Recommended Treatments for Chlamydia and Gonorrhea
For uncomplicated chlamydial infections, the recommended first-line treatments are azithromycin 1 g orally in a single dose OR doxycycline 100 mg orally twice daily for 7 days. For uncomplicated gonorrhea, the recommended treatment is ceftriaxone 500 mg intramuscularly as a single dose. 1, 2, 3
Chlamydia Treatment
First-Line Options:
- Azithromycin 1 g orally in a single dose (97% efficacy rate) 1, 2
- Doxycycline 100 mg orally twice daily for 7 days (98% efficacy rate) 1, 2
Alternative Options (when first-line treatments cannot be used):
- Erythromycin base 500 mg orally four times a day for 7 days 4, 2
- Erythromycin ethylsuccinate 800 mg orally four times a day for 7 days 4, 2
- Levofloxacin 500 mg orally once daily for 7 days 4, 2
- Ofloxacin 300 mg orally twice a day for 7 days 4, 2
Treatment Considerations:
- Azithromycin advantages: single-dose therapy, directly observed treatment possible, better compliance 1, 2
- Doxycycline advantages: lower cost, extensive clinical experience 2
- Medications should be dispensed on-site when possible, with the first dose directly observed to maximize compliance 4, 2
Gonorrhea Treatment
Recommended Regimen:
- Ceftriaxone 500 mg intramuscularly as a single dose for uncomplicated gonorrhea at all anatomic sites 3, 5
Important Considerations:
- Due to increasing antimicrobial resistance, particularly to azithromycin, the CDC now recommends ceftriaxone monotherapy for gonorrhea 5
- If chlamydial co-infection has not been excluded, add doxycycline 100 mg twice daily for 7 days 3, 5
Dual Therapy Considerations
- Patients with gonorrhea are often co-infected with chlamydia, with co-infection rates of 20-40% 4
- When treating gonorrhea, if chlamydial infection has not been excluded, provide treatment for both infections 4, 5
- Routine dual therapy without testing for chlamydia can be cost-effective when co-infection rates are high 4
Implementation Best Practices
- Patients should abstain from sexual intercourse for 7 days after single-dose therapy or until completion of a 7-day regimen 4, 2
- Patients should abstain from sexual activity until all sex partners are treated 4, 2
- All sex partners from the previous 60 days should be evaluated, tested, and treated 2
- Test-of-cure is not routinely recommended after completing treatment with recommended regimens unless:
- Therapeutic compliance is questionable
- Symptoms persist
- Reinfection is suspected 2
Special Populations
Pregnancy:
- For chlamydia during pregnancy, recommended treatments are:
- Azithromycin 1 g orally in a single dose
- Amoxicillin 500 mg orally three times a day for 7 days 1
- Doxycycline and fluoroquinolones (ofloxacin, levofloxacin) are contraindicated during pregnancy 1
Rectal Chlamydia:
- Recent evidence shows doxycycline (100 mg twice daily for 7 days) is superior to azithromycin (1 g single dose) for rectal chlamydial infections, with cure rates of 96.9% vs. 76.4% respectively 6
Common Pitfalls and Caveats
- Gastrointestinal side effects with erythromycin often lead to poor compliance, making it a less desirable alternative 2
- Consider retesting women approximately 3 months after treatment due to high risk of reinfection 2
- Antimicrobial resistance in N. gonorrhoeae is an ongoing concern, particularly to azithromycin 5
- For rectal chlamydial infections, doxycycline should be preferred over azithromycin due to significantly higher efficacy 6