Chlamydial Genitourinary Infections - Clinicals, Diagnosis, and Management

Sexual and Reproductive Health

Clinicals - History

Fact Explanation
Vaginal discharge. Chlamydia causes cervicitis which usually gives rise to a yellow or cloudy mucoid and odorless discharge. The discharge maybe blood stained in cases of chronic endometritis caused by ascending Chlamydia infection. Vaginal discharge.
Chlamydia causes cervicitis which usually gives rise to a yellow or cloudy mucoid and odorless discharge. The discharge maybe blood stained in cases of chronic endometritis caused by ascending Chlamydia infection.
Urethral discharge and dysuria in men. Due to urethritis. Urethral discharge and dysuria in men.
Due to urethritis.
Fever, lower abdominal pain/ chronic pelvic pain, deep dyspareunia Ascending chlamydial infection causes endometritis and pelvic inflammatory disease (PID) which causes these symptoms. Fever, lower abdominal pain/ chronic pelvic pain, deep dyspareunia
Ascending chlamydial infection causes endometritis and pelvic inflammatory disease (PID) which causes these symptoms.
Irregular per vaginal bleeding. This is caused by an easily friable inflamed endometrium caused by Chlamydia endometritis. Irregular per vaginal bleeding.
This is caused by an easily friable inflamed endometrium caused by Chlamydia endometritis.
Sub fertility. Ascending chlamydial infection causes endometritis and acute salpingitis which are usually asymptomatic thus, not diagnosed and treated leading to sub fertility. Also Chlamydia spreads further and result in PID which also contributes to sub fertility. Sub fertility.
Ascending chlamydial infection causes endometritis and acute salpingitis which are usually asymptomatic thus, not diagnosed and treated leading to sub fertility. Also Chlamydia spreads further and result in PID which also contributes to sub fertility.
Ectopic pregnancy which presents with vaginal bleeding with period of amenorrhoea. Ectopic pregnancy occurs due to PID caused by Chlamydial infection. Ectopic pregnancy which presents with vaginal bleeding with period of amenorrhoea.
Ectopic pregnancy occurs due to PID caused by Chlamydial infection.
Pregnant women may present with early rupture of membranes associated with gush of amniotic fluid expulsion. Chlamydia complicates pregnancy by causing premature rupture of membrane and and premature delivery. Pregnant women may present with early rupture of membranes associated with gush of amniotic fluid expulsion.
Chlamydia complicates pregnancy by causing premature rupture of membrane and and premature delivery.
Being of adolescents or of younger age group, history of having multiple sexual partners in the last year These are known risk factors for Chlamydial infection. Both young men and women are at higher risk than older population to have the infection. Also high number of sexual partners in the lifetime do not seem to increase the risk, this is thought to be due to development of immunity due to repeated exposure. Being of adolescents or of younger age group, history of having multiple sexual partners in the last year
These are known risk factors for Chlamydial infection. Both young men and women are at higher risk than older population to have the infection. Also high number of sexual partners in the lifetime do not seem to increase the risk, this is thought to be due to development of immunity due to repeated exposure.
May present with triad of symptoms of urethritis (cervicitis in women), conjunctivitis, and arthritis with asymmetric and multiple joint involvement. Painless mucocutaneous lesions may also occur. This is known as Reiter syndrome, occur as a complication of untreated Chlamydial infection. May present with triad of symptoms of urethritis (cervicitis in women), conjunctivitis, and arthritis with asymmetric and multiple joint involvement. Painless mucocutaneous lesions may also occur.
This is known as Reiter syndrome, occur as a complication of untreated Chlamydial infection.
Right upper abdominal pain. Transperitoneal spread of PID will result in peri hepatitis results in this symptom. Presence of peri hepatitis and PID is know as Fitz-Hugh-Curtis syndrome. Right upper abdominal pain.
Transperitoneal spread of PID will result in peri hepatitis results in this symptom. Presence of peri hepatitis and PID is know as Fitz-Hugh-Curtis syndrome.

Clinicals - Examination

Fact Explanation
Lower abdominal tenderness, Right upper abdominal tenderness. Lower abdominal tenderness maybe due to PID and right upper abdominal tenderness occur due to Fitz-Hugh-Curtis. Lower abdominal tenderness, Right upper abdominal tenderness.
Lower abdominal tenderness maybe due to PID and right upper abdominal tenderness occur due to Fitz-Hugh-Curtis.
Vaginal discharge will be visible. Mucopurulent discharge, yellow to cloudy in nature. Vaginal discharge will be visible.
Mucopurulent discharge, yellow to cloudy in nature.
Urethral discharge maybe expressed by compressing the urethra. Especially in male patients, this can be used as a sample for investigations. Urethral discharge maybe expressed by compressing the urethra.
Especially in male patients, this can be used as a sample for investigations.
Uterine, adenexial tenderness maybe elicited by bimanual palpation. Cervical motion tenderness maybe present. This maybe due to PID caused by ascending Chlamydial infection. Uterine, adenexial tenderness maybe elicited by bimanual palpation. Cervical motion tenderness maybe present.
This maybe due to PID caused by ascending Chlamydial infection.
Speculum examination may reveal erythematous and oedemaous cervix. Due to Chlamydial cervicitis. Speculum examination may reveal erythematous and oedemaous cervix.
Due to Chlamydial cervicitis.
Contact bleeding is present and elicited in vaginal and speculum examination. Due cervicitis caused by Chlamydia the cervix becomes easily friable, thus results in contact bleeding. Contact bleeding is present and elicited in vaginal and speculum examination.
Due cervicitis caused by Chlamydia the cervix becomes easily friable, thus results in contact bleeding.

Investigations - Diagnosis

Fact Explanation
Microscopic examination and culture of urethral discharge. There will be more than 5 white cells per high power field. Culture would not yield any organisms. Microscopic examination and culture of urethral discharge.
There will be more than 5 white cells per high power field. Culture would not yield any organisms.
Culture of an endocervical sample and ABST (Antibiotic sensitivity test) Culture on an appropriate culture plates (McCoy cell culture media), will result in inclusion bodies in the infected cells which can be visualized by staining them, usually with specific fluorescein-conjugated monoclonal antibodies. Fluorescein based detection is more specific than iodine or Giemsa based inclusion detection. Culture of an endocervical sample and ABST (Antibiotic sensitivity test)
Culture on an appropriate culture plates (McCoy cell culture media), will result in inclusion bodies in the infected cells which can be visualized by staining them, usually with specific fluorescein-conjugated monoclonal antibodies. Fluorescein based detection is more specific than iodine or Giemsa based inclusion detection.
Nucleic acid amplification(NAAT) test of samples from endocervical swabs of women, urethral swabs of men, and urine of both sexes. This test is mainly used in screening due to high sensitivity. Nucleic acid amplification(NAAT) test of samples from endocervical swabs of women, urethral swabs of men, and urine of both sexes.
This test is mainly used in screening due to high sensitivity.
Nucleic Acid Hybridization (Nucleic Acid Probe) Tests Samples need not be refridgerated but should be processed on or before 7 days from collection. Nucleic Acid Hybridization (Nucleic Acid Probe) Tests
Samples need not be refridgerated but should be processed on or before 7 days from collection.
Enzyme Immunoassays (EIA) *Should not be used on samples obtained from rectum. The sample need not be refridgerated but have to be processed before the time mentioned by the manufacturer of the EIA kit.
Enzyme labeled antibody detects LPS (lipopolysaccharide) which is not species-specific of Chlamydia.
Samples obtained from rectum will cause cross reaction thus should not be used.
Enzyme Immunoassays (EIA) *Should not be used on samples obtained from rectum.
The sample need not be refridgerated but have to be processed before the time mentioned by the manufacturer of the EIA kit.
Enzyme labeled antibody detects LPS (lipopolysaccharide) which is not species-specific of Chlamydia.
Samples obtained from rectum will cause cross reaction thus should not be used.
Direct fluorescent antibody- specimen from endocervical swab or brush Sample is used to prepare a slide and then processed within 7 days. The slides are stained with flouroscein monoclonal antibodies and visualised under flouroscent microscopy. Some kits contain MOMP (major outer membrane protein) antibodies which are more specific than LPS (lipopolysaccharide) antibody containing kits. Direct fluorescent antibody- specimen from endocervical swab or brush
Sample is used to prepare a slide and then processed within 7 days. The slides are stained with flouroscein monoclonal antibodies and visualised under flouroscent microscopy. Some kits contain MOMP (major outer membrane protein) antibodies which are more specific than LPS (lipopolysaccharide) antibody containing kits.
Chlamydia rapid test. This is a less specific test and is not recommended where other tests are feasible. Chlamydia rapid test.
This is a less specific test and is not recommended where other tests are feasible.

Investigations - Management

Fact Explanation
Follow up investigation is recommended in pregnant women, in those who symptoms persist or when reinfection is suspected. Screening test is done 3 to 4 weeks after completion of therapy. Follow up investigation is recommended in pregnant women, in those who symptoms persist or when reinfection is suspected.
Screening test is done 3 to 4 weeks after completion of therapy.
A follow up should be done in 3 months time, if not whenever patient seeks next medical care within the first 12 months of treatment. Reinfection rates are high in those who are not re-treated within several months. This is usually due to new sexual partners or untreated sexual partners. A follow up should be done in 3 months time, if not whenever patient seeks next medical care within the first 12 months of treatment.
Reinfection rates are high in those who are not re-treated within several months. This is usually due to new sexual partners or untreated sexual partners.
DNA amplification test is used on endocervical swabs in women, urethral swabs in men, or first-void urine specimens from both sexes. All sexually active nonpregnant and pregnant women who are 24 years or younger should be screened. (Reduce rate of PID and reduces the prevelece of Chlamydia)

If more than 24 years of age, regardless of the fact whether they are pregnant or not, screen only if they are high risk

Evidence on whether to screen asymptomatic men is lacking.
DNA amplification test is used on endocervical swabs in women, urethral swabs in men, or first-void urine specimens from both sexes.
All sexually active nonpregnant and pregnant women who are 24 years or younger should be screened. (Reduce rate of PID and reduces the prevelece of Chlamydia)

If more than 24 years of age, regardless of the fact whether they are pregnant or not, screen only if they are high risk

Evidence on whether to screen asymptomatic men is lacking.

Management - Supportive

Fact Explanation
Tracing and treating the sexual partner is indicated. This prevents reinfection as well as infection from spreading on to other sexual contacts. Tracing and treating the sexual partner is indicated.
This prevents reinfection as well as infection from spreading on to other sexual contacts.

Management - Specific

Fact Explanation
Single dose azithromycin 1g orally or oral doxycycline 100 mg bd for seven days. Alternatively, oral erythromycin base 500 mg qds 7 days or oral erythromycin ethylsuccinate 800 mg qds for 7 days or oral levofloxacin 500 mg od for 7 days or oral ofloxacin 300 mg bd for 7 days are also used. Single dose azithromycin 1g orally or oral doxycycline 100 mg bd for seven days.
Alternatively, oral erythromycin base 500 mg qds 7 days or oral erythromycin ethylsuccinate 800 mg qds for 7 days or oral levofloxacin 500 mg od for 7 days or oral ofloxacin 300 mg bd for 7 days are also used.
For pregnant mothers-erythromycin 200 mg qds for 7 days or base or amoxicillin 500mg tds for 7 days. Treatment of pregnant mothers reduces risk of transmission of infection to the baby during child birth. Doxycycline, ofloxacin, and levofloxacin should not be used in pregnancy. For pregnant mothers-erythromycin 200 mg qds for 7 days or base or amoxicillin 500mg tds for 7 days.
Treatment of pregnant mothers reduces risk of transmission of infection to the baby during child birth. Doxycycline, ofloxacin, and levofloxacin should not be used in pregnancy.
Erythromycin base 250 mg orally four times a day for 14 days. This regimen is used if gasterointestinal side effects occur to higher dose regimen erythromycin, usually in pregnancy. Erythromycin base 250 mg orally four times a day for 14 days.
This regimen is used if gasterointestinal side effects occur to higher dose regimen erythromycin, usually in pregnancy.
If patient is suspected of having PID with has high fever associated with nausea and vomiting hospital admission maybe necessary. When oral regime is not tolerated by the patient iv regime might have to be started. Also underlying tubo ovarian abscess/ surgical conditions should be excluded. If patient is suspected of having PID with has high fever associated with nausea and vomiting hospital admission maybe necessary.
When oral regime is not tolerated by the patient iv regime might have to be started. Also underlying tubo ovarian abscess/ surgical conditions should be excluded.

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