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<i>Chlamydia</i>

Chlamydia

Chlamydia is the most prevalent sexually transmitted infection in the UK and is caused by Chlamydia trachomatis, an obligate intracellular pathogen. Approximately 1 in 10 young women in the UK have Chlamydia. The incubation period is around 7-21 days, although it should be remembered a large percentage of cases are asymptomatic

Features
  • asymptomatic in around 70% of women and 50% of men
  • women: cervicitis (discharge, bleeding), dysuria
  • men: urethral discharge, dysuria

Potential complications
  • epididymitis
  • pelvic inflammatory disease
  • endometritis
  • increased incidence of ectopic pregnancies
  • infertility
  • reactive arthritis
  • perihepatitis (Fitz-Hugh-Curtis syndrome)

Investigation
  • traditional cell culture is no longer widely used
  • nuclear acid amplification tests (NAATs) are now the investigation of choice
  • urine (first void urine sample), vulvovaginal swab or cervical swab may be tested using the NAAT technique
  • for women: the vulvovaginal swab is first-line
  • for men: the urine test is first-line
  • Chlamydiatesting should be carried out two weeks after a possible exposure

Screening
  • in England the National Chlamydia Screening Programme is open to all men and women aged 15-24 years
  • the 2009 SIGN guidelines support this approach, suggesting screening all sexually active patients aged 15-24 years
  • relies heavily on opportunistic testing

Pap smear demonstrating infected endocervical cells. Red inclusion bodies are typical

Management
  • doxycycline (7 day course) is first-line
    • this is now preferred to azithromycin due to concerns about Mycoplasma genitalium. This infection is often coexistant in patients with Chlamydia and there is evidence of rising levels of macrolide resistance, hence why doxycycline is preferred
    • if doxycycline is contraindicated / not tolerated then either azithromycin (1g od for one day, then 500mg od for two days) should be used
  • if pregnant then azithromycin is first-line with erythromycin or amoxicillin as possible alternatives. The SIGN guidelines suggest azithromycin 1g stat is the drug of choice 'following discussion of the balance of benefits and risks with the patient'
  • patients diagnosed with Chlamydia should be offered a choice of provider for initial partner notification - either trained practice nurses with support from GUM, or referral to GUM
  • for men with urethral symptoms: all contacts since, and in the four weeks prior to, the onset of symptoms
  • for women and asymptomatic men all partners from the last six months or the most recent sexual partner should be contacted
  • contacts of confirmed Chlamydia cases should be offered treatment prior to the results of their investigations being known (treat then test)

Another Pap smear demonstrating infected endocervical cells. Stained with H&E
+PassMedicine Notes

Chlamydia is the most prevalent sexually transmitted infection in the UK and is caused by Chlamydia trachomatis, an obligate intracellular pathogen. Approximately 1 in 10 young women in the UK have Chlamydia. The incubation period is around 7-21 days, although it should be remembered a large percentage of cases are asymptomatic

Features
  • asymptomatic in around 70% of women and 50% of men
  • women: cervicitis (discharge, bleeding), dysuria
  • men: urethral discharge, dysuria
Potential complications
  • epididymitis
  • pelvic inflammatory disease
  • endometritis
  • increased incidence of ectopic pregnancies
  • infertility
  • reactive arthritis
  • perihepatitis (Fitz-Hugh-Curtis syndrome)
Investigation
  • traditional cell culture is no longer widely used
  • nuclear acid amplification tests (NAATs) are now the investigation of choice
  • urine (first void urine sample), vulvovaginal swab or cervical swab may be tested using the NAAT technique
  • for women: the vulvovaginal swab is first-line
  • for men: the urine test is first-line
  • Chlamydiatesting should be carried out two weeks after a possible exposure
Screening
  • in England the National Chlamydia Screening Programme is open to all men and women aged 15-24 years
  • the 2009 SIGN guidelines support this approach, suggesting screening all sexually active patients aged 15-24 years
  • relies heavily on opportunistic testing
usb004.jpg# Pap smear demonstrating infected endocervical cells. Red inclusion bodies are typical Management
  • doxycycline (7 day course) is first-line
    • this is now preferred to azithromycin due to concerns about Mycoplasma genitalium. This infection is often coexistant in patients with Chlamydia and there is evidence of rising levels of macrolide resistance, hence why doxycycline is preferred
    • if doxycycline is contraindicated / not tolerated then either azithromycin (1g od for one day, then 500mg od for two days) should be used
  • if pregnant then azithromycin is first-line with erythromycin or amoxicillin as possible alternatives. The SIGN guidelines suggest azithromycin 1g stat is the drug of choice 'following discussion of the balance of benefits and risks with the patient'
  • patients diagnosed with Chlamydia should be offered a choice of provider for initial partner notification - either trained practice nurses with support from GUM, or referral to GUM
  • for men with urethral symptoms: all contacts since, and in the four weeks prior to, the onset of symptoms
  • for women and asymptomatic men all partners from the last six months or the most recent sexual partner should be contacted
  • contacts of confirmed Chlamydia cases should be offered treatment prior to the results of their investigations being known (treat then test)
uwb005.jpg#http://en.wikipedia.org/wiki/Chlamydia infection Another Pap smear demonstrating infected endocervical cells. Stained with H&E

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