Chlamydia

Question 1

Is chlamydia reportable?

Answer 1

Yes

Question 2

What is the most frequently reported SID in the US? What age group has the highest incidence of this disease?

Answer 2

Chlamydia

< 25 years

Question 3

List the potential, serious sequelae of chlamydia.

Answer 3

• Pelvic pain
• PID
• Ectopic pregnancy
• Infertility

Question 4

What are the signs and symptoms and assessment findings of chlamydia?

Answer 4

• Mucopurulent cervicitis
• Edematous, congested, friable cervix
• Vaginal discharge
• Cervical motion tenderness (chandelier test)
• Dysuria/urethritis
• Salpingitis
• Proctitis, epididymitis
• Abnormal vaginal bleeding
• Pelvic pain, prostatitis

Question 5

Fill in the blanks:
____ percentage of _______ infected with chlamydia are asymptomatic.

Answer 5

75%
women

Question 6

Who should be screened for chlamydia?

Answer 6

Screen all:
- sexually-active women < 25 years
- pregnant women

Question 7

What test should be used to screen for chlamydia?

Answer 7

NAAT:
- most sensitive
- can use urine, vaginal, or rectal samples

Question 8

When should patients with chlamydia have a follow-up visit or be re-screened?

Answer 8

1 month follow-up with:
- pregnancy
- s/s persist
- reinfection

3 month re-screen after Rx for all patients d/t high reinfection rates

Question 9

Describe chlamydia management, including pharmaceutical treatments, non-pharmaceutical management, and differential diagnoses to rule out.

Answer 9

• Rx treatment:
  
  • Doxycycline 100 mg PO BID x 7 days
    –OR–
  • Doxycycline delayed release 200 mg PO QD x 7 days
• Alternate Rx treatment:
  
  • Levofloxacin 500 mg PO QD x 7 days
  • Azithromycin 1 g PO x 1 (if retest positive or if 7-day compliance doubtful)
• Offer HIV PrEP to:
  - Men who have sex with men
  - HIV + patients
• Refer sexual contacts in last 60 days
• Rule out:
  - HIV
  - Gonorrhea
  - Syphilis