
What advice should be given to patients with chlamydia and their partner(s)?
- Primarily sexually transmitted
- Infection is often asymptomatic
- May have had for months or years
- No test is 100% sensitive
- Complications of not treating chlamydia
- Importance of identifying and treating sexual partners
- Importance of compliance
- Side-effects of treatment
- Avoidance of sexual intercourse for a week after single-dose therapy
- Importance of testing for other STI’s
- Advice on safer sex
When should chlamydia be referred to a GUM clinic?
- Chlamydia is confirmed but cannot be managed in primary care
- Pregnancy
- PID
- Intolerance of treatment
- Diagnostic uncertainty
- Presence of ongoing symptoms despite treatment
- Multiple sexual partners
- Complicated upper genital tract infection
When should sexual abuse be considered in children or young people with chlamydia?
- <13 without evidence of vertical transmission
- 13-15 without evidence of vertical transmission or contraction from consensual activity with another young person
- 16-17 without evidence of vertical transmission or consensual sexual activity or with evidence of abuse of power
Why is follow-up necessary in chlamydia?
- Follow up partner notification
- Reinforce health education messages
- Check compliance
- Re-treat where necessary
- Arrange repeat testing if indicated
Do follow-ups for chlamydia need to be fat-to-face?
No, telephone is as good and more cost-effective
What are the potential complications of chlamydia?
- PID
- Infertility
- Ectopic pregnancy
- Epididymo-orchitis
- Urethral strictures
- Perihepatitis
- Reactive arthritis
What are the potential complications of chlamydia in pregnancy?
- Premature rupture of membranes
- Pre-term delivery
- Low birth weight
- Post-partum endometritis
- Neonatal ophthalmic infection or pneumonia
How can chlamydia be prevented?
- Promote safe sex
- Encourage early healthcare seeking behaviour
- Primary care involvement
What is the aim of screening for chlamydia?
Reduce the prevalence and transmission of chlamydia
Who can be screened for chlamydia?
Sexually active men and women under 25
Where can chlamydia screening take place?
- Healthcare setting
- Further/higher education
- Youth clubs
- Postal kits
