Chlamydia Test: Types, Purpose, Procedure & Results Test Usage Detection of Copyright 2023 American Academy of Family Physicians. Culture can take up to 6 months, and technical laboratory capacity is limited to research settings. If resistance testing is available, it should be performed and the results used to guide therapy. In settings without access to resistance testing and when moxifloxacin cannot be used, an alternative regimen can be considered, based on limited data: doxycycline 100 mg orally 2 times/day for 7 days, followed by azithromycin (1 g orally on day 1 followed by 500 mg once daily for 3 days) and a test of cure 21 days after completion of therapy (963). In clinical practice, if testing is unavailable, M. genitalium should be suspected in cases of persistent or recurrent urethritis or cervicitis and considered for PID. Or your provider takes a swab of fluid from your Urinalysis usually will show more than five white blood cells per high-powered field, but urethral cultures generally are negative. Chlamydial pneumonia can occur at one to three months of age, manifesting as a protracted onset of staccato cough, usually without wheezing or fever. Men 35 years or younger who have epididymitis are more likely to have C. trachomatis as the etiologic agent than are older men. Recommended Regimens for Chlamydial Infection Among Adolescents and Adults, Recommended Regimen for Chlamydial Infection During Pregnancy, Recommended Regimen for Chlamydial Infection Among Neonates, Recommended Regimen for Chlamydial Pneumonia Among Infants, Recommended Regimens for Chlamydial Infection Among Infants and Children, Centers for Disease Control and Prevention. Chlamydia trachomatis and Neisseria gonorrhoeae are the most common sexually transmitted infections (STIs) in the United States and are required to be reported to state health departments. Screening of asymptomatic M. genitalium infection among women and men or extragenital testing for M. genitalium is not recommended. Because test results for chlamydia often are unavailable at the time initial treatment decisions are being made, treatment for C. trachomatis pneumonia frequently is based on clinical and radiologic findings, age of the infant (i.e., 13 months), and risk for chlamydia in the mother (i.e., aged <25 years, history of chlamydial infection, multiple sex partners, a sex partner with a concurrent partner, or a sex partner with a history of an STI). Thank you for taking the time to confirm your preferences. Female patients should not cleanse the labial area prior to collection. However, most studies of M. genitalium and PID, even those that controlled extensively for other infections and behavioral and biologic risk, are cross-sectional. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. For the first time there are diagnostic tests for Chlamydia trachomatis that are more sensitive than tissue culture. The differential diagnosis of gonococcal infections depends on the particular clinical syndrome. Predictive value of test will vary depending on disease prevalence. Monday - Friday TAT 1 day Infants treated with either of these antimicrobials should be followed for IHPS signs and symptoms. Data are lacking regarding use of NAATs for specimens from extragenital sites (rectum and pharynx) among boys and girls (553); other nonculture tests (e.g., DFA) are not recommended because of specificity concerns. [Chlamydia trachomatis urogenital infections in women. Best The correct volume of urine has been added when the fluid level is between the black lines on the urine transport tube label. These cookies may also be used for advertising purposes by these third parties. Twenty percent of women who develop PID become infertile, 18 percent develop chronic pelvic pain, and 9 percent have a tubal pregnancy.2 The Centers for Disease Control and Prevention (CDC) recommends that physicians maintain a low threshold for diagnosing PID and that empiric treatment be initiated in women at risk of sexually transmitted disease (STD) who have uterine, adnexal, or cervical motion tenderness with no other identifiable cause.2. To obtain a complete sexual history, the five Ps (partners, practices, pregnancy attitudes, previous STIs, and protection from STIs) model can be used as outlined in Table 2.2,5, The U.S. Preventive Services Task Force (USPSTF) recommends behavioral counseling on condom use, communication strategies for safer sex, and problem solving with those at increased risk of STIs.6 Adolescents and adults diagnosed with an STI in the past year, people reporting irregular condom use, and those with multiple partners or with partners belonging to a high-risk group are at increased risk. Rectal infection with M. genitalium has been reported among 1%26% of MSM (937940) and among 3% of women (941). The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. In addition, systematic reviews and meta-analyses have noted an association with macrolide antimicrobials, especially erythromycin, during pregnancy and adverse child outcomes, indicating cautious use in pregnancy (830831). trachomatis acute infections have been diagnosed by cell culture, direct immunofluorescence, enzyme immunoassay, direct DNA hybridization, and more WebChlamydia trachomatis RNA, TMA, Urogenital 11361 Gonorrhea, if indicated d Neisseria gonorrhoeae RNA, TMA, Urogenital 11362 Chlamydia and gonorrhea Chlamydia/Neisseria gonorrhoeae RNA, TMA, Urogenital 11363 HIV testing HIV-1/2 Antigen and Antibodies, Fourth Generation, with Reflexes b 91431 Hepatitis C testing Patient information: See related handouts on chlamydia, written by the authors of this article, and on gonorrhea, which has been adapted from a previously published AFP article. WebChlamydia trachomatis Neisseria gonorrhoeae RNA TMA | Quest Diagnostics Chlamydia trachomatis / Neisseria gonorrhoeae RNA, TMA Test code (s) 11363 (X), 11361 (X), The cervix tends to bleed easily when rubbed with a polyester swab or scraped with a spatula. Because most infections are asymptomatic, screening is key to preventing complications such as pelvic inflammatory disease and infertility and decreasing community and vertical neonatal transmission. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Hospitalization also is indicated if surgical emergencies cannot be excluded.2 The CDC-recommended options for the treatment of PID are listed in Table 2.2, Doxycycline and ofloxacin (Floxin) are contraindicated during pregnancy; therefore, the CDC recommends erythromycin base or amoxicillin for the treatment of chlamydial infection in pregnant women (Table 3).2 Amoxicillin is more effective and tends to have fewer side effects than erythromycin in the treatment of antenatal chlamydial infection, and thus is better tolerated.7,8 Preliminary data suggest that azithromycin is a safe and effective alternative.2. All nonpregnant people should be tested for reinfection approximately three months after treatment or at the first visit in the 12 months after treatment. Preserved urine in grey-top tube is unacceptable. In a community-based cohort of female college students, incident chlamydial infection was also associated with BV and high-risk HPV infection (785). Amoxicillin is recommended for the treatment of chlamydial infection in women who are pregnant. You will be subject to the destination website's privacy policy when you follow the link. Women who present within 12 months after the initial infection and have not been screened should be reassessed for infection regardless of whether the patient believes her sex partner was treated or not.2, PID usually can be treated on an outpatient basis. If health department partner management strategies (e.g., disease intervention specialists) are impractical or unavailable for persons with chlamydia, and if a provider is concerned that sex partners are unable to promptly access evaluation and treatment services, EPT should be considered as permitted by law (see Partner Services). All Rights Reserved. Chlamydia trachomatis is the most common bacterial sexually transmitted infection (STI) globally, leading to late sequelae like pelvic inflammatory disease and infertility [ 1, 2 ]. CDC twenty four seven. Azithromycin (Zithromax) or doxycycline (Vibramycin) is recommended for the treatment of uncomplicated genitourinary chlamydial infection. Detection of Chlamydia trachomatis mRNA using digital Women with chlamydial infection in the lower genital tract may develop an ascending infection that causes acute salpingitis with or without endometritis, also known as PID. Nonpregnant people treated for chlamydial or gonococcal infections should be tested for reinfection three months after treatment. You can review and change the way we collect information below. Chlamydial diseases are sexually transmitted and caused by the bacterium Chlamydia trachomatis. However, this bacterium acts more like a virus. This can affect the way chlamydia infection is transmitted and the risk factors that are important in acquiring it. Chlamydia infections can affect the vagina, cervix, and rectum, among other areas. Because of concerns regarding chlamydia persistence after exposure to penicillin-class antibiotics that has been demonstrated in animal and in vitro studies, amoxicillin is listed as an alternative therapy for C. trachomatis for pregnant women (828,829). M. genitalium infections among women are also frequently asymptomatic, and the consequences associated with asymptomatic M. genitalium infection are unknown. in vitro . Topical antibiotic therapy alone is inadequate for treating ophthalmia neonatorum caused by chlamydia and is unnecessary when systemic treatment is administered. Persons who receive a diagnosis of chlamydia should be tested for HIV, gonorrhea, and syphilis. The purpose of the study performed by Jiang et al. Nevertheless, no data have been published that assess the benefits of testing women with PID for M. genitalium, and the importance of directing treatment against this organism is unknown. Although evidence is insufficient to recommend routine screening for C. trachomatis among sexually active young men because of certain factors (i.e., feasibility, efficacy, and cost-effectiveness), screening of sexually active young men should be considered in clinical settings with a high prevalence of chlamydia (e.g., adolescent clinics, correctional facilities, or STD specialty clinics) or for populations with a high burden of infection (e.g., MSM) (149,788). However, when gonorrhea testing is performed at the oropharyngeal site, chlamydia test results might be reported because certain NAATs detect both bacteria from a single specimen. WebChlamydia trachomatis. That makes them easy to Doxycycline 100 mg orally 2 times/day for 7 days, Azithromycin 1 g orally in a single dose Healthcare providers and health departments can report Mgen treatment failures through the Mycoplasma genitalium Treatment Failure Registry. Levofloxacin 500 mg orally once daily for 7 days. Urethritis is secondary to C. trachomatis infection in approximately 15 to 55 percent of men, although the prevalence is lower among older men.2 Symptoms, if present, include a mild to moderate, clear to white urethral discharge. 2023 MLABS A Division of Pathology, Michigan Medicine, Chlamydia trachomatis and Neisseria gonorrhoeae RNA, Urine, http://www.pathology.med.umich.edu/handbook/Tables/Aptima_Urine.pdf. Chlamydia Nonculture tests (e.g., DFA and NAAT) can be used. Observational studies have also demonstrated that doxycycline is more efficacious for rectal C. trachomatis infection for men and women than azithromycin (748,811). Physicians should create supportive spaces where patients feel safe sharing information by using open-ended questions; avoiding assumptions regarding sexual preferences, practices, and gender/sex; and normalizing diverse sexual experiences. M. genitalium can be detected among 10%30% of women with clinical cervicitis (767,770,772,914916). Web2021 STI Treatment Guidelines Chlamydial Infections Includes updated treatment and screening recommendations, as well as information on diagnosis, prevention, and special considerations. The CDC recommends that anyone who is tested for chlamydial infection also should be tested for gonorrhea.2 This recommendation was supported by a study5 in which 20 percent of men and 42 percent of women with gonorrhea also were found to be infected with C. trachomatis. Infants should be monitored to ensure prompt and age-appropriate treatment if symptoms develop. Among women, the primary focus of chlamydia screening should be to detect and treat chlamydia, prevent complications, and test and treat their partners, whereas targeted chlamydia screening for men should be considered only when resources permit, prevalence is high, and such screening does not hinder chlamydia screening efforts for women (789791). is a target amplification nucleic acid probe test that utilizes target capture for the . Women can develop reactive arthritis, but the male-to-female ratio is 5:1. They help us to know which pages are the most and least popular and see how visitors move around the site. Extragenital chlamydial testing at the rectal site can be considered for females on the basis of reported sexual behaviors and exposure through shared clinical decision-making by the patient and the provider. In the absence of laboratory results in a situation with a high degree of suspicion of chlamydial infection and the mother is unlikely to return with the infant for follow-up, exposed infants can be presumptively treated with the shorter-course regimen of azithromycin 20 mg/kg body weight/day orally, 1 dose daily for 3 days. Treatment also differs during pregnancy. If patients vomit the dose of azithromycin within one to two hours of taking the medication, an alternative treatment should be considered (Table 1).2. Chlamydia trachomatis is part of the chlamydophila genus. Data regarding the efficacy of azithromycin for ophthalmia neonatorum are limited. Chlamydia Trachomatis Collection of larger volumes of urine may result in rRNA target dilution that may reduce test sensitivity. A test of cure to detect therapeutic failure ensures treatment effectiveness and should be obtained at a follow-up visit approximately 4 weeks after treatment is completed. Clinical manifestations and diagnosis of Symptoms of chlamydial pneumonia typically have a protracted onset and include a staccato cough, usually without wheezing or temperature elevation.2 Findings on chest radiograph include hyperinflation and diffuse bilateral infiltrates; peripheral eosinophilia may be present. Ofloxacin (Floxin) 400 mg orally twice daily for 14 days or levofloxacin (Levaquin) 500 mg orally once daily for 14 days; Ceftriaxone (Rocephin) 250 mg IM in a single dose or cefoxitin (Mefoxin) 2 g IM in a single dose with concurrent probenecid (Benemid) 1 g orally in single dose or other parenteral third-generation cephalosporin; Cefotetan (Cefotan) 2 g IV every 12 hours or cefoxitin 2 g IV every six hours; Clindamycin (Cleocin) 900 mg IV every eight hours; Ampicillin/sulbactam (Unasyn) 3 g IV every six hours; Erythromycin base 500 mg orally four times per day for seven days, Amoxicillin 500 mg orally three times per day for seven days, Erythromycin base 250 mg orally four times per day for 14 days, Erythromycin ethylsuccinate 800 mg orally four times per day for seven days, Erythromycin ethylsuccinate 400 mg four times per day for 14 days, Education and counseling on safer sexual behavior in persons at risk, Identification of asymptomatic infected persons and of symptomatic persons unlikely to seek diagnostic and treatment services, Effective diagnosis and treatment of infected persons, Evaluation, treatment, and counseling of sex partners of persons infected with an STD, Pre-exposure immunizations for vaccine-preventable STDs. When nonadherence to doxycycline regimen is a substantial concern, azithromycin 1 g regimen is an alternative treatment option but might require posttreatment evaluation and testing because it has demonstrated lower treatment efficacy among persons with rectal infection. 2022 Mar 2;75:103448. doi: If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance.