What is the plan of care for Chlamydia?

Management Plan for Chlamydia Infection

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

First-Line Treatment Options

For Non-Pregnant Adults:

• Preferred regimen: Doxycycline 100 mg orally twice daily for 7 days (95.5% efficacy for urogenital infections, 96.9% for rectal infections) 1
• Alternative regimen: Azithromycin 1 g orally in a single dose (92% efficacy for urogenital infections, 76.4% for rectal infections) 1, 2
  • Consider azithromycin when adherence to a 7-day regimen is a concern
  • Note that doxycycline is significantly more effective for rectal chlamydia (27% higher cure rate) 2

For Pregnant Women:

• Preferred regimen: Azithromycin 1 g orally in a single dose 1
• Alternative regimens (if azithromycin cannot be used):
  • Erythromycin base 500 mg orally four times a day for 7 days 3
  • Amoxicillin 500 mg orally three times a day for 7-10 days 3
  • Note: Doxycycline and ofloxacin are contraindicated during pregnancy 3

Partner Management

• All sexual partners from the previous 60 days should be evaluated, tested, and treated 3, 1
• If no sexual contact occurred within 60 days, treat the most recent partner 3
• Patients should be instructed to abstain from sexual intercourse:
  • For 7 days after single-dose therapy (azithromycin), OR
  • Until completion of a 7-day regimen (doxycycline) 3
  • Until all partners have been treated 3

Follow-Up Testing

• Non-pregnant patients: No test of cure needed if treated with doxycycline or azithromycin unless symptoms persist 3, 1
• Pregnant patients: Test of cure recommended 3 weeks after completing treatment 3, 1
• All patients: Consider retesting approximately 3 months after treatment due to high risk of reinfection (up to 39% in some studies) 3, 1

Special Considerations

HIV-Positive Patients

• Same treatment regimens as HIV-negative patients 3, 1

Rectal Infections

• Doxycycline is significantly more effective than azithromycin (96.9% vs 76.4% efficacy) 1, 2
• Recent meta-analysis strongly recommends doxycycline over azithromycin for rectal chlamydia 2

Patient Education

Patients should be advised to:

• Complete the full course of antibiotics even if symptoms resolve earlier
• Ensure all sexual partners are evaluated and treated
• Abstain from sexual activity until treatment is complete and partners are treated
• Return for evaluation if symptoms persist after treatment
• Consider retesting in 3 months due to high reinfection rates

Common Pitfalls to Avoid

1. Inadequate partner treatment: Failure to treat partners is a major cause of reinfection
2. Premature resumption of sexual activity: Emphasize the importance of abstinence until treatment completion
3. Overlooking rectal infections: Doxycycline is significantly more effective than azithromycin for rectal chlamydia
4. Inappropriate testing timing: Testing too soon after treatment may yield false-positive results due to dead organisms
5. Neglecting pregnant patients: Pregnant women require special consideration including mandatory test of cure and appropriate antibiotic selection

By following this evidence-based approach to chlamydia management, you can effectively treat the infection while minimizing complications and preventing transmission to partners.