Urethritis & Cervicitis, Chlamydial

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

• Long-term sequelae may include ectopic pregnancy and infertility

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

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

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