Chlamydia Flashcards
What site of infection with chlamydia is best treated with doxycycline over azithromycin?
Rectum. Azithromycin has been shown to be less effective than doxycycline for rectal CT in MSM
Which emerging sexually transmitted pathogen has coinfection rates of 3%-15% with chlamydia?
Mycoplasma genitalium
Why is macrolide resistance in mycoplasma genitalium increasing in prevalence?
Often co-infected with chlamydia which traditionally was treated with azithromycin.
What is the name of the organism that causes chlamydia infection?
Chlamydia trachomatis
What type of organism is C trachomatis
small gram negative obligate intracellular bacterium
What cells of the body does Chlamydia trachomatis prefer?
Squamo-columnar epithelial cells
How many groups of different serovars (serologically variant strains) of C trachomatis are there?
3 groups - A, B, Ba & C; D-K; L1-L3
What clinical presentation/syndrome do each of the serovar groups of C trachomatis cause?
A-C = chronic conjunctivitis and blindness (serious eye disease endemic in Africa and Asia); D-K = genital tract infection; L1-L3 = lymphogranuloma venereum (LGV) genital ulcer disease in tropical countries)
Which serovar group of C trachomatis is responsible for urogenital infection?
Serotype D-K
What percentage of all chlamydia diagnoses are in adults less than 25 years old?
70%
What is the estimated prevalence rate of chlamydia infection in 15–24-year olds?
1.5-10% Varies dependent on study
What are the risk factors for chlamydia infection (4)?
<25 yrs old
a new sexual partner
more than one sexual partner in past year
lack of consistent condom use
Chlamydia infection has a high frequency of trans- mission, what is the concordance rate?
75%
What percentage of chlamydia infection will spontaneously resolve if left untreated for 12 months?
50%
What are the potential complications of chlamydia urogenital infection?
pelvic inflammatory disease (PID) endometritis salpingitis tubal infertility ectopic pregnancy sexually acquired reactive arthritis (SARA) Perihepatitis
What symptoms might a woman get with chlamydia infection?
Increase vaginal discharge post coital and Intermenstrual bleeding dysuria lower abdominal pain deep dyspareunia
What signs may be identified on examination of a woman with chlamydia infection?
mucopurulent cervicitis +/- contact bleeding
pelvic tenderness
cervical motion tenderness
What symptoms might a man get with chlamydia infection?
urethral discharge
dysuria
What signs may be identified on examination of a man with chlamydia infection?
urethral discharge
What percentage of women will have concurrent urogenital and anogenital chlamydia infection?
77.3%
What percentage of men who have sex with men have chlamydia rectal infection?
3%-10.5%
What is the usual presentation of chlamydial conjunctivitis?
unilateral, chronic, low grade irritation of the conjunctiva
What percentage of people with chlamydia infection develop sexually acquired reactive arthritis (SARA)?
less than 1%
What percentage of women with untreated chlamydia will develop PID?
16% (from a recent analysis of all prospective stu-
dies of women with treated and untreated PID)
What is the potential risk of developing tubal infertility after PID?
1% to 20%
What is the rate of re-infection with chlamydia in young people?
10-30%
What group of patients are more likely to be infected with LGV?
HIV positive MSM
What percentage of people with LGV infection are asymptomatic?
26%
What is the most likely presentation of LGV infection?
Proctitis
- tenesmus
- anorectal bloody discharge
- diarrhoea or altered bowel habit
Which test for chlamydia in women has a sensitivity of 96-98%?
Vulvovaginal swab for NAAT
How long should a patient hold their urine for for first void urine to test for chlamydia infection?
at least 1 hour
When should LGV testing be performed?
Symptoms of PROCTITIS
Routinely for HIV positive MSM with C trachomatis at any site
What is the sensitivity of culture for diagnosing chlamydia?
60-80%
What percentage does the ‘microbiological cure rate’ have to be to be considered an effective treatment for chlamydia?
> 95%
A meta-analysis of randomised controlled trials
comparing doxycycline with azithromycin found a small but statistically significant
increased benefit of doxycycline over azithromycin
for urogenital chlamydia. What was the percentage difference?
3%
First line treatment for uncomplicated urogenital and pharyngeal chlamydia infection?
Doxycycline 100mg oral twice daily for 7 days or
Azithromycin 1gram oral stat (note lower dose than for GC)
What are the alternative regimens for chlamydia infection?
Erythromycin 500mg oral twice daily for 10-14 days
Ofloxacin 200mg oral twice daily for 7 days
First line treatment for rectal chlamydia infection?
DOXYCYCLINE 100mg twice daily 7 days or
Azithromycin 1gram oral stat AND test of cure
What is the risk associated with using ofloxacin for chlamydia infection (2)?
risk of C difficile
Tendon rupture
What is the limitation of using erythromycin for rectal chlamydia?
Need higher dosing ie 4 times a day and therefore risk of discontinuation of treatment due to side effects
What are the treatment options for chlamydia infection in pregnancy?
AZITHROMYCIN 1 g as a single dose or
Erythromycin 500 mg four times daily for seven days or
Erythromycin 500 mg twice daily for 14 days or
Amoxicillin 500 mg three times a day for seven days.
When should a test of cure be performed for chlamydia infection?
If treated in pregnancy
If rectal infection and treated with azithromycin
If rectal infection and treated with a week of doxycycline ?LGV
If a person is CO-INFECTED with RECTAL chlamydia and gonorrhoea what regimen should be used?
Ceftriaxone 500mg IM and
azithromycin 1g oral stat and
Doxycycline 100mg oral twice daily 7 days
(NOTE*** the chlamydia guideline is older than the gonorrhoea therefore suggest Ceftriaxone dose and azithromycin incorrect)
Chlamydia Re-infection is common. Within what timeframe dose it usually occur?
two to five months (of previous infection)
When following a positive test for chlamydia is it recommend that a person <25 yrs old has their next test?
3 months
What side effects or caution should be considered when prescribing azithromycin?
hepatotoxicity (including cholestatic jaun- dice)
rash
QT prolongation
What specific GI side effects can doxycycline cause? And how should these be managed?
dysphagia
oesophageal irritation
Patients should be advised to swallow cap- sules whole with plenty of fluid during meals while sit- ting or standing
How does neonatal chlamydia infection manifest?
ophthalmia neonatorum
pneumonia
How does transmission of chlamydia to the neonate occur?
direct contact with the infected maternal genital tract
infection may involve the eyes, oropharynx, urogenital tract or rectum.
When does neonatal conjunctival chlamydia present?
5-12 days after birth
When does neonatal chlamydia pneumonia present?
1-3 months old
Where should specimens be collected from for neonatal chlamydia pneumonia?
Nasopharynx
What is the treatment for neonatal chlamydia infection?
Erythromycin 50mg/kg/day oral 4 divided doses for 14 days
Who else needs assessed following neonatal chlamydia infection diagnosis?
Mother of neonate - test, treat and offer PN
How long should a person abstain from sex following treatment with azithromycin for chlamydia?
1 week
How far back should partner notification be considered for chlamydia infection in males with urethral symptoms?
all contacts since, and in the four weeks prior to, the onset of symptoms
How far back should partner notification be considered for chlamydia infection other than males with urethral symptoms i.e. all females, asymptomatic males and males with symptoms at other sites?
all contacts in the six months prior to presentation
