Treatment for Male Partner of Patient with Chlamydia
Treat this male patient immediately with azithromycin 1 g orally as a single dose without waiting for test results. 1, 2
Immediate Treatment Approach
The male partner should receive empiric treatment for chlamydia without waiting for his own test results. 1 This approach is critical because:
- Sex partners of infected patients have a substantially increased risk of chlamydial infection and should be treated presumptively 1
- Delaying treatment while waiting for test results increases risk of disease complications and ongoing transmission 1
- The adverse consequences of treating an uninfected person are primarily psychosocial, while antibiotics for chlamydia have relatively uncommon and mild side effects 1
First-Line Treatment Regimen
Azithromycin 1 g orally as a single dose is the preferred treatment option 2, 3, offering:
- 97% cure rate for uncomplicated chlamydial infection 2
- Single-dose directly observed therapy, eliminating compliance concerns 2
- Immediate dispensing on-site when possible to maximize adherence 2
Doxycycline 100 mg orally twice daily for 7 days is an equally effective alternative 2, with:
Testing Recommendations
Despite empiric treatment, this male partner should still be tested for chlamydia 1 because:
- A positive test result provides firm grounds for partner notification of his other contacts 1
- Testing facilitates appropriate medical care if symptoms develop 1
- Testing may identify additional partners who need treatment 1
He should also be evaluated for symptoms of urethritis and other sexually transmitted infections 1, including:
- Gonorrhea testing (coinfection rates are 20-40% in high-prevalence populations) 2
- Syphilis serologic testing 3
- HIV screening 2
Sexual Activity Restrictions
The patient must abstain from all sexual intercourse for 7 days after initiating treatment 2, 4, specifically:
- 7 days after single-dose azithromycin therapy 2, 4
- Until completion of the full 7-day doxycycline regimen if that option is chosen 2, 4
- Until his female partner has also completed treatment 1, 2
Follow-Up Management
Test-of-cure is NOT recommended 2, 5 for this asymptomatic male partner treated with recommended regimens because:
- Cure rates exceed 97-98% with azithromycin or doxycycline 2
- Testing before 3 weeks post-treatment can yield false-positive results from dead organisms 5, 4
Repeat testing at 3 months after treatment is strongly recommended 2, 5 because:
- Reinfection rates are high, particularly when partners may not have been adequately treated 2, 5
- This 3-month retest screens for reinfection, not treatment failure 5
Critical Pitfalls to Avoid
Do NOT wait for his test results before treating 1—the increased prevalence of chlamydia among sex partners of infected patients warrants immediate empiric treatment 1
Do NOT assume the female partner was adequately treated—directly verify her treatment status 2 as failing to treat sex partners leads to reinfection in up to 20% of cases 2
Do NOT perform test-of-cure in asymptomatic patients treated with recommended regimens 2, 5—this wastes resources and may yield false-positive results 2
Do NOT allow sexual activity to resume until both partners have completed treatment and 7 days have elapsed 2, 4—premature resumption of sexual activity is a major cause of reinfection 5, 4
When Physical Examination May Be Deferred
For male partners who are unable or unwilling to present for evaluation, treatment without physical examination may be reasonable 1 if:
- The partner has no symptoms of urethritis 1
- The partner has no known drug allergies to azithromycin or doxycycline 1
- The partner is counseled by phone or in writing about treatment instructions 6
This approach, known as expedited partner therapy, is supported when partners are unable or unwilling to seek medical care 6, though in-person evaluation with testing for other STIs including HIV remains preferable 6