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DipGUM > Chlamydia > Flashcards

Chlamydia Flashcards

1
Q

What site of infection with chlamydia is best treated with doxycycline over azithromycin?

A

Rectum. Azithromycin has been shown to be less effective than doxycycline for rectal CT in MSM

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2
Q

Which emerging sexually transmitted pathogen has coinfection rates of 3%-15% with chlamydia?

A

Mycoplasma genitalium

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3
Q

Why is macrolide resistance in mycoplasma genitalium increasing in prevalence?

A

Often co-infected with chlamydia which traditionally was treated with azithromycin.

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4
Q

What is the name of the organism that causes chlamydia infection?

A

Chlamydia trachomatis

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5
Q

What type of organism is C trachomatis

A

small gram negative obligate intracellular bacterium

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6
Q

What cells of the body does Chlamydia trachomatis prefer?

A

Squamo-columnar epithelial cells

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7
Q

How many groups of different serovars (serologically variant strains) of C trachomatis are there?

A

3 groups - A, B, Ba & C; D-K; L1-L3

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8
Q

What clinical presentation/syndrome do each of the serovar groups of C trachomatis cause?

A

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)

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9
Q

Which serovar group of C trachomatis is responsible for urogenital infection?

A

Serotype D-K

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10
Q

What percentage of all chlamydia diagnoses are in adults less than 25 years old?

A

70%

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11
Q

What is the estimated prevalence rate of chlamydia infection in 15–24-year olds?

A

1.5-10% Varies dependent on study

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12
Q

What are the risk factors for chlamydia infection (4)?

A

<25 yrs old
a new sexual partner
more than one sexual partner in past year
lack of consistent condom use

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13
Q

Chlamydia infection has a high frequency of trans- mission, what is the concordance rate?

A

75%

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14
Q

What percentage of chlamydia infection will spontaneously resolve if left untreated for 12 months?

A

50%

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15
Q

What are the potential complications of chlamydia urogenital infection?

A 
pelvic inflammatory disease (PID)
endometritis
salpingitis
tubal infertility
ectopic pregnancy
sexually acquired reactive arthritis (SARA)
Perihepatitis
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16
Q

What symptoms might a woman get with chlamydia infection?

A 
Increase vaginal discharge
post coital and Intermenstrual bleeding
dysuria
lower abdominal pain
deep dyspareunia
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17
Q

What signs may be identified on examination of a woman with chlamydia infection?

A

mucopurulent cervicitis +/- contact bleeding
pelvic tenderness
cervical motion tenderness

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18
Q

What symptoms might a man get with chlamydia infection?

A

urethral discharge

dysuria

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19
Q

What signs may be identified on examination of a man with chlamydia infection?

A

urethral discharge

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20
Q

What percentage of women will have concurrent urogenital and anogenital chlamydia infection?

A

77.3%

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21
Q

What percentage of men who have sex with men have chlamydia rectal infection?

A

3%-10.5%

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22
Q

What is the usual presentation of chlamydial conjunctivitis?

A

unilateral, chronic, low grade irritation of the conjunctiva

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23
Q

What percentage of people with chlamydia infection develop sexually acquired reactive arthritis (SARA)?

A

less than 1%

24
Q

What percentage of women with untreated chlamydia will develop PID?

A

16% (from a recent analysis of all prospective stu-

dies of women with treated and untreated PID)

25
Q

What is the potential risk of developing tubal infertility after PID?

A

1% to 20%

26
Q

What is the rate of re-infection with chlamydia in young people?

A

10-30%

27
Q

What group of patients are more likely to be infected with LGV?

A

HIV positive MSM

28
Q

What percentage of people with LGV infection are asymptomatic?

A

26%

29
Q

What is the most likely presentation of LGV infection?

A

Proctitis

  • tenesmus
  • anorectal bloody discharge
  • diarrhoea or altered bowel habit
30
Q

Which test for chlamydia in women has a sensitivity of 96-98%?

A

Vulvovaginal swab for NAAT

31
Q

How long should a patient hold their urine for for first void urine to test for chlamydia infection?

A

at least 1 hour

32
Q

When should LGV testing be performed?

A

Symptoms of PROCTITIS

Routinely for HIV positive MSM with C trachomatis at any site

33
Q

What is the sensitivity of culture for diagnosing chlamydia?

A

60-80%

34
Q

What percentage does the ‘microbiological cure rate’ have to be to be considered an effective treatment for chlamydia?

A

> 95%

35
Q

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?

A

3%

36
Q

First line treatment for uncomplicated urogenital and pharyngeal chlamydia infection?

A

Doxycycline 100mg oral twice daily for 7 days or

Azithromycin 1gram oral stat (note lower dose than for GC)

37
Q

What are the alternative regimens for chlamydia infection?

A

Erythromycin 500mg oral twice daily for 10-14 days

Ofloxacin 200mg oral twice daily for 7 days

38
Q

First line treatment for rectal chlamydia infection?

A

DOXYCYCLINE 100mg twice daily 7 days or

Azithromycin 1gram oral stat AND test of cure

39
Q

What is the risk associated with using ofloxacin for chlamydia infection (2)?

A

risk of C difficile

Tendon rupture

40
Q

What is the limitation of using erythromycin for rectal chlamydia?

A

Need higher dosing ie 4 times a day and therefore risk of discontinuation of treatment due to side effects

41
Q

What are the treatment options for chlamydia infection in pregnancy?

A

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.

42
Q

When should a test of cure be performed for chlamydia infection?

A

If treated in pregnancy
If rectal infection and treated with azithromycin
If rectal infection and treated with a week of doxycycline ?LGV

43
Q

If a person is CO-INFECTED with RECTAL chlamydia and gonorrhoea what regimen should be used?

A

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)

44
Q

Chlamydia Re-infection is common. Within what timeframe dose it usually occur?

A

two to five months (of previous infection)

45
Q

When following a positive test for chlamydia is it recommend that a person <25 yrs old has their next test?

A

3 months

46
Q

What side effects or caution should be considered when prescribing azithromycin?

A

hepatotoxicity (including cholestatic jaun- dice)
rash
QT prolongation

47
Q

What specific GI side effects can doxycycline cause? And how should these be managed?

A

dysphagia
oesophageal irritation
Patients should be advised to swallow cap- sules whole with plenty of fluid during meals while sit- ting or standing

48
Q

How does neonatal chlamydia infection manifest?

A

ophthalmia neonatorum

pneumonia

49
Q

How does transmission of chlamydia to the neonate occur?

A

direct contact with the infected maternal genital tract

infection may involve the eyes, oropharynx, urogenital tract or rectum.

50
Q

When does neonatal conjunctival chlamydia present?

A

5-12 days after birth

51
Q

When does neonatal chlamydia pneumonia present?

A

1-3 months old

52
Q

Where should specimens be collected from for neonatal chlamydia pneumonia?

A

Nasopharynx

53
Q

What is the treatment for neonatal chlamydia infection?

A

Erythromycin 50mg/kg/day oral 4 divided doses for 14 days

54
Q

Who else needs assessed following neonatal chlamydia infection diagnosis?

A

Mother of neonate - test, treat and offer PN

55
Q

How long should a person abstain from sex following treatment with azithromycin for chlamydia?

A

1 week

56
Q

How far back should partner notification be considered for chlamydia infection in males with urethral symptoms?

A

all contacts since, and in the four weeks prior to, the onset of symptoms

57
Q

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?

A

all contacts in the six months prior to presentation

DipGUM (39 decks)

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