Chlamydia

• Most common STD
• 2002 CDC guidelines: screen sexually active adolescents and young adults every year
• Most cases asymptomatic (62% in both males and females)

Clinical manifestations:

• Neonatal conjunctivitis (see Ophthalmia Neonatorum)
• trachoma
• pneumonia
• genital tract infection
• lymphogranuloma venereum
• may be associated with Fitz-Hugh-Curtis syndrome

Neonatal infection

• 50% of vaginally delivered neonates with infected mothers are themselves infected
• nasopharynx most commonly infected.
• 25-50% risk of conjunctivitis
• Asymptomatic infection acquired at birth can persist for as long as 3 years
• Incubation period variable, usually > 1 wk
• Ophthalmia Neonatorum

Key review points for STD's in general:

• Most common STD in adolescents = chlamydia; gonorrhea is #2
• CDC recommends testing all sexually active adolescents q year for gonorrhea/chlamydia
• Neonatal conjunctivitis: topical PPX not effective for chlamydia. Gonorrhea-requires IV cephalosporin; chlamydia-PO erythromycin; both need saline irrigation
• Uncomplicated genital infections in adolescents/children > 8yrs: if poor F/U or in areas of high incidence of concurrent infections, may use dual therapy for gonorrhea & chlamydia without testing for both:
  • Ceftriaxone x 1 (Ciprofloxacin or Ofoxacinx 1 on east coast) for gonorrhea
  • PLUS Doxycycline x 7 days or Azithromycinx 1 for chlamydia
• Complicated Gonococcal Infections require more prolonged therapy.
  • Though the newer tests (PCR, LCR) are used routinely for testing of adolescents, in the prepubertalchild evaluated for child abuse the gold standard remains culture.
  • Asymptomatic chlamydialinfection can persist for up to 3 years
  • If febrile, r/o PID