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Chlamydia

Background knowledge ๐Ÿง 

Definition

  • Chlamydia is a common sexually transmitted infection (STI) caused by the bacterium Chlamydia trachomatis
  • Affects both men and women, primarily the genital tract but can also infect the rectum and eyes

Epidemiology

  • Most commonly reported STI in the UK
  • Highest prevalence among young adults aged 15-24
  • Screening programs have increased detection rates

Aetiology and Pathophysiology

  • Caused by Chlamydia trachomatis, an obligate intracellular bacterium
  • Transmitted through vaginal, anal, and oral sex
  • Infects the epithelial cells of the genital tract
  • Can lead to complications such as pelvic inflammatory disease (PID) and infertility if untreated

Clinical Features ๐ŸŒก๏ธ

Symptoms

  • Often asymptomatic, especially in women
  • Abnormal vaginal or penile discharge
  • Dysuria (painful urination)
  • Lower abdominal pain
  • Pain during intercourse (dyspareunia) in women
  • Rectal pain and discharge (if rectal infection)

Signs

  • Cervical motion tenderness
  • Pelvic tenderness
  • Conjunctivitis (if ocular infection)
  • Epididymal tenderness in men
  • Inflamed and friable cervix

Investigations ๐Ÿงช

Tests

  • Nucleic acid amplification tests (NAATs) are the gold standard
  • Urine samples or swabs from the endocervix, urethra, rectum, or pharynx
  • Screening recommended for sexually active individuals under 25
  • Consider testing for other STIs simultaneously

Management ๐Ÿฅผ

Management

  • First-line treatment: Doxycycline 100mg twice daily for 7 days
  • Alternative: Azithromycin 1g as a single dose followed by 500mg once daily for 2 days
  • Abstain from sexual activity until 7 days after treatment completion
  • Partner notification and treatment is essential
  • Follow-up testing to ensure eradication is recommended in certain cases
  • Follow UK guidelines (BASHH)

Complications

  • Pelvic Inflammatory Disease (PID) in women
  • Ectopic pregnancy and infertility in women
  • Epididymo-orchitis in men
  • Reactive arthritis
  • Neonatal conjunctivitis and pneumonia if transmitted during childbirth

Prognosis

  • Excellent prognosis with early and appropriate treatment
  • Risk of complications increases with delayed treatment
  • Regular screening and treatment of partners crucial to prevent reinfection

Key points

  • Chlamydia is often asymptomatic, especially in women
  • Screening and early treatment are essential to prevent complications
  • Partner notification and treatment are critical to control spread
  • Follow UK guidelines for management (BASHH)

References

  • BASHH guidelines on the management of Chlamydia (https://www.bashh.org/guidelines)
  • NICE guidelines on STIs (https://www.nice.org.uk/guidance/ng221)
  • Public Health England – Chlamydia statistics (https://www.gov.uk/government/collections/sexual-and-reproductive-health-and-hiv)

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