Chlamydia

Key points

• Chlamydia is the most prevalent sexually transmitted infection in the UK and is caused by Chlamydia trachomatis, an obligate intracellular pathogen. Approximately 1 in 10 young women in the UK have Chlamydia.
• asymptomatic in around 70% of women and 50% of men
• women: cervicitis (discharge, bleeding), dysuria
• men: urethral discharge, dysuria Potential complications
• pelvic inflammatory disease
• TREATMENT (BASHH): DOXYCYCLINE 100 mg TWICE DAILY for 7 DAYS is FIRST-LINE for uncomplicated urogenital, pharyngeal AND rectal chlamydia · azithromycin is now an ALTERNATIVE, not first-line, because of rising macrolide resistance (particularly in Mycoplasma genitalium) and inferior efficacy at rectal sites.
• Doxycycline is CONTRAINDICATED IN PREGNANCY — azithromycin is used instead · test of cure is recommended for rectal infection and in pregnancy · if LGV is suspected (rectal symptoms with a positive chlamydia NAAT) a longer 3-WEEK doxycycline course may be given pending LGV typing.
• Diagnosis is by NAAT · offer partner notification and full STI screening including gonorrhoea, syphilis and HIV.