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4: Y4 - Gynaecology [8] > [1] Chlamydia > Flashcards

[1] Chlamydia Flashcards

1
Q

What is chlamydia?

A

A sexually transmitted infection caused by the Chlamydiae bacteria

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2
Q

What type of bacteria are Chlamydiae?

A

Small, obligate intracellular gram -ve bacteria

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3
Q

What cells are infected by Chlamydiae bacteria?

A

Human columnar and transitional epithelium

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4
Q

What type of Chlamydiae causes chlamydia most often?

A

Chlamydia trachomatis

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5
Q

What types of infections are caused by Chlamydia trachomatis?

A
  • Ocular infection
  • Genitourinary infections
  • Proctitis
  • Sexually acquired reactive arthritis
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6
Q

What can cause varying patterns of disease in chlamydia?

A

Different serological variants of C. trachomatis

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7
Q

What serological variants of C. trachomatis are responsible for GU infection?

A

Types D-K

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8
Q

How common is chlamydia compared to other STI’s?

A

It is the most commonly diagnosed STI in the UK

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9
Q

How common is chlamydia in terms of causing infertility?

A

It is the most common cause of preventable infertility worldwide

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10
Q

In what group of people is chlamydia most common?

A

Sexually active people under the age of 25

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11
Q

What percentage of cases of chlamydia occur in under 25’s?

A

75%

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12
Q

What percentage of people between 15-24 are infected with chlamydia?

A

1.5-10%

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13
Q

How many new cases of chlamydia occur each year worldwide?

A

131 million

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14
Q

What proportion of chlamydia cases are asymptomatic?

A

The majority

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15
Q

What are the risk factors for chlamydia?

A
  • 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
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16
Q

How are most cases of chlamydia detected?

A

During screening or investigations for other GU illness

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17
Q

What are the symptoms seen in women with chlamydia?

A
  • Vaginal discharge
  • Dysuria
  • Vague lower abdo pain
  • Fever
  • Intermenstrual or postcoital bleeding
  • Deep dyspareunia
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18
Q

What are the two common presentations of chlamydia in men?

A
  • Classical urethritis

- Epididymo-orchitis

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19
Q

What are the symptoms of classical urethritis in men with chlamydia?

A
  • Dysuria

- Urethral discharge

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20
Q

What are the symptoms of epididymis-orchitis in men with chlamydia?

A
  • Unilateral testicular pain

- Swelling (with or without)

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21
Q

What could be possible presentations of chlamydia in both sexes?

A
  • Young adults with reactive arthritis
  • Upper abdominal pain due to perihepatitis
  • Proctitis with mucopurulent discharge
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22
Q

What is Reiter’s syndrome? (Shouldn’t really use this anymore)

A

A triad of urethritis, arthritis and conjunctivitis that can be triggered by chlamydial infections

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23
Q

What is upper abdominal pain due to perihepatitis a feature of?

A

Fits-Hugh Curtis Syndrome

24
Q

When may proctitis with mucopurulent discharge be a feature of chlamydia?

A

Due to rectal chlamydia following anal intercourse

25
Q

What are the signs of chlamydia in women?

A
  • Friable, inflamed cervix
  • Mucopurulent endocervical discharge
  • Abdominal tenderness
  • Pelvic adnexal tenderness on bimanual palpation
  • Cervical excitation
26
Q

What are the signs of chlamydia in men?

A
  • Epididymal tenderness
  • Mucoid or mucopurulent discharge
  • Perineal fullness due to prostatitis
27
Q

What are the differentials for chlamydia?

A
  • Gonorrhoea
  • Trichomonas vaginalis
  • UTI
  • Bacterial vaginosis
  • Endometriosis
  • Urethral/vaginal foreign body
  • Periurethral abscess
28
Q

What test can identify chlamydia?

A

Nuclei acid amplification tests

29
Q

How are samples for nucleic acid amplification tests obtained in suspected chlamydia?

A
  • Vulvovaginal swab in women

- First catch urine specimen in men

30
Q

How is a vulvovaginal swab for chlamydia performed?

A
  • Swab inserted about 5cm into vagina and rotated gently for 10-30 seconds
31
Q

How is a first catch urine specimen for chlamydia taken?

A
  • Should not have passed urine for last hour

- Catch first 20ml of sample

32
Q

What are the criteria for testing for chlamydia?

A
  • 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
33
Q

What does management of chlamydia include?

A
  • Antibiotics
  • Screening for other STI’s
  • Partner notification
34
Q

What is the first line treatment for uncomplicated chlamydia?

A
  • Single dose of 1g azithromycin
35
Q

What is an alternative to single dose treatment for chlamydia?

A

Doxycycline 100mg BD for 7 days

36
Q

If doxycycline and azithromycin are contraindicated what can be given for chlamydia?

A
  • Erythromycin 500mg BD for 10-14 days
37
Q

What antibiotics should be given for chlamydia in pregnancy?

A
  • Azithromycin 1g

- Erythromycin 500mg QDS for 7 days or BD for 14 days

38
Q

When is test of cure advised in chlamydia?

A
  • Pregnancy
  • Persistent symptoms
  • Non-compliance
  • Re-exposed
39
Q

When should test of cure be performed if required?

A

At least 3 weeks after treatment

40
Q

What could cause a second positive result after chlamydia treatment?

A
  • Poor adherence
  • Re-infection
  • Inadequacy of treatment
  • False positive
41
Q

When should a person detected positive on screening for chlamydia have a re-test?

A

3 months later

42
Q

What is the ‘look back’ period for contact tracing in a male with urethral symptoms of chlamydia?

A
  • 4 weeks prior to symptoms

- All contacts since symptoms

43
Q

What is the ‘look back’ period for contact tracing in asymptomatic and non-urethral symptoms of chlamydia in men and women?

A

6 months

44
Q

What should at-risk contacts be offered in chlamydia?

A
  • Informed of risk
  • Offered treatment
  • Contact tracing
  • STI testing
45
Q

How can partners of individuals be informed of risk of chlamydia?

A
  • By index patient (patient referral)

- By HCP (provider referral)

46
Q

What advice should be given to patients with chlamydia and their partner(s)?

A
  • 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
47
Q

When should chlamydia be referred to a GUM clinic?

A
  • 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
48
Q

When should sexual abuse be considered in children or young people with chlamydia?

A
  • <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
49
Q

Why is follow-up necessary in chlamydia?

A
  • Follow up partner notification
  • Reinforce health education messages
  • Check compliance
  • Re-treat where necessary
  • Arrange repeat testing if indicated
50
Q

Do follow-ups for chlamydia need to be fat-to-face?

A

No, telephone is as good and more cost-effective

51
Q

What are the potential complications of chlamydia?

A
  • PID
  • Infertility
  • Ectopic pregnancy
  • Epididymo-orchitis
  • Urethral strictures
  • Perihepatitis
  • Reactive arthritis
52
Q

What are the potential complications of chlamydia in pregnancy?

A
  • Premature rupture of membranes
  • Pre-term delivery
  • Low birth weight
  • Post-partum endometritis
  • Neonatal ophthalmic infection or pneumonia
53
Q

How can chlamydia be prevented?

A
  • Promote safe sex
  • Encourage early healthcare seeking behaviour
  • Primary care involvement
54
Q

What is the aim of screening for chlamydia?

A

Reduce the prevalence and transmission of chlamydia

55
Q

Who can be screened for chlamydia?

A

Sexually active men and women under 25

56
Q

Where can chlamydia screening take place?

A
  • Healthcare setting
  • Further/higher education
  • Youth clubs
  • Postal kits

4: Y4 - Gynaecology [8] (52 decks)

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