Talking Chlamydia – Advice for Clinicians
Chlamydia advice for clinicians on testing, treatment and notification from SHINE SA. Chlamydia is the most commonly notified STI in Australia and notifications …
Chlamydia trachomatis is the most
common bacterial STI worldwide.
It's very easy to catch, and very easy to pass on.
Chlamydia is a bacterial infection
that's transmitted through body fluids.
It infects the genitals, and it can
also infect the eye and the rectum.
It also has a really good way of hiding inside the
cells from the body's immune system.
The vast majority of people with Chlamydia have no symptoms,
that's more than 70 percent.
Those that have symptoms,
it depends where the infection is.
Chlamydia has some important
long-term health consequences;
up to 40 percent of people with Chlamydia
can develop Pelvic Inflammatory Disease,
and that's a leading cause of infertility.
Pelvic Inflammatory Disease can also predispose
to Endometriosis and Chronic Pelvic Pain,
and anyone who's infected with Chlamydia
has an increased risk of HIV transmission.
It can cause a number of clinical
conditions including Trachoma,
Urogenital infection, and Neonatal Pneumonia and Conjunctivitis,
and finally it causes a condition called Lymphogranuloma Venereum.
Dysuria is common with pain when passing urine,
penile or vaginal discharge,
abnormal vaginal bleeding can present as either
post-coital bleeding, or intermenstrual bleeding.
They may also have pelvic pain, or testicular pain,
and finally if there's anal rectal infection
they might have anal pain, or discharge,
but again in this area it's often asymptomatic.
If the infection is in the cervix it can ascend
to cause upper genital tract infection.
This in-turn can cause Pelvic Inflammatory Disease, or PID.
PID can cause chronic pelvic pain,
and if it affects the fallopian tubes
it can cause tubal factor infertility.
Anyone who's sexually active
should be tested for Chlamydia,
but particularly people 30 and under
should be tested at least annually.
If someone's had a new partner in the last 12 months,
has had an STI in the last 12 months,
or who has a partner who has an STI,
should also be offered annual testing.
In addition, some people are at
increased risk of complications
such as if they're having a termination of pregnancy
or an IUD inserted.
Other groups that might need testing include
men who have sex with men.
They may need testing up to four times per year.
Opportunistic screening refers to offering someone a test when they've come in for a different reason,
so for example if they've come in for a contraceptive consult
asking them whether they think
they need to have an STI test,
and explaining why that you're asking.
Because most people with
Chlamydia have no symptoms
it's important to take every opportunity
when you see a young person
to offer them testing even if they
come to you for other reasons.
Clients will come in for different things,
and you can just drop it into the
conversation around preventive health,
as one of the things to add mostly
there for their travel vaccinations,
or cervical screening testing, that sort of thing.
It's really important to normalize talking about sex.
You can bring it up as part of a routine consultation,
you can introduce it when discussing
contraception or cervical screening,
you can mention Chlamydia when
someone has come in for a sore knee.
Just say; people under 30 have a high chance
of Chlamydia, should we test you today?
If they're symptomatic you definitely want to offer them examination in case you need to take additional tests,
or offer them treatment on the day.
If they have no symptoms,
it's important to find out which parts of their
body may have been exposed to Chlamydia,
so you need to take a sexual history.
For people who have had penile intercourse,
the best sample is a first passed urine.
This doesn't need to be done first thing in the morning,
it can be done any time of day as long as
it's been 20 minutes since they've last urinated.
Usually you want to collect the first third of
the urine which has the most epithelial cells.
For someone who has had vaginal intercourse,
they can do their own self collected vaginal swab.
Finally if someone's had Anal Rectal
they need to do a self collected anal swab.
It's important to bring up anal sex because it's common,
not just amongst men who have sex with men,
but also women.
Anal infections are very common.
There are some special groups
such as men who have sex with men,
where you might want to offer
something called three site testing,
because an infection can be present
in one part of the body, and not others.
So in this case you'd offer pharyngeal swabbing,
a urine sample,
and then self-collected anal rectal swabbing.
It's important to talk about how the person will receive their results,
whether you're going to contact them,
or whether they need to contact you.
You need to talk about what to do with a positive result,
and reassure them that they can come
back for a simple antibiotic treatment.
Look it's really important to let them
know what causes Chlamydia,
how it's passed on,
and how they can prevent themselves
from having the infection again.
It's important to advise them to
abstain from sex for at least 7 days
after they and their partner have had treatment.
Not everyone needs a test of cure.
Pregnant women do, and people with
rectal Chlamydia need a test of cure,
otherwise we recommend that
everyone has a test of reinfection
in about three months,
and offering blood-borne
virus screening at that time as well.
Reinfection rates are very common, and it's really important to make sure they haven't been reinfected,
as the chance of Pelvic Inflammatory Disease
and other complications is
much greater with reinfection.
As clinicians we're responsible for notification.
Chlamydia is a notifiable infection in Australia,
and each state and territory has
an infectious diseases branch.
You need to assist the client
in notifying their partner;
so they may be able to notify their partner directly,
or they may wish for you to do it.
There are various websites where
either clinicians or clients can
anonymously notify any recent sexual contacts,
and you can assist them with that.
If you're unsure how to treat Chlamydia,
there are national guidelines which are available online,
and should be checked because treatment can change.
Chlamydia is easy to test, and easy to treat.
So don't be afraid to start the conversation now.