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Key Features

  • Chlamydia trachomatis immunotypes D–K are isolated in about 50% of cases of nongonococcal urethritis and cervicitis by appropriate techniques

  • Coinfection with gonococci is common

  • Postgonococcal (ie, chlamydial) urethritis may persist after successful treatment of the gonococcus

Clinical Findings

  • Urethritis and occasionally epididymitis, prostatitis, or proctitis

  • Females may be asymptomatic or may have symptoms and signs of cervicitis, salpingitis, or pelvic inflammatory disease

Diagnosis

  • The urethral or cervical discharge due to C trachomatis tends to be less painful and less purulent than gonococcal infection

  • Sensitive and specific nucleic acid amplification tests permit diagnosis of both chlamydia infection and gonorrhea on a vaginal swab or urine sample

Treatment

  • Sexual partners of infected patients should also be treated

  • Presumptively administered therapy still indicated in some cases

  • A single oral 1-g dose of azithromycin is effective for uncomplicated urethritis and cervicitis and has the advantage of improved patient compliance and minimal toxicity

  • Doxycycline, 100 mg twice daily for 7 days, or levofloxacin, 500 mg once daily for 7 days; however, both are contraindicated in pregnancy

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