Chlamydia Flashcards
Definition
STI = obligate intracellular bacterium Chlamydia trachomatis.
It has an incubation period of 7-21 days
Infection sites
Columnar epithelial-lined mucous membranes of the:
- Conjunctiva
- Pharynx
- Urethra
- Endocervix
- Rectum
Transmission
- Direct passage of infected secretions from one mucous membrane to another = sexual intercourse MC (e.g. oral, vaginal, or anal)
- Vertical transmission
Epidemiology
- < 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
Urethritis signs and symptoms
- Dysuria (without frequency)
- Mucopurulent urethral discharge
Vaginitis and cervicitis signs and symptoms
- Mucopurulent endocervical discharge
- Deep dyspareunia
- Easily induced endocervical bleeding: post-coital or intermenstrual bleeding
Proctitis signs and symptoms
- Anal discharge (infrequent)
- Anal or peri-anal discomfort
- Tender anus with tenesmus and blood discharge
Epididymo-orchitis signs and symptoms
Swollen and tender epididymis: due to transluminal spread of bacteria
Pelvic inflammatory disease (PID) signs and symptoms
Fever, abdominal, adnexal and cervical motion tenderness
Pharyngitis signs and symptoms
Usually asymptomatic
Sore throat
Chlamydial conjunctivitis signs and symptoms
Painful, red eyes, usually from autoinoculation
Atleast 70% of women 50% of men infected are asymptomatic
Diagnosis
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
Treatment
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
General treatment
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
Contact tracing and partner notification
Partner notification = extremely important
Prevention and screening
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
Complications
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
General complications
- Reactive arthritis
- Trachoma
- Lymphogranuloma venereum (LGV)
Pregnancy complications
Miscarriage,
Preterm delivery,
Congenital infections;
- There is also a risk of vertical transmission, classically causing chlamydial conjunctivitis in the newborn, as well as pneumonia
