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 Epidemichttp://youtu.be/D4Y3QXOZY6E
Signs and Symptoms: Women• Vaginal Discharge• Burning or painful urination• Abdominal or low back pain• Nausea• Fever• Pain with intercourse• Vaginal bleeding between periods.
Signs and Symptoms: Men • Burning, frequent, and painful urination • Penile discharge • Swollen and painful testicles • If rectally: characterized by pain, discharge, and bleeding.
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.
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)
Complications During and After PregnancyDuring:Some evidence suggests that it maylead to premature delivery After: Babies may become infected in the respiratory tract or their eyes during the birthing process.
Diagnostic Testing:Based on individual sexual history and lab results. • Urinalysis
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.
Diagnostic Testing Pap SmearAlthough a pap smearitself can’t be used todetect Chlamydia, theswab taken during thetest is used for theantigen detection test.Occasionally somecellular changes will occurmaking the cells reactiveand containing pustules.These are not conduciveto diagnosing Chlamydia.
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 CultureA culture is obtained from through aspiration.
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.
‘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
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.
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 chlamydiashould abstain fromsexual intercourse untilafter full course ofantibiotics or at least 7days from single dose. •Pregnant women would be treated with erythromycin.
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.
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.
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
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.
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.
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
ORAL ANTIBIOTICS Nursing •Patient needs to know to continue to takeInterventions 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.
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
Patient TeachingCause: A bacterium, ChlamydiaTrachomatis 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.
Patient TeachingSymptoms: 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
Patient TeachingTESTING 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
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 abnormalTreatment discharge, burning with• One time antibiotic, PO: urination, or a genital rash azithromycin or sore.