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 gonococcal component

• Long-term sequelae may include ectopic pregnancy and infertility

Clinical Findings

• Urethritis and occasionally epididymitis, prostatitis, or proctitis

• Women 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, less purulent, and watery compared with gonococcal infection

• A patient with clinical signs and symptoms of urethritis or cervicitis is assumed to have chlamydial infection until proven otherwise

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

Treatment

• Doxycycline, 100 mg orally twice daily for 7 days, is the preferred regimen but is contraindicated in pregnancy

• Alternative regimen

  • Levofloxacin 500 mg orally once daily for 7 days

  • Azithromycin 1 g orally as a single dose (preferred in pregnancy)

• Presumptively administered therapy still indicated in some cases

  • Individuals with gonococcal infection in whom no chlamydial testing was performed or a test other than a nucleic acid amplification test was used to exclude the diagnosis

  • Individuals for whom a test result is pending but are considered unlikely to follow up

  • Sexual contacts of documented cases

• Studies for HIV and syphilis should also be performed