Johns Hopkins Division of Infectious Diseases
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  Chlamydial infection
Author: Anne Marie Rompalo Last modified: December 19, 2001


  • Approximately 3-4 million estimated new cases in USA per year.
  • Decreasing prevalence in selected areas with control programs that include clinic -based screening.
  • Risk factors: adolescence, new or multiple sexual partners, lack of barrier contraceptive.
  • Transmission:
  • Exact transmission rates are unknown.
  • Up to 68% transmission occurs from infected men to women.
  • High prevalence of coinfection in partners (>50%).
  • Significant asymptomatic reservoir exists in the population.
  • Re-infection is common.


  • adolescence
  • new or multiple sexual partners
  • lack of barrier contraceptive.
  • Transmission:
  • Exact rates unknown. Up to 68% from men to women.
  • High prevalence of coinfection in partners (>50%).
  • Significant asymptomatic reservoir exists in the population.
  • Re-infection is common.


  • Genital infection in men:
  • Urethritis
  • Majority (>50%) asymptomatic.
  • Incubation period unknown (probably 5-10 days in symptomatic infection).
  • Symptoms/signs: discharge, pain and burning on urination, urethral discharge on exam.
  • Epididymitis:
  • Infrequent but most common local complication in males.
  • Up to 70% of sexually transmitted cases due to chlamydia infection, others are due to gonorrhea infections; some cases have both pathogens
  • Bacterial etiology varies by sexual behavior and age:
  • It is important to distinguish sexually transmitted cases in heterosexuals (due to chlamydia and/or gonorrhea) and men who have sex with men (due to Escherichia coli and/or gonorrhea) from non-sexuall
  • Symptoms/signs: fever, epididymal/testicular pain, evidence of discharge, epididymal tenderness/mass on exam.
  • Possible sequelae:
  • Role for chlamydial infection in male sterility is unproved.
  • Risk of prostatitis is unknown.
  • Syndromes seen in men or women:
  • Conjunctivitis:
  • Can occur as a result of autoinoculation from infected genitalia in adults
  • Signs/symptoms: Conjunctiva in adults often has a follicular appearance and the secretions are not purulent


  • Diagnostic Testing
  • Gram stained smear: From male urethral exudate > 5 White Blood Cells seen under the microscope in the absence of gram-negative intracellular diplococci (gonorrhea) is diagnostic for non-gonococcal ure
  • Culture: Expensive and technically difficult; approved for use in all possible infected sites
  • Non-culture tests: Rely on detection of bacterial products (proteins, nucleic acid) in patient samples:
  • Non-amplified tests: Non-amplified tests require adequate numbers of protein or DNA to detect presence of chlamydia infection. Must collect a swab from the infected area for this testing.
  • Amplified tests: Can be done on swabs taken from infected areas, but can be used on first 10-15 cc of urine specimens from men and women. (Must be > 2 hours after last urination)
  • Azithromycin, 1.0 gram orally in a single dose, OR
  • Doxycycline 100 mg orally twice daily for 7 days
  • Alternative Regimens
  • Erythromycin base 500 mg orally four times a days for 7 days, OR
  • Erythromycin ethylsuccinate 800 mg orally four times a day for 7 days, OR
  • Ofloxacin 400 mg orally twice a day for 7 days, OR
  • Levofloxacin 500 mg orally once a day for 7 days
  • No clinically significant emergence of drug resistance among CT strains.
  • Prevention and Counseling
  • Screening Recommendations For Men:
  • The role of routine chlamydia screening in sexually active men is currently under investigation
  • Partner management
  • Sexual partners in the previous 60 days should be treated and tested if possible. Health care providers should treat the most recent sex partner even if the time of the last sexual encounter was > 60
  • Condoms are effective when used properly.
  1. CDC 2001 ;  Guidelines for treatment of sexually transmitted diseases. ;

  2. United States Preventive Services Task Force (USPSTF) 2001 ;  AHRQ, DHHS Screening for chlamydia infection. ;

Copyright © 2002 The Johns Hopkins University School of Medicine. All rights reserved.