What is the recommended treatment plan for a non-pregnant woman diagnosed with vaginal chlamydia?

Treatment for Vaginal Chlamydia in Non-Pregnant Women

Treat with either azithromycin 1 g orally as a single dose or doxycycline 100 mg orally twice daily for 7 days—both achieve 97-98% cure rates and are equally effective first-line options. 1, 2

First-Line Treatment Selection

Choose between two equally effective regimens based on patient-specific factors:

• Azithromycin 1 g orally, single dose is preferred when compliance is uncertain, as it allows directly observed therapy in the clinic and eliminates the risk of incomplete treatment 1, 2
• Doxycycline 100 mg orally twice daily for 7 days is preferred when cost is a primary concern, as it has extensive clinical experience and lower cost than azithromycin 1, 2
• Both regimens demonstrate microbial cure rates of approximately 97-98% in clinical trials 1, 2

Critical implementation: Dispense medication on-site whenever possible and directly observe the first dose to maximize compliance 1, 2

Alternative Treatment Regimens

Use these only when first-line options cannot be tolerated:

• Levofloxacin 500 mg orally once daily for 7 days (88-94% efficacy, but lacks clinical trial validation for chlamydia) 1
• Ofloxacin 300 mg orally twice daily for 7 days (similar efficacy to first-line agents but more expensive with no compliance advantage) 1, 2
• Erythromycin base 500 mg orally four times daily for 7 days (inferior option due to gastrointestinal side effects causing poor compliance) 2, 3
• Erythromycin ethylsuccinate 800 mg orally four times daily for 7 days (same limitations as erythromycin base) 2, 3

Mandatory Sexual Activity Restrictions

• Patients must abstain from all sexual intercourse for 7 days after initiating treatment, regardless of which regimen is used 1, 2
• Sexual activity must remain restricted until all sex partners have been treated to prevent reinfection 1, 2

Partner Management Protocol

• All sex partners from the previous 60 days must be evaluated, tested, and empirically treated with a chlamydia-effective regimen, even if asymptomatic 1, 2
• If the last sexual contact was >60 days before diagnosis, the most recent partner must still be treated 1, 2
• Failing to treat sex partners leads to reinfection in up to 20% of cases 1

Concurrent Gonorrhea Considerations

• If gonorrhea is confirmed or prevalence is high in your patient population, treat for both infections concurrently with ceftriaxone 250 mg IM single dose plus azithromycin 1 g orally single dose 1, 3
• Coinfection rates range from 20-40% in many populations 3
• In high-prevalence settings (such as many STD clinics), presumptive treatment for both infections is appropriate even without testing 4

Follow-Up and Retesting Strategy

• Test-of-cure is NOT recommended for non-pregnant patients treated with recommended regimens who are asymptomatic after treatment, as cure rates exceed 97% 1, 2
• Mandatory retesting at 3 months after treatment is strongly recommended for all women due to reinfection rates reaching up to 39% in some populations 1, 2
• This 3-month retesting is for reinfection screening, not test-of-cure, and should be performed regardless of whether partners were reportedly treated 1, 2
• Repeat infections carry elevated risk for pelvic inflammatory disease and other complications compared to initial infection 1, 2

Additional STI Testing at Initial Visit

• Test for gonorrhea, syphilis, and HIV at the time of chlamydia diagnosis 1
• Consider HPV vaccination referral if age-appropriate 1

Common Pitfalls to Avoid

• Do NOT wait for test results if compliance with return visit is uncertain in high-prevalence populations—treat presumptively 4
• Do NOT perform test-of-cure before 3 weeks post-treatment, as nucleic acid amplification tests can yield false-positive results from dead organisms 1
• Do NOT assume partners were treated—directly verify or use expedited partner therapy strategies 1
• Do NOT use erythromycin as first-line treatment due to poor compliance from gastrointestinal side effects 1, 2