Case study: Chlamydia Infection

The case

A 19-year-old woman presented because of the recent onset of breakthrough bleeding. She has been taking the same oral contraceptive Pill for two years, she has not forgotten any pills or had diarrhoea or vomiting. She has been with her current sexual partner for four months and has recently stopped using condoms as additional protection. She is otherwise well.

On examination the vulva and vagina are healthy and there is no inflammation. There is a small cervical ectropion and profuse mucopurulent discharge from the cervix. There is no tenderness on bimanual vaginal examination and no masses palpable. What is the diagnosis, management and differential diagnosis? 

Diagnosis and management

The diagnosis is chlamydia infection. It is very often asymptomatic but can have serious consequences of pelvic pain and fertility problems if untreated. It is more common in women who have a cervical ectropion. The presence of mucopurulent discharge should alert the clinician to the possibility of chlamydia. Diagnosis is confirmed by taking an endocervical swab. Treatment is with antibiotics, either azithromycin 1g immediately or doxycycline 100mg twice daily for seven days. Any sexual contacts need to be traced and treated. 

Possible different diagnoses

  • Gonorrhoea.
  • Cervical ectropion.
  • Trichomonas.

Differential diagnosis

Gonorrhoea

  • Occasionally presents with skin lesions.
  • May cause pelvic inflammatory disease.
  • Treatment is with antibiotics. 

Contributed by Dr Gwen Lewis, a GP in Windsor, Berkshire

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