Will testicular swelling resolve with azithromycin treatment for chlamydia and can doxycycline be used to prevent reinfection?

Treatment for Testicular Swelling Following Chlamydia Infection

Doxycycline 100 mg orally twice daily for 7 days is recommended to treat your persistent symptoms after azithromycin therapy, as it has superior efficacy for chlamydial infections and will address potential complications like testicular involvement. 1, 2

Current Situation Assessment

• Your symptoms suggest possible incomplete clearance of chlamydial infection despite azithromycin treatment 2
• Testicular swelling can occur as a complication of chlamydial infection and may take longer to resolve than urethral symptoms 2
• Weekly azithromycin dosing is not a standard treatment regimen for chlamydia and may have contributed to incomplete resolution 1

Recommended Treatment Approach

• Switch to doxycycline 100 mg orally twice daily for 7 days as it has been shown to have excellent efficacy (98% cure rate) for chlamydial infections 1
• Doxycycline is preferred over continuing azithromycin when symptoms persist after initial treatment 2, 1
• Testicular involvement may require the full course of appropriate antibiotics to completely resolve 2

Sexual Activity Recommendations

• Abstain from sexual activity (including masturbation) until:
  • You complete the full course of antibiotic treatment 2
  • All symptoms have completely resolved, including testicular swelling 2
  • At least 7 days have passed since starting treatment 2

Partner Management

• All sexual partners from the past 60 days should be evaluated and treated 2, 1
• If your last sexual contact was more than 60 days ago, your most recent partner should still be treated 2
• Partner treatment is essential to prevent reinfection 1

Follow-Up Recommendations

• No test of cure is needed if you complete the full doxycycline course and symptoms resolve 2, 1
• If symptoms persist after completing doxycycline treatment, return for further evaluation 2
• Consider rescreening in 3-4 months as reinfection rates are high 2, 1

Important Clinical Considerations

• Lymphogranuloma venereum (LGV), which you mentioned as a concern, typically requires a longer treatment course (21 days of doxycycline) if confirmed 2
• The pimples on your pubic bone may represent lymph node involvement, which should improve with appropriate antibiotic therapy 2
• Testicular involvement can occur as a complication of ascending chlamydial infection and may take longer to resolve than urethral symptoms 2

Treatment Efficacy Comparison

• While both azithromycin and doxycycline are recommended first-line treatments for uncomplicated chlamydial infection, recent evidence suggests doxycycline may be more effective for complicated or persistent infections 1, 3
• A recent randomized controlled trial showed doxycycline achieved 100% cure rate compared to 74% for azithromycin in certain chlamydial infections 3
• The weekly azithromycin regimen you were taking is not a standard recommended approach for chlamydia treatment 2, 1