The management of salpingitis is outwith the scope of this guideline. Consideration should be given to managing females with abdominal pain in accordance with guidelines for managing pelvic inflammatory disease (see BASHH 2019 interim update to the 2018 PID guideline).
Complications
Warning
In SIGN 109, national screening of asymptomatic women is not considered cost effective at reducing morbidity for complication rates under 10%, and at the present time there is an absence of data to support a complication rate greater than this. PID can result in infertility, ectopic pregnancy and chronic pelvic pain. The risk of PID increases with each recurrence of C.trachomatis infection.
Other complications
• Perihepatitis (Fitz-Hugh Curtis syndrome)
• Epididymo-orchitis
• Adult conjunctivitis
• Sexually acquired reactive arthritis/Reiters syndrome
• Transmission to neonate (neonatal conjunctivitis, pneumonia)
• Preterm birth and low birth weight
The management of epididymo-orchitis is outwith the scope of this guideline. See West of Scotland guideline for Epididymo-orchitis.
This is an uncommon presentation to GU settings. Patients may be referred from ophthalmology or present with a chronic follicular conjunctivitis, usually unilateral, with a sub-acute onset.
Symptoms:
- foreign-body sensation
- tearing
- mucoid discharge
- redness
- photophobia
- swelling of lids
Incubation usually 1 to 3 weeks.
Management:
Involve ophthalmology team (if not already involved).
1st line:
Doxycycline 100mg orally twice daily for 7 days
2nd line:
Azithromycin 1g orally as a single dose followed by 500mg daily for 2 days
It is essential that all clients with chlamydial conjunctivitis and their sexual partners are assessed for concomitant chlamydial genital tract infection. Refer to a Health Advisor team as per genital chlamydia guidelines.