Island Health logo
Guidelines
Chlamydia trachomatis

Chlamydia trachomatis

General Information

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.

Testing

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)

Treatment for Uncomplicated Chlamydia

  • 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)

Azithromycin 1g PO ONCE as observed therapy when possible
​

Safe in pregnancy and breastfeeding

OR

Doxycycline 100mg PO BID X 7 days if compliance is not an issue
​

Do not use if pregnant or breastfeeding

Second Line Alternatives

Levofloxacin 500mg PO DAILY X 7 days
​

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

Amoxicillin 500mg PO TID X 7 days
​

Perform test of cure

Microbiology

Chlamydia trachomatis