SkullRing.org Medical Weblog

Chlamydiae are sensitive to various antibiotics including tetracycline and erythromycin. Tetracyclines are also effective against mycoplasmal infections. No effective single dose treatment is available. Penicillins and other beta lactams are ineffective. Standard practice is to treat patients on the demonstration of cervicitis or urethritis or on the basis of a contact history.

Patients should avoid sexual intercourse until treatment is completed. The importance of compliance with treatment should be stressed.

The recommended treatment for NGU or NGC is a tetracycline (e.g. doxycycline 100 mg twice daily taken with food or milk for 10 days). Regimens for treatment of PID are detailed on pp. 14-15. The sequelae of these infections can be serious and treatment should not be delayed until laboratory investigations are complete.

Tetracyclines are contraindicated in pregnancy and children of 8 years of age or less.
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The diagnosis of chlamydia is commonly presumptive but should be confirmed using laboratory tests. Direct detection using commercially available immunofluorescence or ELISA monoclonal antibody techniques permits rapid diagnosis. False positive and negative results occur; false positive results can be a problem, particularly in patients who deny risk of sexually transmitted infection. Results must be interpreted having regard to the clinical context

Chlamydiae are obligate intracellular parasites; isolation requires tissue culture techniques and takes 3 or 4 days. Direct tests are not as sensitive as culture but are reliable and much less expensive. Culture is only available from a few laboratories.

Serology is of limited value. Complement fixation tests for antibody are not very specific and have largely been superseded. ELISA and immunofluorescence techniques detect chlamydial group antibodies. Microimmunofluorescence tests can detect type specific antibodies. Seroconversion or a 4-fold increase in titre in serum samples collected 2 weeks apart indicates acute infection. A high titre of IgG antibodies and the presence of IgM antibodies probably indicate current infection. Negative serology may be of value in excluding chlamydial infectioa
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