From the Guidelines
Chlamydia should be treated with antibiotics, and to maximize compliance, medications should be dispensed on site with the first dose directly observed. The treatment guidelines recommend that persons treated for chlamydia should be instructed to abstain from sexual intercourse for 7 days after single-dose therapy or until completion of a 7-day regimen 1.
Key Considerations
- To minimize transmission, patients should abstain from sexual intercourse for 7 days after treatment
- Patients should also be instructed to abstain from sexual intercourse until all of their sex partners are treated to minimize the risk for reinfection 1
- The goal of treatment is to prevent long-term complications, such as pelvic inflammatory disease and infertility, and to reduce the risk of transmission to others
Treatment Approach
- The standard treatment approach involves dispensing medications on site and directly observing the first dose to ensure compliance 1
- Patients should be instructed to follow the treatment regimen as directed and to complete the entire course of antibiotics, even if symptoms disappear
- Follow-up care is crucial to ensure that the infection has been cleared and to prevent reinfection or transmission to others 1
From the FDA Drug Label
Uncomplicated urethral, endocervical, or rectal infection in adults caused by Chlamydia trachomatis: 100 mg, by mouth, twice a day for 7 days. Urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae.
The treatment for chlamydia is doxycycline 100 mg, by mouth, twice a day for 7 days 2 or azithromycin 3.
- Doxycycline is indicated for the treatment of uncomplicated urethral, endocervical, or rectal infections in adults caused by Chlamydia trachomatis 2.
- Azithromycin is indicated for the treatment of urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae 3.
From the Research
Treatment Options for Chlamydia
- Azithromycin: a single 1-g dose is as effective as a standard seven-day course of doxycycline for the treatment of uncomplicated genital chlamydial infections 4, 5
- Doxycycline: a seven-day course is a common treatment option for chlamydia, with a bacteriological cure rate similar to azithromycin 4, 6
Efficacy of Azithromycin and Doxycycline
- Azithromycin has a bacteriological cure rate of 95-100% for uncomplicated genital chlamydial infections 6
- Doxycycline has a bacteriological cure rate of 88-100% for uncomplicated genital chlamydial infections 6
- A study found that doxycycline had a significantly higher microbiological anorectal cure rate than azithromycin for the treatment of anorectal Chlamydia trachomatis infection in women concurrent with vaginal infection 7
Pharmacoeconomic Considerations
- Azithromycin is more expensive than doxycycline, but its single-dose regimen may improve patient compliance and reduce costs associated with treatment failure 6
- A pharmacoeconomic analysis found that azithromycin saved around $US1200 per major outcome avoided compared to doxycycline for the treatment of confirmed C. trachomatis infection 6
Ongoing Research
- A randomized controlled trial is currently underway to compare the treatment efficacy of azithromycin and doxycycline for rectal chlamydia among men who have sex with men 8