Reactive arthritis develops in a small percentage of individuals with chlamydial infection. WebA chlamydia test looks for the bacteria that cause the infection (Chlamydia trachomatis). Patient information: See related handouts on chlamydia, written by the authors of this article, and on gonorrhea, which has been adapted from a previously published AFP article. Testing for cure is indicated in patients who are pregnant and should be performed three weeks after completion of treatment.2 Culture is the preferred technique.2 If risk of reexposure is high, screening should be repeated throughout the pregnancy. Amoxicillin is recommended for the treatment of chlamydial infection in women who are pregnant. The majority of posttreatment infections do not result from treatment failure but rather from reinfection caused by failure of sex partners to receive treatment or initiation of sexual activity with a new infected partner (823), indicating a need for improved education and treatment of sex partners. NICOLE YONKE, MD, MPH, MIRANDA ARAGN, MD, AND JENNIFER K. PHILLIPS, MD, Related Letter to the Editor:Doxycycline Preferred for the Treatment of Chlamydia. Chlamydia trachomatis,Neisseria gonorrhoeae, and Chlamydia trachomatis infection most commonly affects the urogenital tract. A urethral discharge can be elicited by compressing the urethra during the pelvic examination. Like ophthalmia neonatorium, pneumonia secondary toC. 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. 2. Insufficient evidence to recommend screening in this population, Consider screening high-risk populations, such as adolescents, patients in correctional facilities, and patients seen in sexually transmitted infection clinics, Cisgender men presenting to adolescent and sexually transmitted infection clinics, No evidence-based interval recommendation, Test of cure four weeks after treatment and retest within three months, Sexually active, cisgender women, transgender men, and nonbinary people with a cervix, Sexually active men who have sex with men, Annually or every three to six months if high risk, Urethral, rectal, and pharyngeal screening for gonococcal infection, based on anatomic site of exposure, Screen based on anatomy and site of exposure, Immediate, unlimited access to all AFP content, Immediate, unlimited access to this issue's content, Immediate, unlimited access to just this article. MSM with chlamydia have a high risk for coexisting infections, especially undiagnosed HIV, among their partners and might have partners without HIV who could benefit from HIV PrEP. Untreated chlamydia infections can lead to serious health issues including pelvic inflammatory disease (PID) and infertility. Uncomplicated gonococcal infection should be treated with a single 500-mg dose of intramuscular ceftriaxone in people weighing less than 331 lb (150 kg). Untreated chlamydial infection in men can spread to the epididymis. All Rights Reserved. If testing the partner is not possible, the antimicrobial regimen that was provided to the patient can be provided. Among women, M. genitalium has been associated with cervicitis, PID, preterm delivery, spontaneous abortion, and infertility, with an approximately twofold increase in the risk for these outcomes among women infected with M. genitalium (766). Neonates born to mothers at high risk for chlamydial infection, with untreated chlamydia, or with no or unconfirmed prenatal care, are at high risk for infection. In men, chlamydial infection of the lower genital tract causes urethritis and, on occasion, epididymitis. The eyelid should be everted and the sample obtained from the inner aspect of the eyelid. Urethritis is secondary to C. trachomatis infection in approximately 15 to 55 percent of men, although the prevalence is lower among older men.2 Symptoms, if present, include a mild to moderate, clear to white urethral discharge. This content is owned by the AAFP. treatment Even when symptoms occur, they're often mild. Women can develop reactive arthritis, but the male-to-female ratio is 5:1. Re-cap the urine specimen transport tube tightly and label with two identifiers. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. 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. Erythromycin base or ethylsuccinate 50 mg/kg body weight/day orally divided into 4 doses daily for 14 days, Azithromycin suspension20 mg/kg body weight/day orally, 1 dose daily for 3 days. 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. Pregnant patients diagnosed with chlamydia or gonorrhea should have a test of cure four weeks after treatment. Chlamydia Prevalence of M. genitalium among women with PID ranges from 4% to 22% (925,926) and was reported as 60% in one study of women with postabortal PID (918). Healthcare providers and health departments can report Mgen treatment failures through the Mycoplasma genitalium Treatment Failure Registry. pain in the testicles. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Chlamydia Test: Types, Purpose, Procedure & Results Symptoms and Causes 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. 2022 Mar 2;75:103448. doi: Optimal urogenital specimen types for chlamydia screening by using NAAT include first-catch urine (for men) and vaginal swabs (for women) (553). Repeat infections confer an elevated risk for PID and other complications among women. Cookies used to make website functionality more relevant to you. Women with chlamydial infection in the lower genital tract may develop an ascending infection that causes acute salpingitis with or without endometritis, also known as PID. Doxycycline 100 mg orally 2 times/day for 7 days, Azithromycin 1 g orally in a single dose Having partners accompany patients when they return for treatment is another strategy that has been used successfully for ensuring partner treatment (see Partner Services). WebChlamydia trachomatis (/ k l m d i t r k o m t s /), commonly known as chlamydia, is a bacterium that causes chlamydia, which can manifest in various ways, including: trachoma, lymphogranuloma venereum, nongonococcal urethritis, cervicitis, salpingitis, pelvic inflammatory disease. Web2021 STI Treatment Guidelines Chlamydial Infections Includes updated treatment and screening recommendations, as well as information on diagnosis, prevention, and special considerations. 3. Data are lacking regarding use of NAATs for specimens from extragenital sites (rectum and pharynx) among boys and girls (553); other nonculture tests (e.g., DFA) are not recommended because of specificity concerns. Chlamydia If tracheal aspirates or lung biopsies are being collected for pneumonia in infants one to three months of age, the samples should be tested for C. trachomatis.2. 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. Chlamydia trachomatis Detection of Chlamydia trachomatis and Neisseria gonorrhoeae in male or female urine specimens. 1. The first clinical treatment failures after moxifloxacin were associated specifically with the S83I mutation in the parC gene (954,960). Sexually active adolescents and adults at increased risk of acquiring a sexually transmitted infection should receive behavioral counseling to reduce their risk. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Urogenital M. genitalium infection is associated with HIV among both men and women (942944); however, the data are from case-control and cross-sectional studies. Rectal infections often are asymptomatic, although higher prevalence of M. genitalium has been reported among men with rectal symptoms. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. Chlamydia trachomatis-Neisseria gonorrhoeae RNA, Urine. Test of cure (i.e., repeat testing after completion of therapy) to document chlamydial eradication, preferably by NAAT, at approximately 4 weeks after therapy completion during pregnancy is recommended because severe sequelae can occur among mothers and neonates if the infection persists. Data are insufficient to implicate M. Data are limited regarding use of minocycline in instances of treatment failure (966). In addition, systematic reviews and meta-analyses have noted an association with macrolide antimicrobials, especially erythromycin, during pregnancy and adverse child outcomes, indicating cautious use in pregnancy (830831). Asymptomatic infection is common among both men and women. Treatment for Oral Chlamydia. Chlamydia is usually treated with antibiotics like azithromycin which is usually prescribed in a single, large dose, and doxycycline is taken twice per day for about one week. The same antibiotics to treat chlamydia in the groin and may also be prescribed to treat chlamydia in the throat. It is important to avoid Specimens received on Friday afternoon, Saturday and Sunday TAT 2-3 days. Finally, C trachomatis may cause WebC trachomatis can be transmitted from the mother during delivery and is associated with conjunctivitis and pneumonia in the newborn. If M. genitalium is detected, a regimen of moxifloxacin 400 mg orally once daily for 14 days has been effective in eradicating the organism. Genes and mutations associated with Chlamydia trachomatis resistance to antibiotics Resistance to macrolides Mutations in the 23S rRNA gene. A test of cure to detect therapeutic failure ensures treatment effectiveness and should be obtained at a follow-up visit approximately 4 weeks after treatment is completed. CTRNA Persons who have M. genitalium and HIV infection should receive the same treatment regimen as those persons without HIV. All newborns should receive ocular erythromycin 0.5% ointment to prevent gonococcal ophthalmia neonatorum. You can review and change the way we collect information below. Preserved urine in grey-top tube is unacceptable. A meta-analysis and a Cochrane systematic review evaluated data from randomized clinical trials of azithromycin versus doxycycline for treating urogenital chlamydial infection determined that microbiologic treatment failure among men was higher for azithromycin than for doxycycline (748,749). Instead, C. trachomatis infection among neonates is most frequently recognized by conjunctivitis that develops 512 days after birth. Thank you for taking the time to confirm your preferences. Nonculture techniques may be used, but they are less sensitive and specific for nasopharyngeal specimens than for ocular specimens. Doxycycline should be used to treat chlamydia in nonpregnant people. Amoxicillin 500 mg orally 3 times/day for 7 days. Available evidence supports that doxycycline is efficacious for C. trachomatis infections of urogenital, rectal, and oropharyngeal sites. Elevated proinflammatory cytokines have been demonstrated among women with M. genitalium, with return to baseline levels after clearance of the pathogen (917). Data are limited regarding ectopic pregnancy and neonatal M. genitalium infection (935,936). However, molecular assays that incorporate detection of mutations associated with macrolide resistance are under evaluation. 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. qualitative detection of ribosomal RNA (rRNA) from . All nonpregnant people should be tested for reinfection approximately three months after treatment or at the first visit in the 12 months after treatment. Sexual abuse should be considered a cause of chlamydial infection among infants and children. Nevertheless, no data have been published that assess the benefits of testing women with PID for M. genitalium, and the importance of directing treatment against this organism is unknown. 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. All information these cookies collect is aggregated and therefore anonymous. The newest nonculture technique is the nucleic acid amplification test, of which there are several. Persons who receive a diagnosis of chlamydia should be tested for HIV, gonorrhea, and syphilis. Topical antibiotic therapy alone is inadequate for treating ophthalmia neonatorum caused by chlamydia and is unnecessary when systemic treatment is administered. Because most infections are asymptomatic, screening is key to preventing complications such as pelvic inflammatory disease and infertility and decreasing community and vertical neonatal transmission. This assay should not be used for the evaluation of suspected sexual abuse or other medico-legal investigations where chain of custody is required. Doxycycline Preferred for the Treatment of Chlamydia. For this test, you provide a urine sample. Chlamydia trachomatis RNA Clinical microscopy and the amine test (i.e., significant odor release on addition of potassium hydroxide to vaginal secretions) can be used to help differentiate chlamydial infection from other lower genital tract infections such as urinary tract infection, bacterial vaginosis, and trichomoniasis.3 In addition, chlamydial infection in the lower genital tract does not cause vaginitis; thus, if vaginal findings are present, they usually indicate a different diagnosis or a coinfection. Erythromycin is no longer recommended because of the frequency of gastrointestinal side effects, which can result in nonadherence. Data from case-control serologic studies (929931) and a meta-analysis of clinical studies (766) indicate a potential role in causing infertility. 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. They help us to know which pages are the most and least popular and see how visitors move around the site. Although data regarding the benefits of testing women with PID for M. genitalium and the importance of directing treatment against this organism are limited, the associations of M. genitalium with cervicitis and PID in cross-sectional studies using NAAT testing are consistent (928). All sexually active people with a cervix who are younger than 25 years and older people with a cervix who have risk factors should be screened annually for chlamydial and gonococcal infections. Chlamydia trachomatis RNA mutations associated with Chlamydiae species MCRNA - Overview: Chlamydia trachomatis, Miscellaneous Neonatal ocular prophylaxis with erythromycin, the only agent available in the United States for this purpose, is ineffective against chlamydial ophthalmia neonatorum (or pneumonia) (833). Finally, C trachomatis may cause hepatitis Chlamydial Infections - STI Treatment Guidelines - CDC It is caused by Chlamydia trachomatis bacteria which infects both men and women. Chlamydia trachomatis are gram-negative anaerobic bacteria that replicate inside eukaryotic cells (Mohseni, 2019). It is a weak organism that relies on its host for nutrients and survival. It lives inside a host in order to reproduce and survive. In settings without access to resistance testing and when moxifloxacin cannot be used, an alternative regimen can be considered, based on limited data: doxycycline 100 mg orally 2 times/day for 7 days, followed by azithromycin (1 g orally on day 1 followed by 500 mg once daily for 3 days) and a test of cure 21 days after completion of therapy (963). Sexually active people 24 years and younger who have a cervix should be screened for chlamydial and gonococcal infections annually. Specimens for culture isolation and nonculture tests should be obtained from the everted eyelid by using a Dacron (DuPont)-tipped swab or the swab specified by the manufacturers test kit; for culture and DFA, specimens must contain conjunctival cells, not exudate alone. Using the Aptima assays as reference method, the comparison showed that the average specificity of multiplex RT-PCR was 100.0% for the four The U.S. Preventive Services Task Force (USPSTF) recommends behavioral counseling on condom use, communication strategies for safer sex, and problem solving with those at increased risk of STIs. Prenatal screening and treatment of pregnant women is the best method for preventing chlamydial infection among neonates. Untreated chlamydial infection can spread to the epididymis. Levofloxacin is an effective treatment alternative but is more expensive. 2023 MLABS A Division of Pathology, Michigan Medicine, Chlamydia trachomatis and Neisseria gonorrhoeae RNA, Urine, http://www.pathology.med.umich.edu/handbook/Tables/Aptima_Urine.pdf. In addition, physicians should obtain exposure information for the preceding 60 days and consider screening for other STDs such as human immunodeficiency virus (HIV).2, The CDC does not recommend repeat testing for chlamydia after completion of the antibiotic course unless the patient has persistent symptoms or is pregnant.2 Because reinfection is a common problem, the CDC recommends that women with chlamydial infection should be rescreened three to four months after antibiotic completion. 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 trachomatis and Neisseria gonorrhoeae are the most common sexually transmitted infections (STIs) in the United States and are required to be reported to state health departments. Chlamydia trachomatis - Symptoms and causes - Mayo Clinic These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. Transcription mediated amplification (TMA). Currently, the first-choice treatment for anogenital chlamydia consists of a single 1000 mg dose of azithromycin, or 100 mg doxycycline twice daily for 7 days [ 3, 4 ]. Molecular tests for macrolide (i.e., azithromycin) or quinolone (i.e., moxifloxacin) resistance markers are not commercially available in the United States. Chlamydia / N. Gonorrhoeae RNA, TMA - Urine Collection Exposure to C. trachomatis during delivery can cause ophthalmia neonatorum (conjunctivitis) in neonates or chlamydial pneumonia at one to three months of age. The initial episode usually lasts for three to four months, but in rare cases the synovitis may last about one year. This is a corrected version of the article that appeared in print. * An association between oral erythromycin and azithromycin and infantile hypertrophic pyloric stenosis (IHPS) has been reported among infants aged <6 weeks. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. DFA is the only nonculture FDA-cleared test for detecting chlamydia from conjunctival swabs. OR The cervix tends to bleed easily when rubbed with a polyester swab or scraped with a spatula. Testing can be performed on a sample obtained from the nasopharynx. Compared with standard patient referral of partners, this approach to therapy, which involves delivering the medication itself or a prescription by the patient or collaborating pharmacy, has been associated with decreased rates of persistent or recurrent chlamydia among women (125127). Systematic review of randomized controlled trials, Consensus opinion from clinical guidelines, High certainty of substantial net benefit. M. genitalium is an extremely slow-growing organism. Annual screening of all sexually active women aged <25 years is recommended, as is screening of older women at increased risk for infection (e.g., women 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) (149). Infection with C. trachomatis is common in selected geographic areas (911913), although M. genitalium is often the sole pathogen. Given that 3 out of 4 infected women and The prevalence of quinolone resistance markers is much lower (697,956959). A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Culture can take up to 6 months, and technical laboratory capacity is limited to research settings. Clinical manifestations and diagnosis of Erythromycin is no longer recommended because of the frequency of gastrointestinal side effects that can result in therapy nonadherence. WebC. In settings in which M. genitalium testing is available, persons with persistent urethritis, cervicitis, or PID accompanied by detection of M. genitalium should be treated with moxifloxacin. For children weighing 45 kg but aged <8 years: Azithromycin 1 g orally in a single dose, For children aged 8 years: Azithromycin 1 g orally in a single dose. Hospitalization also is indicated if surgical emergencies cannot be excluded.2 The CDC-recommended options for the treatment of PID are listed in Table 2.2, Doxycycline and ofloxacin (Floxin) are contraindicated during pregnancy; therefore, the CDC recommends erythromycin base or amoxicillin for the treatment of chlamydial infection in pregnant women (Table 3).2 Amoxicillin is more effective and tends to have fewer side effects than erythromycin in the treatment of antenatal chlamydial infection, and thus is better tolerated.7,8 Preliminary data suggest that azithromycin is a safe and effective alternative.2. Physicians should create supportive spaces where patients feel safe sharing information by using open-ended questions; avoiding assumptions regarding sexual preferences, practices, and gender/sex; and normalizing diverse sexual experiences. NAATs are the most sensitive tests for these specimens and are the recommended test for detecting C. trachomatis infection (553). Prevalence of molecular markers for macrolide resistance, which highly correlates with treatment failure, ranges from 44% to 90% in the United States, Canada, Western Europe, and Australia (697,702,945953). For the first time there are diagnostic tests for Chlamydia trachomatis that are more sensitive than tissue culture. Female patients should not cleanse the labial area prior to collection. Infections in the rectum may cause problems or 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. The clinical significance of oropharyngeal C. trachomatis infection is unclear, and prevalence is low, even among populations at high risk. Sexually active men who have sex with men should be screened at least annually. The correct volume of urine has been added when the fluid level is between the black lines on the urine transport tube label.