Chlamydia; Treatment

NWHRC Health Center - Chlamydia, Sept 14, 2005

If you test positive for chlamydia, your infection can be cured with antibiotics. Depending on several factors, your health care professional may prescribe azithromycin, in which case you will take only a single dose, or you may be prescribed doxycycline, which requires one pill twice a day for seven days. This may be followed by a test to see if you are cured, but test of cure is not routine and is usually reserved for pregnant women or individuals with persisting or new symptoms. Penicillin is not considered as effective against chlamydia as azithromycin.

If you are pregnant and infected with chlamydia, you still can be treated without harming the fetus. However, doxycycline is not recommended for pregnant women. The recommended regimen for pregnant women is erythromycin or amoxicillin for seven days, yet azithromycin as a single dose is also a possible option and recent studies and expert opinions suggest it is safe and effective. As with any antibiotic treatment, it is important that you take all your pills, even after symptoms disappear.

Because treatment with doxycycline or azithromycin is highly effective, women usually do not need retesting for chlamydia after treatment unless their symptoms persist or reinfection is suspected. Too often, women become reinfected because their partner has not been treated as well. Studies have shown that women who are reinfected with chlamydia have a much greater risk of developing pelvic inflammatory disease (PID). Therefore, it is important that you abstain from sexual contact until your partner has been tested and completed treatment, meaning seven days after a single-dose azithromycin regimen or after completion of a seven-day doxycycline regimen.

In general, treatment is recommended for any partner or partners you had sexual contact with up to 60 days prior to having symptoms or a diagnosis of chlamydia. Some clinics are experimenting with what is called partner-delivered therapy. Patients are given a one-gram dose of azithromycin to give to their partner. There are legal and ethical debates about this approach but in some cases it may be the most effective way to stop the spread of chlamydia, because many infected male partners have no symptoms and are reluctant to seek treatment. Penicillin is not considered as effective against chlamydia as azithromycin or doxycycline.

PID treatment begins with an antibiotic regimen that provides broad coverage against several different bacteria. Treatment should begin as soon as a diagnosis is made, because immediate therapy has been shown to reduce the risk of long-term consequences of PID. Studies are under way to determine whether oral therapy is as effective as parenteral (intravenous) therapy. There are several different treatment options recommended by the Centers for Disease Control and Prevention. Regardless of which type of therapy is chosen, hospitalization is no longer recommended, except in certain circumstances including:

surgery is needed

the patient is pregnant

an oral outpatient regimen cannot be tolerated

a patient does not respond clinically to oral antimicrobial therapy

a patient has severe illness, including high fever, nausea and vomiting

a patient has tubo-ovarian abscess or a weakened immune system

While medication can stop PID, some women may need surgery to remove scar tissue and blockages caused by long-term infection. The most common type of surgery involves laparoscopy.

References

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Fact Sheet: New CDC Treatment Guidelines Critical to Preventing Health Consequences of Sexually Transmitted Diseases." May 9, 2002. http://www.cdc.gov. Accessed June 12, 2004.

"FDA Proposes New Warning for Over-the-Counter Contraceptive Drugs Containing Nonoxynol-9." FDA Talk Paper, January 16, 2003. http://www.fda.gov. Accessed March 2003.

Facts & Answers about STDs: Chlamydia. " American Social Health Association. http://www.ashastd.org. Accessed October 2001.

STD Surveillance 1999. National Profile. Centers for Disease Control and Prevention.

Centers for Disease Control and Prevention. (2002). Sexually transmitted diseases treatment guidelines 2002. MMWR, 2002, 51(No. RR-6).

"Genital infections United States, 1995." Centers for Disease Control and Prevention. MMWR. March 7, 1997. Vol. 46 (9).

Connett, H. "What you need to know about chlamydia." STD Advisor, 1999; Vol. 2. Insert.

"The Hidden Epidemic: Confronting Sexually Transmitted Diseases." Institute of Medicine. Washington, D.C. National Academy Press. 1997.

"Chlamydia in the United States" Centers for Disease Control and Prevention Fact Sheet. Updated Aug. 2001. http://www.cdc.gov. Accessed Sept. 2001.

"Chlamydial Infection" National Institute of Allergy and Infectious Diseases, National Institutes of Health. Fact Sheet. Updated Jan. 2001. http://www.niaid.nih.gov. Accessed Sept. 2001.

Tarja A. et al. "Serotypes of Chlamydia trachomatis and Risk for Development of Cervical Squamous Cell Carcinoma" JAMA 2001;285: 47-51. http://jama.ama-assn.org.