Chlamydia

Question 1

What bacteria is chlamydia caused by?

Answer 1

Caused by Chlamydia trachomatis which is a gram-negative bacteria.

It is an intracellular organism, meaning it enters and replicates within cells before rupturing the cell and spreading to others.

Question 2

Chlamydia is the most common sexually transmitted infection in the UK and a significant cause of infertility. true/false?

Answer 2

true

Question 3

What increases risk of chlamydia infection?

Answer 3

Being young, sexually active and having multiple partners increase the risk of catching the infection

Question 4

Large number of chlamydia infections are asymptomatic. true/false?

Answer 4

True

50% in men and 75% in woman

Asymptomatic patients can still pass on infection

Question 5

What 2 types of swabs are used in sexual health testing for chlamydia?

Answer 5

Charcoal swabs
Nucleic acid amplification test (NAAT) swabs

Question 6

What does NAAT swab do?

Answer 6

check directly for the DNA or RNA of the organism.

NAAT testing is used to test specifically for chlamydia and gonorrhoea.

They are not useful for other pelvic infections (except where specifically testing for Mycoplasma genitalium).

Question 7

Forms of NAAT swab in men and women?

Answer 7

In women, a NAAT test can be performed on a vulvovaginal swab (a self-taken lower vaginal swab), an endocervical swab or a first-catch urine sample.
The order of preference is endocervical, vulvovaginal, and then urine.

In men, a NAAT test can be performed on a first-catch urine sample or a urethral swab.

Question 8

Majority of chlamydia cases in women are symptomatic. true/false?

Answer 8

False

Majority of cases are asymptomatic

Question 9

Common symptoms of chlamydia in females?

Answer 9

Consider in women who are sexually active and present with the following:

Abnormal vaginal discharge
Pelvic pain
Abnormal vaginal bleeding (intermenstrual or postcoital)
Painful sex (dyspareunia)
Painful urination (dysuria)

Question 10

Common symptoms of chlamydia in males?

Answer 10

Consider in men who are sexually active and present with the following:

Urethral discharge or discomfort
Painful urination (dysuria)
Epididymo-orchitis
Reactive arthritis

Question 11

Examination findings for chlamydia?

Answer 11

Pelvic or abdominal tenderness
Cervical motion tenderness (cervical excitation)
Inflamed cervix (cervicitis)
Purulent discharge

Question 12

NAAT is used for chlamydia diagnosis, through which methods can this carried out?

Answer 12

Vulvovaginal swab
Endocervical swab
First-catch urine sample (in women or men)
Urethral swab in men
Rectal swab (after anal sex)
Pharyngeal swab (after oral sex)

Question 13

First line antibiotic for uncomplicated chlamydia infection?

Answer 13

doxycycline 100mg twice a day for 7 days.

Question 14

Doxycycline is fine for use in pregnant women with chlamydia. True/false?

Answer 14

False

Erythromycin, azithromycin or amoxicillin is used instead

Question 15

Factors that should be considered in the management of chlamydia?

Answer 15

Abstain from sex for seven days of treatment of all partners to reduce the risk of re-infection

Refer all patients to genitourinary medicine (GUM) for contact tracing and notification of sexual partners

Test for and treat any other sexually transmitted infections

Provide advice about ways to prevent future infection

Consider safeguarding issues and sexual abuse in children and young people

Question 16

What complications can arise from chlamydia infection?

Answer 16

Pelvic inflammatory disease
Chronic pelvic pain
Infertility
Ectopic pregnancy
Epididymo-orchitis
Conjunctivitis
Lymphogranuloma venereum
Reactive arthritis

Question 17

Pregnancy-related complications of chlamydia infection?

Answer 17

Preterm delivery
Premature rupture of membranes
Low birth weight
Postpartum endometritis
Neonatal infection (conjunctivitis and pneumonia)

Question 18

What is lymphogranuloma venereum (LGV)?

Answer 18

Lymphogranuloma venereum (LGV) is a condition affecting the lymphoid tissue around the site of infection with chlamydia.

It most commonly occurs in men who have sex with men (MSM).

Question 19

How many stages are there to LGV?

Answer 19

3 stages

Primary, secondary and tertiary

Question 20

Primary stage of LGV?

Answer 20

The primary stage involves a painless ulcer (primary lesion). This typically occurs on the penis in men, vaginal wall in women or rectum after anal sex.

Question 21

Secondary stage of LGV?

Answer 21

The secondary stage involves lymphadenitis. This is swelling, inflammation and pain in the lymph nodes infected with the bacteria. The inguinal or femoral lymph nodes may be affected.

Question 22

Tertiary stage of LGV?

Answer 22

The tertiary stage involves inflammation of the rectum (proctitis) and anus.

Proctocolitis leads to anal pain, change in bowel habit, tenesmus and discharge. Tenesmus is a feeling of needing to empty the bowels, even after completing a bowel motion.

Question 23

What is first line treatment for LGV?

Answer 23

Doxycycline 100mg twice daily for 21 days is the first-line treatment for LGV

Question 24

Discharge appearance of chlamydia?

Answer 24

White, yellow or gray discharge from the vagina that may be smelly. Pus in the urine (pyuria).

Symptoms similar to that of UTI or cervicitis