Doxycycline should be used to treat chlamydia in nonpregnant people. However, C. trachomatis also causes trachoma in endemic areas, mostly Africa and the Middle East, and is a leading cause of preventable blindness worldwide. Levofloxacin 500 mg orally once daily for 7 days. 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. 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). You will be subject to the destination website's privacy policy when you follow the link. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Finally, C trachomatis may cause Because chlamydia often doesnt cause symptoms, many people who have chlamydia dont know it and unknowingly infect other people. 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. Transcription mediated amplification (TMA). A negative result does not exclude the possibility of infection. 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. Nonpregnant people treated for chlamydial or gonococcal infections should be tested for reinfection three months after treatment. The clinical significance of oropharyngeal C. trachomatis infection is unclear, and prevalence is low, even among populations at high risk. Thank you for taking the time to confirm your preferences. 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. Molecular tests for macrolide (i.e., azithromycin) or quinolone (i.e., moxifloxacin) resistance markers are not commercially available in the United States. 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. Inequitable access to health insurance and physicians, language barriers, and distrust of medical systems because of discrimination account for some of these disparities, independent of individual sexual behavior.3,4 Other risk factors are reviewed in Table 1.2, Taking a thorough sexual history is important to identify overall risk of infection, as well as anatomic site-specific risk factors. Data are limited regarding ectopic pregnancy and neonatal M. genitalium infection (935,936). If M. genitalium is detected, a regimen of moxifloxacin 400 mg orally once daily for 14 days has been effective in eradicating the organism. Because test results for chlamydia often are unavailable at the time initial treatment decisions are being made, treatment for C. trachomatis pneumonia frequently is based on clinical and radiologic findings, age of the infant (i.e., 13 months), and risk for chlamydia in the mother (i.e., aged <25 years, history of chlamydial infection, multiple sex partners, a sex partner with a concurrent partner, or a sex partner with a history of an STI). 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. Moreover, using chlamydial NAATs at <4 weeks after completion of therapy is not recommended because the continued presence of nonviable organisms (553,818,819) can lead to false-positive results. Sexually active people 24 years and younger who have a cervix should be screened for chlamydial and gonococcal infections annually. Tracheal aspirates and lung biopsy specimens, if collected, should be tested for C. trachomatis. All information these cookies collect is aggregated and therefore anonymous. 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). Amoxicillin is recommended for the treatment of chlamydial infection in women who are pregnant. Sex partners should be referred for evaluation, testing, and presumptive treatment if they had sexual contact with the partner during the 60 days preceding the patients onset of symptoms or chlamydia diagnosis. Testing for chlamydial infection in neonates can be by culture or nonculture techniques. Regular screenings can help reduce chlamydias spread. 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. 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). WebChlamydia is caused by the obligate intracellular bacterium Chlamydia trachomatis and is the most prevalent sexually transmitted infection (STI) caused by bacteria in the United States.In 2020, over 1.5 million documented cases were reported to the C e n te r s f o r Di s e a s e C on t ro l a n d P r e v e n ti o n (CDC). Because of concerns regarding chlamydia persistence after exposure to penicillin-class antibiotics that has been demonstrated in animal and in vitro studies, amoxicillin is listed as an alternative therapy for C. trachomatis for pregnant women (828,829). Patient-collected vaginal swab specimens are equivalent in sensitivity and specificity to those collected by a clinician using NAATs (792,793), and this screening strategy is highly acceptable among women (794,795). Culture techniques are the preferred method for detecting C. trachomatis infection, but they have been replaced in some instances by nonculture techniques. 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. WebComponents: Chlamydia trachomatis RNA, TMA, Urogenital Chlamydia trachomatis RNA, TMA, Urogenital test cost is between $43.00 and $77.00 None $43.00 Order Ulta Lab Tests Compare - Chlamydia and Gonorrhea Test (EW) Covered tests: Chlamydia/Neisseria gonorrhoeae RNA, TMA, Urogenital ( partial ) ( Quest ) WebChlamydia trachomatis RNA, TMA, Urogenital 11361 Gonorrhea, if indicated d Neisseria gonorrhoeae RNA, TMA, Urogenital 11362 Chlamydia and gonorrhea Chlamydia/Neisseria gonorrhoeae RNA, TMA, Urogenital 11363 HIV testing HIV-1/2 Antigen and Antibodies, Fourth Generation, with Reflexes b 91431 Hepatitis C testing Physical findings of urogenital chlamydial infection in women include cervicitis with a yellow or cloudy mucoid discharge from the os. To obtain a complete sexual history, the five Ps (partners, practices, pregnancy attitudes, previous STIs, and protection from STIs) model can be used as outlined in Table 2.2,5, 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.6 Adolescents and adults diagnosed with an STI in the past year, people reporting irregular condom use, and those with multiple partners or with partners belonging to a high-risk group are at increased risk. Among symptomatic patients, POC tests for C. trachomatis can optimize treatment by limiting unnecessary presumptive treatment at the time of clinical decision-making and improve antimicrobial stewardship. Predictive value of test will vary depending on disease prevalence. 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 ]. pain in the testicles. Copyright 2023 American Academy of Family Physicians. Or your provider takes a swab of fluid from your Sensitive and specific methods for diagnosing chlamydial ophthalmia in the neonate include both tissue culture and nonculture tests (e.g., DFA tests and NAATs). Chlamydial diseases are sexually transmitted and caused by the bacterium Chlamydia trachomatis. However, this bacterium acts more like a virus. This can affect the way chlamydia infection is transmitted and the risk factors that are important in acquiring it. Chlamydia infections can affect the vagina, cervix, and rectum, among other areas. These bacteria are gram-negative, anaerobic, intracellular obligates that replicate within eukaryotic cells. Symptoms tend to have a subacute onset and usually develop during menses or in the first two weeks of the menstrual cycle.2 Symptoms range from absent to severe abdominal pain with high fever and include dyspareunia, prolonged menses, and intramenstrual bleeding. The cervix tends to bleed easily when rubbed with a polyester swab or scraped with a spatula. 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. Data are insufficient to implicate M. Specimens received on Friday afternoon, Saturday and Sunday TAT 2-3 days. Using the Aptima assays as reference method, the comparison showed that the average specificity of multiplex RT-PCR was 100.0% for the four All Rights Reserved. Preferred chlamydia treatment is a seven-day course of doxycycline, 100 mg taken by mouth twice per day. Tissue culture is the definitive standard diagnostic test for chlamydial pneumonia. Methods: The clinical data of 92 patients diagnosed with Chlamydia trachomatis (C. trachomatis) infections were Its also possible to get a chlamydia infection in the anus. The correct volume of urine has been added when the fluid level is between the black lines on the urine transport tube label. For women, C. trachomatis urogenital infection can be diagnosed by vaginal or cervical swabs or first-void urine. NICOLE YONKE, MD, MPH, MIRANDA ARAGN, MD, AND JENNIFER K. PHILLIPS, MD, Related Letter to the Editor:Doxycycline Preferred for the Treatment of Chlamydia. You can review and change the way we collect information below. The newest nonculture technique is the nucleic acid amplification test, of which there are several. Doxycycline is also available in a delayed-release 200-mg tablet formulation, which requires once-daily dosing for 7 days and is as effective as doxycycline 100 mg twice daily for 7 days for treating urogenital C. trachomatis infection in men and women. Some women with C. trachomatis infection develop urethritis; symptoms may consist of dysuria without frequency or urgency. Collection of larger volumes of urine may result in rRNA target dilution that may reduce test sensitivity. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. Although data regarding NAATs for specimens from extragenital sites for children are more limited and performance is test dependent (553), no evidence supports that NAAT performance for detecting C. trachomatis for extragenital sites among children would differ from that among adults. * An association between oral erythromycin and azithromycin and infantile hypertrophic pyloric stenosis (IHPS) has been reported among infants aged <6 weeks. A published review reported that C. trachomatis was detected at the anorectal site among 33%83% of women who had urogenital C. trachomatis infection, and its detection was not associated with report of receptive anorectal sexual activity (813). Physicians should obtain a sexual history free from assumptions about sex partners or practices. We take your privacy seriously. 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. 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. 4. Previous evidence indicates that the liquid-based cytology specimens collected for Pap smears might be acceptable specimens for NAAT, although test sensitivity using these specimens might be lower than that associated with use of cervical or vaginal swab specimens (799); regardless, certain NAATs have been cleared by FDA for use on liquid-based cytology specimens. WebInitial C. trachomatisneonatal infection involves the mucous membranes of the eye, oropharynx, urogenital tract, and rectum, although infection might be asymptomatic in See http://www.pathology.med.umich.edu/handbook/Tables/Aptima_Urine.pdf for collection procedure guide. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. To detect chlamydial infection, health care providers frequently rely on screening tests. All Rights Reserved. The differential diagnosis of gonococcal infections depends on the particular clinical syndrome. Thank you for taking the time to confirm your preferences. The purpose of the study performed by Jiang et al. Women with chlamydial infection should be rescreened for infection three to four months after completion of antibiotic therapy. 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. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. For this test, you provide a urine sample. WebChlamydia trachomatis. Female urogenital chlamydia: Epidemiology, chlamydia on pregnancy, current diagnosis, and treatment Ann Med Surg (Lond). 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. Azithromycin (Zithromax) or doxycycline (Vibramycin) is recommended for the treatment of uncomplicated genitourinary chlamydial infection. Prenatal screening and treatment of pregnant women is the best method for preventing chlamydial infection among neonates. Chlamydia trachomatis-Neisseria gonorrhoeae RNA, Urine. 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. The few prospective studies that have evaluated the role of M. genitalium in establishing subsequent PID demonstrated increased PID risk; however, these were not statistically significant associations, often because of a lack of statistical power. Another major advantage is that they can be used with first-catch urine specimens and vaginal swabs. The most common site of Chlamydia trachomatis infection is the urogenital tract, and severity ranges from asymptomatic to life-threatening. In this case, the main symptoms are often: discharge. However, perinatally transmitted C. trachomatis infection of the nasopharynx, urogenital tract, and rectum can persist for 23 years (see Sexual Assault or Abuse of Children). Clinically relevant quinolone resistance often is associated with coexistent macrolide resistance (954). This content is owned by the AAFP. Treatment should be provided promptly for all persons with chlamydial infection; treatment delays have been associated with complications (e.g., PID) in a limited proportion of women (810). Screening of asymptomatic M. genitalium infection among women and men or extragenital testing for M. genitalium is not recommended. Data regarding the efficacy of azithromycin for ophthalmia neonatorum are limited. The majority of persons with C. trachomatis detected at oropharyngeal sites do not have oropharyngeal symptoms. 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. WebC trachomatis can be transmitted from the mother during delivery and is associated with conjunctivitis and pneumonia in the newborn. Data are insufficient to implicate M. genitalium infection with chronic complications among men (e.g., epididymitis, prostatitis, or infertility). This test is not useful for the detection of other Chlamydia species. The treatment of C. trachomatis infection depends on the site of the infection, the age of the patient, and whether the infection is complicated or uncomplicated. Erythromycin is no longer recommended because of the frequency of gastrointestinal side effects, which can result in nonadherence. However, seroassays are suboptimal and inconclusive. 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). WebObjective: The aim of this study was to investigate the relationships between treatment outcomes of patients with urogenital Chlamydia trachomatis infections and minimum inhibitory concentrations (MICs) and drug resistance genes. The initial episode usually lasts for three to four months, but in rare cases the synovitis may last about one year. Instead, C. trachomatis infection among neonates is most frequently recognized by conjunctivitis that develops 512 days after birth. 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). Chlamydial infection cannot be distinguished from other urogenital infections by symptoms alone. Recent studies have demonstrated that among men, NAAT performance on self-collected meatal swabs is comparable to patient-collected urine or provider-collected urethral swabs (796798). However, most studies of M. genitalium and PID, even those that controlled extensively for other infections and behavioral and biologic risk, are cross-sectional. The most frequent clinical manifestation of chlamydial infection in males is urethritis, while the most common finding in females is cervicitis. Providers should provide patients with written educational materials to give to their partners about chlamydia, which should include notification that partners have been exposed and information about the importance of treatment. Erythromycin base or ethylsuccinate 50 mg/kg body weight/day orally, divided into 4 doses daily for 14 days*. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. Multiple sequelae can result from C. trachomatis infection among women, the most serious of which include PID, ectopic pregnancy, and infertility. Patient collection of a meatal swab for C. trachomatis testing might be a reasonable approach for men who are either unable to provide urine or prefer to collect their own meatal swab over providing urine. In men, the infection usually is symptomatic, with dysuria and a discharge from the penis. A chlamydial etiology should be considered for all infants aged 30 days who experience conjunctivitis, especially if the mother has a history of chlamydial infection. It can cause an odorless, mucoid vaginal discharge, typically with no external pruritus, although many women have minimal or no symptoms.2 An ascending infection can result in pelvic inflammatory disease (PID). Detection of Chlamydia trachomatis and Neisseria gonorrhoeae in male or female urine specimens. Test of cure to detect therapeutic failure (i.e., repeat testing 4 weeks after completing therapy) is not advised for nonpregnant persons treated with the recommended or alternative regimens, unless therapeutic adherence is in question, symptoms persist, or reinfection is suspected. Newer NAAT-based POC tests have promising performance and are becoming commercially available (807809). WebC. 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. Although the majority of M. genitalium strains are sensitive to moxifloxacin, resistance has been reported, and adverse side effects and cost should be considered with this regimen. You will be subject to the destination website's privacy policy when you follow the link. The joint involvement is asymmetric, with multiple affected joints and a predilection for the lower extremities. Mothers of infants who have chlamydial pneumonia and the sex partners of these women should be evaluated, tested, and presumptively treated for chlamydia (see, Chlamydial Infection Among Adolescents and Adults). Self-collected rectal swabs are a reasonable alternative to clinician-collected rectal swabs for C. trachomatis screening by NAAT, especially when clinicians are not available or when self-collection is preferred over clinician collection. Test Usage Detection of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis in male or female C. trachomatis also can cause a subacute, afebrile pneumonia with onset at ages 13 months. Centers for Disease Control and Prevention. 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. 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. Because the efficacy of erythromycin treatment for ophthalmia neonatorum is approximately 80%, a second course of therapy might be required (834,835). Doxycycline Preferred for the Treatment of Chlamydia. The arthritis begins one to three weeks after the onset of chlamydial infection. Even when symptoms occur, they're often mild. Doxycycline is contraindicated during the second and third trimesters of pregnancy because of risk for tooth discoloration. The eyelid should be everted and the sample obtained from the inner aspect of the eyelid. Recent studies report a high concordance of M. genitalium among partners of males, females, and MSM; however, no studies have determined whether reinfection is reduced with partner treatment (940,967,968). Men with recurrent NGU should be tested for M. genitalium using an FDA-cleared NAAT. Persons who have M. genitalium and HIV infection should receive the same treatment regimen as those persons without HIV. CDC twenty four seven. Recommended PID treatment regimens are not effective against M. genitalium. Culture can take up to 6 months, and technical laboratory capacity is limited to research settings. Prevalence of the S83I mutation in the United States ranges from 0% to 15% (947); however, correlation with fluoroquinolone treatment failure is less consistent than that with mutations associated with macrolide resistance (953,961,962). M. genitalium infections among women are also frequently asymptomatic, and the consequences associated with asymptomatic M. genitalium infection are unknown. Human data reveal that levofloxacin presents a low risk to the fetus during pregnancy but has potential for toxicity during breastfeeding; however, data from animal studies increase concerns regarding cartilage damage to neonates (431). 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). Resistance-guided therapy has demonstrated cure rates of >90% and should be used whenever possible (759,963); however, it requires access to macrolide-resistance testing. Erythromycin is no longer recommended because of the frequency of gastrointestinal side effects that can result in therapy nonadherence. Infections in the rectum may cause problems or 2. Chlamydia trachomatis infection most commonly affects the urogenital tract. NAATs that are FDA cleared for use with vaginal swab specimens can be collected by a clinician or patient in a clinical setting. Immediately place the swab into the transport tube and carefully break the swab shaft against the side of 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. Untreated chlamydial infection in men can spread to the epididymis. If symptomatic treatment failure or a positive test of cure occurs after this regimen, expert consultation is recommended. More frequent screening than annual for certain women (e.g., adolescents) or certain men (e.g., MSM) might be indicated on the basis of risk behaviors. 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. Which specimen types are suitable for C trachomatis and N gonorrhoeae nucleic acid amplification tests (NAATs)? Infants treated with either of these antimicrobials should be followed for IHPS signs and symptoms. M. genitalium causes symptomatic and asymptomatic urethritis among men and is the etiology of approximately 15%20% of NGU, 20%25% of nonchlamydial NGU, and 40% of persistent or recurrent urethritis (697,909,910). 2022 Mar 2;75:103448. doi: The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.
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