What is the treatment for chlamydia?

Treatment of Chlamydia

Doxycycline 100 mg orally twice daily for 7 days is the recommended first-line treatment for uncomplicated chlamydia infections due to its superior efficacy, particularly for rectal infections. 1

First-line Treatment Options

Doxycycline (Preferred)

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

Azithromycin (Alternative)

• Dosage: 1 g orally in a single dose 1, 3
• Efficacy:
  • Urogenital infections: 92% cure rate
  • Rectal infections: 76.4% cure rate 1, 4
• Advantage: Single-dose therapy improves adherence 1
• Disadvantage: Lower efficacy, especially for rectal infections 1, 4

Treatment Algorithm

1. For most patients: Doxycycline 100 mg orally twice daily for 7 days
2. For patients where adherence is a significant concern: Azithromycin 1 g orally in a single dose
3. For rectal infections: Strongly prefer doxycycline due to significantly higher efficacy (96.9% vs 76.4%) 1, 4

Alternative Treatments (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
• Erythromycin ethylsuccinate 800 mg orally four times daily for 7 days 1
• Amoxicillin 500 mg orally three times daily for 7-10 days (if erythromycin cannot be tolerated) 1

Special Populations

Pregnancy

• First-line: Azithromycin 1 g orally in a single dose 1
• Alternatives:
  • Erythromycin base 500 mg orally four times daily for 7 days
  • Erythromycin base 250 mg orally four times daily for 14 days
  • Amoxicillin 500 mg orally three times daily for 7-10 days
• Note: Doxycycline and erythromycin estolate are contraindicated during pregnancy 1

Children

• Children <8 years: Erythromycin 50 mg/kg/day divided into four doses daily for 10-14 days 1
• Children ≥8 years: Age-appropriate doxycycline dosing 1

Post-Treatment Care

• Patients should complete the entire course of medication even if symptoms resolve quickly 1
• Abstain from sexual activity for 7 days after treatment initiation and until all partners are treated 1
• Use condoms consistently and correctly to reduce risk of reinfection 1
• Return for reevaluation if symptoms persist or recur after treatment 1
• Test of cure is not routinely recommended if symptoms resolve 1
• Consider retesting 3 months after treatment due to high risk of reinfection 1
• All sexual partners from the past 60 days should be notified, evaluated, and treated 1

Common Pitfalls to Avoid

1. Underestimating the importance of partner treatment: Failure to treat partners is a common cause of reinfection
2. Using azithromycin for rectal infections: The significantly lower efficacy (76.4% vs 96.9%) makes doxycycline strongly preferred 1, 4
3. Inadequate follow-up: Consider retesting within 3-12 months due to high reinfection rates 1
4. Incomplete treatment course: Emphasize the importance of completing the full course of antibiotics even after symptoms resolve 1
5. Failing to screen for other STIs: Patients with chlamydia should be tested for other STIs including gonorrhea, syphilis, and HIV