1. Reason for surveillance
2. Case definitions
3. Notification criteria and procedure
4. The disease
5. Managing single notifications
6. Managing special situations

1. Reason for surveillance

To monitor the epidemiology of the disease and so inform prevention strategies.

2. Case definition

A confirmed case requires laboratory definitive evidence (excluding eye infections).

Laboratory definitive evidence

• Isolation of Chlamydia trachomatis, or
• Detection of C. trachomatis by nucleic acid testing, or
• Detection of C. trachomatis antigen.

Clinical evidence

Not applicable

Epidemiological evidence

Not applicable

Factors to be considered in case identification

Clinical manifestations of chlamydial infections are difficult to distinguish from gonorrhoea. Symptoms are not necessarily present in all cases.

3. Notification criteria and procedure

Chlamydia trachomatis infection of any site is to be notified by laboratories on microbiological confirmation (ideal reporting by routine mail). Only confirmed cases should be entered onto NCIMS.

4. The disease

Infectious agent

The bacterium Chlamydia trachomatis.

Mode of transmission

Contact with exudate from mucous membranes of infected people, almost always as a result of sexual activity or perinatal transmission.

Timeline

The typical incubation period is poorly defined, probably 7 to 14 days or more.

The period of communicability is unknown. Relapses are common, and an infected person may be intermittently infectious over many months.

Clinical presentation

Many infections are asymptomatic. The usual clinical presentation in males is a urethral discharge. Proctitis may be a presentation of the disease in persons who practise receptive anal intercourse. In females, mucopurulent cervicitis is the usual presentation. Congenital chlamydia generally presents as conjunctivitis or pneumonia in neonates.

5. Managing Single Notifications

Response times

Data entry

Within 5 working days of notification enter on NCIMS confirmed cases only.

Response procedure

Cases under 16 years

• Where a case is reported in a child <16 years old, the PHU must send a letter to the doctor who requested the test to undertake an assessment of the risk of harm according to the mandatory reporting guidelines and obligations under the Children and Young Persons (Care and Protection) Act, 1998 and resources for clinical management (Therapeutic Guidelines: Antibiotic).
• Where a case of chlamydia is reported in a child aged 12 years or under, the PHU must also directly contact the doctor (eg by telephone) to ensure the mandatory reporting obligations have been addressed. If no contact can be made, the PHU should contact the Child Wellbeing Unit (1300 480 420) or make a direct report to the Department of Community services.
• The PHU should make reasonable attempts to record in NCIMS the Indigenous status of all cases under 16 years, for example by checking the LHD patient management system and/or calling the diagnosing doctor.
• All actions should be documented in the NCIMS record.

Case management

Investigation and treatment

In general, the attending medical practitioner is responsible for treatment.

Refer to Therapeutic Guidelines: Antibiotic.

Education

In general, the case's doctor provides educational and counselling. The medical practitioner should provide information to the case about the nature of the infection and the mode of transmission.

Contact Management

Identification of contacts

Sexual contacts usually up to 6 months depending on symptoms.

Investigation and treatment

The attending doctor is responsible for contact tracing. PHU's should work with Sexual Health Service Staff to assist if requested. Contacts require counselling, examination and testing, and are usually treated.

6. Managing Special Situations

Case clustering

Case clustering, for example among clients of a sex industry establishment, may indicate the need to initiate an education and/or screening program to meet local requirements.