An organism that is responsible for Chlamydia
Chlamydia Trachomatis
- gram-negative
- intracellular bacteria
(3) different serotypes of Chlamydia and what do they cause
- Serotypes A-C – cause ocular infection
- Serotypes D-K – responsible for classical genitourinary infection
- Serotypes L1-L3 – cause lymphogranuloma venereum (LGV), infection in men who have sex with men, often resulting in proctitis (inflammation of inner rectum lining)
How does the transmission of chlamydia occur? (4)
- via unprotected vaginal, anal or oral sex
- penetration is not always necessary – infection can be spread via direct skin-to-skin contact of the genitals
- If infected semen/vaginal fluid enters the eye it can cause chlamydial conjunctivitis
- possible for an infected mother to pass on the infection to her baby during delivery
Risk factors for Chlamydia infection
- Age <25
- Sexual partner positive for chlamydia
- Recent change in sexual partner
- Co-infection with another STI
- Non-barrier contraception or lack of consistent use of barrier contraception
What’s the incubation period for chlamydia?
7-21 days → after which people may become symptomatic
Is chlamydia symptomatic or asymptomatic?
50% men and 70% women are asymptomatic
What are other than genito-urinary symptoms of chlamydia infection?
- chlamydial conjunctivitis → chlamydia can infect conjunctiva → eye irritation
- infection of the rectum → discomfort and discharge
- infection of the pharynx → often no symptoms
Symptoms of chlamydial infection in women
- Dysuria
- Abnormal vaginal discharge
- Intermenstrual or postcoital bleeding
- Deep dyspareunia
- Lower abdominal pain
Signs of chlamydial infection in women
- Cervicitis +/- contact bleeding
- Mucopurulent endocervical discharge
- Pelvic tenderness
- Cervical excitation
Symptoms of chlamydial infection in men
- Urethritis
- Dysuria
- Urethral discharge
- Epididymo-orchitis
- Testicular pain
Signs of chlamydial infection in men
- Epididymal tenderness
- Mucopurulent discharge
Can Chlamydia be seen via microscopy?
Chlamydia is too small to be seen via microscopy so a nucleic acid amplification test (NAAT) is the recommended investigation
What specimen do we use for NAAT investigation in order to detect chlamydia (both in women and men)?
- Women: Vulvo-vaginal swab (first choice), endocervical swab or first catch urine sample
- Men: first catch urine sample (first choice) or urethral swab
- If indicated, swabs may also need to be taken from the rectum, eye(s) and throat.
What to do (apart from medical Rx) if a patient is tested positive for chlamydia?
- contact tracing is necessary so that the patient’s current sexual partner(s) and recent partners can be tested and treated
- full STI screen due to the possibility of co-infection and the similar nature of signs and symptoms
Usual treatment for chlamydia
- Doxycycline 100mg twice daily for 7 days
OR
- Azithromycin 1g single dose
Alternative (for 1st line) medical treatment foe chlamydia
Alternative treatment when doxycycline and azithromycin are contraindicated:
- Erythromycin 500mg twice daily for 10- 14days
- Ofloxacin 200mg bd or 400mg od for seven days
Advice to the patient that is treated for chlamydia
Patients are advised to avoid sexual intercourse and oral sex until they and/or their partner have completed treatment (or 7 days following azithromycin)
Do we need to test for chlamydia after administration of the treatment?
Test of cure is not usually required unless the patient is:
- pregnant
- compliance was poor
- symptoms persist
- if aged <25, repeat testing is recommended 3 months after treatment
Complications of infection with chlamydia in women
- ascending infection → salpingitis and/or endometriosis
Endometriosis →PID (PID can lead to ectopic pregnancy, perihepatitis)
- the above may result in infertility
Complications of chlamydial infection in men
- epididymitis or epididymo-orchitis → testes become painful and swollen
- If left untreated can affect fertility
- sexually acquired reactive arthritis where the joints/eyes/urethra become inflamed and this is more common in men
Does chlamydia cause complications in pregnancy?
Chlamydia may increase the risk of:
- premature delivery with low birth weight
- miscarriage
- stillbirth
Treatment of chlamydia in pregnancy
- treated with antibiotics
- contraindications doxycycline and ofloxacin
- use instead: azithromycin and erythromycin
Presentation of chlamydia infection in a neonate
- inflammation and discharge in their eyes, indicative of neonatal chlamydial conjunctivitis (5-12 days after birth)
- pneumonia (1-3 months after birth)
*swabs can be taken from the eyelid or nasopharynx as indicated*
Treatment of neonatal chlamydial infection
oral erythromycin
