Management of gonorrhoea and Chlamydia trachomatis infections in pregnancy

RHL practical aspects by Lumbiganon P

FIRST CONTACT (PRIMARY CARE) LEVEL

The objectives of managing patients with gonorrhoea, Chlamydia or other sexually transmitted disease (STD) are not only limited to antibiotic treatment but also at reducing and preventing future risk behaviour and ensuring that sexual partners are also appropriately treated. This can be achieved by making correct diagnosis, giving appropriate treatment including treating co-infection and sexual partner and, providing adequate health education.

REFERRAL HOSPITAL (SECONDARY CARE) LEVEL

Concerning the antibiotic regimen, for gonorrhoea, this review was based on 2 trials from developed countries. The prevalence of PPNG in developing countries is usually much higher. It may not be appropriate for developing countries to adopt the results of this review. Since it is very unlikely, if not impossible to have similar trials from developing countries, perhaps health care providers in these countries should follow their national guideline. This guideline is usually based on the information about the prevalence of PPNG and the in vitro sensitivity of the organism to various antibiotics. More attention should be paid to the diagnosis of Chlamydia trachomatis infection during pregnancy. The diagnostic test most feasible to implement is probably, antigen detection by the ELISA (Enzyme linked immuno-sorbent assay) technique. Erythromycin should remain as the treatment of choice until more evidence becomes available, especially from research in developing countries. Amoxycillin may be an alternative when erythromycin is not tolerated.

Acknowledgement: Dr Wiwat Rojanapitayakorn, Department of Communicable Disease Control, and Ministry of Public Health, Thailand.

Sources of support: Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

AT HOME OR IN THE COMMUNITY

Health seeking behaviour in cases of vaginal discharge should be improved through community education.


This document should be cited as: Lumbiganon P. Management of gonorrhoea and Chlamydia trachomatis infections in pregnancy: RHL practical aspects (last revised: 15 September 2004). The WHO Reproductive Health Library; Geneva: World Health Organization.

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