Chlamydia and LGV: Key information and resources

Key information and additional resources for Chlamydia trachomatis infections (including lymphogranuloma venereum (LGV)).

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Key Information

Public health importance

C. trachomatis is the most common reportable sexually transmitted infection in Canada. If not treated, C. trachomatis can spread from a local site of inoculation and lead to serious complications and/or sequelae, such as pelvic inflammatory disease (PID), ectopic pregnancy, infertility, chronic pelvic pain, epididymo-orchitis and Reiter syndrome.

C. trachomatis LGV genotypes are more invasive than non-LGV genotypes and preferentially affect the lymph tissue. Infection may be accompanied by systemic symptoms, painful lymphadenopathy, inflammation and, if untreated, anogenital scarring.

Note: C. trachomatis infections are reported to public health authorities in all provinces and territories by laboratories, physicians and designated health care professionals. Not all provinces and territories separate their surveillance data into LGV genotypes (L1, L2 or L3) and non-LGV genotypes.

Screening

Screening for chlamydia (C. trachomatis genotypes D to K) is recommended in asymptomatic sexually active people under 25 years, all pregnant people, neonates born to mothers with chlamydia and any other people with risk factors for sexually transmitted and blood-borne infection (STBBI).

Routine LGV genotyping of asymptomatic chlamydia infections is not recommended. Consider LGV genotyping when anasymptomatic rectal chlamydia infection is diagnosed in gay, bisexual and other men who have sex with men (gbMSM) with risk factors for LGV.

Diagnostic testing

Nucleic Acid Amplification Tests (NAATs) are the most sensitive tests for detecting C. trachomatis.

Screen females using NAAT on vaginal or cervical swabs, or first-void urine. Screen males using NAAT on first-void urine. As appropriate, obtain specimens from exposed extra-genital sites (pharyngeal or rectal swabs).

Where clinical manifestations suggest a sexually transmitted infection (STI), obtain specimens prior to treatment. Clinical presentation and sexual history determine which specimens should be collected and the type of test to use. NAAT may be carried out on urine specimens or conjunctival, vaginal, and cervical swabs.

For extra-genital specimens, check with local laboratory about the availability of NAAT.

Definitive diagnosis of LGV requires genotyping: it should be requested for C. trachomatis-positive specimens in people who have symptoms consistent with LGV and in sexual partners of people diagnosed with LGV.

Treatment

Anogenital and conjunctival chlamydia in non-pregnant and non-lactating adults: Doxycycline 100 mg PO BID for 7 days or azithromycin 1 g PO in a single dose. Refer to the Treatment section for recommendations for pregnant or lactating people and people nine (9) to 18 years.

LGV: Doxycycline 100 mg PO BID for 21 days.

Follow-up

Chlamydia: Test of cure (TOC) is recommended three weeks after completion of treatment when compliance to treatment is suboptimal, an alternative treatment regimen is used or the person is prepubertal or pregnant.

LGV: TOC is recommended three weeks after completion of treatment. Follow people until TOC for chlamydia is negative and symptoms have resolved.

Repeat screening: Repeat screening is recommended three months post-treatment for all people with C. trachomatis infection.

Partner notification

Test and provide empiric treatment to all sexual partners of the index case within 60 days prior to symptom onset or date of specimen collection (if the index case is asymptomatic).

Resources

Awareness Resources

Surveillance

Journal Articles

Other Guidance

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