What are the symptoms and treatment of chlamydia?

Symptoms and Treatment of Chlamydia

Chlamydia is often asymptomatic in over 80% of cases, but when symptoms occur, they typically include urethritis in men and cervicitis in women, which may present as discharge or dysuria. 1, 2

Symptoms of Chlamydia

In Men:

• Urethritis (most common manifestation)
  • Urethral discharge
  • Dysuria (painful urination)
  • Often mild or absent symptoms compared to gonorrhea 3
• Epididymitis (accounts for 50% of outpatient visits for this condition among young men) 1
• Proctitis in men who engage in receptive anal intercourse
  • Rectal discharge
  • Pain during defecation 3

In Women:

• Often asymptomatic (up to 80% of cases)
• Cervicitis
• Urethral syndrome (acute dysuria-pyuria syndrome)
• Abnormal vaginal discharge
• Intermenstrual bleeding
• Post-coital bleeding

Complications:

• In women:

  • Pelvic inflammatory disease (PID)
  • Salpingitis
  • Perihepatitis (Fitz-Hugh-Curtis syndrome)
  • Tubal factor infertility
  • Ectopic pregnancy 1, 2

• In men:

  • Epididymitis
  • Orchitis
  • Reactive arthritis (Reiter's syndrome) 1, 4

• Other manifestations:

  • Conjunctivitis
  • Reactive arthritis (in both men and women)
  • Pharyngeal infection (though not established as a cause of pharyngitis) 3

Treatment of Chlamydia

Recommended Regimens:

• Azithromycin 1g orally in a single dose OR
• Doxycycline 100mg orally twice a day for 7 days 3, 1

Alternative Regimens:

• Erythromycin base 500mg orally four times a day for 7 days
• Erythromycin ethylsuccinate 800mg orally four times a day for 7 days
• Ofloxacin 300mg orally twice a day for 7 days 3

Special Considerations:

• For pregnant women:
  • Erythromycin base 500mg orally four times a day for at least 7 days
  • Amoxicillin 500mg orally three times a day for 7 days 1, 5

Management Guidelines:

1. Partner notification and treatment is essential - all sexual partners from the past 60 days should be evaluated and treated 3, 1

2. Abstinence from sexual intercourse until:

   • 7 days after single-dose therapy, OR
   • Until completion of 7-day regimen
   • Until all sex partners are treated 3

3. Retesting is recommended approximately 3 months after treatment to prevent reinfection 1

4. Medications should be dispensed on site when possible, with the first dose directly observed to maximize compliance 3

Important Clinical Considerations:

• Azithromycin provides single-dose, directly observed therapy, which may be more cost-effective in populations with poor compliance
• Doxycycline costs less than azithromycin but requires a 7-day regimen
• Erythromycin is less efficacious and has more gastrointestinal side effects that may reduce compliance 3
• Screening is recommended for all sexually active women under 25 years, pregnant women, and those at increased risk 1, 4

Prevention:

• Consistent condom use reduces transmission risk
• Regular screening for high-risk individuals
• Treatment of all sexual partners to prevent reinfection 1

Remember that untreated chlamydia can lead to serious complications, particularly in women, where it can cause long-term reproductive health issues. Early detection and treatment are crucial for preventing these complications.