Genital Tract Infection - Chlamydia

Question 1

What is Chalmydia trachomatis?

Answer 1

Gram-negative intracellular bacterium that enters and replicates within cells before rupturing the cell and spreading.

Question 2

Epidemiology of Chalmydia.

Answer 2

Commonest STI in UK.

Question 3

Risk Factors of Chlamydia.

Answer 3

1. Young and Sexually Active.

2. Multiple Sexual Partners.

Question 4

Incubation Period of Chlamydia.

Answer 4

7-21 Days.

Question 5

Clinical Features of Chlamydia.

Answer 5

1. 50% Men and 75% Women Asymptomatic (can still transmit).
2. Non-Specific Female Symptoms : Abnormal Vaginal Discharge, Pelvic Pain, Abnormal Vaginal Bleeding, Dyspareunia, Dysuria.
3. Non-Specific Male Symptoms : Urethral Discharge/Discomfort, Dysuria, Epididymo-Orchitis, Reactive Arthritis.
4. Rectal Chlamydia + Lymphogranuloma Venereum : Anorectal Symptoms e.g. Discomfort, Discharge, Bleeding, Altered Bowel Habits.

Question 6

Examination Findings of Chlmaydia (4).

Answer 6

1. Pelvic/Abdominal Tenderness.
2. Cervical Excitation (Cervical Motion Tenderness).
3. Cervicitis.
4. Purulent Discharge.

Question 7

Investigations of Chlamydia.

Answer 7

1. Examination.
2. NAAT - Investigation of Choice.
3. 1st Line : Vulvovaginal Swab (Women) and 1st Catch Urine (Men).

Question 8

What is the NCSP?

Answer 8

National Chlamydia Screening Programme - screen every sexually active person under 25 annually or when changing sexual partner.

Question 9

Fate of NCSP Positive Patients.

Answer 9

Retest after 3 months after treatment to ensure they have not contracted Chlamydia again (not to check if treatment worked).

Question 10

GUM Clinic STI Screening (4).

Answer 10

1. Chlamydia.
2. Gonorrhoea.
3. Syphilis - Blood Test.
4. HIV - Blood Test.

Question 11

Sexual Health Testing Swabs (2).

Answer 11

1. Charcoal Swabs.

2. NAAT (Nucleic Acid Amplification Test) Swabs.

Question 12

What are Charcoal Swabs? (3)

Answer 12

1. Microscopy, Culture and Sensitivity.
2. Long Cotton Bud that goes into a tube with a black transport medium (Amies Transport Medium).
3. Endocervical Swabs or High Vaginal Swabs.

Question 13

What Genital Tract issues can Charcoal Swabs detect? (5)

Answer 13

1. Bacterial Vaginosis.
2. Candidiasis.
3. Gonorrhoea (Endocervical Swab).
4. Trichomoniasis (Posterior Fornix Swab).
5. Group B Streptococcus.

Question 14

What are NAAT Swabs?

Answer 14

1. DNA/RNA of Organism.
2. Endocervical Swab, Vulvovaginal (Low Vaginal Swab), 1st Catch Urine/Urethral Swab (Men) - in order of preference.
3. Rectal and Pharyngeal NAAT Swabs if Anal/OOral Sex.

Question 15

What Genital Tract issues can NAAT Swabs detect?

Answer 15

1. Chlamydia.
2. Gonorrhoea.
3. Mycoplasma Genitalium.

Question 16

Management of Chlamydia.

Answer 16

1. BASHH (British Association for Sexual Health and HIV Guidelines.
2. Local and National Guidelines.
3. 1st Line - Uncomplicated = Doxycycline 100mg BD 7 Days.

Question 17

Important Consideration of Azithromycin.

Answer 17

1. Previous Alternative.

2. No Longer Used - Resistance from Mycoplasma genitalium and less effective for Rectal Infection.

Question 18

Contraindications of Doxycycline.

Answer 18

1. Breastfeeding.

2. Pregnancy.

Question 19

Alternatives for Contraindicated Cases (4).

Answer 19

1. Azithromycin 1g STAT and 500mg OD for 2 Days.
2. Erythromycin 500mg QDS 7 Days.
3. Erythromycin 500mg BD for 14 Days.
4. Amoxicillin 500mg TDS for 7 Days.

Question 20

Test of Cure (2).

Answer 20

1. Not Routinely Recommended.

2. Indications : Rectal Cases, Pregnancy, Persisting Symptoms.

Question 21

Lifestyle Advice for Patients with Chlamydia.

Answer 21

1. Abstinence for 7 Days to reduce risk of re-infection.
2. GUM - Contact Tracing and Notification.
3. Test and Treat for Other STIs.
4. Safeguarding and Sexual Abuse.

Question 22

Contact Tracing of Chlamydia.

Answer 22

1. Asymptomatic Men : All Contacts in 4 Weeks Prior to Onset.
2. Women and Symptomatic Men : All Contacts in 6 Months or Most Recent Sexual Partner.
3. Offer Treatment Prior to Testing in Contacts.

Question 23

Complications of Chlamydia (8).

Answer 23

1. Pelvic Inflammatory Disease.
2. Chronic Pelvic Pain.
3. Infertility.
4. Epididymo-Orchitis.
5. Conjunctivitis.
6. Lymphogranuloma Venereum.
7. Reactive Arthritis.
8. Perihepatitis (Fitz-Hugh-Curtis Syndrome).

Question 24

Pregnancy-Related Complications of Chlamydia (6).

Answer 24

1. Preterm Delivery.
2. Ectopic Pregnancy.
3. Premature Rupture of Membranes.
4. Low Birth Weight.
5. Postpartum Endometritis.
6. Neonatal Infection e.g. Conjunctivitis and Pneumonia.

Question 25

What is Lymphogranuloma Venereum?

Answer 25

Condition affecting the lymphoid tissue around site of infection with Chlamydia.

Question 26

Risk Factors of Lymphogranuloma Venereum (2).

Answer 26

1. MSM.

2. HIV.

Question 27

Stages of Lymphogranuloma Venereum (3).

Answer 27

1. Primary Stage : Painless Ulcer - Primary Lesion on Penis, Vaginal Wall, Rectum (Anal Sex).
2. Secondary Stage : Lymphadenitis - Swelling, Inflammation and Pain in Lymph Nodes e.g. Femoral, Inguinal.
3. Tertiary Stage : Proctitis and Anas Inflammation.

Question 28

Clinical Features of Proctocolitis.

Answer 28

1. Anal Pain.
2. Altered Bowel Habit.
3. Tenesmus.
4. Discharge.

Question 29

Management of Lymphogranuloma Venereum (2).

Answer 29

1. Doxycycline 100mg BD for 21 Days.

2. Alternative : Erythromycin, Azithromycin, Ofloxacin.

Question 30

What is Groove Sign?

Answer 30

Swelling of the Inguinal Ligament leading to noticeable grooves above and below : secondary stage of Lymphogranuloma Venereum.

Question 31

Aetiology of Chlamydial Conjunctivitis.

Answer 31

Conjunctival infection as a result of genital fluid coming into contact with eye.

Question 32

Clinical Features of Chlamydial Conjunctivitis.

Answer 32

UNILATERAL :

1. Chronic Erythema.
2. Irritation.
3. Discharge for 2+ weeks.