Chlamydia

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Cause

Chlamydia trachomatis


Clinical presentation

  • Usually asymptomatic in both men and women. 
  • Men
    • urethritis with discharge and dysuria 

    • Complications: 
      • epididymo-orchitis
  • Women
    • cervicitis with vaginal discharge and post coital bleeding. 
    • Complications: 
      • pelvic inflammatory disease: chronic pelvic pain, ectopic pregnancy and infertility. 
      • Mother-to-child transmission: neonatal conjunctivitis and pneumonitis.

Diagnosis

Diagnosis in males

Test

Site/Specimen

Comments

NAAT

FPU

If MSM, also collect anal and pharyngeal swab even if asymptomatic at these sites.

NAAT

Anorectal swab  

If MSM, and patient declines anal examination or has no anorectal symptoms, instruct in self-collection 

Self-collection are as sensitive as those taken by a clinician and may be preferred by some men. 

NAAT

Pharyngeal swab 

Collect if MSM. Self-collection are as sensitive as those taken by a clinician and may be preferred by some men. 

NAAT – Nucleic Acid Amplification Test
FPU – First pass urine
MSM – Men who have sex with men

 

Diagnosis in females

Test

Site/Specimen

Comments

NAAT

Endocervical swab 

Best test if examined

NAAT

Self-collected vaginal swab

As sensitive as clinician taken swabs, and are acceptable to many women

NAAT

FPU

Only if endocervical swab/self-collected vaginal swab cannot be taken e.g. after a hysterectomy. Not as sensitive as self-collected vaginal swab.

NAAT

Anorectal swab

If patient has had anal sex or has ano-rectal symptoms.

If patient declines anal examination,  refer patient for testing at sexual health centre.

NAAT – Nucleic Acid Amplification Test
FPU – First pass urine

  • If a chlamydia result is equivocal or inhibitors are present the test should be repeated. If the initial test was a urine sample, the repeat test should be performed by taking a urethral swab as the inhibitors may persist in the urine. 

Management

Index patient

Condition

Recommended

Comments

Uncomplicated genital or pharyngeal infection

Doxycycline 100mg PO, twice daily for 7 days

OR 

Azithromycin 1g PO, stat

 

Anorectal infection

Doxycycline 100mg PO, twice daily for 7 days

If symptoms of proctitis, consider LGV

Doxycycline is superior to azithromycin for anorectal chlamydia

Pelvic inflammatory disease

Link to PID

 

Epididymo-orchitis

Link to epididymo-orchitis

 

Pregnant women

Azithromycin 1g PO, stat

Doxycycline is contra-indicated

Other alternative antibiotics if azithromycin is contra-indicated:

Amoxycillin 500mg PO, three times a day for 7 days 

OR 

Erythromycin ethylsuccinate (EES) 800mg PO, four times a day for 7 days 

OR

Erythromycin ethylsuccinate (EES) 400mg PO, four times a day for 14 days

  • For genital chlamydia a repeat chlamydia test to exclude re-infection is recommended at three months as re-infection rates are high. 
  • Re-testing at 3 months is also recommended for pharyngeal chlamydial infections in MSM.
  • For rectal chlamydia infections, whether LGV or otherwise, a repeat anal swab should be performed at one month after commencing treatment as a test of cure. 
  • Repeating a test to ensure cure for chlamydia is not recommended except in pregnant women where it should be performed because of low efficacy of some antibiotics. 
  • If a repeat test following treatment is performed it should not be done within 4 weeks of commencing treatment as a persistently positive result could reflect detection of non- viable DNAespecially within the first two weeks. 
  • Chlamydia is notifiable to the Victorian Health Department by laboratories 

Sexual Partners
  • Partner notification should be discussed with patients diagnosed with chlamydia as sex with untreated chlamydia infected partners can result in repeat infection. ‘
  • Consider referring patients to the Let Them Know website (www.letthemknow.org.au) which is designed to support patients to undertake partner notification and which facilitates sending of SMS and email messages to partners. 
  • Partners should be contacted, tested and treated without waiting for their test results. 
  • Individuals should abstain from sex with their partners until 7 days after both have received treatment.
  • Patient delivered partner therapy (PDPT ) for chlamydia treatment is available to those partners who are unable to attend.
    • However , co-infections and complicated infections may be missed if partners do not attend, hence PDPT is not recommended in high risk populations with a high prevalence of HIV such as MSM, and should be used with caution in populations with a high rate of gonorrhoea coinfection. The lack of clinical assessment that occurs with PDPT may lead to a failure to appropriately diagnose and  manage complicated infections such as pelvic inflammatory disease

 

Disclaimer
The content of these treatment guidelines is for information purposes only. The treatment guidelines are generic in character and should be applied to individuals only as deemed appropriate by the treating practitioner on a case by case basis. Alfred Health, through MSHC, does not accept liability to any person for the information or advice (or the use of such information or advice) which is provided through these treatment guidelines. The information contained within these treatment guidelines is provided on the basis that all persons accessing the treatment guidelines undertake responsibility for assessing the relevance and accuracy of the content and its suitability for a particular patient. Responsible use of these guidelines requires that the prescriber is familiar with contraindications and precautions relevant to the various pharmaceutical agents recommended herein.


Last Updated Feb 2021