Seed of Life Birthing Services

Taylor Rackey, CPM Candidate

Revised 08/2020

Evaluation and management of CHLAMYDIA

1. Definition or Key Clinical Information​:​ Chlamydia is an infection that is caused by the bacterium
Chlamydia Trachomatis, a Gram-negative coccoid or rod-shaped bacteria that causes genitourinary tract
and eye infections. Chlamydia is spread through sexual contact (including vaginal, anal, and oral sex), or
contact via infected secretions. Chlamydia is the most commonly reported STD/STI in the United States,
with 1.45 million cases in 2013, 1.70 million cases in 2017, and many others that went unreported
(Schuiling & Likis, 2017; National Coalition of STD Directors, 2019). In Oregon, 364/100,000 individuals
were reported to have chlamydia infections in the state across all counties. It is referenced that while
Oregon’s chlamydia rates have continued to increase over the last 10 years, the overall rate remains
below that of the national average (Oregon Health Authority, 2013). Screening guidelines recommend to
test all pregnant individuals under the age of < 25 years old at their first prenatal visit; recommended to
screen all those asymptomatic living in areas of high prevalence; CDC recommends testing ALL
individuals for chlamydia at the beginning of prenatal care (Schuiling & Likis, 2017; Brucker, Jevitt, &
Osborne, 2019).

2. Assessment
i. Risk Factors
● Any sexually active individual younger than the age of < 25 years old
● New partners
● Multiple partners
● Partner with an STI/STD
● Hx of STD/STI
● Cervical ectopy
● Income
● Race/ethnicity
● Men who have sex with men
● Not using protection during sexual intercourse
● Substance abuse
ii. Subjective Symptoms
*80% of individuals are typically asymptomatic
● Vaginal spotting or post-coital bleeding
● Mucoid or purulent cervical discharge
● Urinary frequency
● Dysuria
● Lower abdominal pain
● Dyspareunia
iii. Objective Signs
● Physical exam may reveal abdominal guarding, referred pain, or rebound tenderness
● Speculum exam may reveal cervical friability
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 ● Reports of pain with cervical movement during a bimanual exam
● Adnexal fullness
● Uterine tenderness
iv. Clinical Test Considerations
● Screening guidelines recommend performing a urine culture, or swab specimen from the
endocervix or vagina. May also include NAATs, cell culture, direct immunofluorescence,
enzyme immunoassay (EIA); NAATs are preferred, as they provide the highest sensitivity
for testing (Schuiling & Likis, 2017). The CDC states that the individual can adequately
collect their own sample (Brucker, Jevitt, & Osborne, 2019).
○ All of those who test positive for chlamydia should also be tested for other
STD/STIs, including gonorrhea, syphilis, and HIV.
○ Recommended to test and treat all partners in the last < 60 days of those who
test positive for chlamydia.
● Differential diagnoses: gonorrhea, trichomoniasis, pelvic inflammatory disease (PID),
appendicitis, and cystitis.
3. Management plan
i. Therapeutic measures to consider
● Recommended regimens include:
○ Azithromycin 1 gram orally in a single-dose
○ OR Doxycycline 100 mg orally twice daily for 7 days
ii. Complementary measures to consider
● Probiotics to help aid gut flora during abx use
● Immune supporting herbs
○ Echinacea
○ Turmeric
○ Garlic
○ Goldenseal
■ Not safe during pregnancy
iii. Considerations for pregnancy, delivery and lactation
● Recommended to test those who are younger than < 25 years of age at the first prenatal
visit.
○ Re-test 3-4wks after treatment regimen and again 3 months after to reduce
neonatal transmission rates
● Advise against tx of chlamydia using Doxycycline in the 2nd/3rd trimester due to the risk
of discolored-teeth.
● Without proper treatment, there are high rates (50-70%) of transmission to the
newborn, resulting in blindness, and/or pneumonia.
iv. Client and family education
● Test all partners within the last < 60 days
○ if partners are unwilling to be seen by a care provider, consider expedited
partner therapy (EPT), which provides medication to be given to the partner by
the individual who tested positive for an STI/STD.
● Advise abstaining from sexual intercourse until partner(s) are treated, and the individual
finished their complete prescribed abx regimen.
v. Follow-up
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 ● No follow-up testing required after treatment unless pregnant, persistent s/sx, unable to
complete treatment, or re-exposure.
○ Due to the high-probability of reinfection, it is recommended to re-screen all
individuals 3 months after treatment.
4. Indications for Consult, Collaboration or Referral
● In the event of a positive chlamydia test, which is a mandated reportable condition, the
facilitating lab will contact the health department, and the provider; the health department will
then call both the provider and the client. Contact with the client and healthcare provider will
then continue through verification of treatment and negative re-test.
5.References
Couture, T. (2019, August 15). Final Minority Health Advisory Committee. Retrieved from
https://www.ncsddc.org/wp-content/uploads/2019/08/Final_Minority-Health-Advisory-Committ
ee_8.15.19.pdf

King, T. L., Brucker, M. C., Jevitt, C., & Osborne, K. (2019). Varney's midwifery (6th ed.). Burlington,
Massachusetts: Jones & Bartlett Learning.

Schuiling, K., & Likis, F. (2017). Women's gynecologic health (3rd ed.). Burlington, Massachusetts: Jones
& Bartlett Learning.

MCU Practice Guideline Template

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