What is the recommended treatment plan for a 19-year-old male with chlamydia, a history of testicular cancer, and habits of vaping and smoking?

Treatment Plan for Chlamydia in a 19-Year-Old Male

Immediate Treatment Recommendation

Treat immediately with either azithromycin 1 g orally as a single dose OR doxycycline 100 mg orally twice daily for 7 days. 1, 2 Both regimens have approximately 97-98% efficacy for uncomplicated genital chlamydia, and treatment should be initiated as soon as possible after diagnosis. 3, 1

First-Line Treatment Options

Azithromycin vs. Doxycycline Decision

• Azithromycin 1 g single dose is preferred in this case because it offers directly observed therapy, eliminates compliance concerns, and is equally efficacious to doxycycline. 1, 2
• The single-dose regimen is particularly advantageous for young adults where follow-through with 7-day regimens may be questionable. 3, 1
• Doxycycline 100 mg twice daily for 7 days remains an excellent alternative, with lower cost and extensive clinical experience. 2, 4
• Both medications should ideally be dispensed on-site with the first dose directly observed to maximize compliance. 1, 2

Special Considerations for This Patient

• History of testicular cancer does NOT alter chlamydia treatment recommendations. 3 Standard first-line therapy applies regardless of cancer history.
• Vaping and marijuana use do not contraindicate either azithromycin or doxycycline. 4, 5
• No drug interactions exist between standard chlamydia treatments and typical post-orchiectomy care. 4, 5

Sexual Activity Restrictions

• Patient must abstain from all sexual intercourse for 7 days after initiating treatment. 3
• Abstinence must continue until all sex partners have been treated to prevent reinfection. 3, 1
• This 7-day abstinence period applies whether single-dose azithromycin or 7-day doxycycline is used. 1, 2

Partner Management - Critical Priority

• Both the current partner (who tested positive) AND the previous partner must be evaluated, tested, and treated. 3
• All sex partners within the preceding 60 days require evaluation and empiric treatment. 3, 1
• Given the 15-month relationship timeline, the current partner is clearly within this window and requires treatment. 3
• Expedited partner therapy (patient-delivered medication) is an acceptable alternative if partners are unlikely to seek care, though written materials about the importance of evaluation should accompany any delivered medication. 3
• The patient should not resume sexual activity until all partners complete treatment. 3, 1

Additional STI Testing Required

• Test for gonorrhea, syphilis, and HIV at this visit. 3
• Coinfection with gonorrhea is common, and all patients diagnosed with chlamydia should be tested for other STIs. 3
• Serologic testing for syphilis is mandatory for all patients with sexually transmitted urethritis. 5

Follow-Up Testing Strategy

• Test-of-cure is NOT recommended if the patient receives recommended treatment and is asymptomatic. 3
• Repeat testing at 3 months post-treatment IS strongly recommended due to high reinfection rates (particularly if partner treatment is uncertain). 3, 1
• Reinfection occurs in a substantial proportion of young adults within 6 months, making 3-month retesting critical. 3
• If symptoms persist after treatment completion, reevaluation with objective signs of urethritis is required before retreatment. 3

Common Pitfalls to Avoid

• Do not skip partner treatment - this is the most common cause of treatment failure and reinfection. 3, 1
• Do not perform test-of-cure at <3 weeks - dead organisms can cause false-positive results. 3
• Do not retreat based on symptoms alone - objective signs of urethritis must be documented before retreatment. 3
• Do not forget the 3-month retest - this is distinct from test-of-cure and addresses the high reinfection risk. 3, 1

Preventive Counseling Documentation

• HPV vaccination referral to health department documented and appropriate. 3
• Smoking cessation counseling provided; patient declined intervention - document continued daily vaping and marijuana use. 3
• Influenza vaccine offered and declined - document refusal. 3

Clinical Documentation Template

Assessment: Chlamydia trachomatis infection (urethritis/cervicitis)

Treatment Plan:

• Azithromycin 1 g PO single dose dispensed and administered in clinic today 1, 5
  • Alternative: Doxycycline 100 mg PO BID x 7 days 1, 4
• Strict sexual abstinence for 7 days and until all partners treated 3, 1
• Partner notification and treatment arranged for current partner (known positive) 3, 1
• Additional STI testing completed: gonorrhea, syphilis, HIV 3
• Return for repeat chlamydia testing in 3 months 3, 1
• Return sooner if symptoms develop or persist 3
• Counseled on reinfection risk and importance of partner treatment 3, 1