Chlamydia trachomatis: Difference between revisions
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==Background== | ==Background== | ||
*Most common STD in the United States<ref name="Keegan">Keegan MB, Diedrich JT, Peipert JF. Chlamydia trachomatis Infection: Screening and Management. Journal of clinical outcomes management : JCOM. 2014;21(1):30-38.</ref> | *Most common [[STD]] in the United States<ref name="Keegan">Keegan MB, Diedrich JT, Peipert JF. Chlamydia trachomatis Infection: Screening and Management. Journal of clinical outcomes management : JCOM. 2014;21(1):30-38.</ref> | ||
*Asymptomatic in > 50% of infected individuals | *Asymptomatic in > 50% of infected individuals | ||
*Risk factors<ref name="Keegan" /> | *Risk factors<ref name="Keegan" /> | ||
| Line 17: | Line 17: | ||
==Clinical Features== | ==Clinical Features== | ||
*Vaginal discharge | *[[Vaginal discharge]] | ||
*Intermenstrual bleeding | *Intermenstrual [[vaginal bleeding]] | ||
*[[Urethritis]] | *[[Urethritis]] | ||
*[[Epididymitis]] | *[[Epididymitis]] | ||
*[[Proctitis]] | *[[Proctitis]] | ||
* | *[[Reactive arthritis]] (urethritis, conjunctivitis, arthritis) | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 29: | Line 29: | ||
{{STD DDX}} | {{STD DDX}} | ||
== | ==Evaluation== | ||
*Endocervical or urethral swab | *Endocervical or urethral swab | ||
*Urine chlamydia test | *Urine chlamydia test | ||
| Line 35: | Line 35: | ||
==Management== | ==Management== | ||
''[[Doxycycline]] is contraindicated in pregnancy<ref>CDC 2015 Sexually Transmitted Diseases Treatment Guidelines https://www.cdc.gov/std/tg2015/chlamydia.htm</ref> | |||
===Not Pregnant=== | |||
*[[Azithromycin]] 1g PO x1 '''OR''' | *[[Azithromycin]] 1g PO x1 '''OR''' | ||
*[[Doxycycline]] 100mg PO BID x7 days | *[[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== | ==Disposition== | ||
Revision as of 17:36, 22 April 2020
Not to be confused with chlamydophila, another genus of pathogenic bacteria
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 vaginal bleeding
- Urethritis
- Epididymitis
- Proctitis
- Reactive arthritis (urethritis, conjunctivitis, arthritis)
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
- Pelvic organ prolapse
- Fistula
- Cystocele
- Other
- Diverticulitis
- Interstitial cystitis
- Behavioral symptom without detectable pathology
Sexually transmitted diseases
- Chancroid
- Chlamydia trachomatis
- Granuloma inguinale
- Hepatitis B
- Herpes Simplex Virus-2
- HIV
- Human papillomavirus
- Lymphogranuloma venereum
- Neisseria gonorrhoeae
- Trichomonas
- Syphilis
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