Chlamydia

Positive result- whats next?

Nurlela Asnawar

Patient history
20 year old female, university student
10 weeks ago, went to CASH clinic for
emergency contraception.
Offered chlamydia testing, result came back
positive.
Was given azithromycin.
Had sex within 7 days after treatment.
Had to retake another azithromycin.

Since then,
Came to Claude Nicol Centre for check up
2 episodes of UPSI with new casual partner.
3 sexual contacts in the last 3 months.
Last 3 episodes of sexual intercourse:
1) 5 days ago, CMP, oral + vaginal sex, no condom
2) 3/52 ago, CMP, vaginal sex, no condom.
3) 2/12 ago, RMP, oral + vaginal sex, condom for
vaginal sex.
) Restarted Cerazette (POP) prior to visit to CASH
clinic.

Chlamydia

Most common bacterial STI in the UK.

Mostly affect young people <25 years old.

Mostly asymptomatic.

Untreated infection associated with

considerable reproductive morbidity.
(PID, ectopic pregnancy, infertility)

Chlamydia positive- what's

next?

i.
ii.

)
)

Antibiotics treatment
Azithromycin1g (single dose) OR
Doxycycline 100mg BD 7days (not suitable
in pregnancy)
Possible side effect: stomach pain,
diarrhoea, feeling sick, vaginal thrush.
Drugs interaction.
Explain about the importance of complying
with treatment.

Abstinence

No sex for 7 days after treatment (genital, oral

and anal sex) even with condom use.

The patient should not resume sex with their

partner(s) until they too have completed
treatment or received negative test results.

If symptomatic, avoid sex until symptoms have

gone.

Why? To prevent re-infection

Partner notification

The 'look-back' period for partner tracing is

* 4 weeks prior to the onset of symptoms (
with urethral symptoms)
* 6 months or to the last previous sexual
partner (whichever is longest) (others)
Those identified should be informed of their risk,
offered treatment, contact tracing and STI testing.
Notification can be done by the patient or by the
health care professional.

Safer sexual practice

CONDOM, CONDOM, CONDOM
Use a latex condom every time they have sex.
Use condom for any type of sex.
Use condom correctly.
Condom is used for STI prevention and not only
for contraception.
Sex toys. (if share, wash + cover with new
condom)
High risk young age (< 25) , multiple partner,
new partner, alcohol and drug used

Testing for other STIs

A full STI screen is encouraged in patient

who is tested positive for chlamydia.

Performed prior to treatment for chlamydia.

In community, where full STI screen is not

possible, the treatment should not be
delayed. However, screening for other STIs
should be delayed for at least a week after
the completion of antibiotic treatment.

Do I need to get re-tested?

A test of cure is not recommended routinely
unless:
i.
Patient is pregnant
ii.
Non-compliant to treatment
iii. Risk of re-infection

) Usually

done 6 weeks after treatment

) Current guideline: for patient < 25, a repeat
test for chlamydia should be offered 3
months after the completion of treatment.

Take home messages

Patient counselling should cover the nature of
disease, transmission issues and risk
reduction.
Clinician should:
i.
Access patients behaviour change potential
ii.
Develop individualised risk-reduction plan
with the patient.
iii. Discuss the prevention strategies
(abstinence, condoms, limiting number of
partner etc.)

References
1.

2.

3.

4.
5.
6.

BASHH, Chlamydia trachomatis UK Testing Guidelines 2010,

http://www.bashh.org/documents/3352.pdf.
BASHH statement on re-testing of young persons diagnosed
with chlamydia infection - September 2013 http://
www.bashh.org/documents/Retesting%20of%20young%20pe
oplediagnosed%20with%20chlamydia%20(Sep%202013
).pdf
BASHH Statement on Partner Notification for Sexually
Transmissible Infections (2012), http://
www.bashh.org/documents/4445.pdf
www.fpa.org.uk
http://www.patient.co.uk/doctor/chlamydial-genital-infection
http://
www.uptodate.com/contents/chlamydia-beyond-the-basics