Warning:

This document is being maintained for historical purposes, but is now out of date. To view current guidelines please visit:

• STD Treatment Guidelines   at http://www.cdc.gov/STD/treatment

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1993 Sexually Transmitted Diseases Treatment Guidelines

09/24/1993

SUGGESTED CITATION
Centers for Disease Control and Prevention. 1993 Sexually
transmitted diseases treatment guidelines. MMWR 1993;42(No. RR-14):
{inclusive page numbers}.

CIO Responsible for this publication:
National Center for Prevention Services,
Division of Sexually Transmitted Diseases and HIV Prevention

Chlamydial Infections Among Infants
     
     Prenatal screening of pregnant women can prevent chlamydial
infection among neonates. Pregnant women less than 25 years of age
and those with new or multiple sex partners should, in particular,
be targeted for screening. Periodic surveys of chlamydial
prevalence can be conducted to confirm the validity of using these
recommendations in specific clinical settings.

     C. trachomatis infection of neonates results from perinatal
exposure to the mother's infected cervix. The prevalence of C.
trachomatis infection generally exceeds 5% among pregnant women,
regardless of race/ethnicity or socioeconomic status. Neonatal
ocular prophylaxis with silver nitrate solution or antibiotic
ointments is ineffective in preventing perinatal transmission of
chlamydial infection from mother to infant. However, ocular
prophylaxis with those agents does prevent gonococcal ophthalmia
and should be continued for that reason (see Prevention of
Ophthalmia Neonatorum).

     Initial C. trachomatis perinatal infection involves mucous
membranes of the eye, oropharynx, urogenital tract, and rectum. C.
trachomatis infection among neonates can most often be recognized
because of conjunctivitis developing 5-12 days after birth.
Chlamydia is the most frequent identifiable infectious cause of
ophthalmia neonatorum. C. trachomatis also is a common cause of
subacute, afebrile pneumonia with onset from 1 to 3 months of age.
Asymptomatic infections of the oropharynx, genital tract, and
rectum among neonates also occur.

Ophthalmia Neonatorum Caused by C. trachomatis
     A chlamydial etiology should be considered for all infants
with conjunctivitis through 30 days of age.

Diagnostic Considerations -
     Sensitive and specific methods to diagnose chlamydial
ophthalmia for the neonate include isolation by tissue culture and
nonculture tests, direct fluorescent antibody tests, and
immunoassays. Giemsa-stained smears are specific for C.
trachomatis, but are not sensitive. Specimens must contain
conjunctival cells, not exudate alone. Specimens for culture
isolation and nonculture tests should be obtained from the everted
eyelid using a dacron-tipped swab or the swab specified by the
manufacturer's test kit. A specific diagnosis of C. trachomatis
infection confirms the need for chlamydial treatment not only for
the neonate, but also for the mother and her sex partner(s). Ocular
exudate from infants being evaluated for chlamydial conjunctivitis
should also be tested for N. gonorrhoeae.

Recommended Regimen -
     Erythromycin 50 mg/kg/day orally divided into 4 doses for 10-
     14 days.

     Topical antibiotic therapy alone is inadequate for treatment
of chlamydial infection and is unnecessary when systemic treatment
is undertaken.

Follow-Up -
     The possibility of chlamydial pneumonia should be considered.
The efficacy of erythromycin treatment is approximately 80%; a
second course of therapy may be required. Follow-up of infants to
determine resolution is recommended.

Management of Mothers and Their Sex Partners -
     The mothers of infants who have chlamydial infection and the
mother's sex partners should be evaluated and treated following the
treatment recommendations for adults with chlamydial infections
(see Chlamydial Infections Among Adolescents and Adults).


Infant Pneumonia Caused by C. trachomatis
     Characteristic signs of chlamydial pneumonia among infants
include a repetitive staccato cough with tachypnea, and
hyperinflation and bilateral diffuse infiltrates on a chest
roentgenogram. Wheezing is rare, and infants are typically
afebrile. Peripheral eosinophilia, documented in a complete blood
count, is sometimes observed among infants with chlamydial
pneumonia. Because variation from this clinical presentation is
common, initial treatment and diagnostic tests should encompass C.
trachomatis for all infants 1-3 months of age who have possible
pneumonia.

Diagnostic Considerations -
     Specimens should be collected from the nasopharynx for
chlamydial testing. Tissue culture remains the definitive standard
for chlamydial pneumonia; nonculture tests can be used with the
knowledge that nonculture tests of nasopharyngeal specimens produce
lower sensitivity and specificity than nonculture tests of ocular
specimens. Tracheal aspirates and lung biopsy specimens, if
collected, should be tested for C. trachomatis.

     The microimmunofluorescence test for C. trachomatis antibody
is useful but not widely available. An acute IgM antibody titer
greater than or equal to 1:32 is strongly suggestive of C.
trachomatis pneumonia.

     Because of the delay in obtaining test results for chlamydia,
inclusion of an agent active against C. trachomatis in the
antibiotic regimen must frequently be decided on the basis of the
clinical and radiologic findings. Conducting tests for chlamydial
infection is worthwhile, not only to assist in the management of an
infant's illness, but also to determine the need for treatment of
the mother and her sex partners.

Recommended Regimen -
     Erythromycin 50 mg/kg/day orally divided into 4 doses for 10-
     14 days.

Follow-Up -
     The effectiveness of erythromycin treatment is approximately
80%; a second course of therapy may be required. Follow-up of
infants is recommended to determine that the pneumonia has
resolved. Some infants with chlamydial pneumonia have had abnormal
pulmonary function tests later in childhood.

Management of Mothers and Their Sex Partners -
     Mothers of infants who have chlamydial infection and the
mother's sex partners should be evaluated and treated according to
the recommended treatment of adults with chlamydial infections (see
Chlamydial Infections Among Adolescents and Adults).

Infants Born to Mothers Who Have Chlamydial Infection
     Infants born to mothers who have untreated chlamydia are at
high risk for infection and should be evaluated and treated as for
infants with ophthalmia neonatorum caused by C. trachomatis.

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