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Hot Topics in Sexually Transmitted Infections and Associated Conditions

(Published November 2013)

Chlamydia

  • Key facts about infection
    • Genital infections caused by CT are the most frequently reported infectious disease in the United States, with 1.4 million cases reported in 2011.13
    • Chlamydial infection can cause urethritis and cervicitis but is often asymptomatic in both men and women.
    • Genital chlamydial infections are associated with several adverse consequences, including PID, ectopic pregnancy, infertility, and chronic pelvic pain.9
    • Co-infection with gonorrhea is common.14,15
  • Screening and diagnosis
    • Routine laboratory screening is recommended in asymptomatic sexually active women who have the following risk factors:
        • Age 25 years
        • Age 26 years with
          • New sex partner
          • Multiple sex partners
          • Inconsistent use of condoms (unless in monogamous relationship)
          • New diagnosis of other STI

Table 3: Testing Options for Chlamydia9,16

Nucleic Acid Amplification Test (NAAT) Culture
Test method of choice-higher sensitivity than culture Not routinely done-may be useful for evaluating and managing suspected treatment failure
Allows the widest variety of testing sites, but specific test kits vary in the specimen types for which they are FDA cleared Used only in research situations to assess possible trends in antimicrobial susceptibility
  • Anatomical sites for testing
    • In women
      • Vaginal swab is the preferred site for NAAT screening and may be collected by either clinician or patient; vaginal swab detects more infections than endocervical swab, which is no longer recommended for routine screening or diagnostic testing.
      • A urine specimen ("first catch" rather than midstream "clean catch") is acceptable when logistical considerations preclude vaginal swab (e.g., screening in nonclinical settings).
      • Rectal swab is recommended if anal sexual exposure has occurred.
      • CT testing of the pharynx is generally not recommended, even in women who perform oral sex, but is usually bundled with GC testing by NAAT.
    • In men
      • Either a first-catch urine specimen or a urethral swab can be used for screening and diagnostic testing.
      • Specimens from the rectum should be tested if sexual exposure has occurred.
      • Pharyngeal CT testing is not recommended, but bundled testing may accompany GC testing by NAAT.
    • NAATs are not FDA cleared for nongenital sites such as the pharynx, although some laboratories have created performance specifications that allow NAATs to be used for these sites. Clinicians should check product inserts or check with their laboratories for specific information.
    • Laboratories may require different types of swabs for different collection sites (e.g., vaginal, male urethral, pharyngeal) for NAATs. Clinicians should ensure use of the correct collection kits.
  • Treatment and management

Table 4: Recommended Regimens for the Treatment of Uncomplicated Genital Chlamydial Infection*9

Medication Dosage Comments
Azithromycin 1 g orally, single dose The usual treatment of choice
Doxycycline 100 mg orally twice daily for 7 days For patients who do not tolerate azithromycin or who are likely to comply with 7 days' treatment; contraindicated in pregnancy
Levofloxacin 500 mg orally once daily for 7 days When neither azithromycin nor doxycycline can be used; contraindicated in pregnancy

* For alternative regimens or for treatment of children or individuals with complicated infection, coexisting HIV infection, or infection at nongenital sites, see CDC treatment guidelines.

    • Treatment is recommended for all opposite-sex partners within the preceding 60 days. EPT is a routine option when the partner may not seek clinical treatment and where allowed by local/state regulations.
    • Clinicians should report cases of confirmed chlamydia to the local or state health department as required by law.