chlamydia trachomatis

Commonest curable bacterial STI in UK

It Causes

Cervicitis
Urethritis
Proctitic
Reactive arthritis( SARA)- sexually aquired Reactive arthritis
Conjunctivitis ( most sexual)
Pharyngitis
LGV

Baby

Ophthalmia Neonatorum( ON)( vertical )
pneumnia

RF

Age 15-25 ( <25) 70%

New partner ,change within 1 year( 75% infectivity)

Screening program + for above age group

Symptoms and signs

May be asymptomatic

cervicitis	urethritis	proctitis	conjunctivitis	Athritis	ON
Muco-purulent discharge PCB, IMB Contact bleeding Motion tenderness Pelvic tenderness	dysuria	Discharge Tenesmus(Up to 77% has concurrent vaginal ,rectal ) LGV Blood stained discharge diarhrhea	Unilateral> B/L redness , discomfort, low grade irritation Pharyngitis Asymptomatic	Pain Swelling	5-12 days after( consider in all <30 days old) Pneumonia

VV swab better sensitive than endocervical

Investigations

Specimen

Specimen( self preferred)

cervicitis	urethritis	proctitis	conjunctivitis	Athritis	ON /pneumonia
VV swab- specimen( HCW or self) of choice VV better than endocervical , no need of speculum, more acceptable, more sensitive 96%, dry swabs, can be posted without loss of sensitivity Self collected2-3 cm in vagina, rotate 30 seconds Endocervical swab	First catch urine Hold urine for 1 hour ,get first 20ml Urethral swabs -2-4cm inside	Anal swabs( proctoscopy( HCW) or blind by self) No need to practice anal sex Test for LGV separately( more in HIV +,MSM( may be asymptomatic)	Conjunctival swab from everted lid Pharyngitis Pharyngeal swab( self)		Conjunctival swab/ Naso pharyngeal swab C.pneumonia and Trachomatis need two different tests Mother :test and treat> then test of cure in 3wks

Window 2 weeks

Re test if sex within 2 weeks

Tests

NAAT-very sensitive and specific
Use POC testing
Nv-CT ( new variant can have false negative)

Management

Uncomplicated – no need to remove IUCD

Cervicitis( urogenital)	urethritis	proctitis	conjunctivitis	Arthritis	ON /Pneumonia
Azithromycin 1g stat 500 2d Or Doxycycline 100mg bd 14 days (LGV 3 weeks)( better ) Cure 98%		Doxycyclin 100bd 7days Azithromycin 1g stat ( 2^nd line) LGV same Rx, 3 weeks Rx	Pharyngitis Same as urogenital		Erythromycin oral Treat for both Gonorhrhea and clamydia

Other drugs

Ofloxacin 200 bd , 400 OD 7 days , Erythomycin 500bd 14 days ,Amoxicillin ( pregnancy)

Doxyclin better than Azithromycin( for proctitis but insufficient data to recommend for cervicitis.)

Orfloxacin similar efficacy to doxy, erythromycin inferior to all

SE of drugs

All GI SE
Doxy -esophagitis, take with meals ,seated ,don’t lie down
Amoxillin -penicillin allergy
Azithro-prolong QT
Erythromycin/Azithro-liver enzyme,J

Follow up

TOC -not routine

Do In pregnancy , poor compliance ,LGV
3 weeks from finishing Rx
TOC can be false positive can be
Non cleared DNA
Too early testing

Follow up test

After 3 months

Treat partner

Avoid oral/vaginal/anal sex even with condom till treatment complete 7 days

Trace partners and treat

All For 6 months
All other symptomatic

Test for HIV, HepB, promote safe sex, vaccination, drug advice ,compliace

Advice : it can persists months

Re infection management

30% reinfect
Diagnosis
NAAT after 3 months
Treatment -should be quick, to avoid complications

Complications

PID/endometritis -16%
Perihepatitis
SF -tubal infertility ( RF-re infection,prolonged infection)
Ectopic
CPP/Adesions

NN-ON

Male -(sexually active reactive arthiritis)SARA, epididymo orchitis>> SF
- SARA usually resolves in few moths

Chlamydia in pregnancy and BF

Do NAAT

Drugs :Azithromycin , eythomycin, amoxicillin safe

Do TOC in 3 weeks( as recurrence difficult to identify)

chlamydia may increase the risk of premature delivery low birth weight increase the chance of miscarriage stillbirth.

however doxycycline and ofloxacin are contraindicated so azithromycin and erythromycin are the drugs of choice.

If a baby contracts chlamydia they may present with inflammation and discharge in their eyes, indicative of neonatal chlamydial conjunctivitis (5-12 days after birth) develop pneumonia (1-3 months after birth).

If suspected, swabs can be taken from the eyelid or nasopharynx as indicated.

Neonates are treated with oral erythromycin.