STI's: Chlamydia

Question 1

What type of bacteria

Answer 1

Gram negative bacteria
Intracellular organism = enters and replicates within cells before rupturing the cell and spreading to others

Question 2

Epidemiology

Answer 2

MC STI in UK
- Significant cause of infertility
Young

Question 3

Risk factors

Answer 3

Sexually active with multiple partners

Question 4

Presentation

Answer 4

The majority of cases of chlamydia in women are asymptomatic. Consider chlamydia in women that are sexually active and present with:
- Abnormal vaginal discharge
- Pelvic pain
- Abnormal vaginal bleeding (intermenstrual or postcoital)
- Painful sex (dyspareunia)
- Painful urination (dysuria)
Consider chlamydia in men that are sexually active and present with:
- Urethral discharge or discomfort
- Painful urination (dysuria)
- Epididymo-orchitis
- Reactive arthritis
It is worth considering rectal chlamydia and lymphogranuloma venereum in patients presenting with anorectal symptoms, such as discomfort, discharge, bleeding and change in bowel habits.

Question 5

Examination findings

Answer 5

Examination Findings
Pelvic or abdominal tenderness
Cervical motion tenderness (cervical excitation)
Inflamed cervix (cervicitis)
Purulent discharge

Question 6

Diagnosis

Answer 6

Nucleic acid amplification tests (NAAT) are used to diagnose chlamydia. This can involve a:

Vulvovaginal swab
Endocervical swab
First-catch urine sample (in women or men)
Urethral swab in men
Rectal swab (after anal sex)
Pharyngeal swab (after oral sex)

Question 7

Management

Answer 7

FIRST LINE (uncomplicated chlamydia infection) = doxycycline 100mg twice a day for 7 days
- CI in preggos + breastfeeding
- Amoxicillin 500mg three times daily for 7 days if CI

Question 8

Other recommendations

Answer 8

Abstain from sex for 7 days of treatment
Test and treat any other sexually transmitted infections

Question 9

Complications

Answer 9

Pelvic inflammatory disease
Chronic pelvic pain
Infertility
Ectopic pregnancy
Epididymo-orchitis
Conjunctivitis
Lymphogranuloma venereum
Reactive arthritis

Question 10

Pregnancy related complications

Answer 10

Preterm delivery
Premature rupture of membranes
Low birth weight
Postpartum endometritis
Neonatal infection (conjunctivitis and pneumonia)