Antepartum screening for Chlamydia trachomatis should be performed early in pregnancy and repeated in the third trimester based on risk factors (see Table 16.1). It has been detected in 2% to 13% of pregnant women, depending on the population, and is generally found in 5% of all popula-tions. In pregnant women, infection is often asymptomatic but may cause urethritis or mucopurulent cervicitis. Like gonorrhea, infection of the upper genital tract is uncom-mon during pregnancy, although chlamydia infection has been associated with postpartum endometritis and infertil-ity. Diagnosis is made by culture, direct fluorescent anti-body staining, enzyme immunoassay, DNA probe, or PCR.
Maternal chlamydia infection at the time of delivery results in colonization of the neonate in 50% of cases. Neonates colonized at birth may go on to develop puru-lent conjunctivitis soon after birth or pneumonia at 1 to 3 months of age. Routine prophylaxis against neonatal gonococcal ophthalmia is not generally effective against chlamydial conjunctivitis; systemic treatment of the infant is necessary. Fortunately, neonatal chlamydial ophthalmia and pneumonia are becoming less common with the insti-tution of universal prenatal screening and treatment. Recommended treatment of genital infection with C. tra-chomatis in pregnancy includes azithromycin or amoxicillin.
Doxycycline and ofloxacin are contraindicated during preg-nancy.
Repeat testing to confirm successful treatment, preferably by culture performed 3 to 4 weeks after completion of ther-apy, is recommended in pregnancy.