Chlamydia trachomatis infections

CHLAMYDIA
(Revised April 29, 2005)

A. Diagnosis

Clinical: Found in 20-35% of patients with NGU, PID, gonorrhea, mucopurulent cervicitis, and up to 10% of asymptomatic STD clinic patients. Laboratory: Definitive diagnosis requires isolation of CT by cell culture or identification by nucleic acid amplification test (NAAT), including strand displacement assay (SDA) and polymerase chain reaction (PCR) in samples from a suspected site (i.e., endocervix, urethra, urine). Current DMHC testing policy is as follows: a test by SDA of urine (in men) or endocervical swab (in women) of all patients. The significance of the presence of CT (other than LGV-associated serovars) in pharynx and rectum is currently unknown; routine testing at these anatomical sites is not indicated.
B. Treatment
Azithromycin 1 gm PO x 1 is the preferred treatment for all confirmed cases of CT, as well as for men and women with suspected chlamydia (e.g., NGU, GC, MPC, or contact to any of these or to PID or epididymitis) who are • ≤19 years old, • thought to be a poor risk for compliance with doxycycline. Other patients should be treated with one of the following regimens. Alternative regimen (for patients in whom tetracyclines are contraindicated or not tolerated): erythromycin 500 mg PO QID for 7d. When patients report intolerance to both doxycycline and 500 mg doses of erythromycin, azithromycin should be used. Other alternatives include: erythromycin 250 mg QID for 14d, ofloxacin 300 mg PO BID x 7d (if >16 years old), Levofloxacin 500 mg QD x 7d, or amoxicillin 500 mg PO TID x 7d.
Note: To enhance compliance, whenever possible, clinic-provided medication
should be dispensed on site and the first dose taken in the clinic under direct
observation. If the patient has not yet eaten on the day of the visit, they should
by advised to delay their first dose of doxycycline or erythromycin until after
eating. Patients should be advised to abstain from sex 7 days after azithromycin
therapy or until other regimens have been completed, as well as until sex partners have been treated. C. Pregnancy

Erythromycin 250 mg PO QID x 14d
Note: Although the CDC recommends erythromycin as a first-line treatment
for chlamydia in pregnant women, single-dose azithromycin has been shown
to be safe and effective for use in pregnancy, based on clinical experience
and preliminary data, and is generally much better tolerated. All pregnant
women with known CT should have a test-of-cure 3 wks after finishing
therapy (or 4 wks after a dose of azithromycin).
D. Follow-up

Because of the high rate of re-infection, all persons with chlamydial infections, especially those younger than 25, should be advised to be re-tested for chlamydia 3-4 months after treatment, regardless of whether the patient believes that his or her sex partner(s) were treated. A positive test in a patient likely to have been compliant with therapy most likely represents re-infection from an untreated partner and renewed efforts to assure partner treatment should be pursued. Note: Given the high sensitivity of NAAT, patients will continue to have a positive
chlamydia result for up to 3 weeks following treatment. Re-testing during this time is not
helpful for determining re-infection or treatment success.
Management of contacts
All patients with CT infection should be interviewed by Colorado Department of Public Health and Environment staff if available. Clients should be given contact cards for all recent sexual contacts to increase the likelihood that partners will be treated. Examine, culture, and treat all partners at risk (those within 60 days prior to onset of symptoms or diagnosis or most recent partner if > 60 days). Delivery of antibiotic therapy by infected patients to their partners (patient delivered partner therapy) is currently not standard of care at DMHC.

Source: http://www.denverhealth.org/Portals/0/docs/public_health/std_clinic/standing_orders/CT%20standing%20orders%20revised%20April%202005.pdf