Genital chlamydial infection

Genital chlamydial infection

dr. Vesta Kucinskiene

Lithuanian University of Health Sciences

Department of Skin and venereal Diseases

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Etiology

Chlamydiae are small, obligate-intracellular Gramnegative

bacteria that infect human columnar and

transitional epithelium.

Chlamydia trachomatis is responsible for:

• Ocular infection (trachoma)

• Genitourinary infections (types D–K)

• Lymphogranuloma venereum (a rare, sexually

transmitted tropical infection causing genital ulcers

and inguinal lymphadenopathy)

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Epidemiology

• Prevalence is dependent on the age and setting

of the population:

– 30 yrs: 1-2%

• In genitourinary medicine clinics prevalence is

as high as 17% in under-20-year-olds.

• The under-20s have a prevalence of around

12% in antenatal and termination of pregnancy

clinics.

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Risk factors

• Age

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Symptoms

In most cases the infection is

asymptomatic and is often only detected

during screening or investigation of other

genitourinary illness.

It is asymptomatic in ~50% of men and

~80% of women.

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Symptoms

If women are symptomatic they may

describe:

• Vaginal discharge

• Dysuria (always consider chlamydia as a cause

of sterile pyuria)

• Vague lower abdominal pain

• Fever

• Intermenstrual or postcoital bleeding

• Dyspareunia

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Symptoms

Men tend to suffer either classical

urethritis with dysuria and urethral

discharge or epididymo-orchitis presenting

as unilateral testicular pain ± swelling.

Fever may also be a presenting feature in

men.

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Complications

• Pelvic inflammatory disease - about 20-40% of untreated

chlamydia cases get PID,

• Scarring of the fallopian tubes,

• Ectopic pregnancy,

• Epidydimitis,

• Infertility,

• Reiter’s sydrome (reactive arthropathy),

• Mother-infant transmission – newborn may catch chlamydia:

– Conjunctivitis (pink eye).

– Pneumonia.

• Low birth weight,

• Prematurity.

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Investigations

• Cell culture

• Antigen detection (DIF) or enzyme

immunoassays (EIAs)

• Nucleic acid amplification tests (NAATs)

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NAATS

• High sensitivity (in general, of 90-95%),

• testing can also be done on urine, vaginal

samples, reducing the need for invasive

tests.

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Taking of samples

• Follow local protocols for taking, storing and

transporting swabs,

• In women undergoing a vaginal examination, an

endocervical swab is preferred. Clean the cervix

and rotate the swab 360 degrees inside the os.

• In those who are not undergoing vaginal

examination, a first-void urine sample (having held

urine for at least 1-2 hours previously) or selfadministered

vaginal swab may be used. Men

should provide urine samples as this test has the

same sensitivity as a urethral swab, which is painful

and invasive.

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Treatment

Current recommended regimens are:

• Doxycycline 100 mg twice daily for 7 days

• Single dose of 1 g of azithromycin

(improves compliance)

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Treatment

• Longer courses of antibiotics are needed

for cases of salpingitis or upper genital

tract infection in men.

• A test of cure is not routine unless the

• A test of cure is not routine unless the

patient is pregnant, has been

noncompliant or been re-exposed. Wait for

5 weeks post end of treatment (or 6 weeks

with azithromycin).

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Recommendations

• The importance of investigating and treating sexual partners

(not resume sex with sexual partner(s) until they too have

completed treatment (or for a week following stat dose of

azithromycin) or received negative test results, otherwise

there is a high risk of reinfection).

• The importance of complying with treatment.

• The need to abstain from sexual intercourse (including oral

sex) even with a condom for a week after single-dose

therapy or until finishing a longer regimen.

• It is important to test for other sexually transmitted infections

including HIV and Hepatitis B.

• Advice on safer sexual practices and condom use.