Chlamydia
DGRefHelp - NHS Dumfries & Galloway
Warning
- Recent studies show an association between chlamydia and preterm birth and low birth weight; they also suggest an increased risk of complications the earlier in the pregnancy the infection occurs.
- Infants who are born vaginally to mothers with untreated genital chlamydia trachomatis infection are at risk for developing C. trachomatis conjunctivitis (15 to 50 percent) and/or pneumonia (5 to 30 percent).
- Untreated infants may have persistent conjunctivitis for months that may result in corneal and conjunctival scarring.
- Up to 1/3 of woman with chlamydia delivering vaginally will develop puerperal infection.
- Azithromycin use in pregnancy remains off label but its use is recommended for uncomplicated genital, rectal and pharyngeal infection.
- The August 2017 BASHH Statement highlighted concerns that some antibiotics (including azithromycin) use in pregnancy maybe associated with an increase in spontaneous abortion. The clinical effective group (CEG) sees no reason at the present time to change recommendations in its current guidelines for treating genital infections in pregnancy based on this recent publication. Azithromycin is more effective and better tolerated than alternative antibiotics for genital chlamydia. The potential risks and benefits of treatment options should be discussed with the patient and this should be documented in the clinical notes.
- When using azithromycin (as in the non pregnant patient) the recommended dose is 1g orally as a single dose, followed by 500mg once daily for two days. Alternative regimens are erythromycin 500mg four times daily for seven days, erythromycin 500mg twice daily for 14 days or amoxicillin 500mg three times a day for seven days.
- Doxycycline should not be used in pregnancy.
- A test of cure should be performed and this is crucial in rectal infection. A test of cure should be done no earlier than three weeks after completing treatment
- A repeat test at 36 weeks gestation is recommended to exclude re-infection.