Chlamydia Flashcards
Definition
Chlamydia trachomatis
- (Obligate intracellular gram -ve parasite -> cannot see under microscope)
Most common bacterial STI in UK
In women affects endocervix ± urethra (in men affects urethra)
Sexual history = multiple sexual partners, no barrier use, history of STIs, low socioeconomic status
Symptoms
Asymptomatic in at least 70-80% of women
Symptomatic (<30%) = purulent PV discharge, dyspareunia, IMB, PCB, abdominal pain, dysuria
Investigations
(n.b. if S/Sof chlamydia, you can treat on suspicion alone, unlike gonorrhoea):
Direct microscopy (non-gonococcal urethritis – just neutrophils, no organisms)
- 1st (NAAT): Men: urethral swab OR first catch urine NAAT; Women: vulvovaginal swab OR first catch urine NAAT
- Nucleic acid amplification tests (NAATs)
- 2nd: Culture and sensitivities
Management
can treat on suspicion before getting laboratory results back:
1st line – doxycycline, 100mg, BD 7 days (contra-indicated in pregnancy and breastfeeding)
2nd line / pregnant / breastfeeding – azithromycin (1g STAT)
- Contact tracing (6 months)
- Avoid sex until treatment has been completed
- Recommend STI screen
- Follow-up appointment by 5-weeks
Complications
- PID (up to 16%), infertility, ectopic
- Reactive arthritis (arthritis, conjunctivitis, urethritis)
- Fitz-Hugh-Curtis (perihepatitis)
- Pregnancy (PTL, PPROM, post-partum endometritis)
