A Breif Synopsis of AFP's "Chlamydia Trachomatis Infections: Screening, Diagnosis, and Management"

A brief synopsis of:
Chlamydia Trachomatis Infections: Screening, Diagnosis, and Management
RANIT MISHORI, MD, MHS; ERICA L. McCLASKEY, MD, MS; and VINCE J. WINKLERPRINS, MD Georgetown University School of Medicine, Washington, District of Columbia 
http://www.aafp.org/afp/2012/1215/p1127.pdf 
Am Fam Physician. 2012 Dec 15;86(12):1127-1132.

     Chlamydia trachomatis is a gram negative bacteria. It is the most common (or at least most commonly reported) STD in the USA and the leading cause of infectious blindness in the world. It affects young adults (more often women) with multiple sex partners.  Most people are asymptomatic. Women may have discharge, vaginal bleeding, cervical friability and dysuria. Men may rarely have symptoms, which are pruritus, discharge, and dysuria. Patients who participate in anal sex may get a rectal infection and those who engage in oral sex may get a pharyngeal infection. Although patients diagnosed with gonorrhea are also treated for chlamydia, those infected with chlamydia are not also treated for gonorrhea. Complications include PID, infertility, and Fitz-Hugh-Curtis syndrome. Infection during pregnancy can cause miscarriage  PROM, preterm labor, low birth weight, and infant death.  Complications for men include epididymoorchitis and infertility. Patients may also get Reiters syndrome and chlamydia-induced reactive arthritis.
     The most sensitive test for diagnosis is nucleic acid amplification tests (NAATs) of a sample from the infected area or even from the urine. Rectal or oralpharyngeal swabs can be used as well. A wet mount will be positive for >10% WBCs/hpf for chlamydial or gonococcal infections. 
     Uncomplicated chlamydia can be treated with azithromycin, doxycycline, erythromycin, levofloxacin, or ofloxacin. Pregnant women can use azithromycin, amoxicillin or erythromycin.  They should also be rechecked after 3-4 weeks. If they are in their first trimester, they can be rechecked in the third trimester. 
     Sexual partners should be notified, treated, and referred for evaluation. They should contact anyone they have had sexual contact with in the last 60 days. They should also abstain form intercource for seven days after the medication is complete. patients can be retested within a year.
   It is recommended that all sexually active women 24 years and younger be screened for chlamydia. Women 25 years and older who have had multiple sexual partners or who have a new sexual partner should be screened as well. All pregnant women should be screened at their first prenatal visit. Men should only be screened if they are in a setting of high prevalence, such as prison or an STD clinic. Men who participate in risky behavior, such as having sex with other men, should also be screened (for genetial and rectal infection if necessary). Urine screening can be done annually in men who have had insertive (rather than receptive) anal intercourse within the last year.
     C. trachomatis can also cause lymphogranuloma venereum (LGV). It presents as a unilateral, tender node in the inguinal or femoral area. It can also cause proctocolitis, rectal discharge, pain, constipation, fissures, strictures or tenesmus. Treatment consist of doxycycline or erythromycin. 
     Neonatal pneumonia can affect infants born to mothers with active chlamydia during labor. It will occur 1-3 months after birth. Symptoms consist of tachypnea and a staccato cough. DIffuse bilateral infiltrates and hyperinflation may be seen on x ray. Lab work may show eosinophilia. Treatment consists of erythromycin. 
     There are three types of ocular infections caused by chlamydia. Neonatal conjunctivitis/ophthalmia neonatorum will present in up to one third of child of chlamydia infected mothers during labor. The patient will have conjunctival injection, discharge, and swollen eyelids. Culture is taken from the everted eyelid. Treatment consists of oral erythromycin or ethylsuccinate. (Silver nitrate protects against gonorrhea, not chlamydia).  Adult inclusion conjunctivitis is a mucopurulent infection associated with the genitourinary infection. The everted eyelid should be cultured. Treatment is with doxycycline or azithromycin. Trachoma is a chronic or recurrent eye infection. it can cause abnormal positioning of the eyelash and lead to scarring of the eyelids. It is the largest cause of blindness worldwide. It is spread through poor hygiene, direct contact and flies. Treatment consists of erythromycin, azithromycin, or doxycycline.