Chlamydia Flashcards
Chlamydia is an STI caused by __________
Chlamydia trachomatis
What body parts can chlamydia infect
Endocervix
Urethra
Rectum
Occasionally pharynx and conjunctivae
Transmission of chlamydia is by…
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
Chlamydia is most commonly diagnosed in which groups
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
Signs and symptoms of urethral chlamydia
~50% are asymptomatic
Dysuria
Discharge (penile urethra)
Signs and symptoms of cervical chlamydia
~75% are asymptomatic
Vaginal discharge
Post coital bleeding
Intermenstrual bleeding
Signs and symptoms of anorectal chlamydia
Often asymptomatic
Discharge
Signs and symptoms of pharyngeal chlamydia
Usually asymptomatic
Complications of chlamydia
Epididymitis or epididymo-orchitis
PID, subfertility, chronic pelvic pain, ectopic pregnancy
Reactive arthritis
Indications for testing for chlamydia
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
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
2 weeks
But if never tested/unlikely to return test now + in 2 weeks
First line treatment if uncomplicated genital or pharyngeal chlamydia infection
Doxycycline BD for 7 days
2nd line treatment if uncomplicated genital or pharyngeal chlamydia infection
Azithromycin 1 g orally, as a single dose
When should you use 2nd line treatment for uncomplicated genital or pharyngeal chlamydia infection OR anorectal infection
Only if doxycycline is contraindicated, or patient is highly likely to be non-adherent
1st line treatment for anorectal chlamydia - asymptomatic
Doxycycline BD 7 days
1st line treatment for anorectal chlamydia - symptomatic
Seek specialist advice as further testing and extended treatment may be required
1st line treatment for anorectal chlamydia - asymptomatic
Azithromycin 1 g orally, and repeat in 1 week
Recommended treatment in pregnancy or breastfeeding
Azithromycin 1 g orally, as a single dose
F/up in chlamydia positive pregnant woman
Test of cure recommended 4 weeks after treatment completed
Rescreen in 3rd trimester
Treatment recommendations if co-infection with gonorrhoea
Ceftriaxone IM as a single dose
PLUS
Doxycycline 100 mg BD for 7 days
Important info to tell patients regarding sex while on treatment for chlamydia
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
Consider ____________ if rectal chlamydia is diagnosed in a male or transgender person who has anal sex with men
HIV pre-exposure prophylaxis (PrEP)
Any special considerations if a patient has an IUD and is chlamydia positive?
Leave it in place and treat as recommended
Main side effects doxycycline
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
Main side effects azithromycin
Nausea, vomiting, diarrhoea
Abdominal discomfort
Dizziness
Headaches
If a person has chlamydia there is a ______% risk of transmission per act of unprotected intercourse
30-50%
Contact tracing necessary?
Yes
All sexual contacts in the last 3 months should be notified
Is patient-delivered partner therapy legal in NZ?
No
Management of contacts if last sexual contact was within the past 2 weeks, symptomatic, or unlikely to return for treatment
Full sexual health check and treat for chlamydia without waiting for test results
Management of contacts if last sexual contact was > 2 weeks previously, asymptomatic and likely to return for treatment
Reasonable to wait for test results, and treat only if positive
Advice for contacts of positive cases while awaiting results/undergoing treatment
Abstain from sex or use condoms until results are available, and for 1 week from the start of treatment
When should f/up occur if chlamydia positive
1 week
What to discuss at 1 week f/up if chlamydia positive
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
When is test of cure recommended with chlamydia
Pregnancy
Rectal chlamydia
When should test of cure be done
≥ 4 weeks after treatment is completed
Recommendations for re-testing post chlamydia infection
Re-infection is common
Retesting at 3 months is recommended, to detect re-infection
Referral to or discussion with a sexual health specialist is recommended for…
Allergy or contraindication to standard treatment options
Patients with anorectal symptoms that may be STI-related
Complicated clinical situations for further management
