Chlamydia Genital Infection

Background

• Chlamydia genital infection is a sexually transmitted infection caused by Chlamydia trachomatis that is often asymptomatic.
• The incubation period is poorly defined and symptoms, if present, may appear several weeks following exposure.
• Perinatal infection of mucous membranes in neonates may occur from exposure to an infected maternal cervix.

Evaluation

• Suspect chlamydia infection in patients with symptoms including:
  • vaginal discharge, postcoital or intermenstrual bleeding, or dysuria in women
  • urethral discharge, dysuria, or scrotal pain or swelling in men
• Confirm infection using nucleic acid amplification tests (NAAT).
  • In women:
    • Use a vaginal swab.
    • If a speculum exam is performed, obtain an endocervical specimen.
    • Consider first-catch urine, though it may detect up to 10% fewer infections than vaginal and endocervical swabs.
  • In men, use first-void urine rather than a urethral swab.
  • Rectal and oropharyngeal swabs may also be performed.
• Screening for chlamydia genital infection:
  • All pregnant women should be screened for chlamydia at the first prenatal visit and those < 25 years old or who have risk factors should be retested in the third trimester.
  • In women, annual screening for chlamydia genital infection is recommended for all sexually active women < 25 years old and for women ≥ 25 years old at an increased risk for infection.
  • In men who have sex with men, annual screening for chlamydia infection is recommended and screening should be considered for sexually active young men in settings where the prevalence of chlamydia is high.
• Test patients with chlamydia infection for other sexually transmitted infections and test patients with other sexually transmitted infections for chlamydia.

Management

• Treat with doxycycline 100 mg orally twice daily for 7 days.
• For pregnant patients, azithromycin 1 g orally in a single dose is the first-line agent.
• Abstinence from sexual intercourse should be continued for 7 days after a single-dose regimen or after completion of a 7-day regimen.
  • Repeat testing 4 weeks after completing therapy (test of cure) is not recommended unless the patient is pregnant, or if there is suspected nonadherence, persistent symptoms, or suspected reinfection.
  • Screening for reinfection (repeat testing 3 months after treatment) is recommended for all patients, regardless of whether the sex partners were also treated.
• Test and treat the most recent sexual partner and all sexual partners within 60 days preceding the onset of symptoms.
• Consider patient-delivered partner therapy if there is a concern that the partner will not seek health services.
• Cure rates with treatment are > 90%, but reinfection occurs in about 20% in 1 year.