Chlamydia Trachomatis Infection

Key Features

• 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

Clinical Findings

• 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

Diagnosis

• 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

Treatment

• 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