Gynae

Question 1

What is the most prevalent STI in the UK?

Answer 1

Chlamydia (1/10 women in the UK)

Question 2

What is the pathogen causing Chlamydia?

Answer 2

Chlamydia trachomatis

Question 3

What is the incubation period for Chlamydia?

Answer 3

7-21 days

Question 4

What proportion of patients with Chlamydia are asymptomatic?

Answer 4

• 70% women
• 50% men

Question 5

What are the symptoms of Chlamydia in women?

Answer 5

• Cervicitis (yellow/ cloudy discharge, pv bleeding outside of periods)
• Dysuria

Question 6

What are the symptoms of Chlamydia in men?

Answer 6

• Urethral discharge (white, cloudy or watery)
• Dysuria

Question 7

What are the complications of Chlamydia?

Answer 7

• Epididymitis
• PID
• Endometritis
• Increased risk of ectopic pregnancy
• Infertility
• Reactive arthritis
• Perihepatitis

Question 8

What are the investigations for chlamydia in women?

Answer 8

Vulvo-vaginal or endocervcal swab

If the woman is opposed to this, a first-catch urine (FCU) sample can be collected (first 20mL urine)

Question 9

What testing is done on the chlamydia samples?

Answer 9

Nucleic acid amplification tests (NAATs)

Question 10

What are the investigations for chlamydia in men?

Answer 10

• FCU specimen of choice
• Urethral swab is an alternative

Question 11

In which patients with suspected chlamydia should rectal samples be taken?

Answer 11

• All HIV-positive men MSM
• All people with proctitis

Question 12

Why are rectal samples in suspected chlamydia patients taken?

Answer 12

To test for lymphogranuloma venereum

Question 13

What is the first line management for chlamydia?

Answer 13

Doxycycline 100mg BD for 7 days

Question 14

What is given if doxycycline is contraindicated in a chlamydia patient?

Answer 14

Azithromycin 1g orally for one day, followed by 500mg orally once daily for two days

Question 15

What should be given in patients with chlamydia if doxycycline and azithromycin are contraindicated?

Answer 15

Erythromycin 500mg BD for 10-14 days

Question 16

What’s the management for chlamydia in pregnant patients?

Answer 16

• Azithromycin 1g orally for one day then 500mg orally BD for two days

Or

• Erythromycin 500mg 4x a day for 7 days

Or

• Amoxicillin 500mg 3x a day for 7 days

Question 17

When should patients with chlamydia be urgently referred to a GUM clinic?

Answer 17

• No response to 1st line treatment
• Suspected PID

Question 18

Which chlamydia patients are offered repeat testing?

Answer 18

Anyone under the age of 25 3-6 months after completion of treatment

Question 19

When should chlamydia testing be carried out?

Answer 19

Two weeks after possible exposure

Question 20

Who is the national chlamydia screening programme open to?

Answer 20

All men and women aged 15-24

Question 21

Who should be contacted for men with chlamydia with urethral symptoms?

Answer 21

All contacts since and in the 4 weeks prior to the onset of symptoms

Question 22

Who should be contacted for women and asymptomatic men with chlamydia?

Answer 22

All partners from the last six months or the most recent sexual partner

Question 23

What should contacts of confirmed chlamydia cases be offered?

Answer 23

Treatment prior to the results of their investigation

Question 24

What is common on histology for chlamydia?

Answer 24

Inclusion bodies