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Key Features

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  • Most common bacterial cause of sexually transmitted infections in the United States

  • In 2013, over 1.4 million cases in adolescents and young adults were reported to the Centers for Disease Control and Prevention

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Clinical Findings

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  • In females

    • May be asymptomatic in 75%

    • Manifests as dysuria, urethritis, vaginal discharge, cervicitis, irregular vaginal bleeding, or pelvic inflammatory disease

    • Presence of mucopus at the cervical os (mucopurulent cervicitis) is a sign of chlamydial infection or gonorrhea

  • In males

    • May be asymptomatic in 70%

    • Manifests as dysuria, urethritis, or epididymitis

    • Some patients complain of urethral discharge

    • On clinical examination, a clear white discharge may be found after milking the penis

    • Proctitis or proctocolitis may occur in adolescents practicing receptive anal intercourse

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Diagnosis

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  • Nucleic acid amplification tests are most sensitive (92%–99%) method to detect Chlamydia

  • Enzyme-linked immunosorbent assay or direct fluorescent antibody tests are less sensitive, but may be the only testing option in some centers

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Treatment

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  • Cervicitis or urethritis

    • Azithromycin, 1 g orally as single dose

    • Doxycycline, 100 mg orally twice a day for 7 days

  • Alternative regimens

    • Erythromycin, 500 mg orally four times a day for 7 days

    • Erythromycin ethylsuccinate, 800 mg orally four times a day for 7 days

    • Levofloxacin 500 mg orally once daily for 7 days

    • Ofloxacin, 300 mg orally twice a day for 7 days

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