Chlamydia Flashcards
Background
Chlamydia trachomatis is the most common bacterial cause of sexually transmitted genital infections.
Can infect the endocervix, urethra, rectum, and occasionally the pharynx and conjunctiva.
Up to 70% of women and 50% of men are asymptomatic.
Complications include:
- PID and subsequent infertility, pelvic pain, ectopic pregnancy
- Epididymo-orchitis
- Sexually acquired reactive arthritis or conjunctivitis
- Fitz-Hugh Curtis syndrome (peri-hepatitis)
- Perinatal transmission at delivery
Causes
C. trachomatis
N. gonorrhoeae
C. trachomatis
M. genitalium
Assessment
A). If the patient is:
- aged
- aged ≥ 30 yr, offer testing according to assessment of risk, presence of anogenital symptoms, or if pt requests a sexual health check.
B). Complete testing:
- if sexual contact with chlamydia or another STI.
- before referral for abortion.
- during IUD insertion. If pt aged
- in all women in early pregnancy irrespective of risk.
C). If pt is asymptomatic, offer the sexual health check with the appropriate routine testing and assessment.
D). If they are concerned about a specific recent sexual event, check:
- Chlamydia and gonorrhoea
- HIV
- Syphilis
F). If the patient is symptomatic, carry out further assessment:
- Females
- Males
Seek sexual health advice if the patient has:
an unexpected positive test.
allergies to standard treatment options.
anorectal symptoms and is a man who has sex with men (MSM).
Complicated chlamydial infections, e.g. symptomatic rectal chlamydia infection – request acute sexual health assessment.
Suspected chlamydia conjunctivitis in adults – complete full sexual health check, treat empirically for chlamydia, and seek ophthalmology advice.
Uncomplicated chlamydial infections (excluding pregnancy)
First-line option for patients who are not pregnant. Doxycycline 100 mg twice daily for 7 days.
- more effective than azithromycin, particularly for rectal and pharyngeal infection and chlamydial urethritis.
If compliance is in doubt or doxycycline is contraindicated, a 1 g immediate dose of azithromycin may be given.
While chlamydia usually does not show resistance to azithromycin, there are increasing concerns that widespread azithromycin use is leading to resistance in other organisms, e.g. gonorrhoea and mycoplasma genitalium.
Patient is pregnant or breastfeeding
Give azithromycin 1 g immediately.
Only if azithromycin is contraindicated –amoxicillin 500 mg three times a day for 7 days.
This regime is much less effective than using azithromycin.
Chlamydia in pregnancy requires a test of cure 5 weeks after treatment.
In addition, testing for reinfection is recommended at the beginning of the third trimester.
Neonatal chlamydia conjunctivitis
occurs between days 5 to 14 of life.
Ranges in severity from mild redness of the conjunctiva with minimal watery discharge, to severe redness and swelling of the lids, and conjunctiva with purulent discharge.
May be unilateral or bilateral.
May be associated with pneumonia in 10 to 20%.
If suspected pneumonia or pneumonitis, severe disease, or compliance concerns, seek paediatric medical advice.
Treat with 14 days oral erythromycin 50 mg/kg/day QID
or after seeking infectious disease advice for approval, with 5 days azithromycin syrup (10mg/kg/dose once daily on day 1, then 5mg/kg once daily on days 2 to 5).
Seek ophthalmology advice.
Follow-up including repeat testing is required to ensure negative result for chlamydia as second courses of macrolides is sometimes required.
Request
Acute sexual health assessment if complicated infection.
Seek sexual health advice if pt has:
- an unexpected positive test.
- allergies to standard treatment options.
- anorectal symptoms and is a man who has sex with men (MSM).
Seek ophthalmology advice if:
- suspected chlamydia conjunctivitis.
- neonatal chlamydia conjunctivitis.
For a person of any age requesting an ‘STI check-up’, test for:
–urine PCR or genital swab for chlamydia and gonorrhoea
–serology for Hepatitis B (if not vaccinated or immune)
–syphilis and HIV
