What is the recommended management for a patient whose partner has tested positive for chlamydia, has had unprotected sex, and is experiencing irregular menses?

From the Guidelines

The patient should receive empiric antibiotic treatment with azithromycin 1 gram as a single oral dose or doxycycline 100 mg orally twice daily for 7 days, as the partner has tested positive for chlamydia and the patient has had unprotected sex. The patient should also undergo testing for chlamydia and other sexually transmitted infections (STIs) including gonorrhea, HIV, and syphilis, but treatment should not be delayed while awaiting results 1. The irregular menses could be related to the chlamydia infection, as pelvic inflammatory disease (PID) is a potential complication that can affect menstrual patterns. The patient should abstain from sexual activity for 7 days after treatment completion and until their partner has also completed treatment to prevent reinfection. Follow-up testing is recommended 3 months after treatment to ensure cure and rule out reinfection. Additionally, the patient should be counseled about safe sex practices, including consistent condom use, and should be offered pregnancy testing if appropriate, as irregular menses could indicate pregnancy.

Some key points to consider in the management of this patient include:

• The importance of treating the patient empirically for chlamydia, given the partner's positive test result and the patient's history of unprotected sex 1
• The need for the patient to abstain from sexual activity for 7 days after treatment completion and until their partner has also completed treatment to prevent reinfection 1
• The recommendation for follow-up testing 3 months after treatment to ensure cure and rule out reinfection 1
• The importance of counseling the patient about safe sex practices, including consistent condom use, and offering pregnancy testing if appropriate 1

It is also important to note that the patient's irregular menses could be related to the chlamydia infection, and that PID is a potential complication that can affect menstrual patterns. Therefore, the patient should be monitored for any signs or symptoms of PID, such as pelvic pain or fever, and should be treated promptly if PID is suspected.

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. Nongonococcal urethritis (NGU) caused by C. trachomatis or U. urealyticum: 100 mg, by mouth, twice a day for 7 days. Urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae.

The recommended management for a patient whose partner has tested positive for chlamydia, has had unprotected sex, and is experiencing irregular menses is to treat the patient for chlamydia.

• Doxycycline 100 mg, by mouth, twice a day for 7 days is a recommended treatment option 2.
• Azithromycin is also an option, however the exact dosage is not specified in the provided drug label for the treatment of chlamydia in adults 3. Pregnancy testing is also recommended due to the patient's irregular menses and history of unprotected sex.

From the Research

Recommended Management

The patient's partner has tested positive for chlamydia, and the patient has had unprotected sex, making it essential to screen for sexually transmitted infections (STIs) [ 4 ]. The patient is also experiencing irregular menses and requests a pregnancy test.

STI Screening

• The patient should be screened for chlamydia, gonorrhea, syphilis, and human immunodeficiency virus (HIV) [ 4 ].
• A full screen for concomitant genital disease is warranted, as most ulcerative genital infections increase the sexual transmission efficiency of HIV [ 5 ].

Treatment Options

• Azithromycin is a recommended treatment for chlamydia, with a single 1 g dose being effective [ 6 , 7 , 8 ].
• For patients with gonorrhea, azithromycin 2.0 g orally or ceftriaxone 250 mg intramuscularly are effective treatment options [ 7 ].

Pregnancy Considerations

• If the patient is pregnant, treatment possibilities are limited due to potential risks for the developing fetus [ 5 ].
• Azithromycin is a recommended treatment for chlamydia in pregnant women, with a single 1 g dose being effective [ 5 ].

Follow-up

• Test of cure and re-testing after several weeks are advisable in most patients with STIs, especially if partner notification and treatment are likely to be less efficient [ 5 ].