eMedicine Specialties > Infectious Diseases > Sexually Transmitted Diseases

Chlamydial Genitourinary Infections: Follow-up

Author: Larry I Lutwick, MD, Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus
Coauthor(s): Renuka Heddurshetti, MD, Fellow in Infectious Diseases, Department of Internal Medicine, State University of New York at Brooklyn; Jeffrey Blitstein, MD, Staff Physician, Department of Internal Medicine, Division of Infectious Disease, VA New York Harbor Health Care System at Brooklyn
Contributor Information and Disclosures

Updated: Apr 20, 2009

Follow-up

Deterrence/Prevention

Individuals who are sexually active should be aware of the risk not only of genitourinary chlamydia infection but also of the whole gamut of STDs and that the best way of avoiding infection is to practice safe sex. This means using appropriate barrier protection (ie, latex condoms).

Complications

  • Reiter syndrome, a reactive arthritis secondary to an immune-mediated response has been associated (among other things) with a primary chlamydial infection.
    • It may present as asymmetric polyarthritis, urethritis, inflammatory eye disease, mouth ulcers, circinate balanitis, and keratoderma blennorrhagica.
    • While the etiology of Reiter syndrome may not be completely clear, 2 clear associations are observed. It usually follows an infectious episode, and 80% of affected patients are human leucocyte antigen-B27 (HLA-B27)–positive.
  • Deeper pelvic complications in the female
    • PID
    • Potential infertility
    • Spread to the newborn during parturition

Prognosis

Treatment failures with primary therapies are quite rare.

Relapse may occur with alternative therapies.

Reinfection is very common and is related to nontreatment of infected sexual partners or acquisition from a new partner.

Patient Education

Appropriate counseling of infected individuals must be performed.

  • Counsel patients to avoid reinfection from the sexual partner by facilitating treatment of the contact prior to sexual reexposure.
  • Counsel patients to use latex condoms to prevent reinfection.

For excellent patient education resources, visit eMedicine's Sexually Transmitted Diseases Center. Also, see eMedicine's patient education articles Sexually Transmitted Diseases and Chlamydia.

Miscellaneous

Medicolegal Pitfalls

  • Remembering to treat patients for chlamydial genitourinary infection even when gonococcal infection is clearly diagnosed is important.
  • Consider testing the cure when treatment with amoxicillin or erythromycin is used instead of the standard doxycycline or azithromycin regimens.
 


More on Chlamydial Genitourinary Infections

Overview: Chlamydial Genitourinary Infections
Differential Diagnoses & Workup: Chlamydial Genitourinary Infections
Treatment & Medication: Chlamydial Genitourinary Infections
Follow-up: Chlamydial Genitourinary Infections
References
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References

  1. Centers for Disease Control and Prevention. Chlamydia screening among sexually active young females enrollees of health plans - United States, 2000-2007. MMWR Weekly. April 17, 2009;58(14):362-365. [Full Text].

  2. Quinn TC, Gaydos C, Shepherd M. Epidemiologic and microbiologic correlates of Chlamydia trachomatis infection in sexual partnerships. JAMA. Dec 4 1996;276(21):1737-42. [Medline].

  3. Bell TA, Sandstrom IK, Eschenbach DA. Treatment of Chlamydia trachomatis in pregnancy with amoxicillin. In: Mardh PA, Holmes KK, Oriel JD, Piot P, Schachter J, eds. Chlamydial Infections. New York, NY: Elsevier Biomedical; 1982:221-4.

  4. Bowie WR. Nongonococcal urethritis. Urol Clin North Am. Feb 1984;11(1):55-64. [Medline].

  5. CDC. Diseases characterized by urethritis and cervicitis (see update from April 13, 2007). MMWR Morb Mortal Wkly Rep [serial online]. Aug 4 2006;55(RR-11):35-49. Available at http://www.cdc.gov/std/treatment/2006/urethritis-and-cervicitis.htm#uc4.

  6. CDC. Update to CDC's sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR Morb Mortal Wkly Rep. Apr 13 2007;56(14):332-6. [Medline]. [Full Text].

  7. CDC, Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep. Aug 4 2006;55(RR-11):1-94. [Medline]. [Full Text].

  8. Cook RL, Hutchison SL, Østergaard L, et al. Systematic review: noninvasive testing for Chlamydia trachomatis and Neisseria gonorrhoeae. Ann Intern Med. Jun 7 2005;142(11):914-25. [Medline].

  9. Donders GG. Management of genital infections in pregnant women. Curr Opin Infect Dis. Feb 2006;19(1):55-61. [Medline].

  10. Donovan B. Sexually transmissible infections other than HIV. Lancet. Feb 14 2004;363(9408):545-56. [Medline].

  11. Dorman SA, Danos LM, Wilson DJ. Detection of chlamydial cervicitis by Papanicolaou stained smears and culture. Am J Clin Pathol. Apr 1983;79(4):421-5. [Medline].

  12. Ehret JM, Judson FN. Susceptibility testing of Chlamydia trachomatis: from eggs to monoclonal antibodies. Antimicrob Agents Chemother. Sep 1988;32(9):1295-9. [Medline].

  13. Hook EW 3rd, Smith K, Mullen C. Diagnosis of genitourinary Chlamydia trachomatis infections by using the ligase chain reaction on patient-obtained vaginal swabs. J Clin Microbiol. Aug 1997;35(8):2133-5. [Medline].

  14. Katz BP, Fortenberry D, Orr DP. Factors affecting chlamydial persistence or recurrence one and three months after treatment. In: Stephens RS, Byrne GI, Christiansen G, et al, eds. Chlamydial Infections, Proceedings of the Ninth International Symposium on Human Chlamydial Infection. San Francisco, Calif: International Chlamydial Symposium; 1998:35-8.

  15. Magat AH, Alger LS, Nagey DA. Double-blind randomized study comparing amoxicillin and erythromycin for the treatment of Chlamydia trachomatis in pregnancy. Obstet Gynecol. May 1993;81(5 ( Pt 1)):745-9. [Medline].

  16. Martin DH, Mroczkowski TF, Dalu ZA. A controlled trial of a single dose of azithromycin for the treatment of chlamydial urethritis and cervicitis. The Azithromycin for Chlamydial Infections Study Group. N Engl J Med. Sep 24 1992;327(13):921-5. [Medline].

  17. Rahman MU, Hudson AP, Schumacher HR Jr. Chlamydia and Reiter's syndrome (reactive arthritis). Rheum Dis Clin North Am. Feb 1992;18(1):67-79. [Medline].

  18. Stamm WE. Chlamydia trachomatis infections: progress and problems. J Infect Dis. Mar 1999;179 Suppl 2:S380-3. [Medline].

  19. Wehbeh HA, Ruggeirio RM, Shahem S. Single-dose azithromycin for Chlamydia in pregnant women. J Reprod Med. Jun 1998;43(6):509-14. [Medline].

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Further Reading

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Keywords

nongonococcal urethritis, nonspecific urethritis, postgonococcal urethritis, Chlamydia trachomatis, Chlamydia puerorum, Chlamydia psittaci, Chlamydia pneumoniae, C trachomatis, C puerorum, C psittaci, C pneumoniae, sexually transmitted diseases, STDs

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Contributor Information and Disclosures

Author

Larry I Lutwick, MD, Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus
Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Coauthor(s)

Renuka Heddurshetti, MD, Fellow in Infectious Diseases, Department of Internal Medicine, State University of New York at Brooklyn
Renuka Heddurshetti, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Jeffrey Blitstein, MD, Staff Physician, Department of Internal Medicine, Division of Infectious Disease, VA New York Harbor Health Care System at Brooklyn
Disclosure: Nothing to disclose.

Medical Editor

John M Leedom, MD, Professor of Medicine, Keck School of Medicine, University of Southern California; Chief, Division of Infectious Diseases, Department of Internal Medicine, Los Angeles County, University of Southern California Medical Center
John M Leedom, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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