CHLAMYDIA
Chlamydia is caused by Chlamydia trachomatis, an obligatory intracellular
bacterium. It is the most common bacterial STD in women, occurring up to
five times more frequently than gonorrhea. The long-term sequelae arise from
pelvic adhesions, causing chronic pain and infertility. When the active infection
ascends to the upper genital tract and becomes symptomatic, it is known as acute
pelvic inflammatory disease (acute PID). Transmission from an infected gravida
to her newborn may take place at delivery, causing conjunctivitis and otitis
media.
Most chlamydial cervical infections, and even salpingo-oophoritis, are
asymptomatic.
The classic cervical finding is mucopurulent cervical discharge. Urethral and
cervical motion tenderness may or may not be noted.
Diagnosis. Nucleic acid amplification test (NAAT) of either cervical discharge
or urine is used.
Management. Single oral dose of azithromycin or oral doxycycline for seven
days (CDC-recommended treatment). Patients should avoid coitus for seven
days after therapy. A test-of-cure (repeat testing 3–4 weeks after completing
therapy) is recommended for pregnant women.