Introduction

Chlamydia is the most commonly reported infectious disease in the U.S., with the greatest prevalence in people younger than 25 (CDC, 2010).  It is caused by the bacterium chlamydia trachomatis (Nair & Baguley, 2010).

Presenting Signs and Symptoms of Chlamydia

The signs and symptoms of chlamydia vary by the gender of the patient.  In women, chlamydia may present with a vaginal discharge, with unusual bleeding between menstrual periods or after intercourse, urethritis, pelvic inflammatory disease, pain in the lower abdomen, or even in reactive arthritis.  The signs and symptoms of chlamydia in men include urethral discharge, dysuria, urethritis, epididymo-orchitis, or again with reactive arthritis (Nair & Baguley, 2010).  Chlamydia may also be transmitted to the eye, and appear as chlamydia conjunctivitis.  However, as many as 50% of men with chlamydia are asymptomatic, and as many as 80% of women with a chlamydia infection are asymptomatic (Flannigan, 2006).  Thus, certain groups of patients should be screened for chlamydia, including patients whose partners have been diagnosed with chlamydia, or who themselves have been diagnosed with chlamydia within the past year, or who have had two or more sexual partners in the past few months, sexually active people under 25, and women terminating a pregnancy (Nair & Baguley, 2010).

Examination Findings and Diagnostic Testing

An examination for chlamydia begins with a sexual history of the patient and gaining informed consent from the patient (Flannigan, 2006).  Multiple tests can be used to diagnose chlamydia. Until the mid-1990s, the standard test was to take an invasive swab from the endocervix (in women) or the urethra (in men) (Flannigan, 2006).  Due to the invasive nature of these tests, a urine test has been  developed; for those who engage in anal sex, a rectal swab may be needed to identify chlamydia (CDC, 2010).  Nucleic acid amplification tests (NAATs) can determine if chlamydia is present.

Treatment

If chlamydia is diagnosed, the recommended treatment regimen is 1 g of azithromycin in a single dose or 100 mg of doxycycline taken orally twice a day for seven days (CDC, 2010). There are alternatives also, including erythromycin base 500 mg taken orally four times a day for seven days, or erythromycin enthysuccinate 800 mg taken orally four times a day for seven days, or levofloxacin 500 mg  taken orally once a day for seven days, or ofloxacin 300 mg taken orally twice a day for seven days (CDC, 2010).  Patients who are erratic about seeking health care should be considered for azithromycin since that single-dose treatment can be directly observed by the clinician (CDC, 2010).

Treatment also should include testing all sexual partners and treating those who test positive (CDC, 2010).  If a female patient is pregnant, getting proper treatment can generally prevent transmission of the disease to the fetus (CDC, 2010).  Generally, except for pregnant women, no follow-up test to confirm the cure is recommended unless there is some reason to believe that the patient did not comply with the full treatment regimen, or unless symptoms persist, or unless it is suspected that the patient may be re-infected; this is because a NAAT conducted less than 3 weeks after the therapy is completed has a fairly high false-positive report (CDC, 2010).  However, patients should be re-tested for chlamydia at their next medical appointment at least three months after completion of treatment (CDC, 2010). Patients should abstain from sexual contact until after the completion of the treatment (or for seven days in the case of azithromycin) (Nair & Baguley, 2010).

Patient Education

To prevent the spread of chlamydia, it is very important to educate patients about their condition.  This includes notifying their partners of the infected patients in the past six months and encouraging them to obtain treatment even before the test results are back (azithromycin, in a single-dose) (CDC, 2010).   In addition, patients should receive written materials about chlamydia (CDC, 2010).

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