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CHLAMYDIA - UNCOMPLICATED ANOGENITAL INFECTION

Chlamydia is a gram negative obligate intracellular bacteria that causes sexually-transmitted infection.

Chlamydia trachomatis is the primary cause of pelvic inflammatory disease (PID) in women which may lead to ectopic pregnancy, infertility, or chronic pelvic pain.
Most infected females are asymptomatic.
But some females may experience vaginal discharge, dysuria, lower abdominal pain, abnormal vaginal bleeding (postcoital or intermenstrual) or breakthrough bleeding, dyspareunia, conjunctivitis, proctitis and reactive arthritis.

Follow Up

  • Patients treated with recommended or alternative regimens do not need to be re-tested for Chlamydia after completing treatment unless symptoms persist or re-infection is suspected or adherence to treatment is in question
  • Test of cure 3-4 weeks after completing therapy is recommended in pregnant patients
    • Culture is the only test used to evaluate efficacy of treatment
    • NAAT done <3 weeks after treatment is completed may yield false-positive results due to the presence of dead organisms 
  • Test for cure may be considered after 3 weeks in those treated with Erythromycin
  • A follow-up face-to-face or phone interview within 4 weeks of treatment is advisable
  • Most post-treatment infections result from reinfection
  • Test for re-infection is advised 3 months after treatment completion or within the following 3-12 months

Counselling

HIV/STI Counseling and Testing

  • STI consultation allows for an opportunity to discuss patient’s risk factors for STIs and HIV
  • Determine patient’s risk for HIV and discuss HIV testing
  • Testing for HIV is recommended and should be offered to all persons seeking evaluation and treatment for STIs
    • Pretest and post-test counseling as well as informed consent are part of the testing procedure
    • Concomitant infection with HIV may complicate management and control of some STIs 
  • Patient diagnosed with Chlamydia should be encouraged to undergo screening against other STIs apart from HIV (eg hepatitis B, syphilis)
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