Makindo Medical Notes Comprehensive Medical Encyclopedia | Education for Healthcare Professionals

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MEDICAL DISCLAIMER: The contents are under continuing development and improvements and despite all efforts may contain errors of omission or fact. This is not to be used for the assessment, diagnosis, or management of patients. It should not be regarded as medical advice by healthcare workers or laypeople. It is for educational purposes only. Please adhere to your local protocols. Use the BNF for drug information. If you are unwell please seek urgent healthcare advice. If you do not accept this then please do not use the website. Makindo Ltd.

Chlamydia trachomatis

⚠️ Chlamydia trachomatis is the most common bacterial STI in the UK. Up to 70% of women and 50% of men are asymptomatic, meaning opportunistic testing is vital. Untreated infection can cause PID, infertility, ectopic pregnancy, and in men, epididymo-orchitis.

🔎 About

Obligate intracellular bacterium with multiple serotypes causing different syndromes.
Spread via unprotected vaginal, anal, or oral sex, and perinatally from mother to infant.
Major cause of preventable infertility worldwide.

🧬 Characteristics & Life Cycle

Elementary bodies (EB): infectious, metabolically inactive, survive outside cells.
Reticulate bodies (RB): intracellular, replicate using host ATP, non-infectious.
Cycle → EB enters cell → converts to RB → divides → reverts to EB → cell lysis → spreads.

🧪 Clinical Features

👩 Women: abnormal vaginal discharge, post-coital or intermenstrual bleeding, pelvic pain, dysuria, deep dyspareunia.
👨 Men: urethral discharge, dysuria, scrotal pain (epididymitis), proctitis if rectal infection.
🍼 Neonates: conjunctivitis, staccato cough (pneumonia).
⚠️ Many are asymptomatic → screening essential.

🌍 Serotypes & Disease

Serotypes A–C → Trachoma 👁️ (leading cause of blindness in some regions).
Serotypes D–K → Genital chlamydia (urethritis, cervicitis, PID, epididymitis, neonatal infections).
Serotypes L1–L3 → Lymphogranuloma venereum (LGV): painful ulcers, buboes, severe proctitis.

📋 Risk Factors

Age <25 years, new or multiple partners, inconsistent condom use.
Socioeconomic deprivation and limited access to sexual health services.

🧪 Investigations

NAAT (nucleic acid amplification test) on first-void urine or self-taken vulvovaginal swab = gold standard.
Other: Giemsa stain (inclusion bodies), immunofluorescence, serology (less common now).
Always test for coinfections → gonorrhoea, HIV, syphilis, hepatitis B.

💊 Management (BASHH 2023)

First-line: Doxycycline 100 mg PO BD for 7 days ✅
Alternatives:
- Azithromycin 1 g stat then 500 mg OD ×2 days (off-label; used in pregnancy or adherence issues)
- Amoxicillin 500 mg TDS ×7 days (pregnancy safe)
- Erythromycin 500 mg BD ×14 days (less used due to GI side effects)
Partner notification and treatment of sexual contacts (look back 6 months).
Avoid sex until patient and partners have completed treatment and symptoms resolve.

🩺 Complications

PID, tubal infertility, ectopic pregnancy
Chronic pelvic pain
Reiter’s syndrome (reactive arthritis) ♻️
Epididymo-orchitis in men

📊 Screening (UK NCSP)

Offer annual screening to all sexually active women and men <25 years.
Also screen after a change of partner.
Pregnant women should be tested if at risk.

📚 References

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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