Should I continue azithromycin treatment for chlamydia or switch to a different medication due to slightly swollen testicles?

Management of Chlamydia Infection with Persistent Symptoms

You should switch from azithromycin to doxycycline 100 mg twice daily for 7 days to effectively treat your persistent chlamydial infection and associated symptoms. 1, 2

Current Situation Assessment

• Your symptoms of slightly swollen testicles after two doses of azithromycin (1g weekly) suggest possible treatment failure or complications of chlamydial infection 1
• Repeated use of the same antibiotic (azithromycin) without complete resolution may indicate:
  • Inadequate treatment duration 1
  • Possible development of reduced susceptibility to azithromycin 2
  • Potential epididymitis as a complication of untreated chlamydia 1

Recommended Treatment Plan

For You:

1. Switch to doxycycline 100 mg orally twice daily for 7 days 1, 2

   • Doxycycline has approximately 98% efficacy against chlamydial infections 2
   • Provides a different mechanism of action when azithromycin appears to be failing 1

2. Complete abstinence from sexual activity:

   • Abstain until you complete the full 7-day treatment course 1
   • Continue abstinence until all symptoms have completely resolved 1
   • Ensure your partner has also completed her treatment before resuming sexual activity 1

For Your Partner:

1. She should also switch to doxycycline 100 mg twice daily for 7 days 1
   • Even without symptoms, she may have an ongoing infection 1
   • The Bartholin's cyst may be related to the chlamydial infection 1
   • Synchronized treatment of both partners is essential to prevent reinfection 1

Follow-Up Recommendations

• If testicular swelling persists or worsens after completing doxycycline treatment, seek immediate medical attention as this could indicate epididymitis requiring additional evaluation 1
• No test of cure is needed if symptoms resolve completely after doxycycline treatment 1, 2
• Consider retesting 3 months after treatment completion to rule out reinfection 1

Important Considerations

• Avoid repeated use of azithromycin: While single-dose azithromycin is generally effective (97% cure rate), repeated use without resolution suggests the need for an alternative regimen 2, 3
• Testicular swelling: This symptom suggests possible epididymitis, which requires a full course of doxycycline rather than single-dose therapy 1
• Partner treatment: Simultaneous treatment of both partners is crucial to prevent the "ping-pong effect" of reinfection 1
• Compliance: Take the full course of doxycycline even if symptoms improve before completion 1

Common Pitfalls to Avoid

• Inadequate treatment duration: Single-dose azithromycin may be insufficient for complicated infections or those with testicular involvement 1, 2
• Premature resumption of sexual activity: This is a common cause of apparent treatment failure 1
• Ignoring partner treatment: Both partners must be treated simultaneously to prevent reinfection 1
• Stopping antibiotics early: Complete the full 7-day course of doxycycline even if symptoms resolve quickly 1