Should chlamydia be treated empirically in partners?

Empirical Treatment of Chlamydia for Partners

Yes, partners of individuals diagnosed with chlamydia should be treated empirically without waiting for test results to prevent reinfection and reduce transmission. 1

Partner Management Recommendations

• Sex partners of patients with chlamydia should be notified, examined, and treated for chlamydia even without testing 1
• For symptomatic patients with chlamydia, partners who had sexual contact within 30 days of symptom onset should be evaluated and treated 1
• For asymptomatic patients with chlamydia, partners who had sexual contact within 60 days of diagnosis should be evaluated and treated 1
• The most recent sex partner should be treated even if last sexual contact was outside these time intervals 1

Rationale for Empirical Treatment

• Empirical treatment prevents reinfection of the index patient and reduces further transmission in the community 1
• Without treatment, partners can remain asymptomatic carriers and continue the chain of transmission 1
• Empirical treatment addresses the high prevalence of chlamydia among partners - studies show 34.2% positivity rate among partners notified for chlamydia exposure 2
• Untreated chlamydial infections can lead to serious complications including PID, ectopic pregnancy, and infertility in women, and epididymitis and orchitis in men 3

Treatment Regimens for Partners

First-Line Options:

• Azithromycin 1 g orally in a single dose 1, 4
• OR
• Doxycycline 100 mg orally twice daily for 7 days 1, 4

Alternative Options (if first-line medications cannot be used):

• Erythromycin base 500 mg orally four times a day for 7 days 1, 4
• Erythromycin ethylsuccinate 800 mg orally four times a day for 7 days 1, 4
• Ofloxacin 300 mg orally twice a day for 7 days 1, 4
• Levofloxacin 500 mg orally once daily for 7 days 1, 4

Special Considerations

Pregnancy

• Azithromycin 1 g orally in a single dose is preferred for pregnant partners 4
• Amoxicillin 500 mg orally three times a day for 7 days is an alternative 4
• Doxycycline and fluoroquinolones (ofloxacin, levofloxacin) are contraindicated during pregnancy 4

Compliance and Follow-up

• Single-dose azithromycin may be preferred when compliance is a concern 1
• Patients and partners should abstain from sexual intercourse until therapy is completed (7 days after single-dose therapy or until completion of a 7-day regimen) 1
• Sexual activity should be avoided until all partners are treated 1
• Test-of-cure is not routinely recommended after treatment with recommended regimens unless symptoms persist or reinfection is suspected 1, 5

Potential Pitfalls and Caveats

• Empirical treatment without testing means approximately 65.8% of partners will receive antibiotics unnecessarily 2
• Partners may have co-infections with other STIs that would be missed without testing - studies show 10.2% of chlamydia-notified clients had gonorrhea and 10.9% had other STIs (syphilis, HIV, hepatitis B) 2
• When treating for chlamydia empirically, consider the high rate of gonorrhea co-infection (20-40%) and the need for potential dual therapy 5, 6
• For rectal chlamydia infections, doxycycline has superior effectiveness compared to azithromycin 7

Implementation Best Practices

• Medications should be dispensed on-site when possible, with directly observed first dose to maximize compliance 5, 4
• Patient referral (having the index patient notify partners) is the most common method, but provider referral (having healthcare providers notify partners) is more effective when feasible 1
• Consider expedited partner therapy (providing medication or prescription to the index patient to give to their partner) where legally permitted 1
• Partners should be counseled about the infection, its transmission, and the importance of treatment 1