Chlamydia

Question 1

Define chlamydia.

Answer 1

Urogenital infection which is a common STI worldwide caused by Chlamydia trichomatis. Usually asymptomatic in men and women.

Question 2

What is the pathophysiology of chlamydia in males and females?

Answer 2

Females - usually affects endocervical canal
Males - affects urethra causing dysuria or penile discharge

Question 3

What is the microbiology of chlamydia?

Answer 3

Gram negative obligate intracellular parasite
Enters cells forming large inclusion bodiest which re-organise into smaller reticulate bodies
Incubation is usually 7-21 days

Question 4

What serotypes of chlamydia cause LGV?

Answer 4

Serotypes L1-3 cause lymphogranuloma venereum (genital ulcer +/- inguinal lymphadenopathy)

Serotypes A-K cause ocular only OR oculogenital disease

Question 5

How common is chlamydia?

Answer 5

Most common bacterial STI
Most infections occur among 15-24yr olds

Question 6

What are the risk factors for chlamydia?

Answer 6

• Age < 25yrs
• New sexual partner or multiple partners
• Infected sexual partner
• Condoms not used
• Hx of STI

Question 7

What are the clinical features of chlamydia?

Answer 7

Cervical discharge - cloudy or yellow
Abnormal vaginal discharge - odourless mucoid
Friable cervix - bleeds easily with friction from polyester swab
Post-coital bleeding
Intermenstrual bleeding
Pelvic pain

Penile discharge - mucoid or mucopurulent

Dysuria

Other:
* Fever/chills - if complicated or ascending
* Nausea/vomiting - if ascends
* Scrotal pain
* Myalgias
* Eye irritation
* Rashes - palms and soles

Question 8

What % are asymptomatic with chlamydia?

Answer 8

85%

Question 9

What is the treatment of choice for chlamydia?

Answer 9

Doxycycline 100mg PO BD for 7 days

• 2nd line: azithromycin 1g PO single dose

AND treat all sexual contact from the past 60 days.

Start tx after test results

Question 10

What is the treatment of choice for chlamydia in pregnancy?

Answer 10

Azithromycin 1g PO once

2nd line: amoxicillin 500mg PO TDS 7 days

Question 11

What are the complications of chlamydia?

Answer 11

Epididymitis

Reactive arthritis

Ophthalmia neonatorum
Ectopic pregnancy
Chlamydia pneumonia
Infertility
PID
Cervical cancer - low risk

Question 12

What is the prognosis with chlamydia?

Answer 12

Nearly all cured with current recommended antibiotic therapy

If untreated has complications.