In SIGN 109, national screening of asymptomatic women is not considered cost effective at reducing morbidity for complication rates under 10%, and at the present time there is an absence of data to support a complication rate greater than this. PID can result in infertility, ectopic pregnancy and chronic pelvic pain. The risk of PID increases with each recurrence of C.trachomatis infection.

 

Other complications

• Perihepatitis (Fitz-Hugh Curtis syndrome).
• Epididymo-orchitis.
• Adult conjunctivitis.
• Sexually acquired reactive arthritis/Reiters syndrome.
• Transmission to neonate (neonatal conjunctivitis, pneumonia).
• Preterm birth and low birth weight.

Management of chlamydial salpingitis

The management of salpingitis is outwith the scope of this guideline. Consideration should be given to managing females with abdominal pain in accordance with guidelines for managing pelvic inflammatory disease (see BASHH PID Guideline)

Management of chlamydial epididymo-orchitis

The management of epididymo-orchitis is outwith the scope of this guideline. See West of Scotland guideline for Epididymo-orchitis.

Chlamydial conjunctivitis in adults

This is an uncommon presentation to GU settings. Patients may be referred from ophthalmology or present with a chronic follicular conjunctivitis, usually unilateral, with a sub-acute onset.

 

Symptoms:

  • foreign-body sensation
  • tearing
  • mucoid discharge
  • redness
  • photophobia
  • swelling of lids.

Incubation usually 1 to 3 weeks.

 

Management:

Involve ophthalmology team (if not already involved).

 

1st line:
Doxycycline 100mg orally twice daily for 7 days.

2nd line:
Azithromycin 1g orally as a single dose followed by 500mg daily for 2 days.

 

It is essential that all clients with chlamydial conjunctivitis and their sexual partners are assessed for concomitant chlamydial genital tract infection. Refer to a Health Advisor team as per genital chlamydia guidelines.

References

  1. British Association of Sexual Heath and HIV Clinical Effectiveness Unit BASHH 2015 UK
    National Guideline for the Management of Infection with Chlamydia trachomatis (2015).
    https://www.bashhguidelines.org/media/1192/ct-2015.pdf [accessed 4th August 2022]
  2. Update on the treatment of Chlamydia trachomatis (CT) infection BASHH Clinical
    Effectivesness Group September 2018 [accessed 4th August 2022] https://www.bashhguidelines.org/media/1191/update-on-the-treatment-of-chlamydia-trachomatis-infection-final-16-9-18.pdf [accessed 4th August 2022]
  3. British Association of Sexual heath and HIV Clinical Effectiveness Unit BASHH UK National Guideline for the Management of Lymphogranuloma Venerum (2013) https://www.bashh.org/documents/2013%20LGV%20guideline.pdf [accessed 4th August 2022]
  4. 2019 European Guideline on the Management of Lymphogranuloma Venereum
    https://onlinelibrary.wiley.com/doi/full/10.1111/jdv.15729 [accessed 4th August 2022]
  5. UK National Guidelines for the Management of Pelvic Inflammatory Disease 2018
    https://www.bashhguidelines.org/media/1170/pid-2018.pdf [accessed 4th August 2022]
  6. United Kingdom National Guideline for the Management of Pelvic Inflammatory Disease
    (2019 Interim Update) https://www.bashhguidelines.org/media/1217/pid-update-2019.pdf[accessed 4th August 2022]
  7. Scottish Bacterial Sexually Transmitted Infections Reference Laboratory (SBSTIRL)
    Samples and Request Forms | Edinburgh and Lothians Laboratory Medicine LGV PCR form Dec 20.pdf (edinburghlabmed.co.uk) [accessed 4th August 2022]
  8. Dr Kate Templeton, Head of Service, Regional Virus Laboratory Specialist Virology
    Centre, Edinburgh [pers comm. 4th August 2022]

Editorial Information

Last reviewed: 30/09/2022

Next review date: 30/09/2024

Author(s): West of Scotland Managed Clinical Network for Sexual Health Clinical Guidelines Group.

Version: 8.1

Approved By: West of Scotland Managed Clinical Network for Sexual Health