Chlamydia Flashcards
What is the difference between uncomplicated and complicated chlamydia
Uncomplicated = the infection has not ascended to the upper genital tract
Complicated = the infection has spread to the upper genital tract, causing pelvic inflammatory disease (PID) in women and epididymo-orchitis in men.
How is chlamydia Trachomatis transmitted + incubation period
Penetrative sex
Autoinoculation
Splash from genital fluids
7-21 days
Risk factors for chlamydia
<25yo
New sexual partner
>1 sexual partner in the last year
Lack of consistent barrier protection use
Symptoms of chlamydia in women
70% are asymptomatic
Increased vaginal discharge.
- Purulent
- Mucopurulent
Post-coital or intermenstrual bleeding.
Deep dyspareunia.
Dysuria.
Pelvic pain and tenderness.
Symptoms of chlamydia in men
50% are asymptomatic
Dysuria.
Mucoid or mucopurulent urethral discharge.
Urethral discomfort/urethritis.
Epididymo-orchitis.
Reactive arthritis
Differentials for chlamydia
Gonorrhoea
Bacterial vaginosis
Vaginal candidiasis
Trichomonas vaginitis
PID
UTI
What examinations would you do for suspected chlamydia
Women
Pelvic examination
Pelvic tenderness
Cervical motion tenderness.
Inflamed or friable cervix (which may bleed on contact).
Discharge seen
Men
Testicular examination
Urethral discharge
Diffuse scrotal swelling and tenderness
Hot, erythematous, swollen hemiscrotum
What investigations would you order for suspected chlamydia
Should be done two weeks after a possible exposure
Women
Bedside: Vulvo-vaginal/endocervical swab for NAAT | first catch urine for NAAT
Men
Bedside: urethral swab for NAAT | extra-genital swab for NAAT
How would you manage a patient with suspected chlamydia
- Refer to GUM clinic
- Give information and advice regarding chlamydia infection
- Doxycycline 100mg 3x daily for 7/7
- Arrange follow up to discuss adherence, symptom resolution, partner notification
If <25 → repeat testing 3-6 months after completion of treatment
What is a contraindication to doxycycline use and give an alternative
Pregnancy and breastfeeding
Azithromycin 1g orally single dose, followed by 500mg orally once daily for 2 days
What are the complications of untreated chlamydia
Women
Pelvic inflammatory disease → infertility, ectopic pregnancy, chronic pelvic pain, Fitz-Hugh-Curtis syndrome
Sexually acquired reactive arthritis (SARA)
Pregnancy - PPROM, pre-term delivery, LBW risk, neonatal infection
Conjunctivitis
Men
Epididymo-orchitis
Lymphogranuloma venerum (LGV) in MSM
Sexually acquired reactive arthritis (SARA)
Conjunctivitis
Prognosis of chlamydia
Untreated infection may persist or resolve spontaneously
Clearance increases with the duration of untreated infection, with up to 50% of infections resolving within 12 months of diagnosis.
Counsel the patient on their chlamydia diagnosis
- Transmission, treatment, possible complications, measures to reduce risk of further STIs
- Refer to resources E.g. BASHH
- Advise to inform the current partner to also be treated for chlamydia - ‘partner pack’
- Sexual intercourse (including oral sex) should be avoided until the partner has completed treatment (or waited 7 days after treatment with azithromycin)
- If they are unwilling to comply, then use condoms
- All sexual contacts in the last 60 days should be tested
- We will give you antibiotics, you need to take them 3x a day for a week
There is a chance that it could heal by itself without treatment
However, there is also a chance that it goes on to cause very serious complications
(Female)
Infection of the pelvis → tubal infertility, ectopic pregnancy, chronic pelvic pain
Issues with pregnancy in the future → pre-term delivery risk
(male)
Infection of the tubes in the scrotum
Bowel issues
Arthritis secondary to infection
