A handout on this topic is available at https: Chlamydia trachomatis is a gram-negative bacterium that infects the columnar epithelium of the cervix, urethra, and rectum, as well as nongenital sites such as the lungs and eyes.
The bacterium is the cause of the most frequently reported sexually transmitted disease in the United States, which is responsible for more than 1 million infections annually. Most persons with this infection are asymptomatic. Untreated infection can result in serious complications such as pelvic inflammatory disease, infertility, and ectopic pregnancy in women, and epididymitis and orchitis in men.
Men and women can experience chlamydia-induced reactive arthritis. Treatment of uncomplicated cases should include azithromycin or doxycycline. Screening is recommended in all women younger than 25 years, in all pregnant women, and in women who are at increased risk of infection.
Screening is not currently recommended in men. In neonates and infants, the bacterium can cause conjunctivitis and pneumonia. Adults may also experience "Sexually transmitted diseases chlamydia trachomatis eye" caused by chlamydia.
Trachoma is a Sexually transmitted diseases chlamydia trachomatis eye ocular infection caused by chlamydia and is endemic in the developing world. Chlamydia trachomatis is a gram-negative bacterium that infects the columnar epithelium of the cervix, urethra, and rectum, as well as nongenital sites.
The bacterium is the cause of the most frequently reported sexually transmitted disease in the United States, 1 and is the leading cause of infectious blindness in the world. Nucleic acid amplification tests are the most sensitive tests for detecting chlamydia infection, and may be performed on endocervical, urethral, vaginal, pharyngeal, rectal, or urine samples.
Azithromycin Zithromax or doxycycline should be used for the treatment of uncomplicated genitourinary chlamydia infection in men and women. Azithromycin or amoxicillin should be used as first-line treatment of genitourinary chlamydia infection in pregnant women.
The USPSTF recommends screening for chlamydia infection in all sexually active nonpregnant women 24 years and younger, and all nonpregnant women 25 years and older who are at increased risk. The USPSTF concludes there is insufficient evidence to recommend for or against the screening of men for chlamydia infection. Although the CDC recommends screening for chlamydia infection in all pregnant women, the USPSTF recommends routine screening only in all pregnant women 24 years and younger, and in pregnant women 25 years and older who are at increased risk.
Some experts recommend screening certain groups of high-risk men e. Preventive Services Task Force. For information about the SORT evidence rating system, go to https: Genitourinary infection affects primarily young adults and persons with multiple sex partners. CDC statistics show that the overall rate of infection was almost three times higher among women than men, 7 although this may be because of existing screening programs for women.
Approximately 79 percent of the U. Young women 15 to 19 years of age carry the highest incidence of disease, followed by women 20 to 24 years of age.
Other groups at higher risk include adolescents and men who have sex with men. According to the CDC, chlamydia infection rates in men are also increasing, and at a faster rate than in women. Between andthe reported infection rate for men rose from Prevalence rates among men vary depending on the subgroups screened. One study reported a prevalence of 3.
Most persons who are infected with C. However, when symptoms of infection are present, in women they most commonly include abnormal vaginal discharge, vaginal bleeding including bleeding after intercourseand dysuria. In men, symptoms may include penile discharge, pruritus, and dysuria. However, in one study, only 2 to 4 percent of infected men reported any symptoms. Persons who have receptive anal intercourse can acquire a rectal infection, which can present as pain, discharge, or bleeding.
Those engaging in oral sex can acquire a pharyngeal infection from an infected partner. Nucleic acid amplification tests NAATs are the most sensitive tests for detecting chlamydia and gonococcal infections. Point-of-care testing at a physician's office is recommended, although increasingly, researchers have begun to evaluate commercially available mail-in kits. To date, commercial kits have not been shown to be reliable, and have lower sensitivity and specificity than NAATs.
Uncomplicated genitourinary chlamydia infection should be treated with azithromycin Zithromax; Sexually transmitted diseases chlamydia trachomatis eye g, single dose or doxycycline mg twice daily for seven days; Table 1 115 — Studies indicate that both treatments are equally effective. Uncomplicated genitourinary infection Erythromycin, mg four times daily for seven days.
Erythromycin ethylsuccinate, mg four times daily for seven days. Levofloxacin Levaquinmg once daily for seven days. Ofloxacin Floxinmg twice daily or mg once daily for seven days. Infection during pregnancy 1 Amoxicillin, mg three times daily for seven days.
Erythromycin, mg four times daily for seven days, or mg four times daily for 14 days. Erythromycin ethylsuccinate, mg four times daily for seven days, or mg four times daily for 14 days. Chronic reactive arthritis 17 Doxycycline, mg twice daily, plus rifampin, mg once daily for six months. Azithromycin, mg once daily for five days, "Sexually transmitted diseases chlamydia trachomatis eye" mg twice weekly, plus rifampin, mg once daily for six months.
Erythromycin, mg four times daily for 21 days. Neonatal pulmonary infection Erythromycin or erythromycin ethylsuccinate, 50 mg per kg daily in four divided doses for 14 days.
Adult-inclusion conjunctivitis 20 Information from references 1and 12 through Alternative regimens for uncomplicated chlamydia infection include erythromycin mg four times daily for seven dayserythromycin ethylsuccinate mg four times daily for seven dayslevofloxacin Levaquin; mg once daily for seven daysor ofloxacin Floxin; mg twice daily or mg once daily for seven days.
Pregnant women may be treated with azithromycin 1 g, single dose or amoxicillin mg three times daily for seven days. Alternative regimens include erythromycin mg four times daily for seven days or mg four times daily for 14 days and erythromycin ethylsuccinate mg four times daily for seven days or mg four times daily for 14 days. Although all three medications show similar effectiveness, a recent review indicates that azithromycin may have fewer adverse Sexually transmitted diseases chlamydia trachomatis eye when compared with erythromycin or amoxicillin in pregnant women.
Test of cure is recommended three to four weeks after completion of treatment in pregnant women only. If chlamydia is detected during the first trimester, repeat testing for reinfection should also be performed within three to six months, or in the third trimester. If this is not possible, clinicians should retest the patient to screen for reinfection when he or she next presents for medical care within 12 months after treatment.
Partners should be notified of infection and treated appropriately. Studies indicate that expedited partner therapy partners treated without medical consultation may improve clinical and behavioral outcomes pertaining to partner management among heterosexual men and women with chlamydia infection. Make diagnosis via specimen collection i. All pregnant women infected with chlamydia should be retested three to four weeks after completing treatment.
Test of cure is not advised for nonpregnant patients who finished one of the courses of treatment. Repeat testing for reinfection of men and women who were recently infected is recommended at Sexually transmitted diseases chlamydia trachomatis eye months after completion of treatment, or within the first year following treatment. Sex partners should be referred for evaluation, testing, and treatment if they engaged in sexual contact within 60 days before a diagnosis was made or at the onset of symptoms.
Advise patients to abstain from sexual contact until they and their sex partners have finished one of the recommended treatments, and for seven days afterward. Information from reference 1. Preventive Services Task Force recommends routine screening in all sexually active women 24 years and younger, and in women 25 years and older who are at increased risk because of having multiple partners or a new sex partner.
There is insufficient evidence to recommend screening in men, although a small number of studies suggest that screening high-risk groups may be useful and cost-effective. In men who have sex with men, some experts recommend screening for rectal infections a rectal swab in those who have had receptive anal intercourse during the preceding year. There are a number of ways to prevent, or at least significantly reduce, the incidence of genitourinary chlamydia infection.
The most definitive methods of prevention are practicing abstinence and being in a long-term, mutually monogamous relationship.