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

Genitourinary infection

(1) Human urinary system: (2) kidney; (3) renal pelvis; (4) ureter; (5) urinary bladder (6) urethra.
Additional structures: (7) adrenal gland; (8) renal artery and vein; (9) inferior vena cava; (10) abdominal aorta; (11) common iliac artery and vein; (12) liver; (13) large intestine; (14) pelvis.

"UTI" frequently refers specifically to acute cystitis, but may also be used as a general term for all urinary infections; use location-specific diagnosis.

• Renal/perirenal
  • Pyelonephritis
    • Emphysematous pyelonephritis
  • Renal abscess
  • Perinephric abscess
• Ureteral
  • Infected urolithiasis
• Bladder
  • Acute cystitis ("UTI")
  • Chronic cystitis
• Urethra/periurethra
  • Urethritis
  • Prostatitis

Diagnostic 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)