RISK FACTORS:
β’ Risk correlates with number of sexual partners
β’ Risk correlates inversely with age
GENERAL MEASURES:
β’ All patients with known or suspected chlamydia should be tested for gonorrhea, syphilis, and HIV (the latter
requires individual counseling and consent)
β’ Some experts recommend that all patients treated for chlamydia should be treated empirically for gonorrhea
simultaneously, unless they are known to be negative for gonorrhea by sensitive lab testing
β’ All partners of patients treated for chlamydia should be tested if possible but treated empirically regardless,
rather than waiting for test results
β’ Some experts recommend treating partners of men being treated for non-specifi c urethritis, others Recommend testing partners and waiting for test results
β’ Neither women with mucopurulent cervicitis nor their partners should be treated empirically for chlamydia in
the absence of other evidence supporting such treatment
ACTIVITY : Abstain from sexual contact until diagnosis and treatment complete for patient and all partners
PATIENT EDUCATION :
β’ Risk-reduction counseling
β’ Safe sex practices, such as barrier protection
β’ Serious sequelae of chlamydial disease such as tubal infertility, chronic pelvic pain
β’ Stress need to finish entire course of antibiotics
DRUG(S) OF CHOICE:
. Urethritis, cervicitis, sexual partners of infected persons
. Doxycycline - 100 mg po bid x 7 days
. Azithromycin - 1 gm orally in a single dose
. Pregnant women - erythromycin base, 250 mg po qid x 14 days
. Other chlamydial syndromes
. Epididymitis - tetracycline, doxycycline, erythromycin for 10-14 days as above.
. Pelvic inflammatory disease - doxycycline for 10-14 days to cover the chlamydial component of PID
(gonorrhea and anaerobic organisms must be treated as well; see CDC recommendations: ceftriaxone 250
mg IM once, cefoxitin, other 3rd generation cephalosporin, or a quinolone), erythromycin for 10-14 days may be needed in pregnant or tetracycline intolerant females to treat chlamydial component.
ALTERNATIVE DRUGS:
β’ Erythromycin base 500 mg po qid x 7 days
β’ Erythromycin ethylsuccinate 800 mg po qid x 7 days
β’ Ofl oxacin 300 mg po bid x 7 days
β’ Levofl oxacin 500 mg po daily x 7 days
PREVENTION/AVOIDANCE:
. Populations with prevalence >5% should be screened at least annually. These include:
. New or more than one sex partner in last 6 months
. Attending adolescent or family planning clinic
. Attending an STD or abortion clinic
. Attending a jail or other detention center or clinic
. Rectal pain, discharge, or tenesmus
. Testicular pain
. All sexually active woman <25 years old
. Consider for all sexually active men <25 years old (studies are pending)
. Only sure way to avoid infection is abstinence, which is not a viable option for many patients. Risk reduction
counseling is an effective prevention measure, emphasizing using barrier protection (e.g., condoms)
and minimizing the number of different sex partners.
Modifiable risk behaviors related to number of sex partners include alcohol or drug use.
POSSIBLE COMPLICATIONS:
. Enhances transmission of and susceptibility to HIV in both sexes
. Males
. Transient oligospermia
. Post epididymitis urethral stricture (rare)
. Females
. Tubal infertility
. Tubal pregnancy
. Chronic pelvic pain
EXPECTED COURSE/PROGNOSIS:
Prognosis good with early and compliant therapy. However, due to the asymptomatic nature of early disease and the population affected, symptomatic PID still accounts annually for 2.5 million outpatient visits and more than one quarter million hospitalizations