Chlamydia trachomatis: Reproductive Tract Infection and Treatment

Chlamydia is the most common bacterial STI. It infects columnar epithelium of:

• Cervix (endocervicitis)
• Urethra (urethritis)
• Rectum (proctitis)
• Pharynx (often asymptomatic)
• Conjunctiva (trachoma — serovars A–C)

Clinical

• 70–80% women, 50% men asymptomatic.
• Symptoms: mucopurulent discharge, dysuria, intermenstrual bleeding, PID (salpingitis → infertility, ectopic).
• LGV (serovars L1–L3): inguinal syndrome, proctocolitis (MSM outbreaks).

Diagnosis

NAAT (urine, swab) — gold standard. Screen annually <25F, pregnant, high-risk.

Treatment

• Doxycycline 100 mg BID × 7 days (preferred).
• Azithromycin 1 g single dose (pregnancy, adherence concerns).
• Test-of-cure at 3–4 weeks if pregnant, rectal/pharyngeal, persistent symptoms.
• Expedited partner therapy (EPT) where legal.

Retest at 3 months (reinfection rate 20–30%).