Chlamydia

Chlamydia is most common STD, if you don’t count HPV. It’s caused by Chlamydia trachomatis serotypes D-K. It may progress to pelvic inflammatory disease.

Clinical features

90% of affected people are asymptomatic. Possible symptoms in women include:

Urethritis with dysuria
Mucopurulent discharge
Postcoital bleeding

Men may experience prostatitis and epididymitis.

Diagnosis and evaluation

PCR of vaginal swab.

Treatment

Single dose 1 g PO azithromycin or doxycyclin for 7 days.

Complications

Reiter syndrome/reactive arthritis is a complication of many bacterial infections, most commonly after chlamydia. It’s associated with HLA-B27 and mostly affects young males. It’s characterised by a clinical triad of:

Arthritis
Conjunctivitis
Urethritis

Trichomoniasis

Trichomoniasis is a sexually transmitted infection caused by trichomonas vaginalis.

Clinical features

It’s asymptomatic in 70%. Foul-smelling, yellow-green coloured vaginal discharge is highly suspicious for trichomoniasis. Other symptoms include:

Itching
Burning
Dyspareunia
Itchiness
Redness
Strawberry cervix – typical appearance of cervix like a strawberry

Diagnosis and evaluation

Physical examination may reveal characteristic appearance or odour.

pH measurement is also important. The pH of the vagina is normally 4 – 4,5, but in case of bacterial vaginosis or trichomoniasis, the pH is > 4,5. The Amine test (for bacterial vaginosis) is positive here as well.

Vaginal smear, the examination of vaginal fluid under the microscope, may also be performed. For trichomoniasis, motile organisms with multiple flagella are visible.

Treatment

Metronidazole is the first line treatment for both the patient and the partner. A single dose 2g p.o. metronidazole may be used.