If symptoms suggest recurrent or persistent urethritis, the CDC recommends treatment with 2 g metronidazole (Flagyl) orally in a single dose plus 500 mg erythromycin base orally four times per day for seven days, or 800 mg erythromycin ethylsuccinate orally four times per day for seven days.2 [ corrected] This recommendation is to provide treatment for other bacterial causes of urethritis. The diagnosis of nongonococcal urethritis can be confirmed by the presence of a mucopurulent discharge from the penis, a Gram stain of the discharge with more than five white blood cells per oil-immersion field, and no intracellular gram-negative diplococci.2 A positive result on a leukocyte esterase test of first-void urine or a microscopic examination of first-void urine showing 10 or more white blood cells per high-powered field also confirms the diagnosis of urethritis. Centers for Disease Control and Prevention. Transcription mediated amplification (TMA). Etiology, transmission and protection: Chlamydia trachomatis is the leading cause of bacterial sexually transmitted infection (STI) globally. Copyright 2023 American Academy of Family Physicians. In the absence of laboratory results in a situation with a high degree of suspicion of chlamydial infection and the mother is unlikely to return with the infant for follow-up, exposed infants can be presumptively treated with the shorter-course regimen of azithromycin 20 mg/kg body weight/day orally, 1 dose daily for 3 days. Saving Lives, Protecting People, Sexually Transmitted Infections Treatment Guidelines, 2021, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Retesting After Treatment to Detect Repeat Infections, HIV Infection: Detection, Counseling, and Referral, Diseases Characterized by Genital, Anal, or Perianal Ulcers, Neurosyphilis, Ocular Syphilis, and Otosyphilis, Syphilis Among Persons with HIV Infection, Managing Persons Who Have a History of Penicillin Allergy, Diseases Characterized by Urethritis and Cervicitis, Gonococcal Infections Among Adolescents and Adults, Gonococcal Infections Among Infants and Children, Vulvovaginal Itching, Burning, Irritation, Odor or Discharge, Terms and Abbreviations Used in This Report, U.S. Department of Health & Human Services, retesting pregnant women during the third trimester who initially tested negative but remained at increased risk for acquiring infection (e.g., women aged <25 years and those aged 25 years who have a new sex partner, more than one sex partner, a sex partner with concurrent partners, or a sex partner who has an STI); and, screening at delivery those pregnant women who were not screened for. Pregnant patients diagnosed with chlamydia or gonorrhea should have a test of cure four weeks after treatment. Treatment of Chlamydia trachomatis infection - UpToDate Chlamydial pneumonia among infants typically occurs at age 13 months and is a subacute pneumonia. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Data are limited regarding the effectiveness and optimal dose of azithromycin for treating chlamydial infection among infants and children weighing <45 kg. treatment Ofloxacin (Floxin) 400 mg orally twice daily for 14 days or levofloxacin (Levaquin) 500 mg orally once daily for 14 days; Ceftriaxone (Rocephin) 250 mg IM in a single dose or cefoxitin (Mefoxin) 2 g IM in a single dose with concurrent probenecid (Benemid) 1 g orally in single dose or other parenteral third-generation cephalosporin; Cefotetan (Cefotan) 2 g IV every 12 hours or cefoxitin 2 g IV every six hours; Clindamycin (Cleocin) 900 mg IV every eight hours; Ampicillin/sulbactam (Unasyn) 3 g IV every six hours; Erythromycin base 500 mg orally four times per day for seven days, Amoxicillin 500 mg orally three times per day for seven days, Erythromycin base 250 mg orally four times per day for 14 days, Erythromycin ethylsuccinate 800 mg orally four times per day for seven days, Erythromycin ethylsuccinate 400 mg four times per day for 14 days, Education and counseling on safer sexual behavior in persons at risk, Identification of asymptomatic infected persons and of symptomatic persons unlikely to seek diagnostic and treatment services, Effective diagnosis and treatment of infected persons, Evaluation, treatment, and counseling of sex partners of persons infected with an STD, Pre-exposure immunizations for vaccine-preventable STDs. Doxycycline 100 mg orally 2 times/day for 7 days, Azithromycin 1 g orally in a single dose The USPSTF and Centers for Disease Control and Prevention (CDC) recommend annual screening for chlamydial and gonococcal infections to prevent infertility and pelvic inflammatory disease in sexually active people 24 years and younger with a cervix and in older people with a cervix who have risk factors. Chlamydia / N. Gonorrhoeae RNA, TMA - Urine Collection Although the clinical significance of oropharyngeal C. trachomatis infection is unclear and routine oropharyngeal screening is not recommended, oropharyngeal C. trachomatis can be sexually transmitted to genital sites (211,814); therefore, if C. trachomatis is identified from an oropharyngeal specimen while screening for pharyngeal gonorrhea, it should be treated. For uncomplicated genitourinary chlamydial infection, the CDC recommends 1 g azithromycin (Zithromax) orally in a single dose, or 100 mg doxycycline (Vibramycin) orally twice per day for seven days (Table 1).2 These regimens have similar cure rates and adverse effect profiles,6 although a benefit of azithromycin is that physicians can administer the dose in the office. However, when gonorrhea testing is performed at the oropharyngeal site, chlamydia test results might be reported because certain NAATs detect both bacteria from a single specimen. Cookies used to make website functionality more relevant to you. Untreated infections may lead to pelvic inflammatory disease; scarring of fallopian tubes, which can increase the risk of ectopic pregnancy; infertility; easier transmission of new HIV infection; and vertical neonatal transmission.2, Young people 15 to 24 years of age account for 61% of all newly diagnosed STIs.1 Racial and ethnic minorities, men who have sex with men (MSM), and transgender and gender diverse people are at higher risk of STIs. Although azithromycin maintains high efficacy for urogenital C. trachomatis infection among women, concern exists regarding effectiveness of azithromycin for concomitant rectal C. trachomatis infection, which can occur commonly among women and cannot be predicted by reported sexual activity. Hospitalization is required if a patient is pregnant; has severe illness, nausea and vomiting, or high fever; has tuboovarian abscess; is unable to follow or tolerate the outpatient oral regimen; or has disease that has been unresponsive to oral therapy. Urine-only screening in an STI clinic misses 83% of infections among MSM.11 They should be screened at each anatomic site of sexual exposure, regardless of condom use, at least annually.2 Routine testing for chlamydial infections of the oropharynx is not recommended, but many laboratories will test for gonococcal and chlamydial infections simultaneously.2 If oropharyngeal chlamydia is diagnosed, it should be treated to decrease the risk of transmission.2. MCRNA - Overview: Chlamydia trachomatis, Miscellaneous Ophthalmia neonatorum can be treated with erythromycin base or ethylsuccinate at a dosage of 50 mg per kg per day orally, divided into four doses per day for 14 days.2 The cure rate for both options is only 80 percent, so a second course of therapy may be necessary. Although C. trachomatis has been the most frequent identifiable infectious cause of ophthalmia neonatorum, neonatal chlamydial infections, including ophthalmia and pneumonia, have occurred less frequently since institution of widespread prenatal screening and treatment of pregnant women. Or your provider takes a swab of fluid from your Sex partners of patients with symptomatic M. genitalium infection can be tested, and those with a positive test can be treated to possibly reduce the risk for reinfection. These tests have good sensitivity (85 percent) and specificity (94 to 99.5 percent) for endocervical and urethral samples when compared with urethral cultures.4 In women with urogenital disease, nucleic acid amplification tests can be used with an endocervical sample or a urine specimen to diagnose chlamydia. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. NAATs have been demonstrated to have improved sensitivity and specificity, compared with culture, for detecting C. trachomatis at rectal and oropharyngeal sites (553,800804), and certain NAAT platforms have been cleared by FDA for these anatomic sites (805). The cervix tends to bleed easily when rubbed with a polyester swab or scraped with a spatula. Resistance to azithromycin has been rapidly increasing and has been confirmed in multiple studies. Chlamydia Trachomatis - an overview | ScienceDirect Topics NAATs are not cleared by FDA for detecting chlamydia from nasopharyngeal specimens, and clinical laboratories should verify the procedure according to CLIA regulations (553). Amoxicillin 500 mg orally 3 times/day for 7 days. To avoid reinfection, sex partners should be instructed to abstain from condomless sexual intercourse until they and their sex partners have been treated (i.e., after completion of a 7-day regimen) and any symptoms have resolved. WebInfection with C. trachomatis is common in selected geographic areas ( 911 913 ), although M. genitalium is often the sole pathogen. All information these cookies collect is aggregated and therefore anonymous. Female urogenital chlamydia: Epidemiology, chlamydia on Levofloxacin is an effective treatment alternative but is more expensive. This is best observed in the morning, before the patient voids. These bacteria are gram-negative, anaerobic, intracellular obligates that replicate within eukaryotic cells. Newer NAAT-based POC tests have promising performance and are becoming commercially available (807809). A high prevalence of C. trachomatis infection has been observed among women and men who were treated for chlamydial infection during the preceding months (753,755,820822). CDC twenty four seven. Ocular specimens from neonates being evaluated for chlamydial conjunctivitis also should be tested for N. gonorrhoeae (see Ophthalmia Neonatorum Caused by N. gonorrhoeae). When nonadherence to doxycycline regimen is a substantial concern, azithromycin 1 g regimen is an alternative treatment option but might require posttreatment evaluation and testing because it has demonstrated lower treatment efficacy among persons with rectal infection. NAATs can be used to test vaginal and urine specimens from girls and urine in boys (see Sexual Assault or Abuse of Children). Between 2015 and 2019, reported chlamydial infections increased by 19%, and reported gonococcal infections increased by 53%.1 These bacteria commonly infect the urogenital, anorectal, and pharyngeal sites but can become disseminated to affect multiple organ systems. Immediately place the swab into the transport tube and carefully break the swab shaft against the side of However, molecular assays that incorporate detection of mutations associated with macrolide resistance are under evaluation. Persons who receive a diagnosis of chlamydia should be tested for HIV, gonorrhea, and syphilis. Azithromycin (Zithromax) 1 g orally in a single dose, Doxycycline (Vibramycin) 100 mg orally twice per day, Erythromycin base 500 mg orally four times per day, Erythromycin ethylsuccinate 800 mg orally four times per day, Levofloxacin (Levaquin) 500 mg once per day. Initial empiric therapy for PID, which includes doxycycline 100 mg orally 2 times/day for 14 days, should be provided at the time of presentation for care. M. genitalium lacks a cell wall, and thus antibiotics targeting cell-wall biosynthesis (e.g., -lactams including penicillins and cephalosporins) are ineffective against this organism. pain. If macrolide sensitive:Doxycycline 100 mg orally 2 times/day for 7 days, followed by azithromycin 1 g orally initial dose, followed by 500 mg orally once daily for 3 additional days (2.5 g total), If macrolide resistant: Doxycycline 100 mg orally 2 times/day for 7 days followed by moxifloxacin 400 mg orally once daily for 7 days, If M. genitalium is detected by an FDA-cleared NAAT: Doxycycline 100 mg orally 2 times/day for 7 days, followed by moxifloxacin 400 mg orally once daily for 7 days. Remove the cap and transfer 2 mL of urine into the Urine Transport Tube using the disposable pipette provided. Because chlamydia often doesnt cause symptoms, many people who have chlamydia dont know it and unknowingly infect other people. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. Data regarding effectiveness of azithromycin in treating chlamydial pneumonia are limited. For women, C. trachomatis urogenital infection can be diagnosed by vaginal or cervical swabs or first-void urine. Some feminine sprays, powders, spermicidal agents, and lubricants may interfere with the assay and should not be used prior to specimen collection. Although chlamydia incidence might be higher among certain women aged 25 years in certain communities, overall, the largest proportion of infection is among women aged <25 years (141). Chlamydia is an infection caused by the Chlamydia trachomatis bacteria. Author disclosure: No relevant financial relationships. In a minority viable C. trachomatis was found in culture at the second visit, indicating that patients may remain infectious at least 7 days after treatment. See http://www.pathology.med.umich.edu/handbook/Tables/Aptima_Urine.pdf for collection procedure guide. These materials also should inform partners about potential therapy-related allergies and adverse effects, along with symptoms indicative of complications (e.g., testicular pain among men and pelvic or abdominal pain among women). Azithromycin (Zithromax) or doxycycline (Vibramycin) is recommended for the treatment of uncomplicated genitourinary chlamydial infection. Exposure to C. trachomatis during delivery can cause ophthalmia neonatorum (conjunctivitis) in neonates or chlamydial pneumonia at one to three months of age.
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