Chlamydia trachomatis

Not to be confused with chlamydophila, another genus of pathogenic bacteria

Background

• Most common STD in the United States
• Asymptomatic in > 50% of infected individuals
• Risk factors
  • Age <26 most prevalent group
  • Cervical ectopy
  • New or multiple sexual partners
  • Inconsistent or lack of use of barrier protection
  • Early coitarche

Complications

• PID
• Ectopic Pregnancy
• Infertility

Clinical Features

• Vaginal discharge
• Intermenstrual bleeding
• Urethritis
• Epididymitis
• Proctitis
• Reiter syndrome (urethritis, conjuctivitis, rash)

Differential Diagnosis

Dysuria

• Genitourinary infection
  • Acute cystitis ("UTI")
  • Pyelonephritis
  • Urethritis
  • Chronic cystitis
  • Infected nephrolithiasis
  • Prostatitis
  • Epididymitis
  • Renal abscess/perinephric abscess
  • Emphysematous pyelonephritis
• Nephrolithiasis
• Urethral issue
  • Urethritis
  • Urolithiasis
  • Urethral foreign body
  • Urethral diverticulum
  • Allergic reaction (contact dermatitis)
  • Chemical irritation
  • Urethral stricture or obstruction
  • Trauma to vagina, urethra, or bladder
• Gynecologic
  • Vaginitis/cervicitis
  • PID
  • Genital herpes
  • Pelvic organ prolapse
  • Fistula
  • Cystocele
• Other
  • Diverticulitis
  • Interstitial cystitis
  • Behavioral symptom without detectable pathology

Sexually transmitted diseases

• Chancroid
• Chlamydia trachomatis
• Granuloma inguinale
• Hepatitis B
• Herpes Simplex Virus-2
• HIV
• Human papillomavirus
• Lymphogranuloma venereum
• Neisseria gonorrhoeae
• Trichomonas
• Syphilis

Evaluation

• Endocervical or urethral swab
• Urine chlamydia test
• Speculum exam

Management

• Azithromycin 1g PO x1 OR
• Doxycycline 100mg PO BID x7 days

Disposition

• Discharge
• Avoid sex for 7 days to prevent transmission
• Partners in the previous 60 days should all be notified/tested/treated
• Rescreen in 3 months

See Also

• STDs
• Proctitis
• Lymphogranuloma venereum (for L1, L2, and L3 serovars)