Chlamydia trachomatis
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
- PID
- Ectopic Pregnancy
- Infertility
Clinical Features
Pelvic speculum exam with view of cervix showing copious whitish discharge from chlamydia infection consistent with PID.
Chlamydia trachomatis on male GU exam consistent with urethritis.
- Vaginal discharge
- Intermenstrual vaginal bleeding
- Urethritis
- Epididymitis
- Proctitis
- Reactive arthritis (urethritis, chlamydial conjunctivitis, arthritis)
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
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
- Ceftriaxone IM x 1
- Chlamydia
- Nonpregnant: doxycycline 100 mg PO BID x 7 days
- Pregnant: azithromycin 1 g PO x 1
Ceftriaxone contraindicated
- Gonorrhea
- Gentamicin 240 mg IM x 1 PLUS azithromycin 2 g PO x 1, OR
- Cefixime 800 mg PO x 1
- Chlamydia^
- Nonpregnant: doxycycline 100 mg PO BID x 7 days
- Pregnant: azithromycin 1 g PO x 1
^Additional chlamydia coverage only needed if treated with cefixime only
Partner Treatment
- Gonorrhea
- Cefixime 800mg PO x 1
- Chlamydia
- Nonpregnant: doxycycline 100mg PO BID x 7 days, OR
- Pregnant: azithromycin 1g PO x 1
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
- Ceftriaxone IM x 1
- Chlamydia
- Nonpregnant: doxycycline 100 mg PO BID x 7 days
- Pregnant: azithromycin 1 g PO x 1
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.
Test of Cure
CDC recommends a repeat culture be obtained 7-14 days after initial treatment only in persons with pharyngeal gonorrhea.
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
- STDs
- Proctitis
- Lymphogranuloma venereum (for L1, L2, and L3 serovars)
- Chlamydia conjunctivitis
References
- ↑ 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.
- ↑ 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
- ↑ 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
- ↑ CDC. Sexually transmitted diseases treatment guidelines. MMWR Recomm Rep 2015;64(No. RR-3). https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6403a1.htm.