Primary prevention
High-risk patients should be counselled on safer sex behaviours such as the use of condoms.[11] In the UK, the National Chlamydia Screening Programme seeks to increase awareness of chlamydial disease among sexually active men and women under 25 years of age. It also provides access to screening and treatment services to prevent onward transmission of infection.[12]
The US Centers for Disease Control and Prevention recommends collecting information on any person who has had sexual contact with a diagnosed patient within the previous 60 days, and the most recent sex partner should be evaluated and treated, even if the time of the last sexual contact was >60 days before symptom onset or diagnosis.[5] Counselling should be given about avoiding condomless sex, and the risk of re-infection with chlamydia and other STIs.[13] Screening for common co-infections such as Neisseria gonorrhoeae and Treponema pallidumshould be routinely performed. Counselling and testing for HIV infection should also generally be done.[5]
UK national guidelines recommend identifying sexual partners at risk of infection in the 6-month period prior to diagnosis of the index case.[2] In males with urethral symptoms, the recommended look back period is 4 weeks.[2][14]
Secondary prevention
Chlamydia infection re-testing should take place 3 months after treatment to identify those who have been re-infected. Testing for a cure is not generally recommended except during pregnancy. In pregnant women, re-test approximately 4 weeks after treatment, and again within 3 months.[5] The UK guidelines recommend a test of cure for rectal chlamydia at least 3 weeks after treatment.[2]
All sexual contacts within the past 60 days should be advised to seek investigation and treatment for chlamydia.
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At the very least, the index case should notify sexual contacts that they may have been exposed to chlamydia. In some US states the law permits expedited partner therapy (EPT), which is the practice of treating the sex partners of persons with sexually transmitted infections (STIs) without an intervening medical evaluation or professional prevention counselling.[35]
CDC: expedited partner therapy
Opens in new window This may be considered as an option to facilitate partner management among heterosexual men and women with chlamydia infection. The American College of Obstetricians and Gynecologists has issued a statement supporting EPT in the management of chlamydial and gonorrhoea infections when the partner is unlikely or unable to otherwise receive in-person evaluation and appropriate treatment.[36]
UK national guidelines recommend identifying sexual partners at risk of infection in the 6-month period prior to diagnosis of the index case.[2] In males with urethral symptoms, the recommended look back period is 6 months.[2]
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