Clinical Significance
This test performed at a doctors office only. For test at a service center use test code #93105, a unisex test.
Chlamydia trachomatis infections are the leading cause of sexually transmitted diseases in the United States. Commonly known as Chlamydia, it can cause cervicitis, pelvic inflammatory disease (PID), epididymitis (inflammation of the tube at the back of the testicle that stores and carries sperm), and proctitis (inflammation or infection of the rectum).
Among women, the consequences of Chlamydial infections are severe if left untreated and can cause serious, permanent damage to a woman's reproductive system. This cn make it difficult or impossible for her to get pregnant later on. Chlamydia can also cause a potentially serious and fatal ectopic pregnancy.
Approximately half of Chlamydial infections are asymptomatic.
If you are experiencing symptoms or may be at risk of exposure do not hesitate to test and seek medical attention as soon as possible.
GONORRHEA
Neisseria gonorrhoeae (gonococci) is the causative agent of gonorrhea. In men, this disease generally results in anterior urethritis accompanied by purulent exudate. In women, the disease is most often found in the cervix, but the vagina and uterus may also be infected.
Test Prep: Do not urinate for at least one hour prior to specimen collection. Female patients should not cleanse the labial area prior to providing the specimen.
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What is gonorrhea?
Gonorrhea is a sexually transmitted disease (STD) caused by infection with the Neisseria gonorrhoeae bacterium. N. gonorrhoeae infects the mucous membranes of the reproductive tract, including the cervix, uterus, and fallopian tubes in women, and the urethra in women and men. N. gonorrhoeae can also infect the mucous membranes of the mouth, throat, eyes, and rectum.
How common is gonorrhea?
Gonorrhea is a very common infectious disease. CDC estimates that approximately 820,000 new gonococcal infections occur in the United States each year, and more than half of these infections are detected and reported to CDC.1 CDC estimates that 570,000 of them were among young people 15-24 years of age. In 2016, 468,514 cases of gonorrhea were reported to CDC.2
How do people get gonorrhea?
Gonorrhea is transmitted through sexual contact with the penis, vagina, mouth, or anus of an infected partner. Ejaculation does not have to occur for gonorrhea to be transmitted or acquired. Gonorrhea can also be spread perinatally from mother to baby during childbirth.
People who have had gonorrhea and received treatment may be reinfected if they have sexual contact with a person infected with gonorrhea.
Who is at risk for gonorrhea?
Any sexually active person can be infected with gonorrhea. In the United States, the highest reported rates of infection are among sexually active teenagers, young adults, and African Americans 2.
What are the signs and symptoms of gonorrhea?
Many men with gonorrhea are asymptomatic 3, 4. When present, signs and symptoms of urethral infection in men include dysuria or a white, yellow, or green urethral discharge that usually appears one to fourteen days after infection 5. In cases where urethral infection is complicated by epididymitis, men with gonorrhea may also complain of testicular or scrotal pain.
Most women with gonorrhea are asymptomatic 6, 7. Even when a woman has symptoms, they are often so mild and nonspecific that they are mistaken for a bladder or vaginal infection 8, 9. The initial symptoms and signs in women include dysuria, increased vaginal discharge, or vaginal bleeding between periods. Women with gonorrhea are at risk of developing serious complications from the infection, regardless of the presence or severity of symptoms.
Symptoms of rectal infection in both men and women may include discharge, anal itching, soreness, bleeding, or painful bowel movements 10. Rectal infection also may be asymptomatic. Pharyngeal infection may cause a sore throat, but usually is asymptomatic 11, 12.
What are the complications of gonorrhea?
Untreated gonorrhea can cause serious and permanent health problems in both women and men.
In women, gonorrhea can spread into the uterus or fallopian tubes and cause pelvic inflammatory disease (PID). The symptoms may be quite mild or can be very severe and can include abdominal pain and fever 13. PID can lead to internal abscesses and chronic pelvic pain. PID can also damage the fallopian tubes enough to cause infertility or increase the risk of ectopic pregnancy.
In men, gonorrhea may be complicated by epididymitis. In rare cases, this may lead to infertility 14.
If left untreated, gonorrhea can also spread to the blood and cause disseminated gonococcal infection (DGI). DGI is usually characterized by arthritis, tenosynovitis, and/or dermatitis 15. This condition can be life threatening.
What about gonorrhea and HIV?
Untreated gonorrhea can increase a person’s risk of acquiring or transmitting HIV, the virus that causes AIDS 16.
How does gonorrhea affect a pregnant woman and her baby?
If a pregnant woman has gonorrhea, she may give the infection to her baby as the baby passes through the birth canal during delivery. This can cause blindness, joint infection, or a life-threatening blood infection in the baby 17. Treatment of gonorrhea as soon as it is detected in pregnant women will reduce the risk of these complications. Pregnant women should consult a health care provider for appropriate examination, testing, and treatment, as necessary.
Who should be tested for gonorrhea?
Any sexually active person can be infected with gonorrhea. Anyone with genital symptoms such as discharge, burning during urination, unusual sores, or rash should stop having sex and see a health care provider immediately.
Also, anyone with an oral, anal, or vaginal sex partner who has been recently diagnosed with an STD should see a health care provider for evaluation.
Some people should be tested (screened) for gonorrhea even if they do not have symptoms or know of a sex partner who has gonorrhea 18. Anyone who is sexually active should discuss his or her risk factors with a health care provider and ask whether he or she should be tested for gonorrhea or other STDs.
CDC recommends yearly gonorrhea screening for all sexually active women younger than 25 years, as well as older women with risk factors such as new or multiple sex partners, or a sex partner who has a sexually transmitted infection.
People who have gonorrhea should also be tested for other STDs.
How is gonorrhea diagnosed?
Urogenital gonorrhea can be diagnosed by testing urine, urethral (for men), or endocervical or vaginal (for women) specimens using nucleic acid amplification testing (NAAT) 19. It can also be diagnosed using gonorrhea culture, which requires endocervical or urethral swab specimens.
If a person has had oral and/or anal sex, pharyngeal and/or rectal swab specimens should be collected either for culture or for NAAT (if the local laboratory has validated the use of NAAT for extra-genital specimens) 20.
What is the treatment for gonorrhea?
Gonorrhea can be cured with the right treatment. CDC now recommends dual therapy (i.e. using two drugs) for the treatment of gonorrhea. It is important to take all of the medication prescribed to cure gonorrhea. Medication for gonorrhea should not be shared with anyone. Although medication will stop the infection, it will not repair any permanent damage done by the disease. Antimicrobial resistance in gonorrhea is of increasing concern, and successful treatment of gonorrhea is becoming more difficult 21. If a person’s symptoms continue for more than a few days after receiving treatment, he or she should return to a health care provider to be reevaluated.
What about partners?
If a person has been diagnosed and treated for gonorrhea, he or she should tell all recent anal, vaginal, or oral sex partners (all sex partners within 60 days before the onset of symptoms or diagnosis) so they can see a health provider and be treated 20. This will reduce the risk that the sex partners will develop serious complications from gonorrhea and will also reduce the person’s risk of becoming reinfected. A person with gonorrhea and all of his or her sex partners must avoid having sex until they have completed their treatment for gonorrhea and until they no longer have symptoms. For tips on talking to partners about sex and STD testing, visit http://www.gytnow.org/talking-to-your-partner.
How can gonorrhea be prevented?
Latex condoms, when used consistently and correctly, can reduce the risk of transmission of gonorrhea 22. The surest way to avoid transmission of gonorrhea or other STDs is to abstain from vaginal, anal, and oral sex, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.
Where can I get more information?
Health care providers with STD consultation requests can contact the STD Clinical Consultation Network (STDCCN). This service is provided by the National Network of STD Clinical Prevention Training Centers and operates five days a week. STDCCN is convenient, simple, and free to health care providers and clinicians. More information is available at www.stdccn.org.
Division of STD Prevention (DSTDP)
Centers for Disease Control and Prevention
www.cdc.gov/std
Sources
- Satterwhite CL, Torrone E, Meites E, et al. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Dis, 40(3), 187–193 (2013).
- CDC. Sexually Transmitted Disease Surveillance, 2016. Atlanta, GA: Department of Health and Human Services; September 2017.
- Handsfield HH, Lipman TO, Harnisch JP, Tronca E, Holmes KK. Asymptomatic gonorrhea in men. N Engl J Med, 290(3), 117–123 (1974).
- Peterman T, Tian L, Metcalf C et al. High incidence of new sexually transmitted infections in the year following a sexually transmitted infection: a case for rescreening. Ann Intern Med, 145(8), 564–572 (2006).
- Harrison WO, Hooper MR, Wiesner PJ et al. A trial of minocycline given after exposure to prevent gonorrhea. N Engl J Med, 300(19), 1074–1078 (1979).
- Wallin J. Gonorrhea in 1972: a 1-year study of patients attending the VD unit in Uppsala. Brit J Vener Dis, 51, 41–47 (1974).
- Platt R, Rice PA, McCormack WM. Risk of acquiring gonorrhea and prevalence of abnormal adnexal findings among women recently exposed to gonorrhea. JAMA, 250(23), 3205–3209 (1983).
- McCormack WM, Johnson K, Stumacher RJ, Donner A, Rychwalski R. Clinical spectrum of gonococcal infection in women. Lancet, 1(8023), 1182–1185 (1977).
- Curran J, Rendtorff R, Chandler R, Wiser W, Robinson H. Female gonorrhea: its relation to abnormal uterine bleeding, urinary tract symptoms, and cervicitis. Obstet Gynecol, 45(2), 195–198 (1975).
- Klein EJ, Fisher LS, Chow AW, Guze LB. Anorectal gonococcal infection. Ann Intern Med, 86, 340–346 (1977).
- Wiesner PJ, Tronca E, Bonin P, Pedersen AHB, Holmes KK. Clinical spectrum of pharyngeal gonococcal infection. N Engl J Med, 288(4), 181–185 (1973).
- Bro-Jorgensen A, Jensen T. Gonococcal pharyngeal infections: report of 110 cases. Brit J Vener Dis, 49, 491–499 (1973).
- Svensson L, Westrom L, Ripa K, Mardh P. Differences in some clinical and laboratory parameters in acute salpingitis related to culture and serologic findings. Am J Obstet Gynecol, 138(7), 1017–1021 (1980).
- Berger R, Alexander E, Harnisch J et al. Etiology, manifestations and therapy of acute epididymitis: prospective study of 50 cases. J Urol, 121(6), 750–754 (1979).
- Holmes KK, Counts GW, Beaty HN. Disseminated gonococcal infection. Ann Intern Med, 74, 979–993 (1971).
- Fleming D, Wasserheit J. From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm DIs, 75(1), 3–17 (1999).
- Thadepalli H, Rambhatla K, Maidman J, Arce JJ, Davidson EC Jr. Gonococcal sepsis secondary to fetal monitoring. Am J Obstet Gynecol, 126(4), 510–512 (1976).
- U.S. Preventive Services Task Force. Screening for gonorrhea: recommendation statement. Ann Fam Med, 3, 263–267 (2005).
- Van Der Pol B, Ferrero DV, Buck-Barrington L et al. Multicenter evaluation of the BDProbeTec ET system for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in urine specimens, female endocervical swabs, and male uerthral swabs. J Clin Microbiol, 39(3), 1008–1016 (2001).
- Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2015. MMWR, 64(RR-3) (2015).
- Centers for Disease Control and Prevention. Cephalosporin susceptibility among Neisseria gonorrhoeae isolates – United States, 2000–2010.MMWR, 60(26), 873–877 (2011).
- Holmes KK, Levine R, Weaver M. Effectiveness of condoms in preventing sexually transmitted infections. Bull World Health Organ, 82(6), 454–461 (2004).
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What is Chlamydia?
Chlamydia is a common sexually transmitted disease (STD) caused by infection with Chlamydia trachomatis. It can cause cervicitis in women and urethritis and proctitis in both men and women. Chlamydial infections in women can lead to serious consequences including pelvic inflammatory disease (PID), tubal factor infertility, ectopic pregnancy, and chronic pelvic pain. Lymphogranuloma venereum (LGV), another type of STD caused by different serovars of the same bacterium, occurs commonly in the developing world, and has more recently emerged as a cause of outbreaks of proctitis among men who have sex with men (MSM) worldwide.1,2How common is chlamydia?
Chlamydia is the most frequently reported bacterial sexually transmitted infection in the United States.3 In 2016, 1,598,354 cases of chlamydia were reported to CDC from 50 states and the District of Columbia,3 but an estimated 2.86 million infections occur annually.4 A large number of cases are not reported because most people with chlamydia are asymptomatic and do not seek testing. Chlamydia is most common among young people. Almost two-thirds of new chlamydia infections occur among youth aged 15-24 years.4 It is estimated that 1 in 20 sexually active young women aged 14-24 years has chlamydia.5Substantial racial/ethnic disparities in chlamydial infection exist, with prevalence among non-Hispanic blacks 5.6 times the prevalence among non-Hispanic whites.3 Chlamydia is also common among men who have sex with men (MSM). Among MSM screened for rectal chlamydial infection, positivity has ranged from 3.0% to 10.5%.6,7 Among MSM screened for pharyngeal chlamydial infection, positivity has ranged from 0.5% to 2.3%.7.8How do people get chlamydia?
Chlamydia is transmitted through sexual contact with the penis, vagina, mouth, or anus of an infected partner. Ejaculation does not have to occur for chlamydia to be transmitted or acquired. Chlamydia can also be spread perinatally from an untreated mother to her baby during childbirth, resulting in ophthalmia neonatorum (conjunctivitis) or pneumonia in some exposed infants. In published prospective studies, chlamydial conjunctivitis has been identified in 18-44% and chlamydial pneumonia in 3-16% of infants born to women with untreated chlamydial cervical infection at the time of delivery.9-12While rectal or genital chlamydial infection has been shown to persist one year or longer in infants infected at birth,13 the possibility of sexual abuse should be considered in prepubertal children beyond the neonatal period with vaginal, urethral, or rectal chlamydial infection.People who have had chlamydia and have been treated may get infected again if they have sexual contact with a person infected with chlamydia.14Who is at risk for chlamydia?
Any sexually active person can be infected with chlamydia. It is a very common STD, especially among young people.3 It is estimated that 1 in 20 sexually active young women aged 14-24 years has chlamydia.5Sexually active young people are at high risk of acquiring chlamydia for a combination of behavioral, biological, and cultural reasons. Some young people don’t use condoms consistently.15 Some adolescents may move from one monogamous relationship to the next more rapidly than the likely infectivity period of chlamydia, thus increasing risk of transmission.16 Teenage girls and young women may have cervical ectopy (where cells from the endocervix are present on the ectocervix).17 Cervical ectopy may increase susceptibility to chlamydial infection. The higher prevalence of chlamydia among young people also may reflect multiple barriers to accessing STD prevention services, such as lack of transportation, cost, and perceived stigma.16-20Men who have sex with men (MSM) are also at risk for chlamydial infection since chlamydia can be transmitted by oral or anal sex. Among MSM screened for rectal chlamydial infection, positivity has ranged from 3.0% to 10.5%.6.7 Among MSM screened for pharyngeal chlamydial infection, positivity has ranged from 0.5% to 2.3%.7.8What are the symptoms of chlamydia?
Chlamydia is known as a ‘silent’ infection because most infected people are asymptomatic and lack abnormal physical examination findings. Estimates of the proportion of chlamydia-infected people who develop symptoms vary by setting and study methodology; two published studies that incorporated modeling techniques to address limitations of point prevalence surveys estimated that only about 10% of men and 5-30% of women with laboratory-confirmed chlamydial infection develop symptoms.21.22 The incubation period of chlamydia is poorly defined. However, given the relatively slow replication cycle of the organism, symptoms may not appear until several weeks after exposure in those persons who develop symptoms.In women, the bacteria initially infect the cervix, where the infection may cause signs and symptoms of cervicitis (e.g., mucopurulent endocervical discharge, easily induced endocervical bleeding), and sometimes the urethra, which may result in signs and symptoms of urethritis (e.g., pyuria, dysuria, urinary frequency). Infection can spread from the cervix to the upper reproductive tract (i.e., uterus, fallopian tubes), causing pelvic inflammatory disease (PID), which may be asymptomatic (“subclinical PID”)23 or acute, with typical symptoms of abdominal and/or pelvic pain, along with signs of cervical motion tenderness, and uterine or adnexal tenderness on examination.Men who are symptomatic typically have urethritis, with a mucoid or watery urethral discharge and dysuria. A minority of infected men develop epididymitis (with or without symptomatic urethritis), presenting with unilateral testicular pain, tenderness, and swelling.24Chlamydia can infect the rectum in men and women, either directly (through receptive anal sex), or possibly via spread from the cervix and vagina in a woman with cervical chlamydial infection.25, 26 While these infections are often asymptomatic, they can cause symptoms of proctitis (e.g., rectal pain, discharge, and/or bleeding).26-28Sexually acquired chlamydial conjunctivitis can occur in both men and women through contact with infected genital secretions.29While chlamydia can also be found in the throats of women and men having oral sex with an infected partner, it is typically asymptomatic and not thought to be an important cause of pharyngitis.26What complications can result from chlamydial infection?
The initial damage that chlamydia causes often goes unnoticed. However, chlamydial infections can lead to serious health problems with both short- and long-term consequences.In women, untreated chlamydia can spread into the uterus or fallopian tubes and cause pelvic inflammatory disease (PID). Symptomatic PID occurs in about 10 to 15 percent of women with untreated chlamydia.30,31 However, chlamydia can also cause subclinical inflammation of the upper genital tract (“subclinical PID”). Both acute and subclinical PID can cause permanent damage to the fallopian tubes, uterus, and surrounding tissues. The damage can lead to chronic pelvic pain, tubal factor infertility, and potentially fatal ectopic pregnancy.32,33Some patients with chlamydial PID develop perihepatitis, or “Fitz-Hugh-Curtis Syndrome”, an inflammation of the liver capsule and surrounding peritoneum, which is associated with right upper quadrant pain.In pregnant women, untreated chlamydia has been associated with pre-term delivery,34 as well as ophthalmia neonatorum (conjunctivitis) and pneumonia in the newborn.Reactive arthritis can occur in men and women following symptomatic or asymptomatic chlamydial infection, sometimes as part of a triad of symptoms (with urethritis and conjunctivitis) formerly referred to as Reiter’s Syndrome.35What about chlamydia and HIV?
Untreated chlamydia may increase a person’s chances of acquiring or transmitting HIV – the virus that causes AIDS.36How does chlamydia affect a pregnant woman and her baby?
In pregnant women, untreated chlamydia has been associated with pre-term delivery,34 as well as ophthalmia neonatorum (conjunctivitis) and pneumonia in the newborn. In published prospective studies, chlamydial conjunctivitis has been identified in 18-44% and chlamydial pneumonia in 3-16% of infants born to women with untreated chlamydial cervical infection at the time of delivery.9-12 Neonatal prophylaxis against gonococcal conjunctivitis routinely performed at birth does not effectively prevent chlamydial conjunctivitis.37-39Screening and treatment of chlamydia in pregnant women is the best method for preventing neonatal chlamydial disease. All pregnant women should be screened for chlamydia at their first prenatal visit. Pregnant women under 25 and those at increased risk for chlamydia (e.g., women who have a new or more than one sex partner) should be screened again in their third trimester. Pregnant women with chlamydial infection should be retested 3 weeks and 3 months after completion of recommended therapy.40Who should be tested for chlamydia?
Any sexually active person can be infected with chlamydia. Anyone with genital symptoms such as discharge, burning during urination, unusual sores, or rash should refrain from having sex until they are able to see a health care provider about their symptoms.Also, anyone with an oral, anal, or vaginal sex partner who has been recently diagnosed with an STD should see a health care provider for evaluation.Because chlamydia is usually asymptomatic, screening is necessary to identify most infections. Screening programs have been demonstrated to reduce rates of adverse sequelae in women.31,41 CDC recommends yearly chlamydia screening of all sexually active women younger than 25, as well as older women with risk factors such as new or multiple partners, or a sex partner who has a sexually transmitted infection..40 Pregnant women should be screened during their first prenatal care visit. Pregnant women under 25 or at increased risk for chlamydia (e.g., women who have a new or more than one sex partner) should be screened again in their third trimester.40 Women diagnosed with chlamydial infection should be retested approximately 3 months after treatment.40 Any woman who is sexually active should discuss her risk factors with a health care provider who can then determine if more frequent screening is necessary.Routine screening is not recommended for men. However, the screening of sexually active young men should be considered in clinical settings with a high prevalence of chlamydia (e.g., adolescent clinics, correctional facilities, and STD clinics) when resources permit and do not hinder screening efforts in women.40Sexually active men who have sex with men (MSM) who had insertive intercourse should be screened for urethral chlamydial infection and MSM who had receptive anal intercourse should be screened for rectal infection at least annually; screening for pharyngeal infection is not recommended.. More frequent chlamydia screening at 3-month intervals is indicated for MSM, including those with HIV infection, if risk behaviors persist or if they or their sexual partners have multiple partners.40At the initial HIV care visit, providers should test all sexually active persons with HIV infection for chlamydia and perform testing at least annually during the course of HIV care. A patient’s health care provider might determine more frequent screening is necessary, based on the patient’s risk factors.42How is chlamydia diagnosed?
There are a number of diagnostic tests for chlamydia, including nucleic acid amplification tests (NAATs), cell culture, and others. NAATs are the most sensitive tests, and can be performed on easily obtainable specimens such as vaginal swabs (either clinician- or patient-collected) or urine.43Vaginal swabs, either patient- or clinician-collected, are the optimal specimen to screen for genital chlamydia using NAATs in women; urine is the specimen of choice for men, and is an effective alternative specimen type for women.43 Self-collected vaginal swab specimens perform at least as well as other approved specimens using NAATs.44 In addition, patients may prefer self-collected vaginal swabs or urine-based screening to the more invasive endocervical or urethral swab specimens.45 Adolescent girls may be particularly good candidates for self-collected vaginal swab- or urine-based screening because pelvic exams are not indicated if they are asymptomatic.Chlamydial culture can be used for rectal or pharyngeal specimens, but is not widely available. NAATs have demonstrated improved sensitivity and specificity compared with culture for the detection of C. trachomatis at non-genital sites46-48 Most tests, including NAATs, are not FDA-cleared for use with rectal or pharyngeal swab specimens; however, NAATS have demonstrated improved sensitivity and specificity compared with culture for the detection of C. trachomatis at rectal sites46-48 and however, some laboratories have met regulatory requirements and have validated NAAT testing on rectal and pharyngeal swab specimens.What is the treatment for chlamydia?
Chlamydia can be easily cured with antibiotics. HIV-positive persons with chlamydia should receive the same treatment as those who are HIV-negative.Persons with chlamydia should abstain from sexual activity for 7 days after single dose antibiotics or until completion of a 7-day course of antibiotics, to prevent spreading the infection to partners. It is important to take all of the medication prescribed to cure chlamydia. Medication for chlamydia should not be shared with anyone. Although medication will cure the infection, it will not repair any permanent damage done by the disease. If a person’s symptoms continue for more than a few days after receiving treatment, he or she should return to a health care provider to be reevaluated.Repeat infection with chlamydia is common.49 Women whose sex partners have not been appropriately treated are at high risk for re-infection. Having multiple chlamydial infections increases a woman’s risk of serious reproductive health complications, including pelvic inflammatory disease and ectopic pregnancy.50,51 Women and men with chlamydia should be retested about three months after treatment of an initial infection, regardless of whether they believe that their sex partners were successfully treated.40Infants infected with chlamydia may develop ophthalmia neonatorum (conjunctivitis) and/or pneumonia.10 Chlamydial infection in infants can be treated with antibiotics.What about partners?
If a person has been diagnosed and treated for chlamydia, he or she should tell all recent anal, vaginal, or oral sex partners (all sex partners within 60 days before the onset of symptoms or diagnosis) so they can see a health care provider and be treated. This will reduce the risk that the sex partners will develop serious complications from chlamydia and will also reduce the person’s risk of becoming re-infected. A person with chlamydia and all of his or her sex partners must avoid having sex until they have completed their treatment for chlamydia (i.e., seven days after single dose antibiotics or until completion of a seven-day course of antibiotics) and until they no longer have symptoms. For tips on talking to partners about sex and STD testing, visit www.gytnow.org/talking-to-your-partner/To help get partners treated quickly, healthcare providers in some states may give infected individuals extra medicine or prescriptions to give to their sex partners. This is called expedited partner therapy or EPT. In published clinical trials comparing EPT to traditional patient referral (i.e., asking the patient to refer their partners in for treatment), EPT was associated with fewer persistent or recurrent chlamydial infections in the index patient, and a larger reported number of partners treated.52 For providers, EPT represents an additional strategy for partner management of persons with chlamydial infection; partners should still be encouraged to seek medical evaluation, regardless of whether they receive EPT. To obtain further information regarding EPT, including the legal status of EPT in a specific area, see the Legal Status of Expedited Partner Therapy.How can chlamydia be prevented?
Latex male condoms, when used consistently and correctly, can reduce the risk of getting or giving chlamydia.53 The surest way to avoid chlamydia is to abstain from vaginal, anal, and oral sex, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.Where can I get more information?
Division of STD Prevention (DSTDP)
Health care providers with STD consultation requests can contact the STD Clinical Consultation Network (STDCCN). This service is provided by the National Network of STD Clinical Prevention Training Centers and operates five days a week. STDCCN is convenient, simple, and free to health care providers and clinicians. More information is available at
www.stdccn.org
.
Centers for Disease Control and Prevention
www.cdc.gov/stdCDC-INFO Contact Center
1-800-CDC-INFO (1-800-232-4636)
TTY: (888) 232-6348
Contact CDC-INFOCDC National Prevention Information Network (NPIN)
P.O. Box 6003
Rockville, MD 20849-6003
1-800-458-5231
1-888-282-7681 Fax
1-800-243-7012 TTY
E-mail: npin-info@cdc.govAmerican Sexual Health Association (ASHA)
P.O. Box 13827
Research Triangle Park, NC 27709-3827
1-800-783-987References1. O’Farrell N, Morison L, Moodley P, et al. Genital ulcers and concomitant complaints in men attending a sexually transmitted infections clinic: implications for sexually transmitted infections management. Sexually transmitted diseases 2008;35:545-9.2. White JA. Manifestations and management of lymphogranuloma venereum. Current opinion in infectious diseases 2009;22:57-66.3. CDC. Sexually Transmitted Disease Surveillance, 2016. Atlanta, GA: Department of Health and Human Services; September 2017.4. Satterwhite CL et al, Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. STD 2013 Mar;40(30):187-935. Torrone E, Papp J, Weinstock H. Prevalence of Chlamydia trachomatis Genital Infection Among Persons Aged 14–39 Years — United States, 2007–2012. MMWR 2014;63:834-8.6. Marcus JL, Bernstein KT, Stephens SC, et al. Sentinel surveillance of rectal chlamydia and gonorrhea among males–San Francisco, 2005-2008. Sexually transmitted diseases 2010;37:59-61.7. Pinsky L, Chiarilli DB, Klausner JD, et al. Rates of asymptomatic nonurethral gonorrhea and chlamydia in a population of university men who have sex with men. Journal of American college health : J of ACH 2012;60:481-4.8. Park J, Marcus JL, Pandori M, Snell A, Philip SS, Bernstein KT. Sentinel surveillance for pharyngeal chlamydia and gonorrhea among men who have sex with men–San Francisco, 2010. Sexually transmitted diseases 2012;39:482-4.9. Frommell GT, Rothenberg R, Wang S, McIntosh K. Chlamydial infection of mothers and their infants. The Journal of pediatrics 1979;95:28-32.10. Hammerschlag MR, Chandler JW, Alexander ER, English M, Koutsky L. Longitudinal studies on chlamydial infections in the first year of life. Pediatric infectious disease 1982;1:395-401.11. Heggie AD, Lumicao GG, Stuart LA, Gyves MT. Chlamydia trachomatis infection in mothers and infants. A prospective study. American journal of diseases of children (1960) 1981;135:507-11.12. Schachter J, Grossman M, Sweet RL, Holt J, Jordan C, Bishop E. Prospective study of perinatal transmission of Chlamydia trachomatis. JAMA : the journal of the American Medical Association 1986;255:3374-7.13. Bell TA, Stamm WE, Wang SP, Kuo CC, Holmes KK, Grayston JT. Chronic Chlamydia trachomatis infections in infants. JAMA : the journal of the American Medical Association 1992;267:400-2.14. Batteiger BE, Tu W, Ofner S, et al. Repeated Chlamydia trachomatis genital infections in adolescent women. The Journal of infectious diseases 2010;201:42-51.15. Eaton DK, Kann L, Kinchen S, et al. Youth risk behavior surveillance – United States, 2011. Morbidity and mortality weekly report Surveillance summaries (Washington, DC : 2002) 2012;61:1-162.16. Kraut-Becher JR, Aral SO. Gap length: an important factor in sexually transmitted disease transmission. Sexually transmitted diseases 2003;30:221-5.17. Singer A. The uterine cervix from adolescence to the menopause. British journal of obstetrics and gynaecology 1975;82:81-99.18. Cunningham SD, Kerrigan DL, Jennings JM, Ellen JM. Relationships between perceived STD-related stigma, STD-related shame and STD screening among a household sample of adolescents. Perspectives on sexual and reproductive health 2009;41:225-30.19. Elliott BA, Larson JT. Adolescents in mid-sized and rural communities: foregone care, perceived barriers, and risk factors. The Journal of adolescent health : official publication of the Society for Adolescent Medicine 2004;35:303-9.20. Tilson EC, Sanchez V, Ford CL, et al. Barriers to asymptomatic screening and other STD services for adolescents and young adults: focus group discussions. BMC public health 2004;4:21.21. Farley TA, Cohen DA, Elkins W. Asymptomatic sexually transmitted diseases: the case for screening. Preventive medicine 2003;36:502-9.22. Korenromp EL, Sudaryo MK, de Vlas SJ, et al. What proportion of episodes of gonorrhoea and chlamydia becomes symptomatic? International journal of STD & AIDS 2002;13:91-101.23. Wiesenfeld HC, Sweet RL, Ness RB, Krohn MA, Amortegui AJ, Hillier SL. Comparison of acute and subclinical pelvic inflammatory disease. Sexually transmitted diseases 2005;32:400-5.24. Berger RE, Alexander ER, Monda GD, Ansell J, McCormick G, Holmes KK. Chlamydia trachomatis as a cause of acute “idiopathic” epididymitis. The New England journal of medicine 1978;298:301-4.25. Barry PM, Kent CK, Philip SS, Klausner JD. Results of a program to test women for rectal chlamydia and gonorrhea. Obstetrics and gynecology 2010;115:753-9.26. Jones RB, Rabinovitch RA, Katz BP, et al. Chlamydia trachomatis in the pharynx and rectum of heterosexual patients at risk for genital infection. Annals of internal medicine 1985;102:757-62.27. Quinn TC, Goodell SE, Mkrtichian E, et al. Chlamydia trachomatis proctitis. The New England journal of medicine 1981;305:195-200.28. Thompson CI, MacAulay AJ, Smith IW. Chlamydia trachomatis infections in the female rectums. Genitourinary medicine 1989;65:269-73.29. Kalayoglu MV. Ocular chlamydial infections: pathogenesis and emerging treatment strategies. Current drug targets Infectious disorders 2002;2:85-91.30. Haggerty CL, Gottlieb SL, Taylor BD, Low N, Xu F, Ness RB. Risk of sequelae after Chlamydia trachomatis genital infection in women. The Journal of infectious diseases 2010;201 Suppl 2:S134-55.31. Oakeshott P, Kerry S, Aghaizu A, et al. Randomized controlled trial of screening for Chlamydia trachomatis to prevent pelvic inflammatory disease: the POPI (prevention of pelvic infection) trial. BMJ (Clinical research ed) 2010;340:c1642.32. Cates W, Jr., Wasserheit JN. Genital chlamydial infections: epidemiology and reproductive sequelae. American journal of obstetrics and gynecology 1991;164:1771-81.33. Westrom L, Joesoef R, Reynolds G, Hagdu A, Thompson SE. Pelvic inflammatory disease and fertility. A cohort study of 1,844 women with laparoscopically verified disease and 657 control women with normal laparoscopic results. Sexually transmitted diseases 1992;19:185-92.34. Rours GI, Duijts L, Moll HA, et al. Chlamydia trachomatis infection during pregnancy associated with preterm delivery: a population-based prospective cohort study. European journal of epidemiology 2011;26:493-502.35. Carter JD, Inman RD. Chlamydia-induced reactive arthritis: hidden in plain sight? Best practice & research Clinical rheumatology 2011;25:359-74.36. Fleming DT, Wasserheit JN. From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sexually transmitted infections 1999;75:3-17.37. Bell TA, Sandstrom KI, Gravett MG, et al. Comparison of ophthalmic silver nitrate solution and erythromycin ointment for prevention of natally acquired Chlamydia trachomatis. Sexually transmitted diseases 1987;14:195-200.38. Chen JY. Prophylaxis of ophthalmia neonatorum: comparison of silver nitrate, tetracycline, erythromycin and no prophylaxis. The Pediatric infectious disease journal 1992;11:1026-30.39. Isenberg SJ, Apt L, Wood M. A controlled trial of povidone-iodine as prophylaxis against ophthalmia neonatorum. The New England journal of medicine 1995;332:562-6.40. Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2015. MMWR, 64(RR-3) (2015).41. Scholes D, Stergachis A, Heidrich FE, Andrilla H, Holmes KK, Stamm WE. Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection. The New England journal of medicine 1996;334:1362-6.42. CDC. Incorporating HIV prevention into the medical care of persons living with HIV. Recommendations of CDC, the Health Resources and Services Administration, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recommendations and reports : Morbidity and mortality weekly report Recommendations and reports / Centers for Disease Control 2003;52:1-24.43. APHL. Laboratory Diagnostic Testing for Chlamydia trachomatis and Neisseria gonorrhoeae. Expert Consultation Meeting Summary Report. January 13-15, 2009. Atlanta, GA.44. Schachter J, Chernesky MA, Willis DE, et al. Vaginal swabs are the specimens of choice when screening for Chlamydia trachomatis and Neisseria gonorrhoeae: results from a multicenter evaluation of the APTIMA assays for both infections. Sexually transmitted diseases 2005;32:725-8.45. Doshi JS, Power J, Allen E. Acceptability of chlamydia screening using self-taken vaginal swabs. International journal of STD & AIDS 2008;19:507-9.46. Bachmann LH, Johnson RE, Cheng H, et al. Nucleic acid amplification tests for diagnosis of Neisseria gonorrhoeae and Chlamydia trachomatis rectal infections. Journal of clinical microbiology 2010;48:1827-32.47. Mimiaga MJ, Mayer KH, Reisner SL, et al. Asymptomatic gonorrhea and chlamydial infections detected by nucleic acid amplification tests among Boston area men who have sex with men. Sexually transmitted diseases 2008;35:495-8.48. Schachter J, Moncada J, Liska S, Shayevich C, Klausner JD. Nucleic acid amplification tests in the diagnosis of chlamydial and gonococcal infections of the oropharynx and rectum in men who have sex with men. Sexually transmitted diseases 2008;35:637-42.49. Hosenfeld CB, Workowski KA, Berman S, et al. Repeat infection with Chlamydia and gonorrhea among females: a systematic review of the literature. Sexually transmitted diseases 2009;36:478-89.50. Hillis SD, Owens LM, Marchbanks PA, Amsterdam LF, Mac Kenzie WR. Recurrent chlamydial infections increase the risks of hospitalization for ectopic pregnancy and pelvic inflammatory disease. American journal of obstetrics and gynecology 1997;176:103-7.51. Bakken IJ, Skjeldestad FE, Lydersen S, Nordbo SA. Births and ectopic pregnancies in a large cohort of women tested for Chlamydia trachomatis. Sexually transmitted diseases 2007;34:739-43.52. Trelle S, Shang A, Nartey L, Cassell JA, Low N. Improved effectiveness of partner notification for patients with sexually transmitted infections: systematic review. BMJ (Clinical research ed) 2007;334:354.53. Holmes KK, Levine R, Weaver M. Effectiveness of condoms in preventing sexually transmitted infections. Bulletin of the World Health Organization 2004;82:454-61.
