Chlamydia - Infectious Diseases in Pregnancy

CHLAMYDIA

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.