2015 UK national guideline for the management of infection with Chlamydia trachomatis

International Journal of STD and AIDS

Volumn 27, Issue 4, 2016, Pages 251-267

  Nwokolo, Nneka C ^a   Dragovic, Bojana ^b   Patel, Sheel ^a   Tong, CY William ^c   Barker, Gary ^d   Radcliffe, Keith ^e  

^a CHELSEA AND WESTMINSTER HOSPITAL   (United Kingdom)

^b QUEEN MARY S HOSPITAL   (United Kingdom)

^c BARTS HEALTH NHS TRUST   (United Kingdom)

^d St Helens Hospital   (United Kingdom)

^e Clinical Effectiveness Group of the British Association of Sexual Health and HIV   (United Kingdom)

Author keywords

bacterial STIs; Chlamydia; Chlamydia trachomatis; diagnosis; guideline; LGV; lymphogranuloma venereum; Sexually transmitted infection; treatment

Indexed keywords

ARTICLE; CHLAMYDIA TRACHOMATIS; CLINICAL FEATURE; CONSULTATION; DIAGNOSTIC TEST; GENITAL TRACT INFECTION; HEALTH CARE PERSONNEL; HEALTH PROMOTION; HUMAN; INFECTION PREVENTION; NONHUMAN; PRACTICE GUIDELINE; PRIORITY JOURNAL; SEXUALLY TRANSMITTED DISEASE; UNITED KINGDOM; URINE CULTURE; UTERINE CERVIX CYTOLOGY; CHLAMYDIA INFECTIONS; DISEASE MANAGEMENT; MALE;

CHLAMYDIA INFECTIONS; CHLAMYDIA TRACHOMATIS; DIAGNOSTIC TESTS, ROUTINE; DISEASE MANAGEMENT; HEALTH PROMOTION; HUMANS; MALE; PRACTICE GUIDELINES AS TOPIC;

EID: 84958172231     PISSN: 09564624     EISSN: 17581052     Source Type: Journal    
DOI: 10.1177/0956462415615443     Document Type: Article

References (152)

1. Public Health England. www.gov.uk/government/statistics/sexually-transmitted-infections-stis-annual-data-tables (2014, accessed 26 February 2015)
2. P.SonnenbergS.CliftonS.Beddows. Prevalence, risk factors, and uptake of interventions for sexually transmitted infections in Britain: findings from the National Surveys of Sexual Attitudes and Lifestyles (Natsal). Lancet2013; 382: 1795–1806.
3. J.MacleodC.SalisburyN.Low. Coverage of the uptake of systematic postal screening for genital Chlamydia trachomatis and prevalence of infection in the United Kingdom general population: cross sectional study. BMJ2005; 330: 940–940.
4. N.LowA.McCarthyJ.Macleod. Epidemiological, social, diagnostic and economic evaluation of population screening for genital chlamydia infection. Health Technol Assess2007; 11: iii–165.
5. L.McKayH.CleryK.Carrick-Anderson. Genital Chlamydia trachomatis infection in a sub-group of young men in the UK. Lancet2003; 361: 1792–1792.
6. E.J.AdamsA.CharlettW.J.Edmunds. Chlamydia trachomatis in the United Kingdom: a systematic review and analysis of prevalence studies. Sex Transm Infect2004; 80: 354–362.
7. K.A.FentonC.H.MercerA.M.Johnson. Reported sexually transmitted disease clinic attendance and sexually transmitted infections in Britain: prevalence, risk factors, and proportionate population burden. J Infect Dis2005; 191(Suppl 1): S127–S138.
8. G.Paz-BaileyE.H.KoumansM.Sternberg. The effect of correct and consistent condom use on chlamydial and gonococcal infection among urban adolescents. Arch Pediatr Adolesc Med2005; 159: 536–542.
9. L.WarnerM.MacalusoH.D.Austin. Application of the case-crossover design to reduce unmeasured confounding in studies of condom effectiveness. Am J Epidemiol2005; 161: 765–773.
10. L.BrabinE.FairbrotherD.Mandal. Biological and hormonal markers of chlamydia, human papillomavirus, and bacterial vaginosis among adolescents attending genitourinary medicine clinics. Sex Transm Infect2005; 81: 128–132.
11. A.E.MirandaC.L.SzwarcwaldR.L.Peres. Prevalence and risk behaviors for chlamydial infection in a population-based study of female adolescents in Brazil. Sex Transm Dis2004; 31: 542–546.
12. L.WarnerD.R.NewmanH.D.Austin. Condom effectiveness for reducing transmission of gonorrhea and chlamydia: the importance of assessing partner infection status [see comment]. Am J Epidemiol2004; 159: 242–251.
13. S.M.RogersW.C.MillerC.F.Turner. Concordance of Chlamydia trachomatis infections within sexual partnerships. Sex Transm Infect2008; 84: 23–28.
14. A.R.Markos. The concordance of Chlamydia trachomatis genital infection between sexual partners, in the era of nucleic acid testing. Sex Health2005; 2: 23–24.
15. E.J.PostemaL.RemeijerW.I.van der Meijden. Epidemiology of genital chlamydial infections in patients with chlamydial conjunctivitis: a retrospective study. Genitourin Med1996; 72: 203–205.
16. K.StenbergP.A.Mardh. Treatment of concomitant eye and genital chlamydial infection with erythromycin and roxithromycin. Acta Ophthalmol1993; 71: 332–335.
17. J.L.JoynerJ.M.DouglasJrM.Foster. Persistence of Chlamydia trachomatis infection detected by polymerase chain reaction in untreated patients. Sex Transm Dis2002; 29: 196–200.
18. S.A.MorreA.J.van den BruleL.Rozendaal. The natural course of asymptomatic Chlamydia trachomatis infections: 45% clearance and no development of clinical PID after one-year follow-up. Int J STD AIDS2002; 13(Suppl 2): 12–18.
19. K.S.ParksP.B.DixonC.M.Richey. Spontaneous clearance of Chlamydia trachomatis infection in untreated patients. Sex Transm Dis1997; 24: 229–235.
20. M.R.GoldenJ.A.SchillingerL.Markowitz. Duration of untreated genital infections with Chlamydia trachomatis: a review of the literature. Sex Transm Dis2000; 27: 329–337.
21. A.J.Van den BruleC.MunkJ.F.Winther. Prevalence and persistence of asymptomatic Chlamydia trachomatis infections in urine specimens from Danish male military recruits. Int J STD AIDS2002; 13(Suppl 2): 19–22.
22. M.MolanoC.J.MeijerE.Weiderpass. The natural course of Chlamydia trachomatis infection in asymptomatic Colombian women: a 5-year follow-up study. J Infect Dis2005; 191: 907–916.
23. J.S.SheffieldW.W.AndrewsM.A.Klebanoff. Spontaneous resolution of asymptomatic Chlamydia trachomatis in pregnancy. Obstet Gynecol2005; 105: 557–562.
24. W.M.GeislerC.WangS.G.Morrison. The natural history of untreated Chlamydia trachomatis infection in the interval between screening and returning for treatment. Sex Transm Dis2008; 35: 119–123.
25. M.J.PriceA.E.AdesD.D.Angelis. Mixture-of-exponentials models to explain heterogeneity in studies of the duration of Chlamydia trachomatis infection. Stat Med2013; 32: 1547–1660.
26. T.DarvilleT.Hiltke. Pathogenesis of genital tract disease due to Chlamydia trachomatis. J Infect Dis2010; 201(suppl 2): S114–S125.
27. A.AghaizuE.J.AdamsK.Turner. What is the cost of pelvic inflammatory disease and how much could be prevented by screening for Chlamydia trachomatis? Cost analysis of the Prevention of Pelvic Infection (POPI) Trial. Sex Transm Infect2011; 87: 312–317.
28. UK National Chlamydia Screening Programme. www.chlamydiascreening.nhs.uk/ps/resources/data-tables/CTAD%20Data%20Tables%202013%20Annual%20data%20%20for%20publication_FINAL130614.pdf (2013, accessed 26 February 2015)
29. J.L.MarcusK.T.BernsteinS.C.Stephens. Sentinel surveillance of rectal chlamydia and gonorrhea among males – San Francisco, 2005–2008. Sex Transm Dis2010; 37: 59–61.
30. A.DingR.Challenor. Rectal Chlamydia in heterosexual women: more questions than answers. Int J STD AIDS2013; 25: 587–592.
31. G.van LiereC.HoebeP.Wolffs. High co-occurrence of anorectal chlamydia with urogenital chlamydia in women visiting an STI clinic revealed by routine universal testing in an observational study; a recommendation towards a better anorectal chlamydia control in women. BMC Infect Dis2014; 14: 274–274.
32. J.GratrixA.E.SinghJ.Bergman. Evidence for increased Chlamydia case finding after the introduction of rectal screening among women attending 2 Canadian sexually transmitted infection clinics. Clin Infect Dis2015; 60: 398–404.
33. M.JavanbakhtP.GorbachA.Stirland. Prevalence and correlates of rectal chlamydia and gonorrhea among female clients at sexually transmitted disease clinics. Sex Transm Dis2012; 39: 917–922.
34. P.M.BarryC.K.KentS.S.Philip. Results of a program to test women for rectal chlamydia and gonorrhea. Obstet Gynecol2010; 115: 753–759.
35. L.PinskyD.B.ChiarilliJ.D.Klausner. Rates of asymptomatic nonurethral gonorrhea and chlamydia in a population of university men who have sex with men. J Am Coll Health2012; 60: 481–484.
36. P.OakeshottS.KerryA.Aghaizu. Randomized control trial of screening for Chlamydia trachomatis to prevent pelvic inflammatory disease: the POPI (prevention of pelvic infection) trial. BMJ2010; 340: c1642–c1642.
37. I.G.M.Van ValkengoedS.M.MorreA.J.C.van de Brule. Overestimation of complication rates in evaluation of Chlamydia trachomatis screening programmes – implications for cost effectiveness analysis. Int J Epidemiol2004; 33: 416–425.
38. W.E.StammM.E.GuinanC.Johnson. Effect of treatment regimens for Neisseria gonorrhoeae on simultaneous infection with Chlamydia trachomatis. N Engl J Med1984; 310: 545–549.
39. I.SimmsP.Horner. Has the incidence of pelvic inflammatory disease following chlamydial infection been overestimated?Int J STD AIDS2008; 19: 285–286.
40. M.J.PriceA.E.AdesD.De Angelis. Risk of pelvic inflammatory disease following Chlamydia trachomatis infection: analysis of prospective studies with a multistate model. Am J Epidemiol2013; 178: 484–492.
41. J.PaavonenL.WestromD.EschenbachPelvic inflammatory disease. In: (eds). Sexually transmitted diseases, 4th ed. New York: McGraw Hill Medical, 2008, pp. 1017–1050.
42. L.WestromR.JoesoefG.Reynolds. Pelvic inflammatory disease and fertility: a cohort study of 1,884 women with laparoscopically verified disease and 657 control women with normal laparoscopic results. Sex Transm Dis1992; 19: 185–192.
43. P.A.Mardh. Tubal factor infertility, with special regard to chlamydial salpingitis. Curr Opin Infect Dis2004; 17: 49–52.
44. R.B.NessD.E.SoperH.E.Richard. Chlamydia antibodies, chlamydia heat shock protein and adverse sequelae after pelvic inflammatory disease: the PID Evaluation and Clinical Health (PEACH) study. Sex Transm Dis2008; 3: 129–135.
45. S.D.HillisR.JoesoefP.A.Marchbanks. Delayed care of pelvic inflammatory disease as a risk factor for impaired fertility. Am J Obstet Gynecol1993; 168: 1503–1509.
46. D.S.LaMontagneK.BasterL.Emmett. for the Chlamydia recall study advisory group. Incidence and re-infection rates of genital chlamydial infection among women aged 16–24 years attending general practice, family planning and genitourinary medicine clinics in England: a prospective cohort study. Sex Transm Dis2007; 83: 292–303.
47. R.E.BergerE.R.AlexanderG.D.Monda. Chlamydia trachomatis as a cause of acute “idiopathic” epididymitis. N Engl J Med1978; 298: 301–304.
48. D.A.HawkinsD.Taylor-RobinsonB.J.Thomas. Microbiological survey of acute epididymitis. Genitourin Med1986; 62: 342–344.
49. F.M.MulcahyC.J.BignellR.Rajakumar. Prevalence of chlamydial infection in acute epididymo-orchitis. Genitourin Med1987; 63: 16–18.
50. G.BezoldJ.A.PolitchN.B.Kiviat. Prevalence of sexually transmissible pathogens in semen from asymptomatic male infertility patients with and without leukocytospermia. Fertil Steril2007; 87: 1087–1097.
51. V.AkandeC.TurnerP.Horner. Impact of Chlamydia trachomatis in the reproductive setting: British fertility society guidelines for practice. Hum Fertil2010; 13: 115–125.
52. K.A.CunninghamK.W.Beagley. Male genital tract chlamydial infection: implications for pathology and infertility. Biol Reprod2008; 79: 180–189.
53. G.A.GreendaleS.T.HaasK.Holbrook. The relationship of Chlamydia trachomatis infection and male infertility. Am J Public Health1993; 83: 996–1001.
54. P.Joki-KorpelaN.SahrakorpiM.Halttunen. The role of Chlamydia trachomatis infection in male infertility. Fertil Steril2009; 91(4 Suppl): 1448–1450.
55. Götz H, Nieuwenhuis R, Ossewaarde T, et al. Preliminary report of an outbreak of lymphogranuloma venereum in homosexual men in the Netherlands, with implications for other countries in western Europe, www.eurosurveillance.org/ViewArticle.aspx?ArticleId=2367 (2004, accessed 26 February 2015)
56. A.AhdootD.P.KotlerJ.S.Suh. Lymphogranuloma venereum in human immunodeficiency virus-infected individuals in New York City. J Clin Gastroenterol2006; 40: 385–390.
57. H.JebbariS.AlexanderH.Ward. Update on lymphogranuloma venereum in the United Kingdom. Sex Transm Infect2007; 83: 324–326.
58. Van de Laar MJW. The emergence of LGV in Western Europe: what do we know, what can we do? www.eurosurveillance.org/ViewArticle.aspx?ArticleId=641 (2006, accessed 26 February 2015)
59. G.HughesS.AlexanderI.Simms. Lymphogranuloma venereum diagnoses among men who have sex with men in the U.K.: interpreting a cross-sectional study using an epidemic phase-specific framework. Sex Transm Infect2013; 89: 542–547.
60. W.E.StammLymphogranuloma venereum. In: (eds). Sexually transmitted diseases, 4th ed. New York: McGraw Hill Medical, 2008, pp. 595–605.
61. J.White. Manifestations and management of lymphogranuloma venereum. Curr Opin Infect Dis2009; 22: 57–66.
62. C.J.SaxonG.HughesC.Ison. Increasing asymptomatic lymphogranuloma venereum infection in the UK: results from a national case-finding study. Sex Transm Infect2013; 89: A190–A191.
63. Dr Sarah Alexander and Dr Gwenda Hughes. STBRU, PHE, Colindale, London – personal communication
64. S.SkidmoreP.HornerH.Mallinson. Testing specimens for Chlamydia trachomatis. Sex Transm Infect2006; 82: 272–275.
65. C.CarderD.MerceyP.Benn. Chlamydia trachomatis. Sex Transm Infect2006; 82: iv10–iv12.
66. K.V.OtaI.E.TamariM.Smieja. Detection of Neisseria gonorrhoeae and Chlamydia trachomatis in pharyngeal and rectal specimens using the BD Probetec ET system: the Gen-Probe Aptima Combo 2 assay and culture. Sex Transm Infect2009; 85: 182–186.
67. S.AlexanderC.IsonJ.Parry. Self-taken pharyngeal and rectal swabs are appropriate for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae in asymptomatic men who have sex with men. Sex Transm Infect2008; 84: 488–492.
68. S.SkidmoreP.HornerA.Herring. Vulvovaginal-swab or first-catch urine specimen to detect Chlamydia trachomatis in women in a community setting?J Clin Microbiol2006; 44: 4389–4394.
69. J.SchachterJ.M.ChowH.Howard. Detection of Chlamydia trachomatis by nucleic acid amplification testing: our evaluation suggests that CDC-recommended approaches for confirmatory testing are ill-advised. J Clin Microbiol2006; 44: 2512–2517.
70. M.J.HopkinsG.SmithI.J.Hart. Screening tests for Chlamydia trachomatis or Neisseria gonorrhoeae using the Cobas 4800 PCR system do not require a second test to confirm: an audit of patients issued with equivocal results at a sexual health clinic in the Northwest of England, UK. Sex Transm Infect2012; 88: 495–497.
71. S.SkidmoreS.Corden. Second tests for Chlamydia trachomatis and Neisseria gonorrhoeae. Sex Transm Infect2012; 88: 497–497.
72. P.HornerS.SkidmoreA.Herring. Enhanced enzyme immunoassay with negative-gray-zone testing compared to a single nucleic acid amplification technique for community-based chlamydial screening of men. J Clin Microbiol2005; 43: 2065–2069.
73. S.ChongD.JangX.Song. Specimen processing and concentration of Chlamydia trachomatis added can influence false-negative rates in the LCx assay but not in the APTIMA Combo 2 assay when testing for inhibitors. J Clin Microbiol2003; 41: 778–782.
74. Ripa T and Nilsson P. A variant of Chlamydia trachomatis with deletion in cryptic plasmid: implications for use of PCR diagnostic tests, www.eurosurveillance.org/ViewArticle.aspx?ArticleId=3076 (2006, accessed 26 February 2015)
75. H.M.Seth-SmithS.R.HarrisK.Persson. Co-evolution of genomes and plasmids within Chlamydia trachomatis and the emergence in Sweden of a new variant strain. BMC Genomics2009; 10: 239–239.
76. M.UnemoH.M.Seth-SmithL.T.Cutcliffe. The Swedish new variant of Chlamydia trachomatis: genome sequence, morphology, cell tropism and phenotypic characterization. Microbiology2010; 156: 1394–1404.
77. M.UnemoI.N.Clarke. The Swedish new variant of Chlamydia trachomatis. Curr Opin Infect Dis2011; 24: 62–69.
78. S.A.SchoemanC.M.StewartR.A.Booth. Assessment of best single sample for finding chlamydia in women with and without symptoms: a diagnostic test study. BMJ2012; 345: e8013–e8013.
79. Papp JR, Schachter J, Gaydos CA, et al. Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae, www.cdc.gov/mmwr/preview/mmwrhtml/rr6302a1.htm (2014, accessed 26 February 2015)
80. J.SchachterM.A.CherneskyD.E.Willis. Vaginal swabs are the specimens of choice when screening for Chlamydia trachomatis and Neisseria gonorrhoeae: results from a multicenter evaluation of the APTIMA assays for both infections. Sex Transm Dis2005; 32: 725–728.
81. J.SchachterW.M.McCormackM.A.Chernesky. Vaginal swabs are appropriate specimens for diagnosis of genital tract infection with Chlamydia trachomatis. J Clin Microbiol2003; 41: 3784–3789.
82. M.J.LoeffelholzS.J.JirsaR.K.Teske. Effect of endocervical specimen adequacy on ligase chain reaction detection of Chlamydia trachomatis. J Clin Microbiol2001; 39: 3838–3841.
83. L.E.WelshT.C.QuinnC.A.Gaydos. Influence of endocervical specimen adequacy on PCR and direct fluorescent-antibody staining for detection of Chlamydia trachomatis infections. J Clin Microbiol1997; 35: 3078–3081.
84. J.MoncadaJ.SchachterE.W.HookIII. The effect of urine testing in evaluations of the sensitivity of the Gen-Probe Aptima Combo 2 assay on endocervical swabs for Chlamydia trachomatis and Neisseria gonorrhoeae: the infected patient standard reduces sensitivity of single site evaluation. Sex Transm Dis2004; 31: 273–277.
85. C.A.GaydosT.C.QuinnD.Willis. Performance of the APTIMA Combo 2 assay for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in female urine and endocervical swab specimens. J Clin Microbiol2003; 41: 304–309.
86. M.A.CherneskyE.W.HookIII. Women find it easy and prefer to collect their own vaginal swabs to diagnose Chlamydia trachomatis or Neisseria gonorrhoeae infections. Sex Transm Dis2005; 32: 729–733.
87. J.S.DoshiJ.PowerE.Allen. Acceptability of chlamydia screening using self-taken vaginal swabs. Int J STD AIDS2008; 19: 507–509.
88. C.A.GaydosC.FarshyM.Barnes. Can mailed swab samples be dry-shipped for the detection of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis by nucleic acid amplification tests?Diagn Microbiol Infect Dis2012; 73: 16–20.
89. M.A.CherneskyD.H.MartinE.W.HookIII. Ability of new APTIMA CT and APTIMA GC assays to detect Chlamydia trachomatis and Neisseria gonorrhoeae in male urine and urethral swabs. J Clin Microbiol2005; 43: 127–131.
90. C.A.WisniewskiJ.A.WhiteC.E.Michel. Optimal method of collection of first-void urine for diagnosis of Chlamydia trachomatis infection in men. J Clin Microbiol2008; 46: 1466–1469.
91. C.A.GaydosC.P.CartwrightP.Colaninno. Performance of the Abbott RealTime CT/NG for detection of Chlamydia trachomatis and Neisseria gonorrhoeae. J Clin Microbiol2010; 48: 3236–3243.
92. M.J.MimiagaK.H.MayerS.L.Reisner. Asymptomatic gonorrhea and chlamydial infections detected by nucleic acid amplification tests among Boston area men who have sex with men. Sex Transm Dis2008; 35: 495–498.
93. L.DizeP.AgredaN.Quinn. Comparison of self-obtained penile-meatal swabs to urine for the detection of C. trachomatis, N. gonorrhoeae and T. vaginalis. Sex Transm Infect2013; 89: 305–307.
94. M.A.CherneskyD.JangE.Portillo. Self-collected swabs of the urinary meatus diagnose more Chlamydia trachomatis and Neisseria gonorrhoeae infections than first catch urine from men. Sex Transm Infect2013; 89: 102–104.
95. J.SchachterJ.MoncadaS.Liska. Nucleic acid amplification tests in the diagnosis of chlamydial and gonococcal infections of the oropharynx and rectum in men who have sex with men. Sex Transm Dis2008; 35: 637–642.
96. L.H.BachmannR.E.JohnsonH.Cheng. Nucleic acid amplification tests for diagnosis of Neisseria gonorrhoeae and Chlamydia trachomatis rectal infections. J Clin Microbiol2010; 48: 1827–1832.
97. S.WayalC.LlewellynH.Smith. Self-sampling for oropharyngeal and rectal specimens to screen for sexually transmitted infections: acceptability among men who have sex with men. Sex Transm Infect2009; 85: 60–64.
98. A.H.FreemanK.T.BernsteinR.P.Kohn. Evaluation of self-collected versus clinician-collected swabs for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae pharyngeal infection among men who have sex with men. Sex Transm Dis2009; 38: 1038–1039.
99. J.J.Van der HelmC.J.HoebeM.S.van Rooijen. High performance and acceptability of self-collected rectal swabs for diagnosis of Chlamydia trachomatis and Neisseria gonorrhoeae in men who have sex with men and women. Sex Transm Dis2009; 36: 493–497.
100. J.J.Van der HelmL.O.SabajoA.W.Grunberg. Point-of-care test for detection of urogenital chlamydia in women shows low sensitivity. A performance evaluation study in two clinics in Suriname. PLoS One2012; 7: e32122–e32122.
101. L.Mahilum-TapayV.LaitilaJ.J.Wawrzyniak. New point of care Chlamydia Rapid Test – bridging the gap between diagnosis and treatment: performance evaluation study. BMJ2007; 335: 1190–1194.
102. W.HuangC.A.GaydosM.R.Barnes. Comparative effectiveness of a rapid point-of-care test for detection of Chlamydia trachomatis among women in a clinical setting. Sex Transm Infect2013; 89: 104–114.
103. C.A.GaydosB.Van Der PolM.Jett-Goheen. Performance of the Cepheid CT/NG Xpert rapid PCR test for detection of Chlamydia trachomatis and Neisseria gonorrhoeae. J Clin Microbiol2013; 51: 1666–1672.
104. S.D.GoldenbergJ.FinnE.Sedudzi. Performance of the GeneXpert CT/NG assay compared to that of the Aptima AC2 Assay for detection of rectal Chlamydia trachomatis and Neisseria gonorrhoeae by use of residual Aptima samples. J Clin Microbiol2012; 50: 3867–3869.
105. C.Y.LauA.K.Qureshi. Azithromycin versus doxycycline for genital chlamydial infections: a meta-analysis of randomized clinical trials. Sex Transm Dis2002; 29: 497–502.
106. B.E.BatteigerW.TuS.Ofner. Repeated Chlamydia trachomatis genital infections in adolescent women. J Infect Dis2010; 201: 42–51.
107. M.R.GoldenW.L.WhittingtonH.H.Handsfield. Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection. N Engl J Med2005; 352: 676–685.
108. P.J.Horner. The case for further treatment studies of uncomplicated genital Chlamydia trachomatis infection. Sex Transm Infect2006; 82: 340–343.
109. H.H.Handsfield. Questioning azithromycin for chlamydial infection. Sex Transm Dis2011; 38: 1028–1029.
110. J.R.SchwebkeA.RompaloS.Taylor. Re-evaluating the treatment of nongonococcal urethritis: emphasizing emerging pathogens – a randomized clinical trial. Clin Infect Dis2011; 52: 163–170.
111. F.Y.S.KongS.N.TabriziM.Law. Azithromycin versus doxycycline for the treatment of genital chlamydia infection: a meta-analysis of randomized controlled trials. Clin Infect Dis2014; 59: 193–205.
112. F.DrummondN.RyderH.Wand. Is azithromycin adequate treatment for asymptomatic rectal chlamydia?Int J STD AIDS2011; 22: 478–480.
113. N.M.SteedmanA.McMillan. Treatment of asymptomatic rectal Chlamydia trachomatis: is single-dose azithromycin effective?Int J STD AIDS2009; 20: 16–18.
114. F.Y.KongS.N.TabriziC.K.Fairley. The efficacy of azithromycin and doxycycline for the treatment of rectal chlamydia infection: a systematic review and meta-analysis. J Antimicrob Chemother2015; 70: 1290–1297.
115. V.S.KitchenC.DoneganH.Ward. Comparison of ofloxacin with doxycycline in the treatment of non-gonococcal urethritis and cervical chlamydial infection. J Antimicrob Chemother1990; 26(Suppl D): 99–105.
116. Horner P, Boag F, Radcliffe K, et al. UK national guideline for the management of genital tract infection with Chlamydia trachomatis, www.bashh.org (2006, accessed 19 March 2014)
117. C.C.LinnemannJrC.L.HeatonM.Ritchey. Treatment of Chlamydia trachomatis infections: comparison of 1- and 2-g doses of erythromycin daily for seven days. Sex Transm Dis1987; 14: 102–106.
118. L.RahangdaleS.GuerryH.M.Bauer. An observational cohort study of Chlamydia trachomatis treatment in pregnancy. Sex Transm Dis2006; 33: 106–110.
119. M.SarkarC.WoodlandG.Koren. Pregnancy outcome following gestational exposure to azithromycin. BMC Pregnancy Childbirth2006; 30: 6–18.
120. Brocklehurst P and Rooney G. Interventions for treating genital Chlamydia trachomatis infection in pregnancy, http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000054/pdf (1998, accessed 19 March 2014)
121. C.D.AdairM.GunterT.G.Stovall. Chlamydia in pregnancy: a randomized trial of azithromycin and erythromycin. Obstet Gynecol1998; 91: 165–168.
122. C.BignellM.Fitzgerald. UK national guideline for the management of gonorrhoea in adults. Int J STD AIDS2011; 22: 541–547.
123. GRASP 2013 Report: the gonococcal resistance to anti microbials surveillance programme (England and Wales), www.gov.uk/government/uploads/system/uploads/attachment_data/file/368477/GRASP_Report_2013.pdf (2013, accessed 1 April 2015)
124. N.H.Dukers-MuijrersS.A.MorreA.Speksnijder. Chlamydia trachomatis test-of-cure cannot be based on a single highly sensitive laboratory test taken at least 3 weeks after treatment. PLoS One2012; 7: e34108–e34108.
125. C.A.RenaultD.M.IsraelskiV.Levy. Time to clearance of Chlamydia trachomatis ribosomal RNA in women treated for chlamydial infection. Sex Health2011; 8: 69–73.
126. A.K.Van der BijJ.SpaargarenS.A.Morré. Diagnostic and clinical implications of anorectal lymphogranuloma venereum in men who have sex with men: a retrospective case-control study. Clin Infect Dis2006; 42: 186–194.
127. S.N.S.PallawelaA.K.SullivanN.Macdonald. Clinical predictors of rectal lymphogranuloma venereum infection: results from a multicentre case–control study in the UK. Sex Transm Infect2014; 90: 269–274.
128. H.WardI.MartinN.Macdonald. Lymphogranuloma venereum in the United Kingdom. Clin Infect Dis2007; 44: 26–32.
129. P.FrenchC.A.IsonN.Macdonald. Lymphogranuloma venereum in the United Kingdom. Sex Transm Infect2005; 81: 97–98.
130. K.A.WorkowskiBerman. Sexually transmitted diseases treatment guidelines. MMWR2010; 59: 1–110.
131. A.R.BhengrajP.SrivastavaA.Mittal. Lack of mutation in macrolide resistance genes in Chlamydia trachomatis clinical isolates with decreased susceptibility to azithromycin. Int J Antimicrob Agents2011; 38: 178–179.
132. P.J.Horner. Azithromycin antimicrobial resistance and genital Chlamydia trachomatis infection: duration of therapy may be the key to improving efficacy. Sex Transm Infect2012; 88: 154–156.
133. K.M.SandozD.D.Rockey. Antibiotic resistance in Chlamydiae. Future Microbiol2010; 5: 1427–1442.
134. C.B.HosenfeldK.A.WorkowskiS.Berman. Repeat infection with chlamydia and gonorrhea among females: a systematic review of the literature. Sex Transm Dis2009; 36: 478–489.
135. M.FungK.C.ScottC.K.Kent. Chlamydial and gonococcal reinfection among men: a systematic review of data to evaluate the need for retesting. Sex Transm Infect2007; 83: 304–309.
136. J.C.HeijneC.L.AlthausS.A.Herzog. The role of reinfection and partner notification in the efficacy of Chlamydia screening programs. J Infect Dis2011; 203: 372–377.
137. Ministry of Health (New Zealand). Chlamydia management guidelines, www.health.govt.nz/publication/chlamydia-management-guidelines (2008, accessed 20 March 2015)
138. Scottish Intercollegiate Guidelines Network. Management of genital Chlamydia trachomatis infection. A national clinical guideline (109), Edinburgh: Scottish Intercollegiate Guidelines Network, 2009.
139. Public health agency of Canada. Canadian guidelines on sexually transmitted infections, www.phac-aspc.gc.ca/std-mts/sti-its/cgsti-ldcits/section-5-2-eng.php (2010, accessed 20 March 2015)
140. J.C.HeijneS.A.HerzogC.L.Althaus. Insights into the timing of repeated testing after treatment for Chlamydia trachomatis: data and modelling study. Sex Transm Infect2012; 98: 57–62.
141. Dr Sarah Alexander. STBRU, PHE, Colindale, London – personal communication
142. J.SchachterM.GrossmanJ.Holt. Infection with Chlamydia trachomatis: involvement of multiple anatomic sites in neonates. J Infect Dis1979; 139: 232–234.
143. M.R.HammerschlagM.GellingP.M.Roblin. Treatment of neonatal chlamydial conjunctivitis with azithromycin. Pediatr Infect Dis J1998; 17: 1049–1050.
144. R.Sanson-FisherJ.BowmanS.Armstrong. Factors affecting nonadherence with antibiotics. Diagn Microbiol Infect Dis1992; 15: 103S–109S.
145. N.LowT.RobertsM.Huengsberg. Partner notification for chlamydia in primary care: randomised controlled trial and economic evaluation. BMJ2006; 332: 14–14.
146. McClean H, Radcliffe K, Sullivan A et al. 2012 BASHH statement on partner notification for sexually transmissible infections, http://std.sagepub.com/content/early/2013/06/18/0956462412472804.full.pdf+html (2013, accessed 5 December 2014)
147. Society of Sexual Health Advisers. SSHA manual, www.ssha.info/wp-content/uploads/ha_manual_2004_complete.pdf (2004, accessed 5 December 2014)
148. National Institute for Health and Clinical Excellence. Public Health Intervention Guidance PH03. Preventing sexually transmitted infections and under 18 conceptions, http://guidance.nice.org.uk/PH3 (2007, accessed 5 December 2014)
149. G.A.F.S.van LiereC.J.P.A.HoebeN.H.T.M.Dukers-Muijrers. Evaluation of the anatomical site distribution of chlamydia and gonorrhoea in men who have sex with men and in high-risk women by routine testing: cross-sectional study revealing missed opportunities for treatment strategies. Sex Transm Infect2014; 90: 58–60.
150. G.A.van LiereC.J.HoebeA.M.Niekamp. Standard symptom- and sexual history-based testing misses anorectal Chlamydia trachomatis and Neisseria gonorrhoeae infections in swingers and men who have sex with men. Sex Transm Dis2013; 40: 285–289.
151. H.SugunendranH.D.BirleyH.Mallinson. Comparison of urine, first and second endourethral swabs for PCR based detection of genital Chlamydia trachomatis infection in male patients. Sex Transm Infect2001; 77: 423–426.
152. R.A.McCartneyJ.WalkerA.Scoular. Detection of Chlamydia trachomatis in genitourinary medicine clinic attendees: comparison of strand displacement amplification and the ligase chain reaction. Br J Biomed Sci2001; 58: 235–238.