Urethritis & Cervicitis, Chlamydial

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

Long-term sequelae may include ectopic pregnancy and infertility

Urethritis and occasionally epididymitis, prostatitis, or proctitis

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

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

Urine testing does not exclude infection at other sites, such as rectal or pharyngeal disease

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