Chlamydia trachomatis

(Redirected from Chlamydia)

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

Background

  • Most common STD in the United States[1]
  • Asymptomatic in > 50% of infected individuals
  • Risk factors[1]
    • Age <26 most prevalent group
    • Cervical ectopy
    • New or multiple sexual partners
    • Inconsistent or lack of use of barrier protection
    • Early coitarche

Complications

Clinical Features

Differential Diagnosis

Dysuria

Sexually transmitted diseases

Evaluation

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

Management

Presumed GC/chlamydia of cervix, urethra, or rectum (uncomplicated)[2]

Typically, treatment for both gonorrhea and chlamydia is indicated, if one entity is suspected.

Standard

  • Gonorrhea
    • Ceftriaxone IM x 1
      • 500 mg, if weight <150 kg
      • 1 g, if weight ≥150 kg
  • Chlamydia


Ceftriaxone contraindicated

^Additional chlamydia coverage only needed if treated with cefixime only

Partner Treatment

Presumed GC/chlamydia of the pharynx (uncomplicated)[3]

Standard
Typically, treatment for both gonorrhea and chlamydia is indicated, if one entity is suspected.

  • Gonorrhea
    • Ceftriaxone IM x 1
      • 500 mg, if weight <150 kg
      • 1 g, if weight ≥150 kg
  • Chlamydia


Ceftriaxone contraindicated

  • No reliable alternative treatments are available for pharyngeal gonorrhea
    • For persons with a history of a beta-lactam allergy, a thorough assessment of the reaction is recommended.[4]
    • For persons with an anaphylactic or other severe reaction (e.g. Stevens Johnson syndrome) to ceftriaxone, consult an infectious disease specialist for an alternative treatment recommendation.

Disposition

  • Discharge
  • Avoid sex for 7 days to prevent transmission
  • Partners in the previous 60 days should all be notified/tested/treated[1]
  • Rescreen in 3 months

See Also

References

  1. 1.0 1.1 1.2 Keegan MB, Diedrich JT, Peipert JF. Chlamydia trachomatis Infection: Screening and Management. Journal of clinical outcomes management : JCOM. 2014;21(1):30-38.
  2. Cyr SS et al. Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. MMWR. Center for Disease Control and Prevention. 2020. 69(50):1911-1916
  3. Cyr SS et al. Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. MMWR. Center for Disease Control and Prevention. 2020. 69(50):1911-1916
  4. CDC. Sexually transmitted diseases treatment guidelines. MMWR Recomm Rep 2015;64(No. RR-3). https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6403a1.htm.