Chlamydia Information for Health Professionals

Chlamydia Facts

• There is an epidemic of Chlamydia trachomatis in the Hunter New England region and throughout Australia.
• Chlamydia infection can occur at any age but infection is most common in young adults under the age of 25 years. Up to 10% of young people have the infection.
• It is a common infection in both males and females.
• It is a major preventable cause of infertility and can cause ectopic pregnancy and chronic pelvic pain.
• It can increase the risk of HIV transmission.
• Most infections (in men and women) are asymptomatic (up to 90%).
• Infection can persist for years if untreated.
• It is highly infectious – at least 50% of partners of a confirmed case will be infected. Treating contacts is thus very important (see below).
  
  
  

Target Groups for Testing

The following people should be offered routine testing at least annually:

• sexually active men and women under the age of 25
• men who have sex with men
• sex industry workers

Testing is also recommended for people who have:

• a history of inconsistent condom use
• recent partner change
• unplanned pregnancy
• symptoms suggestive of chlamydia
• another STI
• a sexual partner with chlamydia
  
  
  

Chlamydia Symptoms

• Most men and women (up to 90%) will have no symptoms.
• In women, infection may result in pain on urination, lower abdominal pain, or intermenstrual or post coital bleeding.
• In men, infection may result in urethral discharge, pain on urination or urethral irritation.
  
  
  

Test Options

• The chlamydia PCR test is highly sensitive (95%+) and specific (95%+).
• For men: Initial stream urine taken at any time of the day (plus an anal swab if indicated)*
• For women: Initial stream urine or a cervical swab (plus an anal swab if indicated).* Other options include a Thin Prep specimen, or a high vaginal swab. 
  
  
  

Treatment Options for Uncomplicated Infection

• Azithromycin 1000mg stat; or
• Doxycycline 100mg b.d. for 7 days (not for use in pregnancy or breast feeding)

In pregnancy:

• Azithromycin 1000mg stat  (Category B1);   or
• Amoxicillin 500mg tds for 7 days  (Category A);   or
• EES 800mg QID for 7 days  (Category A)
  
  
  

Patient Follow-Up

• A repeat test should not be conducted less than 4 weeks after the initial positive test due to the likelihood of bacterial DNA still being present.
• It is recommended that a pregnant woman testing positive be tested for cure at 4 weeks after treatment.
• All others with a positive test should be retested at 3-6 months because of the high risk of reinfection.
• The frequency of further testing should then be based on an assessment of continuing risk factors.
  
  
  

Partner Notification

• All sexual contacts for the past 6 months should be offered empirical treatment for chlamydia and tested for chlamydia and other STIs. A contact letter is available for use during this process. To download a contact tracing letter, see the Resources and Links page.
• Further information for clinicians is available in the Australasian Contact Tracing Manual
• Partner notification information for patients is available elsewhere on this site. Patients can be directed to this resource by giving them the following web address: www.chlamydiahelp.net