Chlamydia trachomatis
From Ganfyd
Contents |
Introduction
Cause of sexually transmitted infection (particularly urethritis and pelvic inflammatory disease), female infertility, and also trachoma.
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.
Clinical
- Asymptomatic in between 50-88% of those infected[1]
- 46% of infections clear spontaneously within a year[1]
History
- 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
Examination
 | It is absolutely vital to have a chaperone present in all such examinations. |
- 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.
Complications
- Pelvic inflammatory disease
- Ectopic pregnancy - association inconsistent
- Tubal infertility -
- Epididymitis
- Epididymo-orchiltis
- Associated in pregnancy with premature rupture membranes, low birth weight, neonatal conjunctivitis and pneumonia
Investigations
Blood tests
- Serology
Urine
- Bacterial PCR
Cell culture
Rarely used.
Treatment
Medical
Azithromycin 1 gram stat is the most usual treatment.
Contact tracing
Counselling about risk
Prevention
Notification
External links
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