Chlamydia

Microbiology

Chlamydiae are obligate intracellular bacteria.  Chlamydia trachomatis is the organism that causes the STI but also causes a conjunctivitis.  There are many serotypes:

• A, B and C are usually the cause of ‘tropical’ eye infection- Trachoma
• D-K are the cause of genital infection
• There are also rarer serotypes (L1, L2 and L3) that cause an infection of the lymph nodes- lymphogranuloma venereum

Signs/symptoms

• Females
  • 70% will be asymptomatic
  • Persistent discharge (due to a chlamydial vaginitis/cervicitis)
  • Intermenstrual bleeding
  • Pelvic inflammatory disease (Pelvic pain)
• Males
  • 50% will be asymptomatic
  • Dysuria (due to a urethritis)
  • Clear discharge

Diagnosis/Investigations

• Females
  • Endocervical swab (best)
  • Self taken vulvovaginal swab
• Males
  • First pass urine culture
• Rectal swab if appropriate

PCR for gonococcus and chlamydia trachomatis.  Very accurate test.

Complications

• Females
  • Pelvic inflammatory disease
    • Salpingitis
  • Increased risk of ectopic pregnancy and infertility
  • Eye infections (adults and neonates)
• Males
  • Epididymo-orchitis
  • Reiter’s syndrome (urethritis, conjunctivitis and arthritis)
  • Lymphogranuloma venereum (particularly among gay men)

Management

• Uncomplicated (not PID/reiter’s etc)
  • Azithromycin(single oral dose) OR
  • Doxycycline (PO for 7 days)
• If complicated
  • Doxycycline and metronidazole (PO for 14 days) (PID)
  • Doxycycline (PO 10-14 days) (epididymo-orchitis)
  • Doxycyline (PO 21 days) (LGV)
• Contact partners to offer screening and treatment (if sexual contact within 4 months)