Chlamydia

What is chlamydia?

Chlamydia is a sexually transmitted disease. infection (ITS) caused by the bacterium Chlamydia trachomatis with DK serotypes.

L1-L3 chlamydia serotypes cause venereal lymphogranuloma (LGV), which is discussed separately.

Who gets Chlamydia infection?

Chlamydia is a very common STI.

Risk factors include:

  • Be over 25 years old
  • New or multiple sexual partners
  • Inconsistent use of condoms.

What are the clinical features of chlamydia?

Chlamydia can cause very mild symptoms or no symptoms; asymptomatic Infection occurs in approximately 70% of women and 50% of men.

In men, the most common signs and symptoms are:

  • Download urethra
  • Urethral irritation
  • Pain when urinating
  • Swelling or testicular pain.

In women, the most common signs and symptoms are:

  • Abnormal vaginal discharge
  • Pain when urinating
  • Abnormal vaginal bleeding (eg, bleeding between periods or after sex)
  • Pain in the lower abdominal area
  • Painful sexdyspareunia)

Chlamydia infection at extragenital sites

Chlamydia infections can also occur in the rectum, eyes, and throat.

Rectal infection generally occurs in men who have sex with men (MSM). It can also occur in heterosexual women who receive anal sex. Rectal chlamydia in women who do not have anal sex is believed to be the result of the infection spreading from the vagina. Rectal chlamydia is usually asymptomatic, but it can infrequently cause anal discharge and discomfort.

Chlamydia conjunctivitis It can occur in adults, where it is acquired sexually. It can also occur in newborn babies due to mother-to-child transmission. Chlamydia infection in the throat is usually asymptomatic.

What are the complications of chlamydia?

Chlamydia infection can cause complications of varying severity and duration, particularly after multiple infections over time.

Possible complications in men include:

  • Epididymisorchitis
  • Sexually acquired reagent arthritis
  • Perihepatitis (less likely to occur in women)
  • Chronic pain syndrome
  • Sexually acquired conjunctivitis
  • Balanitis (eruption affecting the glans of the penis)
  • Sterility.

Possible complications in women include:

  • Pelvic inflammatory disease (PID)
  • Tubal infertility
  • Ectopic the pregnancy
  • Sexually acquired reactive arthritis
  • Sexually acquired conjunctivitis
  • Perihepatitis (Fitz-Hugh Curtis syndrome)
  • Chronic pelvic pain.

Mother-to-child transmission can cause chlamydia conjunctivitis and pneumonia in newborns.

A triad of reactive arthritis, conjunctivitis, and urethritis it is known as Reiter's syndrome.

How is chlamydia diagnosed?

In symptomatic individuals, examination results may include urethral discharge, abnormal vaginal discharge, cervicitis and contact bleeding, tenderness on bimanual examination (cervical excitation, attached tenderness) and rectal discharge. Since these findings can also occur with other STIs, laboratory tests are required to confirm the diagnosis of chlamydia.

In women, clinical samples may include:

  • A vulvovaginal swab taken by a clinician or by the patient; it has the best sensitivity (96–98%)
  • An endocervical swab taken after the vulvovaginal swab during a speculum exam.

A urine sample is not routinely recommended in women because bacterial The urine load is much less than in men.

In men, clinical samples may include:

  • Urine from the first empty morning (or last at least one hour before)
  • Urethral swab, and has a similar or greater sensitivity.

Clinical samples at extragenital sites.

The rectal and pharyngeal swabs can be taken by a doctor or the patient. Proctoscopy should be performed if there are rectal symptoms.

Research

Tests for chlamydia infection may include:

  • Chlamydia nucleic acid Amplification test (NAAT): the NAAT of chlamydia can be combined with tests to Neisseria gonorrhea (gonorrhea) and trichomonas vaginalis (trichomoniasis)
  • Enzyme immunoassay (EIA)
  • A point-of-care test with NAAT or EIA is not used routinely
  • Chlamydia culture - this is not widely available, has a low sensitivity (60–80%), and is not used for throat and rectal infections.

What is the treatment of chlamydia?

People receiving treatment for chlamydia should refrain from having sex for at least seven days.

Uncomplicated genital chlamydia infection

  • Doxycycline (100 mg twice a day) for 7 days: 98% cure

  • Single dose (1 g) of azithromycin: cure 92-97%

Uncomplicated rectal chlamydia infection

  • Doxycycline (100 mg twice a day) for 7 days

  • Single dose (1 g) of azithromycin: followed by proof of cure test

Asymptomatic infections at extragenital sites.

  • Doxycycline (100 mg twice a day) for 7 days

Keep in mind that doxycycline is contraindicated Azithromycin is associated with QT prolongation in pregnancy.

Empirical antimicrobial therapy

Proctitis, epididymoorchitis, and pelvic inflammatory disease are treated by a prolonged course of empirical antimicrobial therapy while awaiting test results.

Treatment should cover other possible causes of these presentations, such as gonorrhea. Supportive measures and clinical review are required.

Other treatments

Chlamydia treatment includes a comprehensive sexual health checkup to look for other STIs and reports, treatment, and evidence of sexual contacts.

If the patient is pregnant or has rectal chlamydia, a NAAT test of cure (OCD) should be performed at least four weeks after the end of treatment. If taken earlier, a false positive may occur due to remaining chlamydia DNA. Retesting in 3 months is recommended as reinfection is extremely common.

How can chlamydia be prevented?

For other STIs, the risk of contracting chlamydia infection is reduced through safe sex practices, including limiting the number of sexual partners, using condoms, and preventing reinfection by not having sexual contact with untreated sexual partners. .

If you think you are infected, stop any sexual contact and consult your regular doctor or a specialist doctor at a sexual health clinic.