Chlamydia is the most common cause of bacterial sexually transmitted infection in both males and females. While the majority of patients are asymptomatic, the most frequent manifestation of uncomplicated C. trachomatis is urethritis in males and cervicitis in females. Proctitis, lymphogranuloma venerum, prostatitis, PID and others can also occur.
Island Health is now utilizing a molecular assay that tests for four STI pathogens on all samples that request testing for any STI pathogen. All requests for Chlamydia trachomatis and/or Neisseria gonorrhoea and/or Trichomonas vaginalis and/or Mycoplasma genitalium will result in testing for all four pathogens. The new combined assay will be referred to as the STI Pathogen Panel and this is now the preferred order.
Preferred testing specimen varies by syndrome:
A vaginal swab (can be self collected) is preferred in women
First catch urine can also be done in women but it is somewhat less sensitive than vaginal swab
First catch urine is preferred in men; a urethral swab can also be collected
A rectal swab should be collected for proctitis and LGV; All positive samples are referred to BCCDC for testing that distinguishes between regular and LGV strains of Chlamydia trachomatis.
Testing can also be performed on other swabs (e.g. conjunctival, throat)
Patients with persistent symptoms are usually re-infected and should be retreated as primary treatment failure with adherence is rare
With adherence, cure is achieved in 95% of patients
Resistance to tetracyclines and macrolides is rare; both are first line
Choose azithromycin if patient is unlikely to comply to treatment
Treatment of infections outside the genitourinary tract warrant a referral to an appropriate specialty (e.g. Ophthalmology, Infectious Diseases)
OR
Do not use if pregnant or breastfeeding
Second Line Alternatives
Not a benefit; requires special authority
Not appropriate for pregnant women or children < 18 y/o
Ciprofloxacin or Moxifloxacin should not be substituted; Ofloxacin is not readily available
Alternative in Pregnancy
Chlamydia trachomatis