This site is intended for healthcare professionals.


This quick reference on chlamydia on A4Medicine starts with some basic information about this common sexually transmitted infection. Presentation and complications are discussed with a further explanation of risk to the newborn. Testing including NAAT test is discussed and options of treatment are displayed clearly. In case the GP wishes to treat this condition a brief description of the current prescribing guidance of antibiotics is presented.

Chlamydia trachomatis Humans are the natural host Serovars associated with endemic trachoma are A , B , Ba and C Serovars associated with STIs are D, E, F, G ,H , I ,J and K Lymphogranuloma venereum L1 , L2 and L3  Genital chlamydia most commonly reported bacterial STI worldwide Men → affects urethra ( non-gonococcal urethritis ) ocassionally epididymitis Women →urethritis , cervicitis and pelvic inflammatory disease ( PVD ) Can also infect conjunctiva , rectum and nasopharynx Transmission -direct inoculation of infected secretions from one mucous membrane to another Infection has not ascended the upper genital tract -Uncomplicated infection    Spread to upper genital tract- PID in women
Epididymo-orchitis in men-Complicated

Epidemiology-Most common in people aged 16-25 At least 70 % of infected ♀ and 50 % of infected ♂ remain asymptomatic 2/3 of sexual partners of chlamydia + ve individuals will also be Chlamydia +ve Risk factors
○ Age < 25
○ More than 1 partner in the last year or a recent new sexual partner
○ Lack of consistent use of condoms Untreated infections may persist for > 1 yr ( 50 % cases ) About 95 % will clear spontaneously after 4 yrs

Lymphogranuloma venereum-Caused by L1 , L2 and L3 serotypes Outbreaks in HIV + ve ♂ pts who have sex with men Most presents with proctitis Asymptomatic infection may occur

 ↑ ed Vaginal discharge Post coital ( PCB ) or intermenstural bleeding ( IMB ) Purulent vaginal discharge Mucopurulent cervical discharge Dysuria ( sterile pyuria – may be Chlamydia ) Lower abdominal / pelvic pain Cervica motion tenderness Deep dyspareunia Cervicitis

 Dysuria Mucoid or mucopurulent urethral disharge Urethral discomfort / urethritis Epididymo-orchitis Reactive arthritis

○ 10-40 % will develop PID if not treated
○ risk ↑ es with each recurrence
○ can cause tubal factor infertility , ectopic pregnancy ,chronic pelvic pain
 ADULT CONJUNCTIVITIS ( if eye exposed to secretions )
○ within 1-2 weeks after exposure
○ men > women
○ polyarthritis of wt bearing joints
 PERIHEPATITIS ( Fitz-Hugh-Curtis syndrome )
○ inflammation of hepatic capsule – RUQ pain can be referred to rt shoulder 
○ usually in ♀ with PID
○ rare
○ ↑ risk premature rupture of membranes
○ ↑ risk pre-term delivery and LBW
○ ↑ risk intra-partum pyrexia and late post partum endometritis
○ ↑ risk post-abortal PID
 Refer all ♀ to
 GUM clinic if PID suspected  Rectal infection is usually asymptomatic but anal discharge and anorectal discomfort may happen

Risks to newborn-Eye disease caused by trachoma biovar is called inclusion conjunctivitis Newborn acquires the infection during passage through an infected birth canal Starts a mucopurulent conjunctivitis 7-12 days after delivery Responds to erythromycin or tetracycline treatment 

 10-20 % infants may develop respiratory tract involvment 2-12 weeks after birth Presents with striking tachypnoe , charecteristic paroxysmal cough , absence of fever and eosinophilia Suspect if pneumonitis develops in a newborn who has inclusion conjunctivitis

Testing-Nucleic acid amplification tests ( NAAT ) Endocervical or vulvovaginal swab First catch urine ( FCU ) Kits for self taken VVSs or FCU available FCU ( specimen of choice ) Urethral swab Rectal swabs if indicated by history/ symptoms ( men and women ) to test for LGV ( Lymphogranuloma venerum ) HIV-positive ♂ who have sex with other ♂ Pharyngeal swabs- not done routinely NAAT samples- good for testing even few days after collection

Positive-Treat patient yourself and attend to partner notification + 
check for other STIs -Gonorrhoe , HIV , Syphilis , Hepatitis B
OR Treat patient yourself and refer to GU clinic for partner notification / screening for other STIs
OR Refer all patients to GU clinic Doxycyline 100 mg bd/7D 
( CI in pregnancy ) Azithromycin 1g po stat single dose Erythromycin 500 mg bd for 10-14 days Ofloxacin 200 mf bd/7D or 400 mg od/7 days ( CI in children and growing adults ) Pregnant-Azithromycin 1g single dose or Erythromycin 500 mg qds/7D or Erythromycin 500 mg bd/14 D or Amoxicillin 500 mg tds/7D

If uncertainity seek specialist advise Avoid sexual intercourse
 ( including oral sex ) until the person + partner (s) have completed treatment or waited 7 days after Azithromycin     Urgently refer GUM clinic if there is no response to 1st line Rx

Test of cure-Not routinely recommened if standard 1st line Rx used Consider if anything other than 1st line used Do test
○ pregnant ( ↓ efficacy of antibiotics )
○ non compliance suspected
○ symptoms persist TOC ( swab or urine ) no earlier than 3 weeks after completion of treatment Offer- repeat testing to all people < 25 diagnosed with chlamydia 3-6 months after rx Offer repeat test > 25s who are at ↑ risk of reinfection

Related Topics

Comments - to make a comment on the above chart please log in.