Chlamydia treatment guidelines
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Chlamydia treatment guidelines. What you should know about chlamydia. How to get diagnosed. How can I know if I have chlamydia. How to treat chlamydia
Chlamydia treatment guidelines
Chlamydia is a very common bacterial STI which can be passed on during sex without a condom or other barrier method. You can get chlamydia whether from vaginal sex, anal sex, oral sex, or even just sharing sex toys. However, casual contact like kissing and touching is relatively safe for chlamydia.
It is recommended to get screened for chlamydia and gonorrhea annually. However, rare strains of chlamydia, like LGV, are not usually included in standard tests and might be overlooked. To ensure you are safe from any STDs and receive the appropriate treatment in time, we offer the PCR28 test. This comprehensive test detects 28 common and uncommon pathogens that cause STDs. It helps ensure you are not at risk of untreated STDs from unnoticed infections. For more information about our services, contact us at info.bkk@pulse-clinic.com or chat with us on any of the following platforms:
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Who is at risk of chlamydia
Everyone who is sexually active is at risk of chlamydia, especially for people who have unprotected sex. Both men and women are at risk of chlamydia transmission. Men who have sex with men are also at risk, as chlamydia can be transmitted through oral and anal sex. Chlamydia is also one of the most common STIs. It is estimated that 4% of women and 2.5% of men have chlamydia according to WHO. However, there is a way to reduce this risk, such as:
- Consistently using condoms
- Having routine check up for STIs
- Considering using DoxyPEP
DoxyPEP is a new preventative treatment for syphilis, chlamydia, and gonorrhea. A study found that DoxyPEP is up to 88% effective in chlamydia prevention. When used correctly with other preventative options, DoxyPEP can help greatly reduce the risk of STIs.
Causes of chlamydia
Chlamydia is caused by a bacterium called chlamydia trachomatis.
This infection is usually asymptomatic in both men and women, and could be cured by the correct treatment. If left untreated, chlamydia can cause serious problems like infertility and permanent organ damage. It is important that you detect chlamydia early so you can get the right treatment to get rid of the infection, as the risk of complications is avoidable.
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Clinical presentation
Chlamydia is usually asymptomatic in both men and women.
Men
- Symptoms - urethritis with discharge, dysuria and proctitis
- Complications - epididymo-orchitis. Refer to Epididymo-orchitis treatment guidelines
Women
- Symptoms - cervicitis with vaginal discharge, post coital bleeding and proctitis
- Complications:
- pelvic inflammatory disease (PID) - chronic pelvic pain, ectopic pregnancy and infertility. Refer to PID treatment guidelines
- mother to child transmission - neonatal conjunctivitis and pneumonitis
Diagnosis
Men
| Test | Site/Specimen | Comments |
|---|---|---|
| NAAT | FPU | If MSM, also collect anal and pharyngeal swab even if asymptomatic at these sites. |
| NAAT | Anorectal swab |
|
| NAAT | Pharyngeal swab | Collect if MSM. Self-collection is as sensitive as those taken by a clinician and may be preferred by some men. |
Women
| Test | Site/Specimen | Comments |
|---|---|---|
| NAAT | Endocervical swab | Best test if examined |
| NAAT | Self-collected vaginal swab | As sensitive as clinician taken swabs, and are acceptable to many women |
| NAAT | FPU | Only if endocervical swab/self-collected vaginal swab cannot be taken, for example after a hysterectomy. Not as sensitive as self-collected vaginal swab. |
| NAAT | Anorectal swab |
|
If a chlamydia result is equivocal or inhibitors are present the test should be repeated. If the initial test was a urine sample, the repeat test should be performed by taking a urethral swab as the inhibitors may persist in the urine.
Management
Index patient
Chlamydia is notifiable to the Victorian Health Department by laboratories.
| Condition | Recommended | Comments |
|---|---|---|
| Uncomplicated genital or pharyngeal infection | Doxycycline 100mg PO, twice daily for 7 days OR Azithromycin 1g PO, stat | |
| Anorectal infection | Doxycycline 100mg PO, twice daily for 7 days If symptoms of proctitis in MSM, consider LGV. Refer to LGV treatment guidelines Refer to Proctitis treatment guidelines | Doxycycline is superior to azithromycin for anorectal chlamydia Azithromycin 1g PO, stat, and repeat 1 g PO in 12-24 hours. |
| Pelvic inflammatory disease | Refer to Pelvic inflammatory disease treatment guidelines | |
| Epididymo-orchitis | Refer to Epididymo-orchitis treatment guidelines | |
| Pregnant women | Azithromycin 1g PO, stat | Doxycycline is contra-indicated Other alternative antibiotics if azithromycin is contra-indicated: Amoxycillin 500mg PO, 3 times a day for 7 days |
Follow up
- Genital chlamydia - re-test at 3 months to exclude reinfection (reinfection rates are high)
- Pharyngeal chlamydial infections in MSM - re-test at 3 months
Repeating a test to ensure cure for chlamydia is not recommended except in pregnant women where it should be performed because of low efficacy of some antibiotics.
If a repeat test following treatment is performed it should not be done within 4 weeks of commencing treatment as a persistently positive result could reflect detection of non-viable DNA especially within the first two weeks.
Contact tracing & partner management
- Partner notification should be discussed with patients diagnosed with chlamydia as sex with untreated chlamydia infected partners can result in repeat infection.
- Consider referring patients to Let Them Know. This website supports patients to notify partners and facilitates sending SMS and email messages to partners.
- Treatment for chlamydia is not routinely offered to asymptomatic individuals reporting contact with chlamydia because a proportion will be negative for chlamydia. However, treatment can be offered if the patient prefers, has symptoms, or is unlikely to return for the test result or treatment.
- Individuals should abstain from sex with their partners until 7 days after both have received treatment
- Patient delivered partner therapy(PDPT) for chlamydia treatment is available to those partners who are unable to attend. However, co-infections and complicated infections may be missed if partners do not attend, hence PDPT is not recommended in high risk populations with a high prevalence of HIV such as MSM, and should be used with caution in populations with a high rate of gonorrhoea co-infection. The lack of clinical assessment that occurs with PDPT may lead to a failure to appropriately diagnose and manage complicated infections such as pelvic inflammatory disease.
Related treatment guidelines
- Chlamydia treatment guidelines
- Enteric infections in MSM treatment guidelines
- Gonorrhoea treatment guidelines
- Proctitis treatment guidelines
- Lymphogranuloma venereum treatment guidelines
- Herpes treatment guidelines
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