Chlamydia is a common sexually transmitted infection caused by the bacterium Chlamydia trachomatis. It often has no symptoms but can cause pelvic inflammatory disease and infertility if left untreated. It is transmitted through vaginal, anal, or oral sex. Diagnosis involves antigen detection tests of swabs from the genital area or urine samples. Treatment is usually a single dose of azithromycin or one week of doxycycline antibiotics. Partners must also be treated to prevent reinfection.

2. o Possibly the most
Chlamydia common STI in the United
States with about 2.8
million men and women
Chlamydia trachomatis affected.
o Transmitted through
contact with mucous
membranes found in
eyes, mouth, vagina, rectum
, or urethra.
o Only 25% of men have no
symptoms, rather than the
75% found in females.
o Also known as the:
oClam
oGooey Stuff
oClap Slap
oSilent Epidemic
http://youtu.be/D4Y3QXOZY6E

3. Rates By Sex, 1990 - 2010

4. Rates by County
Lighter blue is Audrain and Howard counties, Darker blue is Boone and Cole.

5. Rates by Age and Sex, 2010

6. Signs and Symptoms: Women
• Vaginal Discharge
• Burning or painful
urination
• Abdominal or low back
pain
• Nausea
• Fever
• Pain with intercourse
• Vaginal bleeding
between periods.

7. Signs and Symptoms: Men
• Burning, frequent, and
painful urination
• Penile discharge
• Swollen and painful
testicles
• If rectally: characterized
by pain, discharge, and
bleeding.

8. Complications for Women
• Cervicitis:
• Pelvic Inflammatory inflammation of the
Disease (PID): cervix.
infection of the
uterus, ovaries and
fallopian tubes.
• Infertility related to
upper genital tract
infection causing
permanent damage
to fallopian tubes.

9. Complications for Men
• Epididymitis: painful
inflammation of the
tube system that is part
of the testicles, which
can lead to being sterile
and infertility.
• Urethritis: inflammation
of the urethra
• Reactive arthritis:
inflammation of
joints, urethra, and
eyes. (Reiters
Syndrome)

10. Complications During and After
Pregnancy
During:
Some evidence suggests that it may
lead to premature delivery
After:
Babies may become infected in the
respiratory tract or their eyes during
the birthing process.

11. Diagnostic Testing:
Based on individual sexual history and lab results.
• Urinalysis

12. Antigen Detection Test
Diagnostic Testing
Antigen detection
methods, including the enzyme-
linked immunosorbent assy and
the direct fluorescent antibody
test are the diagnostic tests of
choice for identifying Chlamydial
infection, although tissue cell
cultures are more sensitive and
specific. Newer nucleic acid
probes using poly-merase chain
reaction are also commercially
available.
•It is a rapid test designed to
detect the presence of the
chlamydia antigen from male and
female swab tests.

13. Diagnostic Testing
Pap Smear
Although a pap smear
itself can’t be used to
detect Chlamydia, the
swab taken during the
test is used for the
antigen detection test.
Occasionally some
cellular changes will occur
making the cells reactive
and containing pustules.
These are not conducive
to diagnosing Chlamydia.

14. Diagnostic Testing
A sample of cells is collected
and allowed to grow for 48-72
hours. A specific stain is used
to detect for the unique
appearance of c. trachomatis.
Cell tissue cultures also allows
for antimicrobial sensitivity
testing.
Cell Tissue Culture
A culture is obtained from through aspiration.

15. Diagnoses in Women
• Chlamydial infection of the cervix (cervicitis)
is a sexually transmitted infection
asymptomatic for 50-70% of women.
• It can be passed through vaginal, anal, or
oral sex.
• 50% of those that do have an asymptomatic
infection, not detected by their doctor, will
develop pelvic inflammatory disease (PID)
– Chronic pelvic pain, infertility, ectopic
pregnancies, and other complications of
pregnancy.

16. ‘Silent Epidemic’
• Chlamydia is known as such because in
women, only 25% of cases are symptomatic.
• The infection can linger for months or years
before being discovered.
• Symptoms of Chlamydia are:
– Unusual vaginal bleeding
and/or dishcharge
– Abdominal pain
– Painful sexual intercourse
– Fever
– Painful urination and frequency
of urination

17. Diagnoses in Men
• Chlamydia shows symptoms of infectious
urethritis in about 50% of cases.
– Painful or burning sensation when urinating
– Unusual discharge from penis
– Swollen/tender testicles
– Fever
• If left untreated, Chlamydia may spread to
testicles causing epididymitis and possibly
sterility in rare cases after 6-8 weeks.
• Chlamydia is a potential cause of prostatitis in
men, but relevance is difficult to determine
because of possible contamination with
urethritis.

18. Treatment
• Recommended first line of treatment for
adults and adolescents is drug therapy with
oral doxycycline for 7 days or oral
azithromycin in a single dose.
•Persons with chlamydia
should abstain from
sexual intercourse until
after full course of
antibiotics or at least 7
days from single dose.
•Pregnant women
would be treated
with erythromycin.

19. Re-Infection
• All sex partners should be
evaluated, tested, treated and retested
within 3 months of initial infection.
• Women whose sex partners have not
been appropriately treated are at high
risk for re-infection.
– Multiple infections can increase risks of
serious reproductive health complications.

20. Treatment Medications
• Recommended Regimens
– Azithromycin: 1 g po in a single dose.
• Binds with ribosomal subunit of bacteria and
inhibits protein synthesis. Broad spectrum
antibiotics.
•Doxycycline: 100 mg po
bid 7 days
•Binds with ribosomal
units to inhibit protein
synthesis, by
inactivating protein
enzymes.

21. Treatment: Medications
• Alternative Regimens
– Erythromycin Base:500 mg po qid 7 days
• Interferes with protein synthesis in the bacteria.
– Erythromycin Ethylsuccinate: 800mg po qid
7 days
• Binds with ribosomes and suppresses protein
synthesis.
– Levofloxacin: 500mg po qd 7 days
• Interferes with conversion of DNA
– Ofloxacin: 300 mg po bid 7 days
• Interferes with conversion of DNA

22. Alternative Treatment
A new option for treating partners of
patients diagnosed with chlamydia is
‘patient delivered partner therapy’.
• It is the clinical practice of
treating the sex partners by
providing prescriptions or
medications to the patient
to take home to his/her
partner without the heath
care provider first
examining the partner.

23. Nursing Considerations
– Always wear gloves
• Laundry needs to be
done properly
• Clean tables and/or
beds and change the
• Wash hands between paper between each
patients exam.

24. Common Nursing Diagnoses
• Sexual dysfunction • Ineffective health
R/T painful sexual maintenance
intercourse R/T multiple sex
AEB Bleeding during partners
intercourse. AEB sanguineous
discharge from the
penis/vagina

25. ORAL ANTIBIOTICS
Nursing •Patient needs to know to continue to take
Interventions medicine as ordered, even if symptoms
subside
•A follow up with both partners is
recommended to ensure that neither
partner is still infected.
PREVENTION
•Teach patients about the importance of
monogamous relationships with uninfected
partners.
•Use of mechanical barriers:
•Condoms
•Simultaneously treating the partner to
prevent re-infection
•Emphasize that it is still possible to spread
infection even though asymptomatic.

26. Nursing Interventions
• Advise abstinence from sex until treatment
has been completed
• Ensure partner is treated at the same time
• Report case to public health department
• Ensure patient begins treatment and will
have access to prescription follow up
• Teach about all STI’s and symptoms
• Explain treatment regimen and adverse
effects
• Encourage abstinence, monogamy, and safer
sex methods
• Stress importance of follow up exam and re-
testing

27. Patient Teaching
Cause:
A bacterium, Chlamydia
Trachomatis
Spread:
Usually during sex, man does not
have to ejaculate to spread
infection. Impossible to become
infected by touching an object
like a toilet seat.

28. Patient Teaching
Symptoms: can cause mild to sever symptoms or none at all.
• Women-up to 50% have • Men- common
no symptoms at symptoms include:
all, most common – Burning or pain with
include: urination
– Vaginal discharge – Discharge from the
penis
– Abnormal vaginal
bleeding – Pain or tenderness of
testes
– Abdominal pain
– Swelling in scrotum
– Pain during sex
– Burning or pain with
urination

29. Patient Teaching
TESTING FOR CHLAMYDIA
• Once yearly testing is
recommended for:
– All sexually active women
younger than 25 years old
– Older women with risk
factors for acquiring
Chlamydia
– All pregnant women

30. Patient Teaching
Prevention
Complications • Avoid sexual intercourse
• Pelvic Inflammatory Disease • Use latex condoms every
(PID) time men have sex
• If infection is not treated • Discuss testing for STI with
about 30% of women will doctor or Nurse
develop scarring of fallopian • See doctor if any symptoms
tubes, resulting in infertility occur
• Do not have sex if you or
your partner has abnormal
Treatment discharge, burning with
• One time antibiotic, PO: urination, or a genital rash
azithromycin or sore.

31. Information Resources
1. http://www.thesite.org/sexandrelationships/safers
ex/sexualhealth/chlamydia
2. http://www.cdc.gov/std/chlamydia/default.htm
3. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH
0002321/
4. http://www.std-gov.org/stds/chlamydia.htm
5. http://www.webmd.com/sexual-
conditions/guide/chlamydia
6. http://drugster.info/ail/pathography/757/
7. http://www.cdc.gov/std/ept/

32. Picture Resources
• http://jamiesideas.wordpress.com/ideas/
• http://www.healthline.com/health-
blogs/teen-health-411/chlamydia-and-teens-0
• http://www.std-gov.org/stds/chlamydia.htm
• http://www.beautifulcervix.com/cervix-photo-
galleries/pap-smear/