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GPEP Sexual Health > Chlamydia > Flashcards

Chlamydia Flashcards

1
Q

Chlamydia is an STI caused by __________

A

Chlamydia trachomatis

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2
Q

What body parts can chlamydia infect

A

Endocervix
Urethra
Rectum
Occasionally pharynx and conjunctivae

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3
Q

Transmission of chlamydia is by…

A

Contact with infected genital secretions
Sexual practices such as fingering which allow inoculation of infected secretions onto mucous membranes
Mother to baby at vaginal delivery

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4
Q

Chlamydia is most commonly diagnosed in which groups

A

Adolescents and young sexually active adults <30yo
Sexual contacts of people with chlamydia
Multiple sexual contacts or a new sexual contact
People who have not consistently used condoms
Māori and Pacific Peoples

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5
Q

Signs and symptoms of urethral chlamydia

A

~50% are asymptomatic
Dysuria
Discharge (penile urethra)

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6
Q

Signs and symptoms of cervical chlamydia

A

~75% are asymptomatic
Vaginal discharge
Post coital bleeding
Intermenstrual bleeding

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7
Q

Signs and symptoms of anorectal chlamydia

A

Often asymptomatic
Discharge

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8
Q

Signs and symptoms of pharyngeal chlamydia

A

Usually asymptomatic

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9
Q

Complications of chlamydia

A

Epididymitis or epididymo-orchitis

PID, subfertility, chronic pelvic pain, ectopic pregnancy

Reactive arthritis

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10
Q

Indications for testing for chlamydia

A

Signs or symptoms of chlamydia
Sexual contacts of people with chlamydia or other STIs
Pregnancy
Before termination of pregnancy
Before IUD insertion in people at risk of STIs
Suspected epididymo-orchitis
Suspected PID
Sexually active patients <30yo opportunistically
MSM
History of sexual assault or intimate partner violence
If the patient requests a sexual health check

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11
Q

If patient is asymptomatic and is concerned about a specific recent sexual event the recommended testing interval is _________ from time of last unprotected sexual intercourse

A

2 weeks

But if never tested/unlikely to return test now + in 2 weeks

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12
Q

First line treatment if uncomplicated genital or pharyngeal chlamydia infection

A

Doxycycline BD for 7 days

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13
Q

2nd line treatment if uncomplicated genital or pharyngeal chlamydia infection

A

Azithromycin 1 g orally, as a single dose

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14
Q

When should you use 2nd line treatment for uncomplicated genital or pharyngeal chlamydia infection OR anorectal infection

A

Only if doxycycline is contraindicated, or patient is highly likely to be non-adherent

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15
Q

1st line treatment for anorectal chlamydia - asymptomatic

A

Doxycycline BD 7 days

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16
Q

1st line treatment for anorectal chlamydia - symptomatic

A

Seek specialist advice as further testing and extended treatment may be required

17
Q

1st line treatment for anorectal chlamydia - asymptomatic

A

Azithromycin 1 g orally, and repeat in 1 week

18
Q

Recommended treatment in pregnancy or breastfeeding

A

Azithromycin 1 g orally, as a single dose

19
Q

F/up in chlamydia positive pregnant woman

A

Test of cure recommended 4 weeks after treatment completed

Rescreen in 3rd trimester

20
Q

Treatment recommendations if co-infection with gonorrhoea

A

Ceftriaxone IM as a single dose

PLUS

Doxycycline 100 mg BD for 7 days

21
Q

Important info to tell patients regarding sex while on treatment for chlamydia

A

Abstain from sex or use condoms for 1 week from the start of treatment and until 1 week after sexual contact/s have been treated

22
Q

Consider ____________ if rectal chlamydia is diagnosed in a male or transgender person who has anal sex with men

A

HIV pre-exposure prophylaxis (PrEP)

23
Q

Any special considerations if a patient has an IUD and is chlamydia positive?

A

Leave it in place and treat as recommended

24
Q

Main side effects doxycycline

A

Nausea, vomiting, diarrhoea
Can make skin more sensitive to the sun
Dysphagia
Oesophageal irritation - take upright (and remain for 30min) with a large glass of water

25
Q

Main side effects azithromycin

A

Nausea, vomiting, diarrhoea
Abdominal discomfort
Dizziness
Headaches

26
Q

If a person has chlamydia there is a ______% risk of transmission per act of unprotected intercourse

A

30-50%

27
Q

Contact tracing necessary?

A

Yes
All sexual contacts in the last 3 months should be notified

28
Q

Is patient-delivered partner therapy legal in NZ?

A

No

29
Q

Management of contacts if last sexual contact was within the past 2 weeks, symptomatic, or unlikely to return for treatment

A

Full sexual health check and treat for chlamydia without waiting for test results

30
Q

Management of contacts if last sexual contact was > 2 weeks previously, asymptomatic and likely to return for treatment

A

Reasonable to wait for test results, and treat only if positive

31
Q

Advice for contacts of positive cases while awaiting results/undergoing treatment

A

Abstain from sex or use condoms until results are available, and for 1 week from the start of treatment

32
Q

When should f/up occur if chlamydia positive

A

1 week

33
Q

What to discuss at 1 week f/up if chlamydia positive

A

Test results
Check symptoms (if any) have resolved
Ask if any condomless sex in the week post-treatment
Check medication was completed and tolerated
Ensure notifiable contacts have been informed
Check if any risk of re-infection. Retreatment is necessary if re-exposed to an untreated contact

34
Q

When is test of cure recommended with chlamydia

A

Pregnancy
Rectal chlamydia

35
Q

When should test of cure be done

A

≥ 4 weeks after treatment is completed

36
Q

Recommendations for re-testing post chlamydia infection

A

Re-infection is common
Retesting at 3 months is recommended, to detect re-infection

37
Q

Referral to or discussion with a sexual health specialist is recommended for…

A

Allergy or contraindication to standard treatment options
Patients with anorectal symptoms that may be STI-related
Complicated clinical situations for further management

GPEP Sexual Health (8 decks)

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