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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)
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.