Chlamydia

Question 1

Chlamydia

Features

Chlamydia is the most prevalent sexually transmitted infection in the UK and is caused by Chlamydia trachomatis, an obligate intracellular pathogen. Approximately 1 in 10 young women in the UK have Chlamydia. The incubation period is around 7-21 days, although it should be remembered a large percentage of cases are asymptomatic

Answer 1

• asymptomatic in around 70% of women and 50% of men
• women: cervicitis (discharge, bleeding), dysuria
• men: urethral discharge, dysuria

Question 2

Chlamydia

Complications/Investigations

Answer 2

Potential complications:

• epididymitis
• pelvic inflammatory disease
• endometritis
• increased incidence of ectopic pregnancies
• infertility
• reactive arthritis
• perihepatitis (Fitz-Hugh-Curtis syndrome)

Investigation:

• traditional cell culture is no longer widely used
• nuclear acid amplification tests (NAATs) are now rapidly emerging as the investigation of choice
• urine (first void urine sample), vulvovaginal swab or cervical swab may be tested using the NAAT technique

Question 3

Chlamydia

Screening

Answer 3

Screening:

• in England the National Chlamydia Screening Programme is open to all men and women aged 15-24 years
• the 2009 SIGN guidelines support this approach, suggesting screening all sexually active patients aged 15-24 years
• relies heavily on opportunistic testing

Question 4

Chlamydia

Management

Answer 4

Management:

• doxycycline (7 day course) or azithromycin (single dose). The 2009 SIGN guidelines suggest azithromycin should be used first-line due to potentially poor compliance with a 7 day course of doxycycline
• if pregnant then azithromycin, erythromycin or amoxicillin may be used. The SIGN guidelines suggest azithromycin 1g stat is the drug of choice ‘following discussion of the balance of benefits and risks with the patient’
• patients diagnosed with Chlamydia should be offered a choice of provider for initial partner notification - either trained practice nurses with support from GUM, or referral to GUM
• for men with urethral symptoms: all contacts since, and in the four weeks prior to, the onset

of symptoms:

• for women and asymptomatic men all partners from the last six months or the most recent sexual partner should be contacted
• contacts of confirmed Chlamydia cases should be offered treatment prior to the results of their investigations being known (treat then test)