Because chlamydia often doesnt cause symptoms, many people who have chlamydia dont know it and unknowingly infect other people. Physical findings of urogenital chlamydial infection in women include cervicitis with a yellow or cloudy mucoid discharge from the os. Levofloxacin is an effective treatment alternative but is more expensive. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. [] was to investigate the mutations retrieved in the 23S rRNA gene and their impact on the resistance in C. trachomatis clinical isolates and wild type Reactive arthritis develops in a small percentage of individuals with chlamydial infection. MLabs does not offer chain of custody testing. Nonsexually transmitted pathogens and even non-infectious processes can also cause urogenital, pharyngeal, and rectal symptoms similar to N. gonorrhoeae. 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. However, presumptive treatment of the neonate is not indicated because the efficacy of such treatment is unknown. Chlamydial infection in newborns can cause ophthalmia neonatorum. Rectal infections often are asymptomatic, although higher prevalence of M. genitalium has been reported among men with rectal symptoms. 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. 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. Twenty percent of women who develop PID become infertile, 18 percent develop chronic pelvic pain, and 9 percent have a tubal pregnancy.2 The Centers for Disease Control and Prevention (CDC) recommends that physicians maintain a low threshold for diagnosing PID and that empiric treatment be initiated in women at risk of sexually transmitted disease (STD) who have uterine, adnexal, or cervical motion tenderness with no other identifiable cause.2. The CDC recommends that anyone who is tested for chlamydial infection also should be tested for gonorrhea.2 This recommendation was supported by a study5 in which 20 percent of men and 42 percent of women with gonorrhea also were found to be infected with C. trachomatis. 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. Doxycycline 100 mg orally 2 times/day for 7 days, Azithromycin 1 g orally in a single dose If health department partner management strategies (e.g., disease intervention specialists) are impractical or unavailable for persons with chlamydia, and if a provider is concerned that sex partners are unable to promptly access evaluation and treatment services, EPT should be considered as permitted by law (see Partner Services). The prevalence of quinolone resistance markers is much lower (697,956959). 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). To minimize disease transmission to sex partners, persons treated for chlamydia should be instructed to abstain from sexual intercourse for 7 days after single-dose therapy or until completion of a 7-day regimen and resolution of symptoms if present. Nucleic acids may persist for up to 4 weeks following appropriate antimicrobial therapy. 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. Processes should be in place to ensure communication between physicians and others caring for the mother and the newborn to ensure thorough monitoring of the newborn after birth. See permissionsforcopyrightquestions and/or permission requests. Screening should include the pharynx, urethra, and rectum based on reported anatomic sites of exposure. The cervix tends to bleed easily when rubbed with a polyester swab or scraped with a spatula. 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. 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). M. genitalium can be detected among 10%30% of women with clinical cervicitis (767,770,772,914916). NAATs that are FDA cleared for use with vaginal swab specimens can be collected by a clinician or patient in a clinical setting. Prophylaxis with silver nitrate or antimicrobial ointment, which reduces the risk of gonococcal infection in neonates, does not reduce the risk of chlamydial infection. 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. Women can develop reactive arthritis, but the male-to-female ratio is 5:1. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Specimens for chlamydial testing should be collected from the nasopharynx. 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. Testing should be accompanied with resistance testing, if available. Regular screenings can help reduce chlamydias spread. WebChlamydia is one of the most common sexually transmitted infections (STIs). Testing for chlamydial infection in neonates can be by culture or nonculture techniques. 1. In addition, peripheral eosinophilia (400 cells/mm3) occurs frequently. 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. Repeat infections confer an elevated risk for PID and other complications among women. 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. Symptoms. Genes and mutations associated with Chlamydia trachomatis resistance to antibiotics Resistance to macrolides Mutations in the 23S rRNA gene. Untreated chlamydia infections can lead to serious health issues including pelvic inflammatory disease (PID) and infertility. Doxycycline Preferred for the Treatment of Chlamydia. Copyright 2023 American Academy of Family Physicians. DFA is the only nonculture FDA-cleared test for detecting C. trachomatis from nasopharyngeal specimens; however, DFA of nasopharyngeal specimens has a lower sensitivity and specificity than culture. 4. Women aged <25 years and those at increased risk for chlamydia (i.e., those 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) should be screened at the first prenatal visit and rescreened during the third trimester to prevent maternal postnatal complications and chlamydial infection in the infant (149). This is a corrected version of the article that appeared in print. Cookies used to make website functionality more relevant to you. The CDC guidelines for the prevention and control of STDs are based on five major concepts (Table 4).2 Primary prevention starts with changing sexual behaviors that increase the risk of contracting STDs.2 Secondary prevention consists of standardized detection and treatment of STDs.9,10, STD prevention messages should be individually tailored and based on stages of patient development and understanding of sexual issues; these messages should be delivered nonjudgmentally.11 Physicians should address misconceptions about STDs among adolescents and young adults (e.g., that virgins cannot become infected). 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. 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. Performing counseling and discussing behavioral interventions have been shown to reduce the likelihood of STDs and reduce risky sexual behavior.12, The CDC recommends annual screening for chlamydial infection in all sexually active women 24 years and younger and in women older than 24 years who are at risk of STDs (e.g., have a new sex partner, have a history of multiple sex partners).2 The U.S. Preventive Services Task Force (USPSTF) strongly recommends that all women 25 years and younger receive routine screening for chlamydia.13 Screening for chlamydial infection is not recommended for men, including those who have sex with other men.14,15 The USPSTF has found insufficient evidence to recommend for or against routine screening of asymptomatic men.13. Centers for Disease Control and Prevention. Untreated chlamydial infection can spread to the epididymis. All nonpregnant people should be tested for reinfection approximately three months after treatment or at the first visit in the 12 months after treatment. All information these cookies collect is aggregated and therefore anonymous. 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). 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. qualitative detection of ribosomal RNA (rRNA) from . In a community-based cohort of female college students, incident chlamydial infection was also associated with BV and high-risk HPV infection (785). Extragenital chlamydial testing at the rectal site can be considered for females on the basis of reported sexual behaviors and exposure through shared clinical decision-making by the patient and the provider. Infection with C. trachomatis is common in selected geographic areas (911913), although M. genitalium is often the sole pathogen. That makes them easy to 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. 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. 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. In men, chlamydial infection of the lower genital tract causes urethritis and, on occasion, epididymitis. Saving Lives, Protecting People, Sexually Transmitted Infections Treatment Guidelines, 2021, https://www.hologic.com/package-inserts/diagnostic-products/aptima-mycoplasma-genitalium-assay, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Retesting After Treatment to Detect Repeat Infections, HIV Infection: Detection, Counseling, and Referral, Diseases Characterized by Genital, Anal, or Perianal Ulcers, Neurosyphilis, Ocular Syphilis, and Otosyphilis, Syphilis Among Persons with HIV Infection, Managing Persons Who Have a History of Penicillin Allergy, Diseases Characterized by Urethritis and Cervicitis, Gonococcal Infections Among Adolescents and Adults, Gonococcal Infections Among Infants and Children, Vulvovaginal Itching, Burning, Irritation, Odor or Discharge, Terms and Abbreviations Used in This Report, U.S. Department of Health & Human Services. Transcription mediated amplification (TMA). 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. Which specimen types are suitable for C trachomatis and N gonorrhoeae nucleic acid amplification tests (NAATs)? Exposure to C. trachomatis during delivery can cause ophthalmia neonatorum (conjunctivitis) in neonates or chlamydial pneumonia at one to three months of age. Thus, using a POC test will likely be a cost-effective diagnostic strategy for C. trachomatis infection (807). C. trachomatis is the most common infectious If either CT or NG is requested, both assays will be performed, reported, and billed. As part of this approach, doxycycline is provided as initial empiric therapy, which reduces the organism load and facilitates organism clearance, followed by macrolide-sensitive M. genitalium infections treated with high-dose azithromycin; macrolide-resistant infections are treated with moxifloxacin (964,965). WebMen and women infected with chlamydia may have a discharge from the penis or vagina, and may notice burning while urinating. Test of cure is not recommended for asymptomatic persons who received treatment with a recommended regimen. WebC trachomatis can be transmitted from the mother during delivery and is associated with conjunctivitis and pneumonia in the newborn. 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. Data are limited regarding the effectiveness and optimal dose of azithromycin for treating chlamydial infection among infants and children weighing <45 kg. Another major advantage is that they can be used with first-catch urine specimens and vaginal swabs. Risk for HIV infection is increased among women with M. genitalium, and evidence indicates that HIV shedding occurs more often among persons with M. genitalium and HIV infection who are not taking ART than among persons without M. genitalium (942,944). Initial C. trachomatis neonatal infection involves the mucous membranes of the eye, oropharynx, urogenital tract, and rectum, although infection might be asymptomatic in these locations. pain in the testicles. Data are insufficient to implicate M. genitalium infection with chronic complications among men (e.g., epididymitis, prostatitis, or infertility). 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). This assay should not be used for the evaluation of suspected sexual abuse or other medico-legal investigations where chain of custody is required. Chlamydial infection is the most frequently reported bacterial infectious disease in the United States, and prevalence is highest among persons aged 24 years (141,784). 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. Some feminine sprays, powders, spermicidal agents, and lubricants may interfere with the assay and should not be used prior to specimen collection. Infants treated with either of these antimicrobials should be followed for IHPS signs and symptoms. 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. Finally, C trachomatis may cause What gender do your partners identify as? 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. If resistance testing is available, it should be performed and the results used to guide therapy. 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. You will be subject to the destination website's privacy policy when you follow the link. Elevated proinflammatory cytokines have been demonstrated among women with M. genitalium, with return to baseline levels after clearance of the pathogen (917). 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). 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. Although evidence is insufficient to recommend routine screening for C. trachomatis among sexually active young men because of certain factors (i.e., feasibility, efficacy, and cost-effectiveness), screening of sexually active young men should be considered in clinical settings with a high prevalence of chlamydia (e.g., adolescent clinics, correctional facilities, or STD specialty clinics) or for populations with a high burden of infection (e.g., MSM) (149,788). Characteristic signs of chlamydial pneumonia among infants include a repetitive staccato cough with tachypnea and hyperinflation and bilateral diffuse infiltrates on a chest radiograph. The arthritis begins one to three weeks after the onset of chlamydial infection. Persons who have chlamydia and HIV infection should receive the same treatment regimen as those who do not have HIV. 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. For Infants and Children Who Weigh <45 kg: Erythromycin base or ethylsuccinate 50 mg/kg body weight/day orally divided into 4 doses daily for 14 days. M. genitalium is identified in the cervix or endometrium of women with PID more often than in women without PID (918924). Levofloxacin 500 mg orally once daily for 7 days. Data from case-control serologic studies (929931) and a meta-analysis of clinical studies (766) indicate a potential role in causing infertility. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Doxy-PEP as an STI Prevention Strategy: Considerations for individuals and healthcare providers of gay or bisexual men or transgender women. Data are insufficient to implicate M. pain. Pregnant patients diagnosed with chlamydia or gonorrhea should have a test of cure four weeks after treatment. M. genitalium infections among women are also frequently asymptomatic, and the consequences associated with asymptomatic M. genitalium infection are unknown. 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. You can review and change the way we collect information below. 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). 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. Between 2015 and 2019, reported chlamydial infections increased by 19%, and reported gonococcal infections increased by 53%.1 These bacteria commonly infect the urogenital, anorectal, and pharyngeal sites but can become disseminated to affect multiple organ systems. The diagnosis of nongonococcal urethritis can be confirmed by the presence of a mucopurulent discharge from the penis, a Gram stain of the discharge with more than five white blood cells per oil-immersion field, and no intracellular gram-negative diplococci.2 A positive result on a leukocyte esterase test of first-void urine or a microscopic examination of first-void urine showing 10 or more white blood cells per high-powered field also confirms the diagnosis of urethritis. As an alternative, prevention efforts should focus on prenatal screening for C. trachomatis, including. The existing evidence between M. genitalium and cervicitis is mostly supportive of a causal association. NAATs are not cleared by FDA for detecting chlamydia from nasopharyngeal specimens, and clinical laboratories should verify the procedure according to CLIA regulations (553). WebA chlamydia test looks for the bacteria that cause the infection (Chlamydia trachomatis). Predictive value of test will vary depending on disease prevalence. Detection of Chlamydia trachomatis and Neisseria gonorrhoeae in male or female urine specimens. Because the efficacy of erythromycin treatment for ophthalmia neonatorum is approximately 80%, a second course of therapy might be required (834,835). 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.