Chlamydia

Question 1

Chlamydia is an STI caused by __________

Answer 1

Chlamydia trachomatis

Question 2

What body parts can chlamydia infect

Answer 2

Endocervix
Urethra
Rectum
Occasionally pharynx and conjunctivae

Question 3

Transmission of chlamydia is by…

Answer 3

Contact with infected genital secretions
Sexual practices such as fingering which allow inoculation of infected secretions onto mucous membranes
Mother to baby at vaginal delivery

Question 4

Chlamydia is most commonly diagnosed in which groups

Answer 4

Adolescents and young sexually active adults <30yo
Sexual contacts of people with chlamydia
Multiple sexual contacts or a new sexual contact
People who have not consistently used condoms
Māori and Pacific Peoples

Question 5

Signs and symptoms of urethral chlamydia

Answer 5

~50% are asymptomatic
Dysuria
Discharge (penile urethra)

Question 6

Signs and symptoms of cervical chlamydia

Answer 6

~75% are asymptomatic
Vaginal discharge
Post coital bleeding
Intermenstrual bleeding

Question 7

Signs and symptoms of anorectal chlamydia

Answer 7

Often asymptomatic
Discharge

Question 8

Signs and symptoms of pharyngeal chlamydia

Answer 8

Usually asymptomatic

Question 9

Complications of chlamydia

Answer 9

Epididymitis or epididymo-orchitis

PID, subfertility, chronic pelvic pain, ectopic pregnancy

Reactive arthritis

Question 10

Indications for testing for chlamydia

Answer 10

Signs or symptoms of chlamydia
Sexual contacts of people with chlamydia or other STIs
Pregnancy
Before termination of pregnancy
Before IUD insertion in people at risk of STIs
Suspected epididymo-orchitis
Suspected PID
Sexually active patients <30yo opportunistically
MSM
History of sexual assault or intimate partner violence
If the patient requests a sexual health check

Question 11

If patient is asymptomatic and is concerned about a specific recent sexual event the recommended testing interval is _________ from time of last unprotected sexual intercourse

Answer 11

2 weeks

But if never tested/unlikely to return test now + in 2 weeks

Question 12

First line treatment if uncomplicated genital or pharyngeal chlamydia infection

Answer 12

Doxycycline BD for 7 days

Question 13

2nd line treatment if uncomplicated genital or pharyngeal chlamydia infection

Answer 13

Azithromycin 1 g orally, as a single dose

Question 14

When should you use 2nd line treatment for uncomplicated genital or pharyngeal chlamydia infection OR anorectal infection

Answer 14

Only if doxycycline is contraindicated, or patient is highly likely to be non-adherent

Question 15

1st line treatment for anorectal chlamydia - asymptomatic

Answer 15

Doxycycline BD 7 days

Question 16

1st line treatment for anorectal chlamydia - symptomatic

Answer 16

Seek specialist advice as further testing and extended treatment may be required

Question 17

1st line treatment for anorectal chlamydia - asymptomatic

Answer 17

Azithromycin 1 g orally, and repeat in 1 week

Question 18

Recommended treatment in pregnancy or breastfeeding

Answer 18

Azithromycin 1 g orally, as a single dose

Question 19

F/up in chlamydia positive pregnant woman

Answer 19

Test of cure recommended 4 weeks after treatment completed

Rescreen in 3rd trimester

Question 20

Treatment recommendations if co-infection with gonorrhoea

Answer 20

Ceftriaxone IM as a single dose

PLUS

Doxycycline 100 mg BD for 7 days

Question 21

Important info to tell patients regarding sex while on treatment for chlamydia

Answer 21

Abstain from sex or use condoms for 1 week from the start of treatment and until 1 week after sexual contact/s have been treated

Question 22

Consider ____________ if rectal chlamydia is diagnosed in a male or transgender person who has anal sex with men

Answer 22

HIV pre-exposure prophylaxis (PrEP)

Question 23

Any special considerations if a patient has an IUD and is chlamydia positive?

Answer 23

Leave it in place and treat as recommended

Question 24

Main side effects doxycycline

Answer 24

Nausea, vomiting, diarrhoea
Can make skin more sensitive to the sun
Dysphagia
Oesophageal irritation - take upright (and remain for 30min) with a large glass of water

Question 25

Main side effects azithromycin

Answer 25

Nausea, vomiting, diarrhoea Abdominal discomfort Dizziness Headaches

Question 26

If a person has chlamydia there is a ______% risk of transmission per act of unprotected intercourse

Answer 26

30-50%

Question 27

Contact tracing necessary?

Answer 27

Yes All sexual contacts in the last 3 months should be notified

Question 28

Is patient-delivered partner therapy legal in NZ?

Answer 28

No

Question 29

Management of contacts if last sexual contact was within the past 2 weeks, symptomatic, or unlikely to return for treatment

Answer 29

Full sexual health check and treat for chlamydia without waiting for test results

Question 30

Management of contacts if last sexual contact was > 2 weeks previously, asymptomatic and likely to return for treatment

Answer 30

Reasonable to wait for test results, and treat only if positive

Question 31

Advice for contacts of positive cases while awaiting results/undergoing treatment

Answer 31

Abstain from sex or use condoms until results are available, and for 1 week from the start of treatment

Question 32

When should f/up occur if chlamydia positive

Answer 32

1 week

Question 33

What to discuss at 1 week f/up if chlamydia positive

Answer 33

Test results Check symptoms (if any) have resolved Ask if any condomless sex in the week post-treatment Check medication was completed and tolerated Ensure notifiable contacts have been informed Check if any risk of re-infection. Retreatment is necessary if re-exposed to an untreated contact

Question 34

When is test of cure recommended with chlamydia

Answer 34

Pregnancy Rectal chlamydia

Question 35

When should test of cure be done

Answer 35

≥ 4 weeks after treatment is completed

Question 36

Recommendations for re-testing post chlamydia infection

Answer 36

Re-infection is common Retesting at 3 months is recommended, to detect re-infection

Question 37

Referral to or discussion with a sexual health specialist is recommended for...

Answer 37

Allergy or contraindication to standard treatment options Patients with anorectal symptoms that may be STI-related Complicated clinical situations for further management