Chlamydia trachomatis: Difference between revisions
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Chlamydia trachomatis
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− | == |
+ | == Background == |
+ | |||
+ | ===Microbiology=== |
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*Small, obligate intracellular [[Stain::Gram-negative]] [[Cellular shape::coccobacillus]] |
*Small, obligate intracellular [[Stain::Gram-negative]] [[Cellular shape::coccobacillus]] |
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**'''Reticulate body (RB):''' replicative form |
**'''Reticulate body (RB):''' replicative form |
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*Virulence factors include lipopolysaccharide (LPS) |
*Virulence factors include lipopolysaccharide (LPS) |
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+ | |||
+ | === Risk Factors === |
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+ | |||
+ | * Sexual contact with chlamydia-infected person |
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+ | * New sexual partner, or more than two sexual partners in the past year |
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+ | * Previous STI |
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+ | * Specific populations: people who inject drugs, incarcerated people, sex trade workers, street-living youth |
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==Clinical Manifestations== |
==Clinical Manifestations== |
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+ | *Incubation period is [[Usual incubation period::2 to 3 weeks]] ([[Incubation period range::up to 6 weeks|Incubation period range::1 to 6 weeks]]) |
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+ | *Many are asymptomatic |
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*Presentation varies by serovar |
*Presentation varies by serovar |
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!Serovars |
!Serovars |
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!Syndromes |
!Syndromes |
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⚫ | |||
⚫ | |||
⚫ | |||
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|- |
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|A to C |
|A to C |
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|[[Trachoma]] (chronic conjunctivitis) |
|[[Trachoma]] (chronic conjunctivitis) |
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⚫ | |||
⚫ | |||
⚫ | |||
|- |
|- |
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|L1 to L3 |
|L1 to L3 |
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*In men, most are symptomatic |
*In men, most are symptomatic |
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− | **Incubation |
+ | **Incubation period is 7 to 21 days in men |
− | **Purulent urethritis |
+ | **Purulent urethritis, urethral itch, dysuria, testicular pain |
+ | **Conjunctivitis |
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+ | **Proctitis (often asymptomatic) |
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+ | **Sequelae include [[epididymo-orchitis]] and [[reactive arthritis]] |
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*In women, often asymptomatic |
*In women, often asymptomatic |
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+ | **Cervicitis, vaginal discharge, dysuria, lower abdominal pain, abnormal vaginal bleeding, dyspareunia |
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+ | **Conjunctivitis |
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+ | **Proctitis (often asymptomatic) |
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+ | **Sequelae include [[pelvic inflammatory disease]], [[ectopic pregnancy]], [[infertility]], [[chronic pelvic pain]], and [[reactive arthritis]] |
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+ | |||
+ | === Lymphogranuloma Venereum === |
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+ | |||
+ | * See [[Lymphogranuloma venereum#Clinical Presentation|lymphogranuloma venereum]] |
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===Fitz-Hugh-Curtis syndrome=== |
===Fitz-Hugh-Curtis syndrome=== |
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*Liver capsular inflammation, possibly autoimmune |
*Liver capsular inflammation, possibly autoimmune |
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+ | |||
+ | === Pediatric Infections === |
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+ | |||
+ | * [[Conjunctivitis]] in neonates |
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+ | * Pneumonia in children under 6 months of age |
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==Diagnosis== |
==Diagnosis== |
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+ | *Molecular testing |
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− | *Urine NAAT ~80% sensitive |
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+ | **Urine NAAT is ~80% sensitive, and is preferred when there is no other indication for a pelvic examination |
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− | *Self-collected vaginal swab better |
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− | * |
+ | **Self-collected vaginal swab likely has better sensitivity, though |
+ | **MD-collected cervical swab best sensitivity (90+%) |
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− | *No more serology! |
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+ | *Culture |
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+ | **For throat specimens |
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+ | *Serology |
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+ | **IgM antibodies can be helpful for diagnosting pneumonia in infants under 3 months of age |
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+ | **Not helpful for diagnosing genital infections |
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==Management== |
==Management== |
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+ | *Non-pregnant, non-lactating adults with urethral, endocervical, rectal, or conjunctival infection |
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− | *For serovars L1-L3 (LGV): treat for 21 days |
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− | * |
+ | **First-line: [[Is treated by::doxycycline]] 100 mg PO bid for 7 days |
+ | **Alternative if adherence likely to be poor: [[azithromycin]] 1 g PO once |
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+ | **Alternative: [[ofloxacin]] 300 mg PO bid for 7 days |
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+ | **Alternative: [[erythromycin]] 2 g/day PO in divided doses for 7 days |
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+ | **Alternative: [[erythromycin]] 1 g/day PO in divided doses for 14 days |
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+ | *Children |
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+ | **Consider child abuse when chlamydia is diagnosed in a prepubertal child |
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+ | ***However, perinatal infection can persist for up to 3 years |
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+ | **≤7 days old |
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+ | ***Infants ≤2 kg: [[erythromycin]] 20 mg/kg/day PO in divided doses for 14+ days |
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+ | ***Infants >2 kg: [[erythromycin]] 30 mg/kg/day PO in divided doses for 14+ days |
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+ | **8 days to 1 month old: [[erythromycin]] 40 mg/kg/day PO in divided doses for 14+ days |
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+ | **1 month to 9 years: [[azithromycin]] 12-15 mg/kg (max 1 g) PO once |
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+ | ***Alternative: [[erythromycin]] 40 mg/kg/day PO in divided doses (max 500 mg qid for 7 days or 250 mg qid for 14 days) |
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+ | ***Alternative: [[sulfamethoxazole]] 75 mg/kg/day PO in divided doses (max 1 g bid) for 10 days |
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+ | **9-18 years: [[doxycycline]] 2.5 mg/kg (max 100 mg) PO bid for 7 days |
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+ | ***Alternative, if adherence likely to be poor: [[azithromycin]] 12-15 mg/kg (max 1 g) PO once |
||
+ | ***Alternative: [[erythromycin]] 40 mg/kg/day PO in divided doses (max 500 mg qid for 7 days or 250 mg qid for 14 days) |
||
+ | ***Alternative: [[sulfamethoxazole]] 75 mg/kg/day PO in divided doses (max 1 g bid) for 10 days |
||
+ | *Pregnant and nursing women with urethral, endocervical, and rectal infections |
||
+ | **[[Azithromycin]] is generally considered safe for this purpose, while [[doxycycline]] and [[fluoroquinolones]] are contraindicated |
||
+ | **Options include any of: |
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+ | ***Alternative: [[amoxicillin]] 500 mg PO tid for 7 days |
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+ | ***Alternative: [[erythromycin]] 2 g/day PO in divided doses for 7 days |
||
+ | ***Alternative: [[erythromycin]] 1 g/day PO in divided doses for 14 days |
||
+ | ***Alternative if adherence is likely to be poor: [[azithromycin]] 1 g PO once |
||
+ | **Ensure that exposed neonates are tested shortly after birth and treated if positive, with monitoring for development of conjunctivitis or pneumonia |
||
+ | *Lymphogranuloma venereum: [[doxycycline]] 100 mg PO bid for 21 days (see [[Lymphogranuloma venereum#Management|LGV-specific page]] for details) |
||
{{DISPLAYTITLE:''Chlamydia trachomatis''}} |
{{DISPLAYTITLE:''Chlamydia trachomatis''}} |
Revision as of 18:56, 16 September 2020
Background
Microbiology
- Small, obligate intracellular Gram-negative coccobacillus
- Very difficult to Gram stain due to lack of peptidoglycan in cell wall
- Two forms exist:
- Elementary body (EB): spore-like form than can survive short times outside the body
- Reticulate body (RB): replicative form
- Virulence factors include lipopolysaccharide (LPS)
Risk Factors
- Sexual contact with chlamydia-infected person
- New sexual partner, or more than two sexual partners in the past year
- Previous STI
- Specific populations: people who inject drugs, incarcerated people, sex trade workers, street-living youth
Clinical Manifestations
- Incubation period is 2 to 3 weeks (Incubation period range::1 to 6 weeks)
- Many are asymptomatic
- Presentation varies by serovar
Serovars | Syndromes |
---|---|
A to C | Trachoma (chronic conjunctivitis) |
D to K | Urethritis, PID, neonatal infection |
L1 to L3 | Lymphogranuloma venereum (LGV) |
Urethritis
- In men, most are symptomatic
- Incubation period is 7 to 21 days in men
- Purulent urethritis, urethral itch, dysuria, testicular pain
- Conjunctivitis
- Proctitis (often asymptomatic)
- Sequelae include epididymo-orchitis and reactive arthritis
- In women, often asymptomatic
- Cervicitis, vaginal discharge, dysuria, lower abdominal pain, abnormal vaginal bleeding, dyspareunia
- Conjunctivitis
- Proctitis (often asymptomatic)
- Sequelae include pelvic inflammatory disease, ectopic pregnancy, infertility, chronic pelvic pain, and reactive arthritis
Lymphogranuloma Venereum
Fitz-Hugh-Curtis syndrome
- Liver capsular inflammation, possibly autoimmune
Pediatric Infections
- Conjunctivitis in neonates
- Pneumonia in children under 6 months of age
Diagnosis
- Molecular testing
- Urine NAAT is ~80% sensitive, and is preferred when there is no other indication for a pelvic examination
- Self-collected vaginal swab likely has better sensitivity, though
- MD-collected cervical swab best sensitivity (90+%)
- Culture
- For throat specimens
- Serology
- IgM antibodies can be helpful for diagnosting pneumonia in infants under 3 months of age
- Not helpful for diagnosing genital infections
Management
- Non-pregnant, non-lactating adults with urethral, endocervical, rectal, or conjunctival infection
- First-line: doxycycline 100 mg PO bid for 7 days
- Alternative if adherence likely to be poor: azithromycin 1 g PO once
- Alternative: ofloxacin 300 mg PO bid for 7 days
- Alternative: erythromycin 2 g/day PO in divided doses for 7 days
- Alternative: erythromycin 1 g/day PO in divided doses for 14 days
- Children
- Consider child abuse when chlamydia is diagnosed in a prepubertal child
- However, perinatal infection can persist for up to 3 years
- ≤7 days old
- Infants ≤2 kg: erythromycin 20 mg/kg/day PO in divided doses for 14+ days
- Infants >2 kg: erythromycin 30 mg/kg/day PO in divided doses for 14+ days
- 8 days to 1 month old: erythromycin 40 mg/kg/day PO in divided doses for 14+ days
- 1 month to 9 years: azithromycin 12-15 mg/kg (max 1 g) PO once
- Alternative: erythromycin 40 mg/kg/day PO in divided doses (max 500 mg qid for 7 days or 250 mg qid for 14 days)
- Alternative: sulfamethoxazole 75 mg/kg/day PO in divided doses (max 1 g bid) for 10 days
- 9-18 years: doxycycline 2.5 mg/kg (max 100 mg) PO bid for 7 days
- Alternative, if adherence likely to be poor: azithromycin 12-15 mg/kg (max 1 g) PO once
- Alternative: erythromycin 40 mg/kg/day PO in divided doses (max 500 mg qid for 7 days or 250 mg qid for 14 days)
- Alternative: sulfamethoxazole 75 mg/kg/day PO in divided doses (max 1 g bid) for 10 days
- Consider child abuse when chlamydia is diagnosed in a prepubertal child
- Pregnant and nursing women with urethral, endocervical, and rectal infections
- Azithromycin is generally considered safe for this purpose, while doxycycline and fluoroquinolones are contraindicated
- Options include any of:
- Alternative: amoxicillin 500 mg PO tid for 7 days
- Alternative: erythromycin 2 g/day PO in divided doses for 7 days
- Alternative: erythromycin 1 g/day PO in divided doses for 14 days
- Alternative if adherence is likely to be poor: azithromycin 1 g PO once
- Ensure that exposed neonates are tested shortly after birth and treated if positive, with monitoring for development of conjunctivitis or pneumonia
- Lymphogranuloma venereum: doxycycline 100 mg PO bid for 21 days (see LGV-specific page for details)