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Chlamydia trachomatis
From WikEM
Not to be confused with chlamydophila, another genus of pathogenic bacteria
Contents
Background
- Most common STD in the United States[1]
- Asymptomatic in > 50% of infected individuals
- Risk factors[1]
- Age <26 most prevalent group
- Cervical ectopy
- New or multiple sexual partners
- Inconsistent or lack of use of barrier protection
- Early coitarche
Complications
- PID
- Ectopic Pregnancy
- Infertility
Clinical Features
- Vaginal discharge
- Intermenstrual bleeding
- Urethritis
- Epididymitis
- Proctitis
- Reiter syndrome (urethritis, conjuctivitis, rash)
Differential Diagnosis
Dysuria
- Genitourinary infection
- Acute cystitis ("UTI")
- Pyelonephritis
- Urethritis
- Chronic cystitis
- Infected nephrolithiasis
- Prostatitis
- Epididymitis
- Renal abscess/perinephric abscess
- Emphysematous pyelonephritis
- Nephrolithiasis
- Urethral issue
- Urethritis
- Urolithiasis
- Urethral foreign body
- Urethral diverticulum
- Allergic reaction (contact dermatitis)
- Chemical irritation
- Urethral stricture or obstruction
- Trauma to vagina, urethra, or bladder
- Gynecologic
- Vaginitis/cervicitis
- PID
- Genital herpes
- Uterine/bladder/vaginal prolapse
- Fistula
- Cystocele
- Other
- Diverticulitis
- Behavioral symptom without detectable pathology
Sexually transmitted diseases
Evaluation
- Endocervical or urethral swab
- Urine chlamydia test
- Speculum exam
Management
Doxycycline is contraindicated in pregnancy[2]
Not Pregnant
- Azithromycin 1g PO x1 OR
- Doxycycline 100mg PO BID x7 days
Pregnant
- Azithromycin 1g PO x 1 'OR
- Amoxicillin 500mg PO Q8hrs x 7 days OR
- Erythromycin 500mg PO Q6hrs x 7 days
Disposition
- Discharge
- Avoid sex for 7 days to prevent transmission
- Partners in the previous 60 days should all be notified/tested/treated[1]
- Rescreen in 3 months
See Also
- STDs
- Proctitis
- Lymphogranuloma venereum (for L1, L2, and L3 serovars)
References
- ↑ 1.0 1.1 1.2 Keegan MB, Diedrich JT, Peipert JF. Chlamydia trachomatis Infection: Screening and Management. Journal of clinical outcomes management : JCOM. 2014;21(1):30-38.
- ↑ CDC 2015 Sexually Transmitted Diseases Treatment Guidelines https://www.cdc.gov/std/tg2015/chlamydia.htm
