Should a patient be automatically treated for chlamydia and gonorrhea if their partner was diagnosed with chlamydia, or should they be tested first?

Management of Partners of Patients with Chlamydia

Partners of patients diagnosed with chlamydia should be treated empirically for both chlamydia and gonorrhea without waiting for test results. 1, 2

Rationale for Empiric Dual Treatment

The CDC explicitly recommends that sex partners be treated empirically with regimens effective against both chlamydia and gonorrhea, regardless of which pathogen was identified in the index patient. 2 This approach is justified by several key factors:

• High co-infection rates: Among patients with gonorrhea, 24.2% of heterosexual men and 38.5% of women also have chlamydia, with even higher rates (over 50%) in women aged 15-19 years. 3

• Risk of reinfection: Treatment is imperative because of the strong likelihood of urethral gonococcal or chlamydial infection in partners, even if asymptomatic, and the high risk of reinfecting the index patient. 2

• Asymptomatic infections: Approximately 53-100% of extragenital gonorrhea and chlamydia infections are asymptomatic or minimally symptomatic, making clinical assessment unreliable. 4

Recommended Treatment Regimen

The partner should receive:

• Ceftriaxone 500 mg IM in a single dose (for gonorrhea coverage)
• PLUS Azithromycin 1 g orally in a single dose (for chlamydia coverage) 2, 5

This dual therapy should be provided regardless of whether the partner has symptoms or whether gonorrhea was specifically identified in the index patient. 2

Partner Management Timeline

Partners who had sexual contact within 60 days preceding the patient's diagnosis should be evaluated and treated. 1, 2 If the last sexual contact was more than 60 days before diagnosis, the most recent sex partner should still be treated. 1

Critical Implementation Points

• Dispense medication on-site whenever possible to maximize adherence and ensure directly observed therapy for the first dose. 1

• Expedited partner therapy (EPT) should be considered when partners cannot be linked to care—this allows delivery of medication or prescription directly to the partner by the patient. 1

• Abstinence counseling: Both the index patient and partner must abstain from sexual intercourse for 7 days after single-dose therapy or until completion of multi-day regimens AND until both partners no longer have symptoms. 1, 2

Testing Considerations

While empiric treatment is the priority, testing partners remains valuable for:

• Surveillance purposes 1
• Enhancing partner notification and compliance 1
• Identifying additional infections (syphilis, HIV) 1, 2

However, treatment should never be delayed while awaiting test results. 2

Follow-Up Requirements

• Retest both partners at 3 months after treatment due to high reinfection rates, regardless of whether they believe their partners were treated. 1, 2

• Test of cure is not routinely needed if recommended treatment was provided and symptoms resolve. 2

• If symptoms persist or recur in either partner, they should return for evaluation. 1, 2

Common Pitfalls to Avoid

• Never wait for partner test results before treating—this delays care and increases reinfection risk. 2

• Never treat only for the identified organism—always provide dual coverage for both chlamydia and gonorrhea. 2

• Never assume negative tests rule out infection—false negatives occur, and the pattern of infection in the index patient warrants empiric treatment. 2

• Never allow sexual contact to resume until both partners complete treatment and 7 days have elapsed after single-dose therapy. 1, 2