Treatment for Partners of Individuals with Chlamydia Infection
Partners of individuals with chlamydia infection should be evaluated, tested, and treated with either doxycycline 100 mg orally twice daily for 7 days (preferred) or azithromycin 1 g orally in a single dose, even without testing confirmation. 1
Partner Management Approach
- Sex partners should be evaluated and treated if they had sexual contact with the infected individual during the 60 days preceding symptom onset or diagnosis 2
- The most recent sex partner should be evaluated and treated even if the last sexual contact was >60 days before symptom onset or diagnosis 2
- If partners are unlikely to seek evaluation and treatment, expedited partner therapy (providing medication or prescription to the index patient for their partner) may be considered for heterosexual partners 2
Treatment Options
First-line Treatment:
- Doxycycline 100 mg orally twice daily for 7 days 1, 3
- Higher efficacy (95.5% for urogenital infections, 96.9% for rectal infections)
- More effective for rectal infections
- Cost-effective option
Alternative Treatment:
- Azithromycin 1 g orally in a single dose 1, 4
- Advantage of single-dose administration (directly observed therapy)
- Improves compliance
- Slightly lower efficacy (92% for urogenital, 76.4% for rectal infections)
Special Considerations
Pregnancy
- For pregnant partners, azithromycin 1 g orally in a single dose is recommended 2, 1
- Doxycycline is contraindicated in pregnancy 2, 1, 3
HIV Infection
- Partners with HIV should receive the same treatment regimen as those without HIV 2
Patient Education
Partners should be advised to:
- Complete the entire course of medication even if symptoms resolve quickly
- Abstain from sexual activity for 7 days after treatment with azithromycin or until completion of the 7-day doxycycline regimen 2, 1
- Use condoms consistently and correctly to reduce risk of reinfection
- Return for reevaluation if symptoms persist or recur after treatment
Follow-up Recommendations
- Routine test of cure is not recommended if symptoms resolve 2, 1
- Consider retesting approximately 3 months after treatment due to high risk of reinfection 2
- All women with chlamydial infection should be retested when they next seek medical care within 3-12 months 2
Clinical Implications
Timely treatment of partners is essential for:
- Preventing reinfection of the index patient
- Reducing the risk of complications such as pelvic inflammatory disease, infertility, and ectopic pregnancy 5
- Breaking the chain of transmission in the community
The single-dose azithromycin regimen has been shown to be as effective as the 7-day doxycycline regimen in multiple studies 6, 7, 8, 9, but recent evidence suggests doxycycline has higher efficacy, particularly for rectal infections 1.