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Chlamydia Nursing Guide

Content Creator: Kelly LaMonica, DNP, MSN, RNC-OB, EFM

Overview: Chlamydia

This content is intended as a Quick Reference for Chlamydia and will cover an overview and nursing considerations utilizing the nursing process.

Chlamydia Etiology and Epidemiology

Chlamydia is a sexually transmitted disease caused by the bacterium Chlamydia trachomatis. It is transmitted by sexual contact through oral, anal, or vaginal intercourse and has an incubation period of 1 to 3 weeks.

Chlamydia can also be transmitted from mother to child via the birth canal of infected mothers. Approximately 100,000 neonates are exposed to C. trachomatis annually and 60% of vaginal births from infected mothers lead to neonate infection (Qureshi, 2021). In these cases, 30-50% develop chlamydial conjunctivitis, which is now more prevalent than gonococcal conjunctivitis, and 3-16% develop chlamydial pneumonia 5 to 14 days after birth.

The most commonly reported bacterial STD in the U.S. is chlamydia, with approximately 4 million cases annually (Qureshi, 2021). The highest prevalence is seen in sexually active adolescent girls, particularly African American females. In the U.S., the overall prevalence of chlamydia is 5% (Qureshi, 2021).

Those infected may be unaware, as 80% of women and 50% of men affected with chlamydia are asymptomatic. However, co-infection with another STD is likely, as 40% of women and 20% of men with chlamydia also have gonorrhea (Qureshi, 2021). Women are also more likely to develop long-term complications from chlamydia, such as pelvic inflammatory disease and infertility.

Risk factors for chlamydia include:

  • Being sexually active before age 25
  • Co-infection with another sexually transmitted disease
  • Having multiple sex partners
  • History of sexually transmitted infection
  • New sex partner
  • Not using a condom consistently

Complications from chlamydia include:

  • Chronic pelvic pain
  • Ectopic pregnancy
  • Infection near the testicles (epididymitis)
  • Infections in newborns, including pneumonia and conjunctivitis, which can lead to blindness
  • Infertility
  • Pelvic inflammatory disease (PID)
    • Infection of the uterus and fallopian tubes, causing fever and pelvic pain
    • Can damage the fallopian tubes, ovaries, and uterus, as well as the cervix
  • Proctitis
  • Reactive arthritis (Reiter’s syndrome)
  • Rectal or urethral strictures
  • Respiratory problems in neonates
  • Stillbirth, fetal demise, or premature delivery

Chlamydia Diagnosis

Most women with chlamydia do not have any symptoms. If they do have symptoms, they can include:

  • Bleeding between periods
  • Burning when urinating
  • Fever
  • Low back pain
  • Lower abdominal pain
  • Nausea
  • Pain during sex
  • Unusual vaginal discharge

Men are usually asymptomatic, but can have:

  • Urethritis, with a mucoid or watery urethral discharge
  • Dysuria

To diagnosis chlamydia, providers should take a:

  • Urine sample
  • Vaginal swab

Chlamydia Management

  • Prescribe antibiotics to treat infection.
  • All sexual partners within 60 days of diagnosis will need treatment.

To prevent chlamydia, advise individuals to:

  • Use condoms
  • Get tested
  • Be monogamous
  • Limit number of sex partners
  • Avoid douching

Nursing Considerations

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnosis, interventions, expected outcomes, and education for individuals with chlamydia are listed below.

Chlamydia Nursing Care Plan

Assessment

  • Take a history and note the following:
    • Fever
    • Mucopurulent discharge from eye(s) or red conjunctivae
    • Lower abdominal or pelvic pain
    • Pain with urination
    • Urinary frequency
    • Intermenstrual or postcoital bleeding
    • Red genitals
    • Genital irritation or discomfort
    • Unilateral pain and swelling of the scrotum
    • Yellow mucopurulent discharge from urethra
    • Sexual history
  • Perform a physical examination and note the following:
    • Adnexal tenderness
    • Bilateral purulent conjunctivitis (neonates)
    • Cervical motion tenderness
    • Dyspareunia
    • Dysuria
    • Genital erythema
    • Groove sign (separation of inguinal and femoral lymph nodes by the inguinal ligament)
    • Localized inguinal adenopathy and ulceration
    • Lower abdominal or pelvic tenderness
    • Lymphogranuloma venereum
    • Mucopurulent cervicitis or cervical erosion
    • Mucopurulent rectal discharge
    • Polyuria
    • Pruritus
    • Scrotal pain
    • Unilateral epididymal tenderness and swelling
    • Upper right quadrant abdominal tenderness (Fitz-­Hugh and Curtis syndrome)
    • Urethritis

Chlamydia Nursing Diagnosis/Risk For

  • Ineffective coping
  • Infection
  • Pain
  • Sexual dysfunction

Interventions

  • Administer antibiotics and pain medication as ordered.
  • Advise individuals of need to practice safe sex and to identify former partners that need testing.

Expected Outcomes

  • Pain relief
  • Remain free of infection
  • Sexual changes related to diagnosis

Individual/Caregiver Education

  • Confirm individual understands diagnosis and treatment plan
  • Ensure individual can identify signs and symptoms of infection, including:
    • Discharge
    • Fever
    • Pain
    • Tenderness
  • Emphasize importance of finishing all antibiotics and knowing potential side effects
  • Confirm individual understands the possible long-term risks and complications of chlamydia, including the possibility of infertility
  • Emphasize importance of washing hands frequently
  • Ensure individual understands need to practice safe sex through:
    • Limiting sexual partners
    • Having new partners tested before intercourse
    • Using proper STD protection through the barrier method
  • Provide an opportunity to discuss how to relieve the pain through relaxation techniques such as:
    • Visualization
    • Guidance
    • Imagination
    • Deep breathing exercises.
    • Yoga
  • Provide discharge instructions, including:
    • Referring all sexual contacts for testing and treatment
    • Avoiding sexual activity until treatment is completed for individual and partner
    • Following up with private physician for treatment and test of cure
    • Returning for treatment if symptoms persist for more than one week despite treatment, or if unusual vaginal bleeding or swelling or unexplained symptoms occur

Learn more and earn CEU credit with Nurse.com's extensive continuing education course catalog.

Pharmacology of Drugs for Sexually Transmitted Infections: Chancroid, Trichomonas, and Chlamydia CE Course

0.5 Contact Hours

Sexually Transmitted Infections: Assessment and Treatment CE Course

1.5 Contact Hours

Additional Information

Release Date
4/1/2022

Content Expiration
9/30/2027

Content Creator
Kelly LaMonica, DNP, MSN, RNC-OB, EFM

Kelly completed her Doctor of Nursing Practice at Grand Canyon University in 2019. She received her MSN at the University of Phoenix in 2011. Dr. LaMonica is a member of the Association of Women’s Health, Obstetric, and Neonatal Nursing (AWHONN) and sits on the Educational Advisory Committee for AWHONN. She was also named a Corresponding Member of the 2020 Research Advisory Panel of AWHONN. Dr. LaMonica is also a member of Sigma Theta Tau International. She is certified in Inpatient Obstetrics and Electronic Fetal Monitoring. Dr. LaMonica is an NRP Instructor. She is a Labor and Delivery Nurse Manager for 3 years and was a Perinatal Risk Nurse for the past 8 years and was a labor and delivery nurse for 7 years prior to that. Dr. LaMonica has also been a Clinical Instructor at Rutgers University and Raritan Valley Community College.

Disclosures
Kelly LaMonica, DNP, MSN, RNC-OB, EFM has no relevant financial or non-financial relationship(s) with ineligible companies to disclose.

Reference herein to any specific commercial product, process, or service by trade name, trademark, service mark, manufacturer or otherwise does not constitute or imply any endorsement, recommendation, or favoring of, or affiliation with, Relias, LLC.

All characteristics and organizations referenced in the following training are fictional. Any resemblance to any actual organizations or persons living or dead, is purely coincidental.

Resources

Chlamydia, Gonorrhea, and Syphilis

https://www.acog.org/womens-health/faqs/chlamydia-gonorrhea-and-syphilis

References

American College of Obstetricians and Gynecologists (ACOG). (2018). Expedited partner therapy. ACOG committee opinion no. 737. Obstet Gynecol, 131(6), e190-e193.https://doi.org/10.1097/aog.0000000000002621

Centers for Disease Control and Prevention (CDC). (2021). National overview - sexually transmitted disease surveillance, 2019. Centers for Disease Control and Prevention. https://www.cdc.gov/std/statistics/2019/overview.htm

Centers for Disease Control and Prevention (CDC). (2016). Chlamydia treatment and care. https://www.cdc.gov/std/chlamydia/treatment.htm

Mayo Clinic (2020). Chlamydia trachomatis. https://www.mayoclinic.org/diseases-conditions/chlamydia/diagnosis-treatment/drc-20355355

National Health Service (NHS). (2018). Chlamydia. National Health Service (NHS). https://www.nhs.uk/conditions/chlamydia/.

Qureshi, S. (2021). Chlamydia (chlamydial genitourinary infections). Medscape. https://emedicine.medscape.com/article/214823-overview

Zikic, A., Schünemann, H., Wi, T., Lincetto, O., Broutet, N., & Santesso, N. (2018). Treatment of neonatal chlamydial conjunctivitis: A systematic review and meta-analysis. Journal of the Pediatric Infectious Diseases Society, 7(3), e107–e115. https://doi.org/10.1093/jpids/piy060

 

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