What is the recommended treatment for a partner with Chlamydia?

Treatment for Partners with Chlamydia

The recommended first-line treatment for a partner with chlamydia is doxycycline 100 mg orally twice daily for 7 days, which has superior efficacy (95.5% for urogenital infections and 96.9% for rectal infections) compared to alternative regimens. 1

Treatment Options

First-Line Treatment

• Doxycycline: 100 mg orally twice daily for 7 days 1, 2
  • Highest efficacy for both urogenital (95.5%) and rectal (96.9%) infections 1
  • FDA-approved specifically for uncomplicated urethral, endocervical, or rectal infections caused by Chlamydia trachomatis 2

Alternative Treatment Options

• Azithromycin: 1 g orally in a single dose 1

  • Efficacy: 92% for urogenital infections, but only 76.4% for rectal infections 1
  • Preferred when adherence is a concern (directly observed therapy possible) 1
  • Lower efficacy compared to doxycycline, especially for rectal infections 3

• Erythromycin options (for patients who cannot take doxycycline):

  • Erythromycin base 500 mg orally four times daily for 7 days 1, 4
  • Erythromycin base 250 mg orally four times daily for 14 days 1
  • Erythromycin ethylsuccinate 800 mg orally four times daily for 7 days 1
  • Erythromycin ethylsuccinate 400 mg orally four times daily for 14 days 1

Partner Management Guidelines

• All sexual partners from the preceding 60 days should be evaluated, tested, and treated 1
• If the last sexual contact was more than 60 days before diagnosis, the most recent partner should still be treated 1
• Partners should abstain from sexual intercourse until:
  • 7 days after completing single-dose therapy, OR
  • Until completion of a 7-day regimen 1

Special Considerations

Co-infection with Gonorrhea

• Consider dual therapy with ceftriaxone 125 mg IM in a single dose PLUS azithromycin 1 g orally in a single dose OR doxycycline 100 mg orally twice daily for 7 days 1
• This approach addresses increasing resistance patterns and treats potential co-infections 1

Pregnancy

• Doxycycline is contraindicated during pregnancy 1
• Azithromycin or erythromycin should be used instead 1, 4

Maximizing Treatment Success

• Medications should be dispensed on-site when possible 1
• First dose should be directly observed to improve compliance 1
• Test of cure is generally not needed after completing treatment with doxycycline or azithromycin unless symptoms persist 1
• Test of cure should be considered 3 weeks after completion of treatment with erythromycin 1

Follow-up Recommendations

• Retesting is recommended approximately 3 months after treatment due to high risk of reinfection (up to 39% in some studies) 1
• Consistent and correct condom use is recommended to reduce reinfection risk 1

Common Pitfalls to Avoid

• Undertreating rectal infections: Azithromycin has significantly lower efficacy for rectal chlamydia (76.4%) compared to doxycycline (96.9%) 1, 3
• Failing to treat partners: High reinfection rates make partner treatment essential 1
• Inadequate follow-up: Retesting at 3 months is crucial due to high reinfection rates 1
• Missing co-infections: Patients with chlamydia often have concurrent gonorrhea requiring dual therapy 1