What is the treatment for Chlamydia (Chlamydia trachomatis) infection?

From the Guidelines

Chlamydia is treated with antibiotics, typically azithromycin or doxycycline, with the standard regimen being either a single 1-gram dose of azithromycin taken orally, or doxycycline 100mg taken twice daily for 7 days, as recommended by the Centers for Disease Control and Prevention (CDC) 1. The treatment of chlamydia is crucial to prevent long-term complications, such as infertility and pelvic inflammatory disease.

• The CDC recommends that chlamydia infection be treated with 1 g of azithromycin in a single oral dose or with oral doxycycline, 100 mg twice daily for 7 days 1.
• For pregnant women, azithromycin is preferred as doxycycline can affect fetal development, and alternative treatments include amoxicillin 500mg three times daily for 7 days 1.
• It's crucial to complete the full course of antibiotics even if symptoms disappear, and sexual partners should also be treated to prevent reinfection, and patients should abstain from sexual activity until both they and their partners complete treatment 1.
• Follow-up testing is recommended 3 months after treatment to ensure the infection has cleared, as reinfection rates are high. The most recent and highest quality study, although not directly provided, would likely support the CDC's recommendations, as they are based on the latest evidence and expert opinion 1.
• The treatment guidelines for chlamydia are regularly updated by the CDC, and clinicians are encouraged to access the CDC Web site to obtain the most up-to-date information 1.
• To minimize transmission, persons treated for chlamydia should be instructed to abstain from sexual intercourse for 7 days after single-dose therapy or until completion of a 7-day regimen, and to minimize the risk for reinfection, patients also should be instructed to abstain from sexual intercourse until all of their sex partners are treated 1.

From the FDA Drug Label

Uncomplicated urethral, endocervical, or rectal infection in adults caused by Chlamydia trachomatis: 100 mg, by mouth, twice a day for 7 days. Urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae.

The treatment for chlamydia is doxycycline 100 mg, by mouth, twice a day for 7 days 2 or azithromycin 3.

• Doxycycline is indicated for the treatment of uncomplicated urethral, endocervical, or rectal infections in adults caused by Chlamydia trachomatis.
• Azithromycin is indicated for the treatment of urethritis and cervicitis due to Chlamydia trachomatis.

From the Research

Treatment Options for Chlamydia

• The primary treatment options for chlamydia include azithromycin and doxycycline 4, 5, 6, 7, 8
• Azithromycin is typically administered as a single 1-g dose, while doxycycline is given as 100 mg twice daily for 7 days 4, 5, 7

Efficacy of Azithromycin and Doxycycline

• Studies have shown that doxycycline may be more effective than azithromycin in treating rectal chlamydia, with higher microbiological cure rates 5, 7, 8
• A systematic review and meta-analysis found that doxycycline had a higher microbiological cure rate than azithromycin, with a risk ratio of 1.21 (95% CI = 1.15-1.28) 8
• Another study found that doxycycline was significantly more effective than azithromycin in treating rectal chlamydia in men who have sex with men, with a microbiologic cure rate of 100% vs 74% 7

Adverse Events and Safety

• Azithromycin may have fewer adverse events than doxycycline, with a lower risk of gastrointestinal side effects 6
• However, the overall safety profile of both treatments is generally considered to be good, with most adverse events being mild and self-limiting 6, 7