Chlamydia   (nongonococcal urethritis)

  • Most common STD (often occurs in pts w/ gonorrhea)  & incidence is on the rise
  • Causes:  Chlamydia trachomatis   or   Ureaplasma urealyticum
  • Manifestations:  pneumonia (in infants), swollen/tender testicles (epididymitis)
  • In Women:
    • Symptoms:  Usually asymptomatic, abnormal vaginal discharge, pain during sex
    • If not treated in women, Chlamydia can result in Pelvic Inflammatory Disease (PID)
  • In Men:
    • Symptoms:  Usually asymptomatic, discharge from the penis (may be runny &/or whitish), burning upon urination
    • If not treated in men, Chlamydia can result in swollen & tender testicles (epididymitis)
  • Diagnosis is based on DNA probe (24 h for results), tissue culture, or chlamydiazyme (rapid & specific but not very sensitive)
  • Treatment for chlamydia:
    • Azithromycin 1 g by mouth once or doxycycline 100 mg PO BID x 7 days  (not approved during prego)
    • Alternatives:  erythromycin base 500 mg QID x 7 days or ofloxacin 300 mg BID x 7 days or erythromycin ethylsuccinate 800 mg BID x 7 days  or levofloxacin 500 mg QD for 7 days
    • For pts w/ both chlamydia & gonorrhea:  2 g azithromycin PO once
    • Pregos:  erythromycin base 500 mg QID x 7 days  or amoxicillin 500 mg TID for 7 days
      • Alternatives:  azithromycin 1 g once or  erythromycin base 250 mg QID x 14 days   or  EES 800 mg QID for 7 days

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