Chlamydia

Question 1

An organism that is responsible for Chlamydia

Answer 1

Chlamydia Trachomatis

• gram-negative
• intracellular bacteria

Question 2

(3) different serotypes of Chlamydia and what do they cause

Answer 2

• Serotypes A-C – cause ocular infection
• Serotypes D-K – responsible for classical genitourinary infection
• Serotypes L1-L3 – cause lymphogranuloma venereum (LGV), infection in men who have sex with men, often resulting in proctitis (inflammation of inner rectum lining)

Question 3

How does the transmission of chlamydia occur? (4)

Answer 3

• via unprotected vaginal, anal or oral sex
• penetration is not always necessary – infection can be spread via direct skin-to-skin contact of the genitals
• If infected semen/vaginal fluid enters the eye it can cause chlamydial conjunctivitis
• possible for an infected mother to pass on the infection to her baby during delivery

Question 4

Risk factors for Chlamydia infection

Answer 4

• Age <25
• Sexual partner positive for chlamydia
• Recent change in sexual partner
• Co-infection with another STI
• Non-barrier contraception or lack of consistent use of barrier contraception

Question 5

What’s the incubation period for chlamydia?

Answer 5

7-21 days → after which people may become symptomatic

Question 6

Is chlamydia symptomatic or asymptomatic?

Answer 6

50% men and 70% women are asymptomatic

Question 7

What are other than genito-urinary symptoms of chlamydia infection?

Answer 7

• chlamydial conjunctivitis → chlamydia can infect conjunctiva → eye irritation
• infection of the rectum → discomfort and discharge
• infection of the pharynx → often no symptoms

Question 8

Symptoms of chlamydial infection in women

Answer 8

• Dysuria
• Abnormal vaginal discharge
• Intermenstrual or postcoital bleeding
• Deep dyspareunia
• Lower abdominal pain

Question 9

Signs of chlamydial infection in women

Answer 9

• Cervicitis +/- contact bleeding
• Mucopurulent endocervical discharge
• Pelvic tenderness
• Cervical excitation

Question 10

Symptoms of chlamydial infection in men

Answer 10

• Urethritis
  
  • Dysuria
  • Urethral discharge
• Epididymo-orchitis
  
  • Testicular pain

Question 11

Signs of chlamydial infection in men

Answer 11

• Epididymal tenderness
• Mucopurulent discharge

Question 12

Can Chlamydia be seen via microscopy?

Answer 12

Chlamydia is too small to be seen via microscopy so a nucleic acid amplification test (NAAT) is the recommended investigation

Question 13

What specimen do we use for NAAT investigation in order to detect chlamydia (both in women and men)?

Answer 13

• Women: Vulvo-vaginal swab (first choice), endocervical swab or first catch urine sample
• Men: first catch urine sample (first choice) or urethral swab
• If indicated, swabs may also need to be taken from the rectum, eye(s) and throat.

Question 14

What to do (apart from medical Rx) if a patient is tested positive for chlamydia?

Answer 14

• contact tracing is necessary so that the patient’s current sexual partner(s) and recent partners can be tested and treated
• full STI screen due to the possibility of co-infection and the similar nature of signs and symptoms

Question 15

Usual treatment for chlamydia

Answer 15

• Doxycycline 100mg twice daily for 7 days

OR

• Azithromycin 1g single dose

Question 16

Alternative (for 1st line) medical treatment foe chlamydia

Answer 16

Alternative treatment when doxycycline and azithromycin are contraindicated:

• Erythromycin 500mg twice daily for 10- 14days
• Ofloxacin 200mg bd or 400mg od for seven days

Question 17

Advice to the patient that is treated for chlamydia

Answer 17

Patients are advised to avoid sexual intercourse and oral sex until they and/or their partner have completed treatment (or 7 days following azithromycin)

Question 18

Do we need to test for chlamydia after administration of the treatment?

Answer 18

Test of cure is not usually required unless the patient is:

• pregnant
• compliance was poor
• symptoms persist
• if aged <25, repeat testing is recommended 3 months after treatment

Question 19

Complications of infection with chlamydia in women

Answer 19

• ascending infection → salpingitis and/or endometriosis

Endometriosis →PID (PID can lead to ectopic pregnancy, perihepatitis)

• the above may result in infertility

Question 20

Complications of chlamydial infection in men

Answer 20

• epididymitis or epididymo-orchitis → testes become painful and swollen
• If left untreated can affect fertility
• sexually acquired reactive arthritis where the joints/eyes/urethra become inflamed and this is more common in men

Question 21

Does chlamydia cause complications in pregnancy?

Answer 21

Chlamydia may increase the risk of:

• premature delivery with low birth weight
• miscarriage
• stillbirth

Question 22

Treatment of chlamydia in pregnancy

Answer 22

• treated with antibiotics
• contraindications doxycycline and ofloxacin
• use instead: azithromycin and erythromycin

Question 23

Presentation of chlamydia infection in a neonate

Answer 23

• inflammation and discharge in their eyes, indicative of neonatal chlamydial conjunctivitis (5-12 days after birth)
• pneumonia (1-3 months after birth)

*swabs can be taken from the eyelid or nasopharynx as indicated*

Question 24

Treatment of neonatal chlamydial infection

Answer 24

oral erythromycin