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For further information, see CMDT Part 33-40: Chlamydia Trachomatis Infections

Key Features

  • An acute and chronic sexually transmitted disease

  • Caused by Chlamydia trachomatis types L1–L3

Clinical Findings

  • In men

    • The initial vesicular or ulcerative lesion (on the external genitalia) is evanescent and often goes unnoticed

    • Inguinal buboes appear 1–4 weeks after exposure, are often bilateral, and have a tendency to fuse, soften, and break down to form multiple draining sinuses, with extensive scarring

  • In women

    • The genital lymph drainage is to the perirectal glands

    • Early anorectal manifestations are proctitis with tenesmus and bloody purulent discharge

  • Late manifestations

    • Chronic cicatrizing inflammation of the rectal and perirectal tissue

      • These changes lead to obstipation and rectal stricture and, occasionally, rectovaginal and perianal fistulas

      • These changes are also seen in patients who have anal coitus

Diagnosis

  • The complement fixation test may be positive (titers > 1:64), but cross-reaction with other chlamydiae occurs

  • Nucleic acid detection tests are sensitive, but not FDA-approved for rectal specimens and cannot differentiate lymphogranuloma venereum (LGV) from non-LGV strains

Treatment

  • Doxycycline, 100 mg twice daily orally for 21 days; contraindicated in pregnancy

  • Erythromycin, 500 mg four times daily orally for 21 days

  • Azithromycin, 1 g orally once weekly for 3 weeks, may also be effective

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