This is the second part of a three part series covering the new WHO guidelines for treatment of Sexually Transmitted Infections (STIs)- Gonorrhea, Chlamydia and Syphilis. This post will describe the guidelines for Chlamydia.
Background Information:
Chlamydia:
Chlamydial infection, caused by Chlamydia trachomatis, is the most common bacterial STI and results in substantial morbidity and economic cost worldwide.
Occurring most commonly among young sexually active adults, C. trachomatis causes cervicitis in women and urethritis in men, as well as extra-genital infections, including rectal and oropharyngeal infections.
Asymptomatic infections are common in both men and women.
Untreated chlamydial infection may cause severe complications in the upper reproductive tract, primarily in young women, including
- ectopic pregnancy,
- salpingitis and
- infertility.
Lymphogranuloma venereum (LGV), caused by a more invasive serovar of C. trachomatis, is increasingly prevalent among men who have sex with men (MSM) in some settings.
Maternal infection is associated with serious adverse outcomes in neonates, such as
- preterm birth,
- low birth weight,
- conjunctivitis,
- nasopharyngeal infection and
- pneumonia
Key Messages:
The objectives of these guidelines are:
to provide evidence-based guidance on treatment of infection with C. trachomatis; and
to support countries to update their national guidelines for treatment of chlamydial infection.
The Recommendations
I. Uncomplicated genital chlamydia
The WHO STI guideline suggests treatment with one of the following options:
- azithromycin 1 g orally as a single dose
- doxycycline 100 mg orally twice a day for 7 days
or one of these alternatives:
- tetracycline 500 mg orally four times a day for 7 days
- erythromycin 500 mg orally twice a day for 7 days
- ofloxacin 200–400 mg orally twice a day for 7 days.
II. Anorectal chlamydial infection
The WHO STI guideline suggests treatment with doxycycline 100 mg orally twice a day for 7 days over azithromycin 1 g orally as a single dose.
III. Genital chlamydial infection in pregnant women
Recommendation 3a
The WHO STI guideline recommends treatment with azithromycin over erythromycin.
Recommendation 3b
The WHO STI guideline suggests treatment with azithromycin over amoxicillin.
Recommendation 3c
The WHO STI guideline suggests treatment with amoxicillin over erythromycin.
Dosages:
- azithromycin 1 g orally as a single dose
- amoxicillin 500 mg orally three times a day for 7 days
- erythromycin 500 mg orally twice a day for 7 days.
IV. Lymphogranuloma venereum (LGV)
The WHO STI guideline suggests treatment with doxycycline 100 mg orally twice daily for 21 days over azithromycin 1 g orally, weekly for 3 weeks.
V. Ophthalmia neonatorum
Recommendation 5
In neonates with chlamydial conjunctivitis, the WHO STI guideline recommends treatment with azithromycin 20 mg/kg/day orally, one dose daily for 3 days, over erythromycin 50 mg/kg/day orally, in four divided doses daily for 14 days.
Recommendation 6
For all neonates, the WHO STI guideline recommends topical ocular prophylaxis for the prevention of gonococcal and chlamydial ophthalmia neonatorum.
Recommendation 7
For ocular prophylaxis, the WHO STI guideline suggests one of the following options for topical application to both eyes immediately after birth:
- tetracycline hydrochloride 1% eye ointment
- erythromycin 0.5% eye ointment
- povidone iodine 2.5% solution
- silver nitrate 1% solution
- chloramphenicol 1% eye ointment.
Remarks:
Recommendations 6 and 7 apply to the prevention of both chlamydial and gonococcal ophthalmia neonatorum.
Caution should be taken to avoid touching eye tissue when applying the topical treatment and to provide a water-based solution of povidone iodine.
DO NOT USE ALCOHOL-BASED POVIDONE IODINE SOLUTION.
Useful Links:
Link to the WHO guideline document (English) [PDF]:
http://apps.who.int/iris/bitstream/10665/246165/1/9789241549714-eng.pdf?ua=1
Link to Annex D: Evidence profiles and evidence-to-decision frameworks (English)[PDF]:
http://apps.who.int/iris/bitstream/10665/246165/5/9789241549714-webannexD-eng.pdf?ua=1
Link to Part 1 of the series:
