Chlamydia

Question 1

Causative organism

Answer 1

Bacterium: chlamydia trachomatis

Question 2

How does gram staining colouring work?

Answer 2

A Gram stain is colored purple. When the stain combines with bacteria in a sample, the bacteria will either stay purple or turn pink or red. If the bacteria stays purple, they are Gram-positive. If the bacteria turns pink or red, they are Gram-negative. (POSITIVE PURPLE, NEGATIVE RED)

Question 3

Is chlamydia gram negative or positive? What colour will it stain?

Answer 3

Negative

Red

Question 4

How does chlamydia gain entry and replicate

Answer 4

“Obligate intracellular parasite”

• Organism enters the cell.
• Large elementary bodies formed > small reticulate bodies > replicate > mature back to elementary bodies.
• 2-3d later cell ruptures
• The free bacteria then penetrate other cells and repeat this cycle

Question 5

Where does chlamydia cause inflammation? How long is incubation?

Answer 5

Incubation 7-21d.
Infection in the urogenital tract = urethral inflammation or cervical inflammation.
WOMEN: Can migrate up to reproductuive tract in women and cause PID or peri-hepatitis (Fitzhugh-Curtis syndrome).
MEN: epididymitis or prostatitis

Question 6

Serotypes

Answer 6

L1, L2, L3 - LGV - Lymphogranuloma venereum

A, B, Ba, C - ocular trachoma

B, Ba, D-K - oculogenital disease in adults and children , infant pneumonia

Question 7

Tell me about LGV

Answer 7

It is a more invasive serotype of chlamydia. Attacks the lymph nodes. More common in MSM, mainly seen in rectum.

Proctitis with bleeding, pus, ulcers and constipation.
Systemic sx: fever, rash, lymphadenopathy. Genital ulcers

Question 8

Signs and symptoms in women

Answer 8

~85% of women and men are asymptomatic

• post coital or intermenstrual bleeding
• odourless discharge, dysuria or pelvic pain
• cervical os may = cloudy or yellow discharge + cervix may bleed easily
• If ascends up urogenital tract: fever/ chills/ myalgias/ nausea/ vomitting

Question 9

Signs and symptoms men

Answer 9

• dysuria and clear/whiteish urethral discharge
• Mild-sev scrotal pain may occur in ascending infections that cause epididymitis [chlamydia being a main cause for this], orchitis, or prostatitis
• Scrotal area tender and warm, cremasteric reflex in tact

Question 10

What is the feeling of needing to poo when you dont called

Answer 10

tenesmus

Question 11

Rare manifestation / complication of chlamydia?

Answer 11

Reactive arthritis - typically 4w after infection.
Can’t see, can’t pee, can’t climb a tree.
Joint pain, stiffness and swelling, inflammation of the eyes, urethra and skin problems

Question 12

Diagnostic testing

Answer 12

NAAT - nucleic acid amplification tests. Sensitivity for NAAT is >90% and specificity is 94-99.5%.

Question 13

After treatment, how long to abstain from sex?

Answer 13

Abstinence from sexual activity is recommended for 7 days after single dose antibiotics or until completion of a 7-day course of antibiotics.

Question 14

First line treatment

Answer 14

Doxy 100mg BD 7/7

Avoid in pregnancy or breast feeding

Question 15

Treatment in pregnancy

Answer 15

Azithromicin 1g stat followed by 500mg OD for 2/7

Question 16

Treatment if rectal chlamydia

Answer 16

Same as standard - doxy 100mg BD 7/7
However, symptomatic MSM with proctitis should be reviewed by a senior*** Empirical LGV treatment should be given = doxycycline 100mg BD for 3/52