Chlamydia in pregnancy

Chlamydia infection in pregnancy has been associated with premature delivery, amnionitis and puerperal infection. If a woman has cervical chlamydial infection at the time of delivery there is a 60% or more occurrence of neonatal chlamydial infection. Possible complications of neonatal chlamydial infection include neonatal conjunctivitis (35-50%) and neonatal pneumonia (10-20%).

Erythromycin, 500mg four times daily for seven days, is the treatment of choice during pregnancy and lactation. This is because tetracycline, the usual drug of choice for chlamydia, may cause fetal abnormality. If erythromycin cannot be tolerated then amoxicillin 500mg tds for 7 days may be used instead (2).

Another alternative regime is Azithromycin 1 gm stat (3)

• however Azithromycin; is probably less than 95% effective
  • safety of azithromycin in pregnancy and lactating mothers has not yet been fully assessed, although available data indicate that it is safe
  • WHO Guidelines recommend 1gm stat to treat C.trachomatis in pregnancy, the BNF recommends its use in pregnancy and lactation only if no alternative is available

Referral to Genitourinay Medicine (GUM) clinic should be considered for all patients (including pregnant women) (2). Management should encompass wider issues such as sexual health promotion, as well as antibacterial treatment. Partners need to be traced, notified and treated. All individuals who have been treated should be offered adequate follow-up.

Due to higher positive chlamydia tests after treatment in pregnancy, attributed to either less efficacious treatment regime, non compliance or re-infection, it is recommended that pregnant woman must have a test of cure 5 weeks after completing therapy, 6 weeks later if given azithromycin.

• advice from the UK National Screening Committee on antenatal screening for chlamydia..click here

Reference:

1. Renton A, Taylor-Robinson D (1998). The need for an assessment of health technology for screening for Chlamydia trachomatis in the population. Leeds, NHS Executive
2. Drug and Therapeutics Bulletin (2001), 39 (4), 27-30.
3. BASHH (2006).UK National Guideline for the Management of Genital Tract Infection with Chlamydia trachomatis