health

CHLAMYDIAL INFECTION IN MEN

Chlamydia is transmitted and presents in a similar way to gonorrhoea; however, urethral symptoms are usually milder and may be absent in over 50% of cases. Conjunctivitis is also milder than in gonorrhoea; pharyngitis does not occur. The incubation period varies from 1 week to a few months. Without treatment, symptoms may resolve but the patient remains infectious for several months. Complications such as epididymo-orchitis and Reiter's syndrome, or sexually acquired reactive arthropathy . Non-specific urethritis is treated identically. The partner(s) of men with chlamydia should be treated even if laboratory tests for chlamydia are negative. Investigation is not mandatory, but serves a useful epidemiological purpose; moreover, positive results encourage further attempts at contact-tracing.

CHLAMYDIAL INFECTION IN WOMEN

The cervix and urethra are commonly involved. Infection is asymptomatic in about 80% of patients but may cause vaginal discharge, dysuria, intermenstrual and/or postcoital bleeding. Lower abdominal pain, dyspareunia and intermenstrual bleeding are features of PID. Examination may reveal mucopurulent cervicitis, contact bleeding from cervix, evidence of PID or no obvious clinical signs. Treatment options are listed in . The patient's male partner(s) should be investigated and treated.

Some infections may clear spontaneously but others persist. PID, with the risk of tubal damage and subsequent infertility or ectopic pregnancy, is an important long-term complication. Other complications include perihepatitis, chronic pelvic pain, conjunctivitis and Reiter's syndrome or SARA. Perinatal transmission may lead to ophthalmia neonatorum and/or pneumonia in the neonate

TREATMENT OF CHLAMYDIAL INFECTION
Standard regimens

Azithromycin 1 g orally as a single dose1 or Doxycycline 100 mg 12-hourly orally for 7 days2 Alternative regimens Erythromycin 500 mg 6-hourly orally for 7 days or 500 mg 12-hourly for 2 weeks or Ofloxacin 200 mg 12-hourly orally for 7 days2