By Helen Carter
Optometrists should be alert to the possibility of chlamydial conjunctivitis in conjunctivitis cases that fail to clear, Optometry Australia optometrist Andrew Kotsos has advised.
He was commenting after a new report revealed that one in 20 young Australians has chlamydia.
The report found that at the end of 2015, there were an estimated 260,000 new cases of chlamydia in 15- to 29-year-olds, translating to five per cent of young Australians having the sexually transmitted disease last year. Nearly three-quarters were undiagnosed and untreated.
The report, by The Kirby Institute for Infection and Immunity in Society, UNSW, was released at the 2016 Australasian Sexual Health Conference in Adelaide on 14-16 November. The institute’s Surveillance Evaluation and Research Program head, Associate Professor Rebecca Guy, said there had been a steady increase in chlamydia notifications in the past 10 years.
‘The increase is due to more testing, including a two-fold increase in general practice in the past eight years,’ she said.
‘The 15- to 29-year-olds accounted for three-quarters of cases of the most commonly reported STD in Australia. Encouragingly, there was a 19 per cent decline in chlamydia notification rates in adolescents aged 15 to 19 years.’
More than 80 per cent of people with chlamydia show no symptoms but regular testing can lead to diagnosis and treatment with single dose antibiotics, to help prevent progression to pelvic inflammatory disease (PID) and infertility in women. One in 10 young women with untreated chlamydia will develop PID.
Mr Kotsos, Optometry Australia’s professional development officer, said that while an optometrist could diagnose chlamydial eye infection based on clinical appearance and laboratory tests, they would then need to refer the patient to a GP or ophthalmologist to prescribe the oral antibiotics needed for treatment.
‘According to current protocols reported on Medscape, treatment consists of systemic antibiotics as topical antibiotics are relatively ineffective in the treatment of this eye disease,’ he said.
‘According to Medscape, conclusions from a 2013 study show single-dose azithromycin should be considered as reliable as long-term alternative regimens for adult inclusion conjunctivitis. Adult inclusion conjunctivitis presents as a unilateral or less commonly bilateral, red eye with mucopurulent discharge, marked hyperaemia, papillary hypertrophy and a predominant follicular conjunctivitis.
‘Conjunctivitis often is chronic and may last for many months,’ he said.
‘Medscape states that inferior tarsal conjunctival follicles are obvious, and a tender enlarged preauricular lymph node common. Keratitis may develop during the second week after onset. Corneal involvement includes a superficial punctate keratitis, small marginal or central infiltrates, epidemic keratoconjunctivitis-like subepithelial infiltrates which tend to be more peripheral than after epidemic keratoconjunctivitis, limbal swelling, and a superior limbal pannus.
‘Untreated disease has a chronic remittent course, and keratitis and possibly iritis occur more commonly in later stages.’
Mr Kotsos suggested optometrists enquire about duration of symptoms, prior treatment and sexual exposure.
‘The Medscape website reports that while women often have a concomitant vaginal discharge secondary to chronic vaginitis or cervicitis, men may have symptomatic or nonsymptomatic urethritis, and simultaneous treatment of all sexual partners is important to prevent reinfection,’ he said.
Associate Professor Mark Roth, optometrist and Principal Fellow in the University of Melbourne Department of Optometry and Vision Science, told SRC this year that optometrists should consider chlamydia in adults with recurrent unilateral red eye. He said single dose one gram azithromycin was excellent against chlamydia.
According to the American Academy of Ophthalmology, bacterial conjunctivitis concurrent with chlamydial infection should be managed with azithromycin, doxycycline, tetracycline or erythromycin. Optometrists cannot prescribe these medications but must refer patients to doctors who can.