Chlamydia Does Not Resolve Without Treatment in Men
No, chlamydia in men does not go away on its own and requires antibiotic treatment to achieve cure. While the infection may remain asymptomatic in many cases, untreated chlamydia persists and can lead to serious complications including epididymitis, prostatitis, and potential fertility problems, while continuing to transmit infection to sexual partners 1.
Why Treatment is Mandatory
Chlamydial infections among men readily respond to treatment with antibiotics, but without treatment, the infection persists 1. The bacteria do not spontaneously clear from the male genital tract.
Asymptomatic infected men may unknowingly infect their sex partners before seeking treatment, making untreated male infection a major driver of transmission to women who then face serious complications including pelvic inflammatory disease and infertility 1.
Most of the morbidity and economic costs of chlamydial infections among heterosexual men result from infection of female sex partners who develop sequelae 1, emphasizing that treating men protects both the individual and their partners.
Complications of Untreated Infection in Men
Chlamydial infections of the lower genitourinary tract account for 30-40% of nongonococcal urethritis cases and 50% of epididymitis cases among adolescent and young adult males 1.
Prostatitis may be associated with C. trachomatis infection, with incidences of up to 39.5% reported in patients with prostatitis 2. Acute prostatitis carries a risk of chronic infection 3.
Epididymitis may lead to reduced fertility 3, and infection can directly damage sperm parameters, DNA fragmentation, and acrosome reaction capacity 2.
The proportion of male partners of infertile couples with evidence of Chlamydia infection is greater than that documented in the general population 2.
Recommended Treatment Regimens
First-line treatment consists of azithromycin 1 g orally in a single dose (97% efficacy) or doxycycline 100 mg orally twice daily for 7 days (98% efficacy) 4, 5.
Azithromycin is preferred when compliance is questionable because it provides single-dose, directly observed therapy 1, 4.
Medications should be dispensed on-site with the first dose directly observed to maximize compliance 1, 4.
Critical Management Steps
Patients must abstain from sexual intercourse for 7 days after single-dose therapy or until completion of a 7-day regimen, and until all sex partners have completed treatment 1, 4.
All sex partners from the preceding 60 days must be evaluated, tested, and treated 1, 4. The most recent sex partner should be treated even if last contact was >60 days before diagnosis 1.
Test-of-cure is not recommended for men treated with recommended regimens unless compliance is questionable, symptoms persist, or reinfection is suspected 1.
Some specialists suggest retesting men approximately 3 months after treatment to detect reinfection 1, though evidence is more limited than for women.
Common Pitfall to Avoid
Do not assume the infection will resolve spontaneously or that asymptomatic infection is harmless. Even without symptoms, untreated chlamydia persists, can cause complications, and continues transmitting to partners 1. Prompt antibiotic treatment is essential for both individual health and public health control of this infection 3.