Chlamydia

Question 1

Definition

Answer 1

STI = obligate intracellular bacterium Chlamydia trachomatis.
It has an incubation period of 7-21 days

Question 2

Infection sites

Answer 2

Columnar epithelial-lined mucous membranes of the:
- Conjunctiva
- Pharynx
- Urethra
- Endocervix
- Rectum

Question 3

Transmission

Answer 3

• Direct passage of infected secretions from one mucous membrane to another = sexual intercourse MC (e.g. oral, vaginal, or anal)
• Vertical transmission

Question 4

Epidemiology

Answer 4

• < 25 years
• New/multiple sexual partners
• Unprotected sexual intercourse: vaginal, oral or anal
• Sharing unwashed sex toys
• Social deprivation
• Contact with genital fluids: infected genital fluids in the eye can cause chlamydial conjunctivitis

Question 5

Urethritis signs and symptoms

Answer 5

• Dysuria (without frequency)
• Mucopurulent urethral discharge

Question 6

Vaginitis and cervicitis signs and symptoms

Answer 6

• Mucopurulent endocervical discharge
• Deep dyspareunia
• Easily induced endocervical bleeding: post-coital or intermenstrual bleeding

Question 7

Proctitis signs and symptoms

Answer 7

• Anal discharge (infrequent)
• Anal or peri-anal discomfort
• Tender anus with tenesmus and blood discharge

Question 8

Epididymo-orchitis signs and symptoms

Answer 8

Swollen and tender epididymis: due to transluminal spread of bacteria

Question 9

Pelvic inflammatory disease (PID) signs and symptoms

Answer 9

Fever, abdominal, adnexal and cervical motion tenderness

Question 10

Pharyngitis signs and symptoms

Answer 10

Usually asymptomatic
Sore throat

Question 11

Chlamydial conjunctivitis signs and symptoms

Answer 11

Painful, red eyes, usually from autoinoculation

Question 12

Atleast 70% of women 50% of men infected are asymptomatic

Question 13

Diagnosis

Answer 13

Nucleic acid amplification (NAAT)
- FIRST LINE:
= Women: vulvovaginal or endocervical swab
= Men: urethral swab
NAAT more sensitive and specific than enzyme immunoassays (EIAs)
Testing is performed on initial presentation. If there are concerns about sexual exposure within the last two weeks, repeat NAAT required 2 weeks after exposure

Question 14

Treatment

Answer 14

FIRST LINE = Abx: 100mg oral doxycycline bd 7 days
- Oral azithromycin: 1g od for one day, followed by 500mg oral azithromycin for 2 days if FL CI
Pregnant: azithromycin, amoxicillin, or erythromycin may be used
- Azithromycin 1g stat is usually the drug of choice

Question 15

General treatment

Answer 15

Test of cure (TOC) = not routinely indicated for uncomplicated genital chlamydia infection, but may be offered to the following:
- Pregnant patients
- Where poor compliance is suspected
- When symptoms persist
Advice sexual abstinence: patients should wait one week after starting treatment before having vaginal intercourse

Question 16

Contact tracing and partner notification

Answer 16

Partner notification = extremely important

Question 17

Prevention and screening

Answer 17

Block transmission:
- Promote the use of condoms
National Chlamydia Screening Programme (NCSP):
- Aims to prevent the dissemination of chlamydia
- Offered to men and women under 25 years old who have ever been sexually active, annually, or on change of sexual partner
- NAAT is the choice of screening

Question 18

Complications

Answer 18

Males:
- Epididymo-orchitis occurs due to transluminal spread, resulting in a red, swollen and tender hemiscrotum
- Prostatitis
- Urethral stricture
Females:
- Pelvic inflammatory disease (PID): this is an infection of the uterus, fallopian tubes, ovaries and inside of the pelvis due to bacterial spread.
- Peritoneal spread

Question 19

General complications

Answer 19

• Reactive arthritis
• Trachoma
• Lymphogranuloma venereum (LGV)

Question 20

Prenancy complications

Answer 20

Miscarriage,
Preterm delivery,
Congenital infections;
- There is also a risk of vertical transmission, classically causing chlamydial conjunctivitis in the newborn, as well as pneumonia