Test Usage Detection of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis in male or female Test of cure (i.e., repeat testing after completion of therapy) to document chlamydial eradication, preferably by NAAT, at approximately 4 weeks after therapy completion during pregnancy is recommended because severe sequelae can occur among mothers and neonates if the infection persists. If tracheal aspirates or lung biopsies are being collected for pneumonia in infants one to three months of age, the samples should be tested for C. trachomatis.2. It is more costly but also has lower frequency of gastrointestinal side effects (817). In addition, systematic reviews and meta-analyses have noted an association with macrolide antimicrobials, especially erythromycin, during pregnancy and adverse child outcomes, indicating cautious use in pregnancy (830831). Thus, using a POC test will likely be a cost-effective diagnostic strategy for C. trachomatis infection (807). Ophthalmia neonatorum can be treated with erythromycin base or ethylsuccinate at a dosage of 50 mg per kg per day orally, divided into four doses per day for 14 days.2 The cure rate for both options is only 80 percent, so a second course of therapy may be necessary. Untreated chlamydial infection can spread to the epididymis. If either CT or NG is requested, both assays will be performed, reported, and billed. When nonadherence to doxycycline regimen is a substantial concern, azithromycin 1 g regimen is an alternative treatment option but might require posttreatment evaluation and testing because it has demonstrated lower treatment efficacy among persons with rectal infection. Because chlamydia often doesnt cause symptoms, many people who have chlamydia dont know it and unknowingly infect other people. We take your privacy seriously. The arthritis begins one to three weeks after the onset of chlamydial infection. Self-collected rectal swabs are a reasonable alternative to clinician-collected rectal swabs for C. trachomatis screening by NAAT, especially when clinicians are not available or when self-collection is preferred over clinician collection. In addition, peripheral eosinophilia (400 cells/mm3) occurs frequently. Erythromycin is no longer recommended because of the frequency of gastrointestinal side effects that can result in therapy nonadherence. Among symptomatic patients, POC tests for C. trachomatis can optimize treatment by limiting unnecessary presumptive treatment at the time of clinical decision-making and improve antimicrobial stewardship. * An association between oral erythromycin and azithromycin and infantile hypertrophic pyloric stenosis (IHPS) has been reported among infants aged <6 weeks. The diagnosis of nongonococcal urethritis can be confirmed by the presence of a mucopurulent discharge from the penis, a Gram stain of the discharge with more than five white blood cells per oil-immersion field, and no intracellular gram-negative diplococci.2 A positive result on a leukocyte esterase test of first-void urine or a microscopic examination of first-void urine showing 10 or more white blood cells per high-powered field also confirms the diagnosis of urethritis. The CDC recommends that anyone who is tested for chlamydial infection also should be tested for gonorrhea.2 This recommendation was supported by a study5 in which 20 percent of men and 42 percent of women with gonorrhea also were found to be infected with C. trachomatis. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Doxycycline should be used to treat chlamydia in nonpregnant people. Because of concerns regarding chlamydia persistence after exposure to penicillin-class antibiotics that has been demonstrated in animal and in vitro studies, amoxicillin is listed as an alternative therapy for C. trachomatis for pregnant women (828,829). Treatment with azithromycin alone has been reported to select for resistance (705,954,955), with treatment of macrolide-susceptible infections with a 1-g dose of azithromycin resulting in selection of resistant-strain populations in 10%12% of cases. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. Thank you for taking the time to confirm your preferences. Chlamydia is a treatable infection. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. In women, chlamydial infection of the lower genital tract occurs in the endocervix. A urethral discharge can be elicited by compressing the urethra during the pelvic examination. Rectal and oropharyngeal C. trachomatis infection among persons engaging in receptive anal or oral intercourse can be diagnosed by testing at the anatomic exposure site. Some feminine sprays, powders, spermicidal agents, and lubricants may interfere with the assay and should not be used prior to specimen collection. Data are lacking regarding use of NAATs for specimens from extragenital sites (rectum and pharynx) among boys and girls (553); other nonculture tests (e.g., DFA) are not recommended because of specificity concerns. Currently, the first-choice treatment for anogenital chlamydia consists of a single 1000 mg dose of azithromycin, or 100 mg doxycycline twice daily for 7 days [ 3, 4 ]. Because test results for chlamydia often are unavailable at the time initial treatment decisions are being made, treatment for C. trachomatis pneumonia frequently is based on clinical and radiologic findings, age of the infant (i.e., 13 months), and risk for chlamydia in the mother (i.e., aged <25 years, history of chlamydial infection, multiple sex partners, a sex partner with a concurrent partner, or a sex partner with a history of an STI). A rare complication of untreated chlamydial infection is the development of Reiter syndrome, a reactive arthritis that includes the triad of urethritis (sometimes cervicitis in women), conjunctivitis, and painless mucocutaneous lesions. C. trachomatis also can cause a subacute, afebrile pneumonia with onset at ages 13 months. The possibility of concomitant chlamydial pneumonia should be considered (see Infant Pneumonia Caused by C. trachomatis). The purpose of the study performed by Jiang et al. To maximize adherence with recommended therapies, on-site, directly observed single-dose therapy with azithromycin should always be available for persons for whom adherence with multiday dosing is a considerable concern. For Infants and Children Who Weigh <45 kg: Erythromycin base or ethylsuccinate 50 mg/kg body weight/day orally divided into 4 doses daily for 14 days. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Tracheal aspirates and lung biopsy specimens, if collected, should be tested for C. trachomatis. The mucocutaneous lesions are papulosquamous eruptions that tend to occur on the palms of the hands and the soles of the feet. Inequitable access to health insurance and physicians, language barriers, and distrust of medical systems because of discrimination account for some of these disparities, independent of individual sexual behavior.3,4 Other risk factors are reviewed in Table 1.2, Taking a thorough sexual history is important to identify overall risk of infection, as well as anatomic site-specific risk factors. Characteristic signs of chlamydial pneumonia among infants include a repetitive staccato cough with tachypnea and hyperinflation and bilateral diffuse infiltrates on a chest radiograph. If resistance testing is available, it should be performed and the results used to guide therapy. Clinical experience and published studies indicate that azithromycin is safe and effective during pregnancy (824826). CDC twenty four seven. NAATs have been demonstrated to have improved sensitivity and specificity, compared with culture, for detecting C. trachomatis at rectal and oropharyngeal sites (553,800804), and certain NAAT platforms have been cleared by FDA for these anatomic sites (805). Recent studies evaluating the lower and upper genital tract using highly sensitive M. genitalium NAAT assays or the role of M. genitalium in histologically defined endometritis have reported significantly elevated risk for PID (928). Testing for chlamydial infection in neonates can be by culture or nonculture techniques. WebChlamydia trachomatis RNA, TMA, Urogenital 11361 Gonorrhea, if indicated d Neisseria gonorrhoeae RNA, TMA, Urogenital 11362 Chlamydia and gonorrhea Chlamydia/Neisseria gonorrhoeae RNA, TMA, Urogenital 11363 HIV testing HIV-1/2 Antigen and Antibodies, Fourth Generation, with Reflexes b 91431 Hepatitis C testing It is caused by Chlamydia trachomatis bacteria which infects both men and women. Chlamydia trachomatis are gram-negative anaerobic bacteria that replicate inside eukaryotic cells (Mohseni, 2019). It is a weak organism that relies on its host for nutrients and survival. It lives inside a host in order to reproduce and survive. Prevalence of molecular markers for macrolide resistance, which highly correlates with treatment failure, ranges from 44% to 90% in the United States, Canada, Western Europe, and Australia (697,702,945953). Most women with chlamydial infection have minimal or no symptoms, but some develop pelvic inflammatory disease. A test of cure to detect therapeutic failure ensures treatment effectiveness and should be obtained at a follow-up visit approximately 4 weeks after treatment is completed. Immediately place the swab into the transport tube and carefully break the swab shaft against the side of Genes and mutations associated with Chlamydia trachomatis resistance to antibiotics Resistance to macrolides Mutations in the 23S rRNA gene. Initial C. trachomatis neonatal infection involves the mucous membranes of the eye, oropharynx, urogenital tract, and rectum, although infection might be asymptomatic in these locations. Test Usage Detection of Having partners accompany patients when they return for treatment is another strategy that has been used successfully for ensuring partner treatment (see Partner Services). Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. Recent studies report a high concordance of M. genitalium among partners of males, females, and MSM; however, no studies have determined whether reinfection is reduced with partner treatment (940,967,968). Data are limited regarding ectopic pregnancy and neonatal M. genitalium infection (935,936). M. genitalium is an extremely slow-growing organism. In men, chlamydial infection of the lower genital tract causes urethritis and, on occasion, epididymitis. Mothers of infants who have chlamydial pneumonia and the sex partners of these women should be evaluated, tested, and presumptively treated for chlamydia (see, Chlamydial Infection Among Adolescents and Adults). Chlamydial infection is the most frequently reported bacterial infectious disease in the United States, and prevalence is highest among persons aged 24 years (141,784). All nonpregnant people should be tested for reinfection approximately three months after treatment or at the first visit in the 12 months after treatment. Two-stage therapy approaches, ideally using resistance-guided therapy, are recommended for treatment. These infants should receive evaluation and age-appropriate care and treatment. Web2021 STI Treatment Guidelines Chlamydial Infections Includes updated treatment and screening recommendations, as well as information on diagnosis, prevention, and special considerations. WebSpontaneous resolution of urogenital Chlamydia trachomatis (CT) without treatment has previously been described, but a limitation of these reports is that DNA or RNA-based amplification tests used do not differentiate between viable infection and non-viable DNA. The CDC guidelines for the prevention and control of STDs are based on five major concepts (Table 4).2 Primary prevention starts with changing sexual behaviors that increase the risk of contracting STDs.2 Secondary prevention consists of standardized detection and treatment of STDs.9,10, STD prevention messages should be individually tailored and based on stages of patient development and understanding of sexual issues; these messages should be delivered nonjudgmentally.11 Physicians should address misconceptions about STDs among adolescents and young adults (e.g., that virgins cannot become infected). Men and women who have been treated for chlamydia should be retested approximately 3 months after treatment, regardless of whether they believe their sex partners were treated; scheduling the follow-up visit at the time of treatment is encouraged (753). No clinical trial data are available that demonstrate that treating M. genitalium cervical infection prevents development of PID or endometritis. Women aged <25 years and those at increased risk for chlamydia (i.e., those who have a new sex partner, more than one sex partner, a sex partner with concurrent partners, or a sex partner who has an STI) should be screened at the first prenatal visit and rescreened during the third trimester to prevent maternal postnatal complications and chlamydial infection in the infant (149). More frequent screening than annual for certain women (e.g., adolescents) or certain men (e.g., MSM) might be indicated on the basis of risk behaviors. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. Which specimen types are suitable for C trachomatis and N gonorrhoeae nucleic acid amplification tests (NAATs)? Persons who receive a diagnosis of chlamydia should be tested for HIV, gonorrhea, and syphilis. Exposure to C. trachomatis during delivery can cause ophthalmia neonatorum (conjunctivitis) in neonates or chlamydial pneumonia at one to three months of age. NAAT for M. genitalium is FDA cleared for use with urine and urethral, penile meatal, endocervical, and vaginal swab samples (https://www.hologic.com/package-inserts/diagnostic-products/aptima-mycoplasma-genitalium-assay). DFA is the only nonculture FDA-cleared test for detecting C. trachomatis from nasopharyngeal specimens; however, DFA of nasopharyngeal specimens has a lower sensitivity and specificity than culture. All information these cookies collect is aggregated and therefore anonymous. Culture can take up to 6 months, and technical laboratory capacity is limited to research settings. Author disclosure: No relevant financial relationships. However, C. trachomatis also causes trachoma in endemic areas, mostly Africa and the Middle East, and is a leading cause of preventable blindness worldwide. Elevated proinflammatory cytokines have been demonstrated among women with M. genitalium, with return to baseline levels after clearance of the pathogen (917). Erythromycin base or ethylsuccinate 50 mg/kg body weight/day orally, divided into 4 doses daily for 14 days*. The newest nonculture technique is the nucleic acid amplification test, of which there are several. These cookies may also be used for advertising purposes by these third parties. Given that 3 out of 4 infected women and Persons who have chlamydia and HIV infection should receive the same treatment regimen as those who do not have HIV. Extragenital chlamydial testing at the rectal site can be considered for females on the basis of reported sexual behaviors and exposure through shared clinical decision-making by the patient and the provider. Epidemiology, incidence and prevalence: The Observational studies have also demonstrated that doxycycline is more efficacious for rectal C. trachomatis infection for men and women than azithromycin (748,811). Doxycycline Preferred for the Treatment of Chlamydia. Providers should provide patients with written educational materials to give to their partners about chlamydia, which should include notification that partners have been exposed and information about the importance of treatment. Similarly, evidence for a role for M. genitalium infection during pregnancy as a cause of perinatal complications, including preterm delivery, spontaneous abortion, or low birthweight, are conflicting because evidence is insufficient to attribute cause (766,932934). Evidence is limited regarding the efficacy of antimicrobial regimens for oropharyngeal chlamydia; however, a recently published observational study indicates doxycycline might be more efficacious than azithromycin for oropharyngeal chlamydia (815). As part of this approach, doxycycline is provided as initial empiric therapy, which reduces the organism load and facilitates organism clearance, followed by macrolide-sensitive M. genitalium infections treated with high-dose azithromycin; macrolide-resistant infections are treated with moxifloxacin (964,965).