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Flashcards in Chlamydia Deck (6):

What is 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.


What are the features of chlamydia?

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


What are the potential complications?

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


What investigations would you carry out?

- traditional cell culture is no longer widely used
- nuclear acid amplification tests (NAATs) are now rapidly emerging as the investigation of choice
- urine (first void urine sample), vulvovaginal swab or cervical swab may be tested using the NAAT technique


What is the approach to 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


What is the management of chlamydia?

- Doxycycline (7 day course) or azithromycin (single dose). The 2009 SIGN guidelines suggest azithromycin should be used first-line due to potentially poor compliance with a 7 day course of doxycycline
- If pregnant then erythromycin or amoxicillin may be used. The SIGN guidelines suggest considering azithromycin '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 symptomatic infection all partners from the four weeks prior to the onset of symptoms should be contacted
- 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)