Treatment for Chlamydia Infection with IUD in Place
For patients with a positive Chlamydia trachomatis result and an IUD in place, the recommended treatment is azithromycin 1 g orally in a single dose OR doxycycline 100 mg orally twice daily for 7 days, and the IUD can remain in place during and after treatment. 1, 2
First-Line Treatment Options
• Azithromycin 1 g orally in a single dose 1 • Doxycycline 100 mg orally twice daily for 7 days 1
Both treatments are equally efficacious with cure rates of 97-98% 1. The choice between these two regimens should consider:
• Azithromycin advantages: Single-dose therapy, directly observed treatment possible, better for patients with questionable compliance 1 • Doxycycline advantages: Lower cost, extensive history of use and safety 1
Alternative Treatment Regimens
If first-line treatments cannot be used, consider:
• Erythromycin base 500 mg orally four times a day for 7 days 1 • Erythromycin ethylsuccinate 800 mg orally four times a day for 7 days 1 • Ofloxacin 300 mg orally twice a day for 7 days 1 • Levofloxacin 500 mg orally once daily for 7 days 1
Note that erythromycin may cause gastrointestinal side effects that can reduce compliance 1.
Management of the IUD
• The IUD can safely remain in place during and after treatment for chlamydial infection 2 • There is no need to remove the IUD for treatment of uncomplicated chlamydial infection 2 • The risk of PID with an IUD in situ is less than 1% 2
Additional Management Considerations
• Partners should be notified, examined, and treated for chlamydia to prevent reinfection 1 • Patients should abstain from sexual intercourse until:
- They and their partners complete treatment 1
- 7 days after single-dose therapy or until completion of a 7-day regimen 1
• Test-of-cure is not routinely recommended after completing treatment with doxycycline or azithromycin 1 • Consider retesting females 3-4 weeks after treatment if using erythromycin regimens 1
Risk Factors for Treatment Failure or Reinfection
• Age ≤24 years 3 • Recent new sexual partner 3 • Multiple sexual partners 3 • Partner with multiple partners 3 • Untreated partners 3
Important Clinical Considerations
• Chlamydial infection can lead to serious sequelae in women including PID, ectopic pregnancy, and infertility 1 • Some women with apparently uncomplicated cervical infection may already have subclinical upper reproductive tract infection 1 • Treatment of cervical infection is believed to reduce the likelihood of these sequelae 1 • Medications for chlamydial infections should ideally be dispensed on-site, with the first dose directly observed to maximize compliance 1