Chlamydia

Symptoms:

Females
  • Unusual vaginal discharge
  • Mucopurulent discharge from the cervical os
  • Cervicitis, cervical erosion or bleeding from the cervix
  • Burning sensation when urinating
  • Lower abdominal pain
  • Pain during intercourse, bleeding between menstrual periods
  • May present with no symptoms
Males
  • Discharge from penis
  • Burning sensation when urinating
  • Burning, itching, or irritation around the opening of the penis
  • Pain/swelling in the testicles (associated with epididymitis)
  • May present with no symptoms

Definitive Diagnosis:

Positive lab results (see Testing)

Testing is recommended at least annually for:
  • Women under age 25
  • Women over 25 with risk factors (new partner, multiple partners, unprotected sex, history of STD, commercial sex, coerced sex)
  • Sexually active men who have sex with men

Also recommended for:

  • Pregnant women of any age
  • People in correctional facilities

See US Preventative Services Task Force for more information.

Tests:

  • Nucleic Acid Amplification Testing (NAAT) - Specimens can be first catch urines, urethral swabs for males, and vaginal or endocervical swabs for females. May also be used for oropharyngeal or rectal swabs if the lab has established specifications for running them (not FDA approved for this use).
Recommended, with reservations:
  • Culture - May be used at all sites, but NAATs are more sensitive, easier, and have a quicker turnaround time. See CDC's lab recommendations for more details.
Not Recommended:
  • Direct Flourescent Antibody - Only meant to test for ocular chlamydia.
  • Enzyme Immunoassay (EIA) - Specimens can be endocervical swabs for females and urethral swabs for males.
  • Nucleic Acid Hybridization - Specimens can be endocervical swabs for females and urethral swabs for males.
  • Test kits are available through referral laboratories. Testing/test kit availability may vary by laboratory.

NOTE: In cases of sexual assault, specific tests should be used. Please see the CDC's Detection of Genitourinary and Extragenital C. trachomatis and N. gonorrhoeae Infections in Cases of Sexual Assault.

Test of Cure:

Except in pregnant women, test-of-cure (i.e., repeat testing 3-4 weeks after completing therapy) is not advised for persons treated with the recommended or alternative regimens, unless therapeutic compliance is in question, symptoms persist, or reinfection is suspected. Moreover, the validity of chlamydial diagnostic testing at < 3 weeks after completion of therapy has not been established. Nucleic acid amplification tests (NAAT) conducted at < 3 weeks after completion of therapy in persons who were treated successfully could yield false-positive results because of the continued presence of nonviable organisms.

Retest:

Unlike the test-of-cure, which is not recommended, repeat C.trachomatis testing of recently infected women or men should be a priority for providers. Retesting should occur approximately 3 months after treatment, regardless of whether they believe that their sex partners were treated. If retesting at 3 months is not possible, clinicians should retest whenever persons next present for medical care in the 12 months following initial treatment.

​First Line Treatment

Azithromycin (Zithromax) 1 gm orally in a single dose
or
Doxycycline 100 mg orally twice a day for 7 days

Recommended first line treatment for HIV positive patients.

Alternative Treatment

Alternative:

Erythromycin base 500mg orally four times a day for 7 days
or
Erythromycin ethylsuccinate 800mg orally four times a day for 7 days
or
Levofloxacin 500mg orally once daily for 7 days
or
Ofloxacin 300mg orally twice a day for 7 days

Pregnant/Breastfeeding

Azithromycin (Zithromax) 1 gm orally in a single dose

Pregnant/Breastfeeding Alternative

Alternative:

Amoxicillin 500mg orally three times a day for 7 days
or
Erythromycin base 500mg orally four times a day for 7 days
or
Erythromycin base 250mg orally four times a day for 14 days
or
Erythromycin ethylsuccinate 800mg orally four times a day for 7 days
or
Erythromycin ethylsuccinate 400mg orally four times a day for 14 days

Pelvic Inflammatory Disease

Ceftriaxone 250mg IM in a single dose &
Doxycycline 100 mg orally twice daily for 14 days
WITH or WITHOUT
Metronidazole 500 mg orally twice daily for 14 days

Alternative:

*Cefoxitin 2 gm IM in a single dose and Probenecid 1 gm orally administered concurrently in a single dose &
*Doxycycline 100 mg orally twice daily for 14 days
WITH or WITHOUT
*Metronidazole 500 mg orally twice daily for 14 days

*Other parenteral third-generation cephalosporin (e.g. ceftizoxime or cefotaxime) &
*Doxycycline 100 mg orally twice daily for 14 days
WITH or WITHOUT
Metronidazole 500 mg orally twice daily for 14 days

Pelvic Inflammatory Disease (PID)

Gonorrhea or chlamydia may progress into PID, though PID may have other causes as well. PID may consist of endometritis, salpingitis, tubo-ovarian abscess, and/or pelvic peritonitis. Patients with PID may be asymptomatic, have mild or non-specific symptoms, or have moderate to severe symptoms. Patients may present with pelvic/lower abdominal pain, vaginal discharge, dyspareunia, or abnormal bleeding. Any female presenting with suspected PID should be evaluated immediately or sent to the hospital or her OB/GYN.

If no other cause for illness is found, and the patient has cervical motion tenderness, uterine tenderness, or adnexal tenderness, she should be treated empirically for PID.

See Treatments for recommended outpatient treatment for mild to moderately severe cases.

Please see the CDC's Sexually Transmitted Diseases Treatment Guidelines, 2015 for more information on the diagnosis and treatment of Pelvic Inflammatory Disease.

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