Chlamydia

Question 1

Is chlamydia nationally notifiable?

Answer 1

Yes - routine, labs only

Question 2

Which organism causes chlamydia?

Answer 2

Chlamydia trachomatis
(bacterium)

Serovars D-K: genitourinary disease
A-C: trachoma
L1-3: lymphogranuloma venerum

Question 3

How is chlamydia transmitted?

Answer 3

Sexual (contact with exudate from mucous membranes)
Perinatal

Question 4

What are the clinical features of chlamydia?

Answer 4

Mostly ASx

Women: mucopurulent cervicitis (vaginal D/C, dysuria, post-coital / inter-menstrual bleeding)

Men: urethritis (D/C, dysuria), epididymo-orchitis

Proctitis and throat infection can also occur.

Congenital: conjunctivitis / PNA

Question 5

What are the complications of chlamhydia?

Answer 5

• Pelvic inflammatory disease (chronic pelvic pain, infertility, ectopic pregnancy)
• PPROM / miscarriage
• Reactive arthritis
• Increased risk HIV transmission

Question 6

Which groups are at high risk of acquiring chlamydia?

Answer 6

Young (15 - 29yo)
MSM
Indigenous
Sex workers
PLHIV
Multiple sexual partners

Question 7

What are the case definitions of chlamydia?

Answer 7

Confirmed - isolation, detection (NAT), antigen detection

Question 8

How is chlamydia diagnosed?

Answer 8

PCR - 1st pass urine; vaginal, endocervical, anorectal, pharyngeal swab

Vaginal and anorectal swabs can be self-collected

Question 9

What is the incubation period of chlamydia?

Answer 9

7-14 days

Question 10

What is the infectious period of chlamydia?

Answer 10

Unclear
Infected individuals likely to be infectious for several months (maybe intermittently) if untreated

Question 11

T/F: chlamydia is the most commonly reported STI in Australia?

Answer 11

True

Question 12

Why are reinfections with chlamydia common?

Answer 12

No lasting immunity

Question 13

How do the rates of chlamydia compare between Indigenous and non-Indigenous people?

Answer 13

5 X rate in Indigenous

Question 14

Which other groups have high rates of chlamydia?

Answer 14

MSM

Question 15

Why is chlamydia a significant public health problem?

Answer 15

Most infections undiagnosed, untreated leading to ongoing transmission and long-term health problems e.g. PID, infertility (female, rarely male).

Question 16

How is chlamydia prevented?

Answer 16

Safe sex - condoms / dental dams with all sexual partners and for oral sex.

STI checks - regular for all sexually active people; at least annually and more frequently if multiple sexual partners; 3/12 for MSM.

If Sx, avoid sexual contact and get tested

Question 17

What resources are available for management of chlamydia?

Answer 17

Australian STI management guidelines
Vic DH protocol

Question 18

How are cases of chlamydia managed?

Answer 18

T - clinician - doxy 7/7 or stat azithro; test for other STIs
I - abstain from sex 7/7 after Rx start; no sex with partners from last 6/12 until tested/treated
E - education re: transmission, sx, prevention

Usually no PH involvement

Question 19

What is the contact definition for chlamydia?

Answer 19

Sexual contacts for up to 6mo (depends on Sx)

Question 20

Who conducts contact tracing?

Answer 20

Case and/or treating clinician.

Support from PHU if requirement.

Question 21

Where can guidance on contact tracing be found?

Answer 21

ASHM guidelines.

Question 22

What confidential resources are available for contact tracing?

Answer 22

Partner notification websites e.g. Let Them Know

Question 23

How are contacts of chlamydia managed?

Answer 23

T - counselling, testing, treament (if needed).
I - N/A
E - education re: safe sex

Question 24

When might public health be involved in the investigation of chlamydia notification(s)?

Answer 24

Cases clustering around sex industry workplace or cases in minors (< 16yo)

Question 25

How should cases associated with sex premised be investigated?

Answer 25

* Facilitate education * Investigate compliance with PH provisions * Initiate steps to prevent/limit transmission

Question 26

How should cases in minors (< 16yo) be managed?

Answer 26

Mandatory reporting and obligations under legislation. Age 12-15yo - risk assessment and report if needed < 12yo - must report