AAUS guideline for chlamydial urethritis

Published:December 07, 2021DOI:https://doi.org/10.1016/j.jiac.2021.11.024

      Abstract

      Urogenital chlamydial infection is the most common sexually transmitted infection. Many cases of chlamydial infection are reported worldwide every year. Genital chlamydial infection in women can also cause obstetric issues, including infertility and miscarriage. For that purpose, appropriate care should be conducted with the latest knowledge.
      Only few guidelines come from Asian countries. The Asian Association of Urinary Tract Infection and Sexually Transmitted Infection (AAUS) belonging to the Urological Association of Asia (UAA) had developed the guidelines regarding chlamydial urethritis. We have collected the feedback and updated the guidelines which is now submitted for consideration of publication. In addition to the levels of evidence, the recommendation grades were defined using the modified GRADE methodology. Herein, we present the new edition of the UAA-AAUS guidelines for chlamydial urethritis.

      Keywords

      Abbreviations:

      AAUS (Asian Association of Urinary Tract Infection and Sexually Transmitted Infection), NAATs (Nucleic acid amplification tests), WHO (World Health Organization), CDC (Centers for Disease Control and Prevention), EB (elementary bodies), RB (reticulate bodies), PCR (polymerase chain reaction), TMA (transcription-mediated amplification), SDA (strand displacement amplification), EIA (Enzyme immunoassay)
      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Journal of Infection and Chemotherapy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Abrams P.
        • Khoury S.
        • Grant A.
        Evidence--based medicine overview of the main steps for developing and grading guideline recommendations.
        Prog Urol. 2007; 17: 681-684
        • Guyatt G.H.
        • Oxman A.D.
        • Kunz R.
        • Vist G.E.
        • Falck-Ytter Y.
        • Schünemann H.J.
        What is "quality of evidence" and why is it important to clinicians?.
        Br Med J Int Ed. 2008; 336: 995-998
        • Guyatt G.H.
        • Oxman A.D.
        • Vist G.E.
        • Kunz R.
        • Falck-Ytter Y.
        • Alonso-Coello P.
        • et al.
        Grade: an emerging consensus on rating quality of evidence and strength of recommendations.
        Br Med J Int Ed. 2008; 336: 924-926
        • Newman L.
        • Rowley J.
        • Vander Hoorn S.
        • Wijesooriya N.S.
        • Unemo M.
        • Low N.
        • et al.
        Global estimates of the prevalence and incidence of four curable sexually transmitted infections in 2012 based on systematic review and global reporting.
        PLoS One. 2015; 10e0143304
        • Rowley J.
        • Vander Hoorn S.
        • Korenromp E.
        • Low N.
        • Unemo M.
        • Abu-Raddad L.J.
        • et al.
        Chlamydia, gonorrhoea, Trichomoniasis and syphilis: global prevalence and incidence estimates, 2016.
        Bull World Health Organ. 2019; 97 (62p): 548
        • Moulder J.W.
        Interaction of chlamydiae and host cells in vitro.
        Microbiol Rev. 1991; 55: 143-190
        • Hafner L.M.
        Pathogenesis of fallopian tube damage caused by Chlamydia trachomatis infections.
        Contraception. 2015; 92: 108-115
        • Schoborg R.V.
        Chlamydia persistence -- a tool to dissect chlamydia--host interactions.
        Microb Infect. 2011; 13: 649-662
        • Reddy B.S.
        • Rastogi S.
        • Das B.
        • Salhan S.
        • Verma S.
        • Mittal A.
        Cytokine expression pattern in the genital tract of Chlamydia trachomatis positive infertile women - implication for t-cell responses.
        Clin Exp Immunol. 2004; 137: 552-558
        • Refaat B.
        • Al-Azemi M.
        • Geary I.
        • Eley A.
        • Ledger W.
        Role of activins and inducible nitric oxide in the pathogenesis of ectopic pregnancy in patients with or without Chlamydia trachomatis infection.
        Clin Vaccine Immunol. 2009; 16: 1493-1503
        • Hu V.H.
        • Harding-Esch E.M.
        • Burton M.J.
        • Bailey R.L.
        • Kadimpeul J.
        • Mabey D.C.
        Epidemiology and control of trachoma: systematic review.
        Trop Med Int Health. 2010; 15: 673-691
        • Hammerschlag M.R.
        Diagnosis of Chlamydial infection in the pediatric population.
        Immunol Invest. 1997; 26: 151-156
        • van Rooijen M.S.
        • van der Loeff M.F.
        • Morré S.A.
        • van Dam A.P.
        • Speksnijder A.G.
        • de Vries H.J.
        Spontaneous pharyngeal Chlamydia trachomatis RNA clearance. A cross-sectional study followed by a cohort study of untreated sti clinic patients in amsterdam, The Netherlands.
        Sex Transm Infect. 2015; 91: 157-164
        • Park J.
        • Marcus J.L.
        • Pandori M.
        • Snell A.
        • Philip S.S.
        • Bernstein K.T.
        Sentinel surveillance for pharyngeal chlamydia and gonorrhea among men who have sex with men--san francisco, 2010.
        Sex Transm Dis. 2012; 39: 482-484
        • Hamasuna R.
        • Takahashi S.
        • Uehara S.
        • Matsumoto T.
        Should urologists care for the pharyngeal infection of Neisseria gonorrhoeae or Chlamydia trachomatis when we treat male urethritis?.
        J Infect Chemother. 2012; 18: 410-413
        • Marcus J.L.
        • Bernstein K.T.
        • Stephens S.C.
        • Snell A.
        • Kohn R.P.
        • Liska S.
        • et al.
        Sentinel surveillance of rectal chlamydia and gonorrhea among males--san francisco, 2005-2008.
        Sex Transm Dis. 2010; 37: 59-61
        • Quinn T.C.
        • Goodell S.E.
        • Mkrtichian E.
        • Schuffler M.D.
        • Wang S.P.
        • Stamm W.E.
        • et al.
        Chlamydia trachomatis proctitis.
        N Engl J Med. 1981; 305: 195-200
        • O'Connell C.M.
        • Ferone M.E.
        Chlamydia trachomatis genital infections.
        Microb Cell. 2016; 3: 390-403
        • McConaghy J.R.
        • Panchal B.
        Epididymitis: an overview.
        Am Fam Physician. 2016; 94: 723-726
        • Rekart M.L.
        • Gilbert M.
        • Meza R.
        • Kim P.H.
        • Chang M.
        • Money D.M.
        • et al.
        Chlamydia public health programs and the epidemiology of pelvic inflammatory disease and ectopic pregnancy.
        J Infect Dis. 2013; 207: 30-38
        • Bender N.
        • Herrmann B.
        • Andersen B.
        • Hocking J.S.
        • van Bergen J.
        • Morgan J.
        • et al.
        Chlamydia infection, pelvic inflammatory disease, ectopic pregnancy and infertility: cross-national study.
        Sex Transm Infect. 2011; 87: 601-608
        • Kent C.K.
        • Chaw J.K.
        • Wong W.
        • Liska S.
        • Gibson S.
        • Hubbard G.
        • et al.
        Prevalence of rectal, urethral, and pharyngeal chlamydia and gonorrhea detected in 2 clinical settings among men who have sex with men: san francisco, California, 2003.
        Clin Infect Dis. 2005; 41: 67-74
        • Lanjouw E.
        • Ouburg S.
        • de Vries H.J.
        • Stary A.
        • Radcliffe K.
        • Unemo M.
        european guideline on the management of Chlamydia trachomatis infections.
        Int J STD AIDS. 2015; 27 (2016): 333-348
        • Takahashi S.
        • Takeyama K.
        • Miyamoto S.
        • Ichihara K.
        • Maeda T.
        • Kunishima Y.
        • et al.
        Incidence of sexually transmitted infections in asymptomatic healthy young Japanese men.
        J Infect Chemother. 2005; 11: 270-273
        • Ito S.
        • Hanaoka N.
        • Shimuta K.
        • Seike K.
        • Tsuchiya T.
        • Yasuda M.
        • et al.
        Male non-gonococcal urethritis: from microbiological etiologies to demographic and clinical features.
        Int J Urol. 2016; 23: 325-331
        • Workowski K.A.
        • Bolan G.A.
        Sexually transmitted diseases treatment guidelines.
        MMWR Recomm Rep (Morb Mortal Wkly Rep). 2015; 64 (2015): 1-137
        • Bezold G.
        • Politch J.A.
        • Kiviat N.B.
        • Kuypers J.M.
        • Wolff H.
        • Anderson D.J.
        Prevalence of sexually transmissible pathogens in semen from asymptomatic male infertility patients with and without leukocytospermia.
        Fertil Steril. 2007; 87: 1087-1097
        • Greendale G.A.
        • Haas S.T.
        • Holbrook K.
        • Walsh B.
        • Schachter J.
        • Phillips R.S.
        The relationship of Chlamydia trachomatis infection and male infertility.
        Am J Publ Health. 1993; 83: 996-1001
        • Joki-Korpela P.
        • Sahrakorpi N.
        • Halttunen M.
        • Surcel H.M.
        • Paavonen J.
        • Tiitinen A.
        The role of Chlamydia trachomatis infection in male infertility.
        Fertil Steril. 2009; 91: 1448-1450
        • Trent M.
        • Bass D.
        • Ness R.B.
        • Haggerty C.
        Recurrent pid, subsequent sti, and reproductive health outcomes: findings from the pid evaluation and clinical health (peach) study.
        Sex Transm Dis. 2011; 38: 879-881
        • Choe H.S.
        • Lee D.S.
        • Lee S.J.
        • Hong S.H.
        • Park D.C.
        • Lee M.K.
        • et al.
        Performance of anyplex™ ii multiplex real-time pcr for the diagnosis of seven sexually transmitted infections: comparison with currently available methods.
        Int J Infect Dis. 2013; 17: e1134-e1140
        • Ursi D.
        • Crucitti T.
        • Smet H.
        • Ieven M.
        Evaluation of the bio-rad dx ct/ng/mg® assay for simultaneous detection of Chlamydia trachomatis, Neisseria gonorrhoeae and mycoplasma genitalium in urine.
        Eur J Clin Microbiol Infect Dis. 2016; 35: 1159-1163
        • Taylor S.N.
        • Liesenfeld O.
        • Lillis R.A.
        • Body B.A.
        • Nye M.
        • Williams J.
        • et al.
        Evaluation of the roche cobas® ct/ng test for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in male urine.
        Sex Transm Dis. 2012; 39: 543-549
        • Gaydos C.A.
        • Van Der Pol B.
        • Jett-Goheen M.
        • Barnes M.
        • Quinn N.
        • Clark C.
        • et al.
        Performance of the cepheid ct/ng xpert rapid pcr test for detection of Chlamydia trachomatis and Neisseria gonorrhoeae.
        J Clin Microbiol. 2013; 51: 1666-1672
        • Nye M.B.
        • Osiecki J.
        • Lewinski M.
        • Liesenfeld O.
        • Young S.
        • Taylor S.N.
        • et al.
        Detection of Chlamydia trachomatis and Neisseria gonorrhoeae with the cobas ct/ng v2.0 test: performance compared with the bd probetec ct q(x) and gc q(x) amplified DNA and aptima ac2 assays.
        Sex Transm Infect. 2019; 95: 87-93
        • Gaydos C.A.
        • Cartwright C.P.
        • Colaninno P.
        • Welsch J.
        • Holden J.
        • Ho S.Y.
        • et al.
        Performance of the abbott realtime ct/ng for detection of Chlamydia trachomatis and Neisseria gonorrhoeae.
        J Clin Microbiol. 2010; 48: 3236-3243
        • Kumamoto Y.
        • Matsumoto T.
        • Fujisawa M.
        • Arakawa S.
        Detection of Chlamydia trachomatis and Neisseria gonorrhoeae in urogenital and oral specimens using the cobas® 4800, aptima combo 2® tma, and probetec™ et sda assays.
        Eur J Microbiol Immunol (Bp). 2012; 2: 121-127
        • Miyazaki N.
        • Yamagishi Y.
        • Izumi K.
        • Kawashima Y.
        • Suematsu H.
        • Mikamo H.
        Evaluation of rapid measurement of Chlamydia trachomatis and Neisseria gonorrhoeae by using automatic gene analyzer "genecube.
        Jpn J Antibiot. 2016; 69: 291-298
        • Meyer T.
        • Klos C.
        • Kofler R.
        • Kilic A.
        • Hänel K.
        Performance evaluation of the pelvocheck ct/ng test kit for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae.
        BMJ Open. 2016; 6e009894
        • Ishiguro T.
        • Saitoh J.
        • Horie R.
        • Hayashi T.
        • Ishizuka T.
        • Tsuchiya S.
        • et al.
        Intercalation activating fluorescence DNA probe and its application to homogeneous quantification of a target sequence by isothermal sequence amplification in a closed vessel.
        Anal Biochem. 2003; 314: 77-86
        • Gaydos C.A.
        Review of use of a new rapid real-time pcr, the cepheid genexpert® (xpert) ct/ng assay, for Chlamydia trachomatis and Neisseria gonorrhoeae: results for patients while in a clinical setting.
        Expert Rev Mol Diagn. 2014; 14: 135-137
        • Mahilum-Tapay L.
        • Laitila V.
        • Wawrzyniak J.J.
        • Lee H.H.
        • Alexander S.
        • Ison C.
        • et al.
        New point of care chlamydia rapid test--bridging the gap between diagnosis and treatment: performance evaluation study.
        Br Med J Int Ed. 2007; 335: 1190-1194
        • Nadala E.C.
        • Goh B.T.
        • Magbanua J.P.
        • Barber P.
        • Swain A.
        • Alexander S.
        • et al.
        Performance evaluation of a new rapid urine test for chlamydia in men: prospective cohort study.
        Br Med J Int Ed. 2009; 339: b2655
        • Takahashi S.
        • Matsukawa M.
        • Kurimura Y.
        • Takeyama K.
        • Kunishima Y.
        • Iwasawa A.
        • et al.
        Clinical efficacy of azithromycin for male nongonococcal urethritis.
        J Infect Chemother. 2008; 14: 409-412
        • Takahashi S.
        • Kiyota H.
        • Ito S.
        • Iwasawa A.
        • Hiyama Y.
        • Uehara T.
        • et al.
        Clinical efficacy of a single two gram dose of azithromycin extended release for male patients with urethritis.
        Antibiotics (Basel). 2014; 3: 109-120
        • Takahashi S.
        • Ichihara K.
        • Hashimoto J.
        • Kurimura Y.
        • Iwasawa A.
        • Hayashi K.
        • et al.
        Clinical efficacy of levofloxacin 500 mg once daily for 7 days for patients with non-gonococcal urethritis.
        J Infect Chemother. 2011; 17: 392-396
        • Takahashi S.
        • Hamasuna R.
        • Yasuda M.
        • Ito S.
        • Ito K.
        • Kawai S.
        • et al.
        Clinical efficacy of sitafloxacin 100 mg twice daily for 7 days for patients with non-gonococcal urethritis.
        J Infect Chemother. 2013; 19: 941-945
        • Ito S.
        • Yasuda M.
        • Seike K.
        • Sugawara T.
        • Tsuchiya T.
        • Yokoi S.
        • et al.
        Clinical and microbiological outcomes in treatment of men with non-gonococcal urethritis with a 100-mg twice-daily dose regimen of sitafloxacin.
        J Infect Chemother. 2012; 18: 414-418
        • Takahashi S.
        • Hamasuna R.
        • Yasuda M.
        • Ishikawa K.
        • Hayami H.
        • Uehara S.
        • et al.
        Nationwide surveillance of the antimicrobial susceptibility of Chlamydia trachomatis from male urethritis in Japan.
        J Infect Chemother. 2016; 22: 581-586
        • Romanowski B.
        • Talbot H.
        • Stadnyk M.
        • Kowalchuk P.
        • Bowie W.R.
        Minocycline compared with doxycycline in the treatment of nongonococcal urethritis and mucopurulent cervicitis.
        Ann Intern Med. 1993; 119: 16-22
        • Borel N.
        • Leonard C.
        • Slade J.
        • Schoborg R.V.
        Chlamydial antibiotic resistance and treatment failure in veterinary and human medicine.
        Curr Clin Microbiol Rep. 2016; 3: 10-18
        • Takahashi S.
        • Yasuda M.
        • Wada K.
        • Matsumoto M.
        • Hayami H.
        • Kobayashi K.
        • et al.
        Nationwide surveillance of the antimicrobial susceptibility of Chlamydia trachomatis from male urethritis in Japan: comparison with the first surveillance report.
        J Infect Chemother. 2021; https://doi.org/10.1016/j.jiac.2021.09.012
        • Kong F.Y.
        • Tabrizi S.N.
        • Law M.
        • Vodstrcil L.A.
        • Chen M.
        • Fairley C.K.
        • et al.
        Azithromycin versus doxycycline for the treatment of genital chlamydia infection: a meta-analysis of randomized controlled trials.
        Clin Infect Dis. 2014; 59: 193-205
        • Páez-Canro C.
        • Alzate J.P.
        • González L.M.
        • Rubio-Romero J.A.
        • Lethaby A.
        • Gaitán H.G.
        Antibiotics for treating urogenital Chlamydia trachomatis infection in men and non-pregnant women.
        Cochrane Database Syst Rev. 2019; 1: Cd010871
        • Dombrowski J.C.
        • Wierzbicki M.R.
        • Newman L.M.
        • Powell J.A.
        • Miller A.
        • Dithmer D.
        • et al.
        Doxycycline versus azithromycin for the treatment of rectal chlamydia in men who have sex with men: a randomized controlled trial.
        Clin Infect Dis. 2021; 73: 824-831
        • Manavi K.
        • Hettiarachchi N.
        • Hodson J.
        Comparison of doxycycline with azithromycin in treatment of pharyngeal chlamydia infection.
        Int J STD AIDS. 2016; 27: 1303-1308
        • Renault C.A.
        • Israelski D.M.
        • Levy V.
        • Fujikawa B.K.
        • Kellogg T.A.
        • Klausner J.D.
        Time to clearance of Chlamydia trachomatis ribosomal RNA in women treated for chlamydial infection.
        Sex Health. 2011; 8: 69-73
        • Kapil R.
        • Press C.G.
        • Hwang M.L.
        • Brown L.
        • Geisler W.M.
        Investigating the epidemiology of repeat Chlamydia trachomatis detection after treatment by using c. Trachomatis ompa genotyping.
        J Clin Microbiol. 2015; 53: 546-549
        • Takahashi S.
        • Kurimura Y.
        • Hashimoto J.
        • Sunaoshi K.
        • Takeda K.
        • Suzuki N.
        • et al.
        Management for males whose female partners are diagnosed with genital chlamydial infection.
        J Infect Chemother. 2011; 17: 76-79