What is the recommended treatment for chlamydia in partners?

Chlamydia Partner Treatment

For partners of individuals with chlamydia infection, doxycycline 100 mg orally twice daily for 7 days is the recommended first-line treatment due to its superior efficacy (96.9% for rectal infections compared to 76.4% with azithromycin). 1

Treatment Options and Efficacy

First-line Treatment

• Doxycycline: 100 mg orally twice daily for 7 days 1, 2
  • Efficacy: 95.5% for urogenital infections, 96.9% for rectal infections 1
  • Treatment failure is uncommon (0-3% in males, 0-8% in females) when the full regimen is completed 1

Alternative Treatment Options

• Azithromycin: 1 g orally in a single dose 1

  • Efficacy: 92% for urogenital infections, 76.4% for rectal infections 1
  • Advantage: Single-dose therapy improves adherence 1
  • Disadvantage: Significantly lower efficacy for rectal infections compared to doxycycline 3

• When doxycycline and azithromycin cannot be used:

  • Ofloxacin: 300 mg orally twice daily for 7 days 1
  • Erythromycin base: 500 mg orally four times daily for 7 days 1, 4
  • Erythromycin ethylsuccinate: 800 mg orally four times daily for 7 days 1, 4

Special Populations

Pregnant Women

• Azithromycin: 1 g orally in a single dose (first-line for pregnant women) 1
• Alternatives when azithromycin cannot be used:
  • Amoxicillin: 500 mg orally three times daily for 7-10 days 1
  • Erythromycin base: 500 mg orally four times daily for at least 7 days 4
  • For women who cannot tolerate this regimen: erythromycin 500 mg orally every 12 hours or 250 mg orally four times daily for at least 14 days 4

Note: Doxycycline and erythromycin estolate are contraindicated during pregnancy 1

Children

• Children ≥8 years: Age-appropriate doxycycline dosing 1
  • For children weighing ≤100 pounds: 2 mg/lb of body weight divided into two doses on first day, then 1 mg/lb daily as single or divided dose 2
  • For children >100 pounds: Adult dose 2
• Children <8 years: Erythromycin 50 mg/kg/day divided into four doses daily for 10-14 days 1

Partner Management Considerations

• All sexual partners from the past 60 days should be notified, evaluated, and treated 1
• Partners should abstain from sexual activity for 7 days after treatment initiation and until all partners are treated 1
• Using condoms consistently and correctly reduces the risk of reinfection 1

Follow-up Care

• Routine test of cure is not recommended if symptoms resolve 1
• Retesting is recommended 3-12 months after treatment due to high risk of reinfection 1
• Patients should complete the entire course of medication even if symptoms resolve quickly 1

Clinical Pitfalls to Avoid

1. Treating rectal infections with azithromycin: The efficacy difference between doxycycline and azithromycin is particularly significant for rectal infections (96.9% vs 76.4%) 1, 3. Always use doxycycline for known rectal infections.

2. Inadequate partner treatment: Studies show a two to threefold increased risk of chlamydial persistence or recurrence when not all partners are treated 5. Ensure all partners from the past 60 days receive treatment.

3. Assuming single-dose therapy is always better for adherence: While single-dose azithromycin improves adherence, its lower efficacy (especially for rectal infections) makes doxycycline the preferred option despite the longer treatment course 1, 3.

4. Overlooking pregnancy status: Using contraindicated medications during pregnancy can lead to complications. Always confirm pregnancy status before prescribing doxycycline 1, 2.