What is the recommended treatment for Chlamydia?

Chlamydia Treatment

First-Line Treatment Recommendations

For uncomplicated genital chlamydia in non-pregnant adults, use either azithromycin 1 g orally as a single dose OR doxycycline 100 mg orally twice daily for 7 days—both achieve approximately 97-98% cure rates and are equally effective. 1, 2

Choosing Between First-Line Options

Select azithromycin when:

• Compliance with multi-day regimens is questionable or unpredictable 1, 2
• Directly observed therapy is desired (single dose can be given in clinic) 1, 2
• Patient has erratic health-care-seeking behavior 2
• Follow-up is uncertain 2

Select doxycycline when:

• Cost is a primary concern (doxycycline is less expensive) 1, 2
• Patient can reliably complete 7-day course 1
• Treating concurrent bacterial vaginosis (doxycycline + metronidazole) 3

Implementation Best Practices

• Dispense medications on-site when possible and directly observe the first dose to maximize compliance 1, 2
• Patients must abstain from all sexual intercourse for 7 days after initiating treatment and until all sex partners are treated 2
• Administer with food or milk if gastric irritation occurs with doxycycline 4

Alternative Treatment Options

Use these alternatives only when first-line options cannot be used: 1, 2

• Erythromycin base 500 mg orally four times daily for 7 days
• Erythromycin ethylsuccinate 800 mg orally four times daily for 7 days
• Ofloxacin 300 mg orally twice daily for 7 days
• Levofloxacin 500 mg orally once daily for 7 days

Important caveat: Erythromycin has poor compliance due to gastrointestinal side effects and should be avoided when possible 1, 2

Special Populations

Pregnancy

Azithromycin 1 g orally as a single dose is the preferred treatment during pregnancy 2

Alternative option:

• Amoxicillin 500 mg orally three times daily for 7 days 1, 2

Contraindicated in pregnancy:

• Doxycycline 2
• Ofloxacin 2

Pediatric Patients (≥8 years, >45 kg)

• Azithromycin 1 g orally as a single dose OR doxycycline 100 mg orally twice daily for 7 days 2

Pediatric Patients (<45 kg)

• Erythromycin base or ethylsuccinate 50 mg/kg/day orally divided into four doses daily for 14 days 2

HIV-Positive Patients

• Use the same treatment regimens as HIV-negative patients 1, 2

Partner Management

All sex partners from the previous 60 days must be evaluated, tested, and treated empirically 1, 2

• If last sexual contact was >60 days before diagnosis, treat the most recent partner 1, 2
• Partners should receive treatment regardless of test results 2

Additional Testing at Initial Visit

Test all chlamydia-positive patients for: 2

• Gonorrhea (coinfection is common—treat presumptively if gonorrhea is present) 2
• Syphilis 2
• HIV 2

Follow-Up Recommendations

Test-of-Cure

Do NOT perform test-of-cure in asymptomatic patients who received recommended treatment 1, 2

Perform test-of-cure only when: 1, 2

• Therapeutic compliance is questionable
• Symptoms persist
• Reinfection is suspected

Repeat Testing

Retest all women approximately 3 months after treatment due to high reinfection rates (this is strongly recommended, not optional) 1, 2

Critical Pitfalls to Avoid

• Never rely on azithromycin to treat incubating syphilis—all patients with chlamydia should receive serologic testing for syphilis at diagnosis 5
• Do not use azithromycin for rectal chlamydia—efficacy may be as low as 82.9% compared to 99.6% for doxycycline; always use doxycycline for rectal infections 6
• Failing to treat sex partners leads to reinfection—treatment failure rates of 0-8% are often due to untreated partners 1, 7
• Do not use non-culture tests (EIA, DFA) in children due to false-positive results from cross-reaction with other organisms 2