Sexually Transmitted DIseases - Chlamydia

Question 1

Pathology : Chlamydia trachomatis (2).

Answer 1

1. Gram-Negative Bacterium.
2. Intracellular Organism - enters and replicates within cells before rupturing the cell and spreading to others.

Question 2

Prevention : NCSP (3).

Answer 2

1. National Chlamydia Screening Programme.
2. Screen every sexually active person below 25 years of age annually or when they have a change in sexual partner.
3. Positive - Retest 3 months after treatment (to check if contracted Chlamydia again).

Question 3

STI Screening Baseline (4).

Answer 3

1. Chlamydia.
2. Gonorrhoea.
3. Syphilis (Blood Test).
4. HIV (Blood Test).

Question 4

Swabs in STI Screening (2).

Answer 4

1. Charcoal (Amies - Black Transport Medium) - Endocervical and High Vaginal Swabs - MC&S : Bacterial Vaginosis, Candidiasis, Gonorrhoea (Endocervical), Trichomonas Vaginalis (Posterior Fornix), GBS.
2. NAAT Swabs (Nucleic Acid Amplification Test) - Women : Endocervical > Vulvovaginal > 1st Catch Urine Sample (preference) or Men : 1st Catch Urine Sample/Urethral Swab :-DNA/RNA of Organism : Chlamydia, Gonorrhoea, Mycoplasma genitalium. Rectal/Pharyngeal (available for Chlamydia if Anal/Oral Sex).

Question 5

Clinical Presentation of Chlamydia (4).

Answer 5

1. Asymptomatic (majority).
2. Women : Abnormal Discharge, Pelvic Pain, Abnormal PV Bleeding, Dysparenuia, Dysuria.
3. Men : Urethral Discharge/Discomfort, Dysuria, Epididymo-orchitis, Reactive Arthritis.
4. Anorectal Symptoms - Rectal Chlamydia, Lymphogranuloma venereum.

Question 6

Examination Findings of Chlamydia (4).

Answer 6

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

Question 7

Medical Management of Chlamydia (4).

Answer 7

1. 1st Line - Uncomplicated : Doxycycline 100mg BD for 7 Days.
2. 2nd Line no longer Azithromycin (due to resistance from M. genitalium).
3. Doxycycline is contraindicated in breastfeeding and pregnancy (Azithromycin, Erythromycin, Amoxicillin).
4. No Test of cure (unless rectal case, pregnancy, or persistent symptoms).

Question 8

Supplementary Management of Chlamydia (5).

Answer 8

1. Sexual Abstinence for 7 Days.
2. Refer to GUM for Contact Tracing and Notification of Partners.
3. Test and Treat STIs.
4. Advice.
5. Safeguarding and Sexual Abuse.

Question 9

What is Lymphogranuloma Venereum (LGV)? (5)

Answer 9

1. Primary Stage - Painless Ulcer (Primary Lesion) : Penis in Men or Vaginal Wall/Rectum (Anal) in Women.
2. Secondary Stage - Lymphadenitis (Swelling, Inflammation and Pain in Lymph Nodes) e.g. Femoral, Inguinal.
3. Tertiary Stage - Proctitis, Proctocolitis (Change in Bowel Habit, Anal Pain, Tenesmus, Discharge).
4. Commonest : MSMs.
5. Management : Doxycycline 100mg BD for 21 Days (Erythromycin, Azithromycin, Ofloxacin).

Question 10

What is Chlamydial Conjunctivitis? (5)

Answer 10

1. Conjunctival infection as a result of sexual activity - genital fluid contact with eye.
2. Chronic erythema, irritation and discharge for 2+ weeks.
3. Unilateral.
4. Can affect neonates with mothers infected with Chlamydia.
5. Differential : Gonococcal Conjunctivitis.