From the Guidelines
Chlamydia can cause pyelonephritis, although it is not the most common cause, with Escherichia coli accounting for more than 90% of cases in young healthy women 1. The infection can ascend through the urinary system to infect the kidneys, resulting in pyelonephritis. This occurs when the infection spreads from the urethra to the bladder and then up the ureters to the kidneys. Some key points to consider include:
- The risk of chlamydia-induced pyelonephritis increases in untreated chlamydial infections
- Symptoms of chlamydia-induced pyelonephritis include flank pain, fever, nausea, vomiting, and painful urination
- Treatment typically involves antibiotics effective against chlamydia, such as doxycycline or azithromycin
- For severe cases, hospitalization and intravenous antibiotics may be necessary
- It's essential to test and treat sexual partners to prevent reinfection and to complete the full course of antibiotics even if symptoms improve
- Regular STI screening is recommended for sexually active individuals, especially those with multiple partners, to detect and treat infections before complications like pyelonephritis develop 1. Key factors that increase the risk of developing pyelonephritis, including chlamydia-induced pyelonephritis, are:
- Sexual activity
- New sexual partner
- Spermicide exposure
- Personal or maternal history of UTIs
- Genetic predisposition
- Diabetes mellitus
- Factors that disrupt urinary flow, such as vesicoureteral reflux, congenital urinary tract anomalies, altered bladder function, pregnancy, renal calculi, or mechanical obstruction 1.
From the Research
Chlamydia and Pyelonephritis
- Chlamydia trachomatis infections are among the most common sexually transmitted diseases in the world and can participate in the initiation and persistence of upper urinary tract infections, including pyelonephritis 2.
- A study found that Chlamydia trachomatis was present in the aspirated urine of 25% of patients with obstructive pyelonephritis, suggesting that it can be a cause of pyelonephritis 2.
- Another study described three cases of recurrent urinary tract infections due to Chlamydia trachomatis, highlighting the potential for Chlamydia to cause chronic or recurrent urinary tract infections, including pyelonephritis 3.
Treatment of Chlamydia Infections
- Azithromycin and doxycycline are commonly used antibiotics for the treatment of urogenital Chlamydia trachomatis infection, but their efficacy and safety have been debated 4, 5, 6.
- A meta-analysis found that doxycycline may have a slightly higher efficacy than azithromycin for the treatment of urogenital chlamydia infection, but the quality of the evidence varies considerably 4.
- A randomized controlled trial found that the efficacy of azithromycin was 97%, and the efficacy of doxycycline was 100% for the treatment of urogenital chlamydia infection in a closed population receiving directly observed treatment 6.
Implications for Pyelonephritis
- The presence of Chlamydia trachomatis in patients with pyelonephritis suggests that it can be a cause of this condition, and treatment should be targeted at its possible underlying presence 2.
- The choice of antibiotic for the treatment of Chlamydia infections, including those that cause pyelonephritis, should be based on the available evidence and clinical guidelines 4, 5, 6.