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Chlamydia

Chlamydia, caused by c. trachomatis, is the most common curable sexually transmitted infection in the UK

5-10% of sexually active individuals aged 20-24 are estimated to be infected 

Symptoms: 
  • Females: 
    • Asymptomatic in 70% 
    • Purulent vaginal discharge 
    • Mucopurulent cervicitis 
    • Dysuria
    • Lower abdominal pain 
    • Post coital or intermenstrual bleeding 
  • Males:
    • Asymptomatic in 50% 
    • Urethral discharge
    • Dysuria 

Diagnosis 
  • Swab of cervix or vulvo-vagina (female) or first voided urine (male) 
  • Nucleic Acid Amplification Test

Management
  • First line: Doxycycline 100mg bd for 7 days OR azithromycin 1g once only 
  • Second line: erythromycin 500mg bd for 10-14 days OR ofloxacin 200mg bd 
  • Contact tracing – last 4 weeks if index patient is symptomatic, 6 months if asymptomatic 
  • uncomplicated genital tract infection with Chlamydia is not an indication for removal of IUD 

Complications
  • Pelvic inflammatory disease in women 
    • risk of infertility – 20%
    • Ectopic pregnancy
    • Chronic pelvic pain – 18% 
    • Fitz-Hugh-Curtis syndrome
      • Inflammation of the liver capsule associated with genital tract infection 
      • Classically presents with sharp RUQ pain
  • Reiter’s syndrome 

References
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Abdelghafour

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