Contributor: MFM Division
Last Update: 1/1/2007
Chlamydia trachomatis is the most common sexually transmitted bacterial pathogen in the United States. All 50 states in the U.S. have laws requiring the reporting of C. trachomatis. Pelvic inflammatory disease (PID) accounts for most of the serious acute illness associated with genital tract infection in women.
Perinatal morbidity associated with C. trachomatis infection includes neonatal conjunctivitis and pneumonitis. Nearly two-thirds of infants born to women with C. trachomatis infection become infected with this organism. Ophthalmic prophylaxis with silver nitrate or erythromycin ointment is effective but 15% of infants may still develop conjunctivitis. Although long-term sequelae from unrecognized and untreated conjunctivitis include corneal scarring and blindness, these can be minimized with close surveillance and systematic treatment. C. trachomatis is a common cause of pneumonia during the first few months of life affecting up to 16% of exposed infants. The role of C. trachomatis infection as a cause of preterm birth remains controversial.
Based on recommendations from the CDC and ACOG, we have adopted the following approach. All pregnant women will be screened for C. trachomatis at the first prenatal physical examination. If the C. trachomatis DNA probe is positive, the patient will be treated and a test of cure will be repeated in approximately 4 weeks. These patients will receive a repeat C. trachomatis DNA probe test in the third trimester as well as any patients that have other high risk factors. These factors include a history of PID or other STDs, multiple partners during the pregnancy, HIV infection, or use of illicit drugs. Patients that present in preterm labor will also be tested for C. trachomatis unless they have test results available from within the preceding 4 weeks.
Azithromycin 1 gram orally in a singe dose is recommended as a first line agent. Alternatively, Erythromycin base 500 mg orally four times a day for 7 days OR Erythromycin ethylsuccinate 800 mg orally four times a day for 7 days. Doxycycline and Ofloxacin are NOT recommended in pregnancy. Patient should be counseled to abstain from intercourse for seven days after treatment begins and until her partner is treated.
Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2006. MMWR 2006;55 (RR-11). Available at: https://www.cdc.gov/