Chlamydia Flashcards
What factors increase the risk of chlamydia transmission?
- being young (under 25)
- multiple sexual partners
- sexually active from a young age
How many cases of chlamydia are asymptomatic?
- 75% cases are asymptomatic in women
- 50% cases are asymptomatic in men
- asymptomatic patients can still pass on the infection
What is involved in the National Chlamydia Screening Programme (NCSP)?
- every sexually active person under 25 should be screened annually
OR
- when they change their sexual partner
- everyone is retested after 3 months to ensure they have not contracted chlamydia again
What are individuals tested for during an STI screening?
- chalmydia
- gonorrhoea
- syphilis (blood test)
- HIV (blood test)
What are the 2 different types of swabs used in sexual health screening?
- charcoal swabs
- nucleic acid amplification test (NAAT) swabs
What are charcoal swabs used for?
- microscopy (looking at the sample under the microscope)
- culture (growing the organism)
- sensitivities (which antibiotics are effective)
- the Aimes transport medium in the tube keeps the micro-organisms alive during transport
What organisms can be confirmed through use of a charcoal swab?
- a charcoal swab can be used for an endocervical** and **high vaginal swab (HVS)
- they can confirm:
- bacterial vaginosis
- candidiasis
- gonorrhoea (endocervical swab)
- trichomonas vaginalis (swab from posterior fornix)
- group B streptococci
How do NAAT swabs work?
What do they test for?
they check directly for the DNA or RNA of an organism
they are used specifically for chlamydia** or **gonorrhoea
OR to test specifically for mycoplasma genitalium
How are NAAT swabs taken in women and men?
women:
- an endocervical swab is preferred
- can be taken as a vulvovaginal swab that the patient takes themselves
men:
- a first-catch urine sample is used
- urethral swab may be used in some situations
When may additional NAAT swabs be considered?
rectal and/or pharyngeal NAAT swabs can diagnose chlamydia in the rectum or throat
(consider if anal / oral sex has taken place)
What is done when gonorrhoea is demonstrated on a NAAT test?
endocervical charcoal swab
- this is required for MC&S
How is a high vaginal swab and vulvovaginal swab taken?
high vaginal swab:
- swab is rotated for 10-15 seconds in the posterior fornix of the vagina
vulvovaginal swab:
- swab is rotated against the vaginal walls
- patient is able to perform this themselves
How may symptomatic women with chlamydia present?
- abnormal vaginal discharge
- pelvic pain
- IMB or PCB
- dyspareunia
- dysuria
How may symptomatic men with chlamydia present?
- urethral discharge or discomfort
- dysuria
- epididymo-orchitis
- reactive arthritis
What are the typical examination findings in chlamydia?
- pelvic / abdominal tenderness
- cervical motion tenderness
- cervicitis (inflamed cervix)
- purulent discharge
How is chlamydia diagnosed?
nucleic acid amplification test (NAAT):
- vulvovaginal / endocervical swab in women
- first-catch urine sample in men
- rectal / pharyngeal swabs for anal / oral sex
What is the treatment for chlamydia?
doxycycline 100mg twice a day for 7 days
When is doxycycline contraindicated?
What are the alternatives?
contraindicated in pregnancy + breastfeeding
- azithromycin, erythromycin or amoxicillin may be used
When is a test of cure recommended for chlamydia?
- test of cure is not routinely recommended
- performed in rectal chlamydia, pregnancy or where symptoms persist
What other advice should be given to patients with a chlamydia diagnosis?
- abstain from sex for 7 days to all partners to reduce risk of re-infection
- ways to prevent future infections
- contact tracing and notification of sexual partners
What are the possible complications of chlamydia infection?
- PID
- chronic pelvic pain
- infertility
- ectopic pregnancy
- epididymo-orchitis
- conjunctivitis
- lymphogranuloma venereum
- reactive arthritis
What are the pregnancy-related complications of chlamydia infection?
- preterm delivery
- premature rupture of membranes
- low birth weight
- postpartum endometritis
- neonatal infection (conjunctivitis + pneumonia)
What is lymphogranuloma venereum (LGV)?
- affects the lymphoid tissue around the site of infection with chlamydia
- most commonly affects MSM
What are the 3 stages of LGV?
primary stage:
- painless ulcer on the penis / vaginal wall / rectum
secondary stage:
- lymphadenitis - swelling, pain + inflammation in the infected lymph nodes
- tends to affect inguinal or femoral LNs
tertiary stage:
- inflammation of the rectum and anus (proctocolitis)
- proctocolitis results in pain, change in bowel habit, tenesmus + discharge
What is the treatment for LGV?
doxycycline 100mg twice daily for 21 days
How can chlamydial conjunctivitis occur?
- when genital fluid comes into contact with the eye
- presents with chronic erythema, irritation + discharge
- lasts for more than 2 weeks
- usually unilateral
What type of organism is chlamydia?
- gram-negative bacteria
- it is an intracellular organism
- it replicates within cells before rupturing this and spreading to others
