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Chlamydia

Medicine > Infection

Background knowledge 🧠

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 🌡️

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 🧪

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 🥼

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.
  • Chlamydia can lead to complications such as PID, infertility and reactive arthritis. 
  • 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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Infection