trachomatis acute infections have been diagnosed by cell culture, direct immunofluorescence, enzyme immunoassay, direct DNA hybridization, and more Sensitive and specific methods for diagnosing chlamydial ophthalmia in the neonate include both tissue culture and nonculture tests (e.g., DFA tests and NAATs). 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). Neonates born to mothers at high risk for chlamydial infection, with untreated chlamydia, or with no or unconfirmed prenatal care, are at high risk for infection. 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. The patient should not have urinated for at least 1 hour prior to sample collection. Treatment for Oral Chlamydia. Chlamydia is usually treated with antibiotics like azithromycin which is usually prescribed in a single, large dose, and doxycycline is taken twice per day for about one week. The same antibiotics to treat chlamydia in the groin and may also be prescribed to treat chlamydia in the throat. It is important to avoid 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. 1. 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. Recommended PID treatment regimens are not effective against M. genitalium. Chlamydia screening programs have been demonstrated to reduce PID rates among women (786,787). These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. WebA chlamydia test looks for the bacteria that cause the infection (Chlamydia trachomatis). Copyright 2023 American Academy of Family Physicians. The most frequent clinical manifestation of chlamydial infection in males is urethritis, while the most common finding in females is cervicitis. Recent studies evaluating the lower and upper genital tract using highly sensitive M. genitalium NAAT assays or the role of M. genitalium in histologically defined endometritis have reported significantly elevated risk for PID (928). Re-cap the urine specimen transport tube tightly and label with two identifiers. A chlamydial etiology should be considered for all infants aged 30 days who experience conjunctivitis, especially if the mother has a history of chlamydial infection. See http://www.pathology.med.umich.edu/handbook/Tables/Aptima_Urine.pdf for collection procedure guide. Detection of C. trachomatis infection during the third trimester is not uncommon among adolescent and young adult women, including those without C. trachomatis detected at the time of initial prenatal screening (827). M. genitalium causes symptomatic and asymptomatic urethritis among men and is the etiology of approximately 15%20% of NGU, 20%25% of nonchlamydial NGU, and 40% of persistent or recurrent urethritis (697,909,910). Currently, the first-choice treatment for anogenital chlamydia consists of a single 1000 mg dose of azithromycin, or 100 mg doxycycline twice daily for 7 days [ 3, 4 ]. All nonpregnant people should be tested for reinfection approximately three months after treatment or at the first visit in the 12 months after treatment. Untreated infections may lead to pelvic inflammatory disease; scarring of fallopian tubes, which can increase the risk of ectopic pregnancy; infertility; easier transmission of new HIV infection; and vertical neonatal transmission.2, Young people 15 to 24 years of age account for 61% of all newly diagnosed STIs.1 Racial and ethnic minorities, men who have sex with men (MSM), and transgender and gender diverse people are at higher risk of STIs. 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. Ofloxacin (Floxin) 400 mg orally twice daily for 14 days or levofloxacin (Levaquin) 500 mg orally once daily for 14 days; Ceftriaxone (Rocephin) 250 mg IM in a single dose or cefoxitin (Mefoxin) 2 g IM in a single dose with concurrent probenecid (Benemid) 1 g orally in single dose or other parenteral third-generation cephalosporin; Cefotetan (Cefotan) 2 g IV every 12 hours or cefoxitin 2 g IV every six hours; Clindamycin (Cleocin) 900 mg IV every eight hours; Ampicillin/sulbactam (Unasyn) 3 g IV every six hours; Erythromycin base 500 mg orally four times per day for seven days, Amoxicillin 500 mg orally three times per day for seven days, Erythromycin base 250 mg orally four times per day for 14 days, Erythromycin ethylsuccinate 800 mg orally four times per day for seven days, Erythromycin ethylsuccinate 400 mg four times per day for 14 days, Education and counseling on safer sexual behavior in persons at risk, Identification of asymptomatic infected persons and of symptomatic persons unlikely to seek diagnostic and treatment services, Effective diagnosis and treatment of infected persons, Evaluation, treatment, and counseling of sex partners of persons infected with an STD, Pre-exposure immunizations for vaccine-preventable STDs. The eyelid should be everted and the sample obtained from the inner aspect of the eyelid. Methods: The clinical data of 92 patients diagnosed with Chlamydia trachomatis (C. trachomatis) infections were Instruct patient to provide 20 to 30 mL of the initial urine stream (NOT midstream) into a urine cup free of any preservatives. 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. It is more costly but also has lower frequency of gastrointestinal side effects (817). In a minority viable C. trachomatis was found in culture at the second visit, indicating that patients may remain infectious at least 7 days after treatment. All Rights Reserved. Because the efficacy of erythromycin treatment for ophthalmia neonatorum is approximately 80%, a second course of therapy might be required (834,835). Nonculture tests (e.g., DFA and NAAT) can be used. Patient collection of a meatal swab for C. trachomatis testing might be a reasonable approach for men who are either unable to provide urine or prefer to collect their own meatal swab over providing urine. Remove the cap and transfer 2 mL of urine into the Urine Transport Tube using the disposable pipette provided. Topical treatment is ineffective for ophthalmia neonatorum and should not be used even in conjunction with systemic treatment. Ocular specimens from neonates being evaluated for chlamydial conjunctivitis also should be tested for N. gonorrhoeae (see Ophthalmia Neonatorum Caused by N. gonorrhoeae). Prevalence of molecular markers for macrolide resistance, which highly correlates with treatment failure, ranges from 44% to 90% in the United States, Canada, Western Europe, and Australia (697,702,945953). A urethral discharge can be elicited by compressing the urethra during the pelvic examination. Molecular tests for macrolide (i.e., azithromycin) or quinolone (i.e., moxifloxacin) resistance markers are not commercially available in the United States. Data are limited regarding ectopic pregnancy and neonatal M. genitalium infection (935,936). Persons who have M. genitalium and HIV infection should receive the same treatment regimen as those persons without HIV. For children weighing 45 kg but aged <8 years: Azithromycin 1 g orally in a single dose, For children aged 8 years: Azithromycin 1 g orally in a single dose. A negative result does not exclude the possibility of infection. WebChlamydia trachomatis (/ k l m d i t r k o m t s /), commonly known as chlamydia, is a bacterium that causes chlamydia, which can manifest in various ways, including: trachoma, lymphogranuloma venereum, nongonococcal urethritis, cervicitis, salpingitis, pelvic inflammatory disease. Saving Lives, Protecting People, Sexually Transmitted Infections Treatment Guidelines, 2021, 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, retesting pregnant women during the third trimester who initially tested negative but remained at increased risk for acquiring infection (e.g., women aged <25 years and those aged 25 years 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); and, screening at delivery those pregnant women who were not screened for. These are discussed separately: 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). A combined assay for simultaneous detection of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) is used. Women with recurrent cervicitis should be tested for M. genitalium, and testing should be considered among women with PID. Conclusion: Most RNA- or DNA-positive results after treatment of urogenital C. trachomatis may be caused by non-viable molecular remnants since they cannot be confirmed by culture. Chlamydial infection in newborns can cause ophthalmia neonatorum. Symptoms and Causes Screening should include the pharynx, urethra, and rectum based on reported anatomic sites of exposure. WebMen and women infected with chlamydia may have a discharge from the penis or vagina, and may notice burning while urinating. Physicians should obtain a sexual history free from assumptions about sex partners or practices. Using the Aptima assays as reference method, the comparison showed that the average specificity of multiplex RT-PCR was 100.0% for the four These bacteria are gram-negative, anaerobic, intracellular obligates that replicate within eukaryotic cells. 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. Asymptomatic infection is common among both men and women. Infection with C. trachomatis is common in selected geographic areas (911913), although M. genitalium is often the sole pathogen. Amoxicillin 500 mg orally 3 times/day for 7 days. M. genitalium is identified in the cervix or endometrium of women with PID more often than in women without PID (918924). Topical antibiotic therapy alone is inadequate for treating ophthalmia neonatorum caused by chlamydia and is unnecessary when systemic treatment is administered. Use the APTIMA Urine Specimen Collection Kit. Test of cure to detect therapeutic failure (i.e., repeat testing 4 weeks after completing therapy) is not advised for nonpregnant persons treated with the recommended or alternative regimens, unless therapeutic adherence is in question, symptoms persist, or reinfection is suspected. 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. 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. Annual screening for rectal C. trachomatis infection should be performed among men who report sexual activity at the rectal site. Patients usually have unilateral testicular pain with scrotal erythema, tenderness, or swelling over the epididymis. Doxy-PEP as an STI Prevention Strategy: Considerations for individuals and healthcare providers of gay or bisexual men or transgender women. 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. Individual CT and NG test options are not available. Because chlamydia often doesnt cause symptoms, many people who have chlamydia dont know it and unknowingly infect other people. MSM who are HIV negative with a rectal chlamydia diagnosis should be offered HIV PrEP. Infections in the rectum may cause problems or Women can develop reactive arthritis, but the male-to-female ratio is 5:1. WebInitial C. trachomatisneonatal infection involves the mucous membranes of the eye, oropharynx, urogenital tract, and rectum, although infection might be asymptomatic in Instead, C. trachomatis infection among neonates is most frequently recognized by conjunctivitis that develops 512 days after birth. Test of cure is not recommended for asymptomatic persons who received treatment with a recommended regimen. Mothers of infants who have ophthalmia caused by chlamydia and the sex partners of these women should be evaluated and presumptively treated for chlamydia (see Chlamydial Infection Among Adolescents and Adults). A meta-analysis and a Cochrane systematic review evaluated data from randomized clinical trials of azithromycin versus doxycycline for treating urogenital chlamydial infection determined that microbiologic treatment failure among men was higher for azithromycin than for doxycycline (748,749). Chlamydia trachomatis infection most commonly affects the urogenital tract. The differential diagnosis of gonococcal infections depends on the particular clinical syndrome. Women with chlamydial infection should be rescreened for infection three to four months after completion of antibiotic therapy. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. C. trachomatis is the most common infectious 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. Clinical Significance: The prevalence of quinolone resistance markers is much lower (697,956959). These cookies may also be used for advertising purposes by these third parties. Finally, C trachomatis may cause NAATs have been demonstrated to have improved sensitivity and specificity, compared with culture, for detecting C. trachomatis at rectal and oropharyngeal sites (553,800804), and certain NAAT platforms have been cleared by FDA for these anatomic sites (805). The cervix tends to bleed easily when rubbed with a polyester swab or scraped with a spatula. Symptoms. The purpose of the study performed by Jiang et al. Rectal infections often are asymptomatic, although higher prevalence of M. genitalium has been reported among men with rectal symptoms. Epidemiology, incidence and prevalence: The Persons who have chlamydia and HIV infection should receive the same treatment regimen as those who do not have HIV. Test should be performed on a first catch random urine specimen. If either CT or NG is requested, both assays will be performed, reported, and billed. Having partners accompany patients when they return for treatment is another strategy that has been used successfully for ensuring partner treatment (see Partner Services). 4. Chlamydia is an infection caused by the Chlamydia trachomatis bacteria. Tissue culture is the definitive standard diagnostic test for chlamydial pneumonia. All sexually active people with a cervix who are younger than 25 years and older people with a cervix who have risk factors should be screened annually for chlamydial and gonococcal infections. Treatment should be provided promptly for all persons with chlamydial infection; treatment delays have been associated with complications (e.g., PID) in a limited proportion of women (810). Infants treated with either of these antimicrobials should be followed for IHPS signs and symptoms. Compared with standard patient referral of partners, this approach to therapy, which involves delivering the medication itself or a prescription by the patient or collaborating pharmacy, has been associated with decreased rates of persistent or recurrent chlamydia among women (125127). If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Female patients should not cleanse the labial area prior to collection. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. You will be subject to the destination website's privacy policy when you follow the link. Annual screening of all sexually active women aged <25 years is recommended, as is screening of older women at increased risk for infection (e.g., women aged 25 years 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) (149). 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). Doxycycline is also available in a delayed-release 200-mg tablet formulation, which requires once-daily dosing for 7 days and is as effective as doxycycline 100 mg twice daily for 7 days for treating urogenital C. trachomatis infection in men and women. Like ophthalmia neonatorium, pneumonia secondary toC. 3. Treating pregnant women usually prevents transmission of C. trachomatis to neonates during birth. * An association between oral erythromycin and azithromycin and infantile hypertrophic pyloric stenosis (IHPS) has been reported among infants aged <6 weeks. You can review and change the way we collect information below. Data regarding the efficacy of azithromycin for ophthalmia neonatorum are limited. Nonculture techniques may be used, but they are less sensitive and specific for nasopharyngeal specimens than for ocular specimens. M. genitalium lacks a cell wall, and thus antibiotics targeting cell-wall biosynthesis (e.g., -lactams including penicillins and cephalosporins) are ineffective against this organism. Copyright 2022 by the American Academy of Family Physicians. Etiology, transmission and protection: Chlamydia trachomatis is the leading cause of bacterial sexually transmitted infection (STI) globally. However, presumptive treatment of the neonate is not indicated because the efficacy of such treatment is unknown. In women, chlamydial infection of the lower genital tract occurs in the endocervix. WebComponents: Chlamydia trachomatis RNA, TMA, Urogenital Chlamydia trachomatis RNA, TMA, Urogenital test cost is between $43.00 and $77.00 None $43.00 Order Ulta Lab Tests Compare - Chlamydia and Gonorrhea Test (EW) Covered tests: Chlamydia/Neisseria gonorrhoeae RNA, TMA, Urogenital ( partial ) ( Quest ) 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. In settings in which M. genitalium testing is available, persons with persistent urethritis, cervicitis, or PID accompanied by detection of M. genitalium should be treated with moxifloxacin. The Centers for Disease Control and Prevention and the U.S. Preventive Services Task Force recommend screening for chlamydial infection in women at increased risk of infection and in all women younger than 25 years. Characteristic signs of chlamydial pneumonia among infants include a repetitive staccato cough with tachypnea and hyperinflation and bilateral diffuse infiltrates on a chest radiograph. Ophthalmia neonatorum can be treated with erythromycin base or ethylsuccinate at a dosage of 50 mg per kg per day orally, divided into four doses per day for 14 days.2 The cure rate for both options is only 80 percent, so a second course of therapy may be necessary. This content is owned by the AAFP. 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. Data are insufficient to implicate M. A more recent article on chlamydial and gonococcal infections is available. 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. Repeat infections confer an elevated risk for PID and other complications among women. All newborns should receive ocular erythromycin 0.5% ointment to prevent gonococcal ophthalmia neonatorum. To detect chlamydial infection, health care providers frequently rely on screening tests. 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. Because most infections are asymptomatic, screening is key to preventing complications such as pelvic inflammatory disease and infertility and decreasing community and vertical neonatal transmission. Rectal and oropharyngeal C. trachomatis infection among persons engaging in receptive anal or oral intercourse can be diagnosed by testing at the anatomic exposure site. Reactive arthritis develops in a small percentage of individuals with chlamydial infection. Moreover, using chlamydial NAATs at <4 weeks after completion of therapy is not recommended because the continued presence of nonviable organisms (553,818,819) can lead to false-positive results. Copyright 2006 by the American Academy of Family Physicians. To obtain a complete sexual history, the five Ps (partners, practices, pregnancy attitudes, previous STIs, and protection from STIs) model can be used as outlined in Table 2.2,5, The U.S. Preventive Services Task Force (USPSTF) recommends behavioral counseling on condom use, communication strategies for safer sex, and problem solving with those at increased risk of STIs.6 Adolescents and adults diagnosed with an STI in the past year, people reporting irregular condom use, and those with multiple partners or with partners belonging to a high-risk group are at increased risk. Hospitalization also is indicated if surgical emergencies cannot be excluded.2 The CDC-recommended options for the treatment of PID are listed in Table 2.2, Doxycycline and ofloxacin (Floxin) are contraindicated during pregnancy; therefore, the CDC recommends erythromycin base or amoxicillin for the treatment of chlamydial infection in pregnant women (Table 3).2 Amoxicillin is more effective and tends to have fewer side effects than erythromycin in the treatment of antenatal chlamydial infection, and thus is better tolerated.7,8 Preliminary data suggest that azithromycin is a safe and effective alternative.2. Untreated chlamydia infections can lead to serious health issues including pelvic inflammatory disease (PID) and infertility. Question 2. However, most studies of M. genitalium and PID, even those that controlled extensively for other infections and behavioral and biologic risk, are cross-sectional. CDC twenty four seven. Erythromycin base or ethylsuccinate 50 mg/kg body weight/day orally divided into 4 doses daily for 14 days, Azithromycin suspension20 mg/kg body weight/day orally, 1 dose daily for 3 days. WebChlamydia trachomatis, Nucleic Acid Amplification, Varies Z Useful For Detecting Chlamydia trachomatis This test is not intended for use in medico-legal applications. 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.
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