Chlamydia are obligate intracellular organisms. As pathogens, Chlamydia trachomatis inhabits the urethra of both males and females, but can also extend further into the genito-urinary system. The serovars that cause trachoma are distinct from those that cause genito-urinary disease.
- Asymptomatic in between 50-88% of those infected
- 46% of infections clear spontaneously within a year
- Risk factors, including:
- Unprotected sexual intercourse
- Multiple partners
- "One night stand"
- Commercial sexual transaction (prostitution - either as the prostitute or as client)
- Other STDs in self or in partner. It may be advisable to ask about previous experience of GUM.
- Bisexual or homosexual orientation
- Include previous Chlamydia exposure
- Treatment history, particularly incomplete treatment
- Partner's sexual history (if known)
- Previous pelvic inflammatory disease
- External genitalia including testes in males
- Urethral swab (specialised transport medium) (Insert 1-4 cm, rotate once)
- Screen for other STDs via high vaginal swab in females
- Offer HIV screening to suitably counselled patients
- Self-applied vaginal swab by females.
In the UK recently screening programmes for asymptomatic sexually active young adults have demonstrated a lower incidence of Chlamydia than was assumed or suggested by those introducing them.
- Pelvic inflammatory disease
- Ectopic pregnancy - association inconsistent
- Tubal infertility -
- Associated in pregnancy with premature rupture membranes, low birth weight, neonatal conjunctivitis and pneumonia
- Bacterial PCR
Azithromycin 1 gram stat is the most usual treatment.
Counselling about risk
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