Policy Title:
Program Area:
Policy Identifier:
(optional)
Approval Date:
Approved by:
COLUMBUS COUNTY HEALTH DEPARTMENT’S
STD/CHLAMYDIA POLICY
Chlamydia
STD Clinic
Effective Date:
Revision
Date(s):
10/2/2002
10/27/2010, 05/29/2013
Kim Smith RN, BSB, MSHCA, Health Director
Hilda Memory RN, BS, MSHA, Director of Nursing
Approved by:
Purpose:
To identify and treat clients positive for Chlamydia and their contacts.
Definitions:
Columbus County Health Department will provide STD screening and treatment for clients with
Chlamydia and their contacts. Staff will provide risk reduction education to clients.
Responsibilities:
Adult Health Nursing Staff
Procedures:
A. Each client requesting STD services will be screened and examined according to the
STD Exam Policy.
B. Examining the female: Genital Exam
To collect a vaginal specimen for Chlamydia test:

Insert the cotton tip swab (collect swab) into the vaginal canal and rotate 30 seconds to ensure adequate sampling by the swab. .

To avoid contamination, do not allow the swab to touch any vaginal surface upon withdrawal.

After collecting the specimen, remove the tube top (tube provided in collection kit) and insert the collection swab to the bottom.

Snap off the swab shaft at the score line.

Replace the cap so that the swab shaft will insert into the center of the cap

Process or ship specimen immediately.
Page 1 of 4

COLUMBUS COUNTY HEALTH DEPARTMENT’S
STD/CHLAMYDIA POLICY
Clinical Manifestations
Chlamydia caused by Chlamydia trachomatis, one of the most prevalent sexually transmitted diseases in the United States today. Manifested in males primarily as a Urethritis.
A.
Female:

Similar to those of gonorrhea and will present most characteristically as a mucopurulent discharge.

Frequently asymptomatic complications are salpingitis with subsequent risk of infertility or ectopic pregnancy.

Incubation period-5 to 10 days or longer.
Medically Indicated
A.
All patients with active or inactive symptoms with positive test results for Chlamydia
should be treated.
B.
Contacts of patients with Chlamydia within the last 60 days should be treated..
Treatment-
1.
Initiate Protocol if either of the following situations applies: a) Patient has a known recent exposure to chlamydia (i.e., referred by DIS, other public health investigators, MD, or by sexual partner who has been treated at initial visit. b) Patient has positive lab culture.
Medication Protocol:
A. Give Azithromycin 1gm p.o. in clinic if not allergic to Azithromycin or Erythromycin.
B.
Give Doxycycline 100mg bid x 7 days if allergic to Azithromycin or Erythromycin.
C. If patient is pregnant or allergic to medication refer to clinician.
Adverse Reactions
A. Azithromycin-Most frequent oral dose related, include abdominal cramping and
discomfort, anorexia, nausea, vomiting, and diarrhea. Mild reactions include
rashes with or without pruritis, and urticaria.
B. Doxycycline- Photosensitivity manifested by exaggerated sunburn, abdominal cramps, rash, and
decreased calcification of deciduous teeth.
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COLUMBUS COUNTY HEALTH DEPARTMENT’S
STD/CHLAMYDIA POLICY
Contraindications
A. Do not use medicine if patient has hypersensitivity or allergic reaction to medication
listed on this medical directive.
Patient Information
A.
Avoid sexual contact for 7 days after treatment.
A.
Counsel patients (male and female) concerning use of condoms
B.
Caution female patients who take oral contraceptives to use a back-up method of birth
control while on antibiotic therapy and for seven days after completion.
C.
Counsel patients regarding the importance of early reevaluation if symptoms persist
or recur.
D.
Counsel about the risk of HIV infection and recommend HIV testing.
E.
If abdominal pain or fever develop, call the Columbus County Health Department
clinic at (910) 640-6615 Ext. 235 or if after clinic hours go to ER. This is very important if
the patient has an IUD.
G. If the patient is using a diaphragm, it needs to be disinfected by cleaning with 70%
Isopropyl (rubbing) alcohol
H. Counsel on necessity of sex partner notification in order to prevent further spread of
the disease. Give the patient contact cards for all partners within the last 60 days.
Follow-Up
A.
Patients with worsening symptoms should return to the clinic and if after clinic hours go to
the ER.
B.
If symptoms continue to persist and or reappear over 2 week after initial treatment return
to the clinic for re-evaluation.
1.
CONSULT with or REFER to back-up physician or midlevel practitioner if any of the following conditions are present:

Inflammation of the pharynx

Inflammation of the rectum

Acute abdominal pain or rebound tenderness

Adenexal tenderness

Fever above 100.4

Inflammation of a joint

Conjunctivitis

Skin lesions
Laws and Rules:
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COLUMBUS COUNTY HEALTH DEPARTMENT’S
STD/CHLAMYDIA POLICY
10A NCAC 41A.0202, 10A NCAC 41A.0204, 10A NCAC 41A.0102
Reference(s):
NC Sexually Transmitted Disease Public Health Program Manual
The Pocket Reference Guide for Clinical Evaluation and Treatment of Clients with Sexually
Transmitted Infections.
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