Chlamydia trachomatis, a small gram-negative bacterium, is the most common cause of bacterial sexually transmitted disease (STD) in both men and women . A significant proportion of patients are asymptomatic, thereby providing an ongoing reservoir for infection. The most frequent clinical manifestation of chlamydial infection in men is urethritis, while the most common finding in women is cervicitis.
The treatment of urethritis, cervicitis, proctitis, and epididymitis secondary to C. trachomatis infection will be reviewed here. The epidemiology, clinical manifestations, and diagnosis of these diseases, as well as other types of C. trachomatis-related diseases, such as pelvic inflammatory disease, reactive arthritis, lymphogranuloma venereum, and endemic trachoma (an ocular infection seen commonly in the developing world), are discussed separately. (See "Approach to dysuria in the adult man" and "Genital Chlamydia trachomatis infections in men" and "Genital Chlamydia trachomatis infections in women" and "Screening for Chlamydia trachomatis" and "Clinical features and diagnosis of pelvic inflammatory disease" and "Reactive arthritis (formerly Reiter syndrome)" and "Lymphogranuloma venereum" and "Epidemiology, diagnosis, and management of trachoma".)
GENERAL TREATMENT PRINCIPLES
Goals of treatment — The goals of treatment are to:
- Prevent complicated infections related to chlamydia and their sequelae (eg, pelvic inflammatory disease, infertility, ectopic pregnancy, epididymitis).
- Decrease the risk of transmission to others; this includes sexual partners and infants at delivery, the latter group at risk of acquiring ocular chlamydial infection from an infected mother. (See "Chlamydia trachomatis infections in the newborn".)
- Attain resolution of symptoms; between 83 and 86 percent of symptomatic patients with cervicitis or urethritis improve clinically within two weeks of starting treatment with doxycycline or azithromycin .
Treatment approach — Complete care of the patient presenting with a chlamydial infection should include: