Family doctor

Chlamydia – a patient’s guide

Chlamydia is common

Chlamydia is the most commonly treatable sexually transmitted infection (STI) acquired in New Zealand. The prevalence of Chlamydia is especially high among young adults and for this reason opportunistic Chlamydia testing of sexually active young people (those under 25 years) is encouraged by the Ministry of Health. Infection is more common in females than males.

Transmission: Chlamydia is transmitted through contact with genital secretions usually during sexual activity. It is relatively infectious (there is approximately a 20% chance of becoming infected per sexual contact with an infected person). Infection from mother to baby may cause conjunctivitis in the newborn (this tends to occur within three weeks of delivery).

If left untreated, chlamydia infection can lead to pelvic inflammatory disease and ectopic pregnancy in females, urethritis, epididymo-orchitis and reactive arthritis in males, as well as infertility in both males and females.

Symptoms don’t usually occur

In over 70% of cases chlamydia will not cause symptoms, which is why it is so easily passed on from one person to another. If symptoms do occur they can include:

• In men:  urethral discharge (milky or clear discharge from the penis), urethral irritation, dysuria (painful urination) or testicular pain/swelling.

·         In women: vaginal discharge (milky or clear), lower abdominal pain, dyspareunia (painful sex), dysuria (painful urination) or irregular vaginal bleeding (i.e. bleeding after sex or bleeding in-between menstrual periods).

Risk factors for Chlamydia infection include:

• Having a change of sexual partner(s) in the previous 6-12 months (and condoms not consistently used)
• Being the sexual partner of a chlamydia positive person
• Having a recent history of Chlamydia (as reinfection is common)
• Having a co-infection with another STI
• Being a mothers of an infant with chlamydial conjunctivitis or pneumonitis

Getting checked for Chlamydia

If asymptomatic (i.e. there are NO symptoms of burning urine, genital pain or irritation, any genital sores or any genital discharge):

For males: a “first void urine” is needed – this involves waiting for ideally at least 2 hours since urine was last passed and then putting the first 20-30mls of urine into a urine specimen pot.

For females: A doctor or nurse will usually perform a swab test.

 An adequate patient collected low vaginal swab (i.e. self-swab) is also acceptable for screening. This is done by placing the Chlamydia swab 2-3 cm into the vagina (about half way along the swab) and then twirled inside touching the vaginal walls for approximately 10 seconds.

If symptomatic (i.e. there ARE symptoms of abdominal pain, burning urine, genital pain or irritation, any genital sores or any genital discharge): In this situation the doctor will be thinking not only of Chlamydia but wanting to rule out other STIs as well.

For males: a “first void urine” is needed to check for chlamydia but in addition the doctor may do a urethral swab to check for other STIs.

For symptomatic rectal infection in men who have sex with men advice is best sought from a sexual health clinic

For females: the doctor will examine the genital area and take appropriate vaginal swabs to rule out other STIs.

A rectal swab in either sex if indicated by history

If the swabs are positive then antibiotics are needed to clear the infection

The standard recommended treatment regimens are:

·         Azithromycin 1 g taken as a single dose or

·         Doxycycline 100 mg twice daily for 7 days.

It is important to avoid sexual intercourse (including oral sex) until they and their partner(s) have completed treatment (or wait 7 days if treated with Azithromycin).

Pregnancy: although azithromycin is not licensed for use in pregnancy in New Zealand, clinical experience and studies overseas suggest it is safe and effective so the choices are:

·         Azithromycin 1 g taken as a single dose or

·         Amoxicillin 500mg three times daily for 1 week or

·         Erthyromycin stearate 500mg four times daily for 1 week

Anyone diagnosed with chlamydia should be encouraged to have screening for other STIs, this may include an HIV test and, where indicated hepatitis B screening and vaccination

Contact tracing/partner notification and repeat testing

Sexual contacts of a person who has tested positive for chlamydia need to be contacted and offered testing and treatment. Contacts should be treated even if testing is declined or negative.

A test of cure (i.e. repeating the chlamydia test after treatment) should be done in pregnant women at 4-6 weeks post treatment A repeat STI screen is recommended for those with positive results after 3 months if they are at risk of re-infection – for example if they have changed their sexual partner or had unprotected sex with an infected partner.

Resources

Ministry of Health: Chlamydia management guidelines 2008

http://www.moh.govt.nz/moh.nsf/pagesmh/8210/$File/chlamydia-management-guidelines.pdf

2006 UK National Guideline for the Management of Genital Tract
Infection with Chlamydia trachomatis
http://www.bashh.org/documents/61/61.pdf