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Chlamydia trachomatis infection
What's new
Updated 2024 WHO guidelines for the treatment of Chlamydia trachomatis infection .
Background
Overview
Definition
C. trachomatis infection is a common bacterial STI characterized primarily by urethritis in males and endocervicitis in females.
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Pathophysiology
The obligate intracellular bacteria C. trachomatis is responsible for the disease and may be transmitted through oral, vaginal or anal sex.
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Disease course
The most common manifestations include urethritis in men and mucopurulent cervicitis, urethritis, and endometritis in women. Disease progression may lead to pelvic inflammatory disease, which in pregnancy results in premature delivery and puerperal and neonatal infections.
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Prognosis and risk of recurrence
C. trachomatis infection during pregnancy is associated with an increased risk of perinatal mortality (RR 1.84, 95% CI 1.15-2.94).
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Guidelines
Key sources
The following summarized guidelines for the evaluation and management of Chlamydia trachomatis infection are prepared by our editorial team based on guidelines from the Center for Disease Control (CDC 2024,2021), the World Health Organization (WHO 2024), the International Union Against Sexually Transmitted Infections (IUSTI/BASHH 2016), and the U.S. Preventive Services Task Force (USPSTF 2014).
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Screening and diagnosis
Diagnostic investigations
Indications for testing: as per BASHH/IUSTI 2016 guidelines, obtain testing for C. trachomatis infection in the following cases:
risk factors for C. trachomatis infection and/or other STI (age < 25 years, new sexual contact in the last year, more than one partner in the last year)
symptoms or signs of urethritis in men
cervical or vaginal discharge with risk factor for STI
acute epididymo-orchitis in a male aged < 40 years or with risk factors for STI
acute pelvic pain and/or symptoms or signs of pelvic inflammatory disease
proctitis/proctocolitis according to risk
purulent conjunctivitis in a neonate or adult
atypical neonatal pneumonia
persons diagnosed with other STI
sexual contact of persons with an STI or pelvic inflammatory disease
termination of pregnancy
any intrauterine interventions or manipulations.
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NAATs
Screening for other STIs
Medical management
Management of uncomplicated urogenital infections
As per WHO 2024 guidelines:
Consider administering doxycycline 100 mg PO BID for 7 days in adult and adolescent patients with uncomplicated genital chlamydial infections. Consider administering azithromycin 1 g PO as a single dose if doxycycline is not available or adherence to multiple doses is a serious concern.
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Consider administering any of the following options if doxycycline and azithromycin are not available:
erythromycin 500 mg PO QID for 7 days
ofloxacin 200-400 mg PO BID for 7 days
tetracycline 500 mg PO QID for 7 days
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Management of uncomplicated rectal/pharyngeal infections
Management of conjunctival infection
Management of sexual partners
Specific circumstances
Pediatric patients: as per CDC 2021 guidelines, administer erythromycin base or ethyl succinate 50 mg/kg body weight/day PO, divided into 4 doses, for 14 days for the treatment of ophthalmia neonatorum caused by C. trachomatis.
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Pregnant and breastfeeding patients
Patient education
General counseling
As per BASHH/IUSTI 2016 guidelines:
Advise patients testing positive for C. trachomatis to abstain from sexual contact for 7 days after they and their partners have completed treatment and their possible symptoms have resolved.
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Provide information (both verbal and written) about the infection, including details about transmission, prevention and complications, to patients with positive C. trachomatis test and their sexual contacts.
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Preventative measures
Post-exposure prophylaxis: as per CDC 2024 guidelines, counsel MSM and transgender women who have had a bacterial STI (specifically syphilis, chlamydia, or gonorrhea) in the past 12 months that doxycycline can be used as post-exposure prophylaxis to prevent these infections. Offer persons in this group a prescription for doxycycline post-exposure prophylaxis (200 mg, not to exceed 200 mg every 24 hours) after shared decision-making, to be self-administered within 72 hours after having oral, vaginal, or anal sex.
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