A 35-year-old male whose sexual partner tested positive only for Chlamydia trachomatis and negative for other sexually transmitted infections: Should he receive only presumptive treatment for chlamydia, or also undergo comprehensive screening for additional STIs?

Treatment and Screening for Male Partner of Chlamydia-Positive Patient

This patient should receive immediate empiric treatment for chlamydia without waiting for test results, AND should undergo comprehensive STI screening including gonorrhea, syphilis, and HIV at the same visit.

Immediate Empiric Treatment is Mandatory

• Sex partners of patients with confirmed chlamydia have a substantially increased risk of infection and must be treated empirically before test results are available. 1
• Delaying treatment while awaiting results increases the risk of disease complications, ongoing transmission, and loss to follow-up. 1
• The adverse consequences of treating an uninfected person are primarily psychosocial, whereas antibiotics for chlamydia have relatively uncommon and mild side effects. 1

First-Line Treatment Options

• Azithromycin 1 g orally as a single dose (97% cure rate) is preferred when compliance is uncertain because it can be given as directly observed therapy. 2, 3
• Doxycycline 100 mg orally twice daily for 7 days (98% cure rate) is equally effective and less expensive, with superior efficacy for rectal infections (96.9% vs 76.4% for azithromycin). 2, 3

Comprehensive STI Screening is Essential

Despite empiric treatment, this patient requires testing for multiple STIs at the initial visit:

Mandatory Screening Tests

• Chlamydia NAAT testing should still be performed even though he is being treated presumptively, as a positive result provides firm grounds for partner notification of his other contacts and facilitates appropriate medical care if symptoms develop. 1
• Gonorrhea NAAT testing is required because coinfection rates range from 20-40% in populations with high gonorrhea prevalence. 1, 3
• Syphilis serology must be performed at the initial visit for all patients diagnosed with or exposed to chlamydia. 2
• HIV testing is recommended for all individuals diagnosed with or exposed to chlamydia. 2

Rationale for Gonorrhea Co-Treatment

• If gonorrhea is confirmed or the prevalence in the patient population exceeds 5%, treat concurrently with ceftriaxone 500 mg IM single dose PLUS the chlamydia regimen. 3
• In high-prevalence settings (such as many STD clinics), presumptive treatment for both gonorrhea and chlamydia should be given without waiting for test results. 1

Critical Management Steps

Sexual Abstinence Requirements

• The patient must abstain from all sexual intercourse for 7 days after initiating treatment (or until completion of 7-day regimens) and until all sex partners are treated. 2, 3

Partner Notification

• All sexual partners from the preceding 60 days must be evaluated, tested, and treated empirically with the same regimen, regardless of symptom status. 2, 3
• If the last sexual contact was more than 60 days before the partner's diagnosis, the most recent partner should still be treated. 1

Follow-Up Testing

• Routine test-of-cure is NOT recommended for asymptomatic men treated with recommended regimens, as cure rates exceed 97%. 2
• Repeat testing at 3 months after treatment is strongly recommended to detect reinfection, which occurs in up to 39% of cases in some populations. 2

Common Pitfalls to Avoid

• Do NOT wait for test results before treating – the increased prevalence of chlamydia among sex partners of infected patients warrants immediate empiric treatment. 1
• Do NOT skip gonorrhea testing – coinfection is common and requires different antimicrobial therapy. 1, 3
• Do NOT assume the partner was the only contact – he may have other partners who need notification and treatment. 1
• Do NOT omit syphilis and HIV screening – these are standard of care for all STI exposures. 2