Chlamydia

Question 1

Chlamydia is the most common STI in the UK. It is caused by Chlamydia trachomatis, a gram negative bacteria that infect columnar and transitional mucosal cells. What of the following is least likely to be infected by Chlamydia trachomatis?

1 - urethra
2 - endocervix
3 - fallopian tubes
4 - rectum
5 - pharynx
6 - conjunctiva

Answer 1

3 - fallopian tubes

Question 2

Chlamydia is the most common STI in the UK. It is caused by Chlamydia trachomatis, a gram negative bacteria that infect columnar and transitional mucosal cells. Which age group are more at risk of infection?

1 - 15-24
2 - 24-35
3 - 35-50
4 - >50

Answer 2

1 - 15-24
- most sexually active

Question 3

Chlamydia trachomatis can be classed based on its serotypes based on the type of surface antigens. Which of the following serotypes is Chlamydia trachomatis that causes genital infections?

1 - A - C
2 - D - K
3 - L1 - L3
4 - all of the above

Answer 3

2 - D - K

A - C = conjunctiva
L1-L3 = lymph nodes

Question 4

Chlamydia trachomatis serotype D-K causes genital infections. Do infected patients always present with symptoms?

Answer 4

• no

Question 5

Chlamydia trachomatis serotype D-K causes genital infections. Which 2 of the following do males typically present with?

1 - dysuria
2 - urethral bleeding
3 - post-coital bleeding
4 - urethral discharge

Answer 5

1 - dysuria
4 - urethral discharge

• typically infects the urethra mucosa called urethritis
• can also cause prostate inflammation called prostatitis

Question 6

Chlamydia trachomatis serotype D-K causes genital infections. Which of the following do females typically present with?

1 - dysuria (urethritis)
2 - urethral bleeding
3 - intermenstrual and/or post-coital bleeding
4 - purulent urethral/cervical discharge
5 - pruritis (itching)
6 - all of the above

Answer 6

5 - all of the above
- can also spread through internal sex organs and cause PID

Question 7

In addition to the typical signs of dysuria and urethral discharge, which of the following can be caused by Chlamydia?

1 - cryptorchidism
2 - epididymo-orchitis
3 - testicular torsion
4 - testicular abscess

Answer 7

2 - epididymo-orchitis
- inflamed testicles

• can also be caused by Gonorrhoea (rare)
  and urinary bacteria such as E. Coli

Question 8

Males present with which of the following that is also extra genital when infected with Chlamydia?

1 - rheumatoid arthritis
2 - osteoarthritis
3 - gout
4 - reactive arthritis

Answer 8

4 - reactive arthritis
- caused by infection in another part of the body
- associated with HLA-B27
- remember cant PEE, SEE or CLIMB A TREE

Question 9

In addition to causing genital infections, which of the following extra-genitals is NOT typically affected by chlamydia trachomatis serotype D-K?

1 - Rectal infection (anal discharge and anorectal discomfort may occur)
2 - Pancreatitis causing elevated amylase
3 - Pharyngeal infection usually asymptomatic
4 - Conjunctival infection causing uni or bilateral low grade irritation

Answer 9

2 - Pancreatitis causing elevated amylase

Question 10

Potentially the most virulent serotypes of chlamydia trachomatis is L1-L3. These can cause which of the following?

1 - conjunctivitis
2 - rectal cancers
3 - lymphogranuloma venereum
4 - all of the above

Answer 10

3 - lymphogranuloma venereum

• infection caused by C. trachomatis that specifically targets the lymph nodes

Question 11

Potentially the most virulent serotypes of chlamydia trachomatis is L1-L3, which can cause lymphogranuloma venereum (LGV). LGV can then lead to which of the following?

1 - proctitis (rectal inflammation)
2 - conjunctivitis
3 - hepatitis
4 - lymphoma

Answer 11

1 - proctitis (rectal inflammation)

Symptoms include:
- Tenesmus (urge to pass stool but cannot go)
- Anorectal discharge (often bloody)
- Anorectal discomfort
- Diarrhoea or altered bowel habit

Question 12

Proctitis is a common problem in men who have sex with other men. It can be caused by a wide variety of things. Which of the following is NOT typically a cause?

1 - Lymphogranuloma Venereum (Chlamydia L1-L3)
2 - Gonorrhoea
3 - Escherichia coli
4 - Chlamydia (D-K type)
5 - Herpes Simplex
6 - Syphilis
7 - Non STIs (eg inflammtory bowel disease)

Answer 12

3 - Escherichia coli

Question 13

Which of the following is the gold standard for diagnosing chlamydia?

1- nucleic acid amplification tests (NAATs)
2 - urinalysis
3 - gram positive staining
4 - serology

Answer 13

1- nucleic acid amplification tests (NAATs)
- PCR to detect chlamydia DNA from genital swab
- currently the most sensitive and specific method of testing for chlamydia

Question 14

Nucleic acid amplification tests (NAATs) is the 1st line test for diagnosing chlamydia and gonorrhoea. What is the best sample to take from a women using NAATs?

1 - cervical swab
2 - vulvoginal swab
3 - first void urine
4 - hysteroscopy biopsy

Answer 14

2 - vulvoginal swab

• rectal swab can also be taken if women reports unprotected anal sex
• endocervical swap and urine are less sensitive

Question 15

Nucleic acid amplification tests (NAATs) is the 1st line test for diagnosing chlamydia and gonorrhoea. What is the best sample to take from a man using NAATs?

1 - cervical swab
2 - vaginal swab
3 - first void urine
4 - hysteroscopy biopsy

Answer 15

3 - first void urine

• rectal swab can also be taken if man reports unprotected anal sex

Question 16

When managing a patient who has been diagnosed with chlamydia, which of the following must be implemented:

1 - Partner Notification & Treatment
2 - Education, health promotion
3 - Abstinence – 7 days AND until partner treated
4 - Antibiotic treatment
5 - Condoms
6 - Prevention and risk reduction
7 - all of the above

Answer 16

7 - all of the above

• this is all standard practice in a GUM clinic

Question 17

What is the 1st line medication when treating a patient with a confirmed diagnosis of chlamydia?

1 - cephalexin 100mg
2 - metronidazole 100mg
3 - doxycycline 100mg
4 - benzathine penicillin 100mg

Answer 17

3 - doxycycline 100mg
- duration depends on type of chlamydia