Doxycycline For Gonorrhea And Chlamydia

I Tested Positive For Chlamydia Or Gonorrhea Now What

Your results are in. The word positive seems to scream back at you from the pages of your lab report, sending your heart pounding and your mind racing: youve just been diagnosed with gonorrhea or chlamydia. Finding out you have one of these sexually transmitted infections can bring up a rollercoaster of emotions. You might experience feelings of shock, confusion, embarrassment, shame, or general worry about your health or the health of your partners. While these emotions are understandable, its important to know that both gonorrhea and chlamydia are extremely common and treatable. In fact, chlamydia and gonorrhea are two of the most common STIs in the U.S. So if youve recently been diagnosed with either of these STIs, youre not alone. Your healthcare provider can help you navigate STI treatment and help you get your health back on track. Heres what you need to know about a chlamydia or gonorrhea diagnosis.

What Are The Pros And Cons

Baeten counted four reasons to consider prescribing doxycycline to someone at high risk of STIs . Namely, that STI rates are on the rise among men who have sex with men in the U.S. evidence that doxycycline prophylaxis works to prevent chlamydia and syphilis the opportunity to synergistically deliver STI prevention with PrEP and, the fact thatother than condomsthere are not many effective ways to prevent STIs.

If youre a sexually activeif you have multiple partners in a given week, if youre in a situation where you enjoy group sex, if you visit sex clubs, this could be a real solution for you, said Klausner. Obviously, it should be used in addition to condoms, but condoms dont work for some people for various reasons.

Baeten also counted four reasons to pause in using antibiotics to try to prevent STIs. First, he said that it isnt totally clear if prophylaxis is that much more beneficial than frequent screening and treatment. It would be a waste of resources to prophylactically treat everyone for STIs, if increased screening and treatment are as effective in curbing new infections. Pill fatigue is another concern, as is drug resistance.

When Should You Test For Gonorrhea Or Chlamydia At Home

If youve recently had unprotected sex or potentially been exposed to gonorrhea or chlamydia, you may think that its important to get tested immediately. But taking an STD test too soon could actually lead to inaccurate results. Why? STDs such as gonorrhea and chlamydia will not be detectable in your system immediately following exposure. If you take a test too early, you may get a false negative result.

So how long should you wait to get tested for STDs? Every STD has a unique incubation period, which is the amount of time that it takes for the STD to be detectable in your system. The incubation period for chlamydia can range from 7 days to 21 days, whereas the incubation period for gonorrhea is up to 14 days.

Therefore, it is best to get tested for chlamydia and gonorrhea two to three weeks following the initial exposure. If you take a test within the first two to three weeks following exposure, its best to get tested again after several weeks to ensure your initial results were accurate.

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Amoxicillin For Chlamydia: Is It Effective

Amoxicillin is not the preferred treatment option for gonorrhea, but is it an effective way to treat chlamydia? The CDC reports that chlamydia can be easily treated with a course of antibiotics. But this does not mean that amoxicillin is effective simply because it is an antibiotic.

The CDC recommends that healthcare providers prescribe either azithromycin or doxycycline to treat chlamydia. The CDC also suggests several alternative antibiotics that can be used to treat chlamydia, including erythromycin, levofloxacin, or ofloxacin.

Amoxicillin is not on the list of antibiotics that the CDC recommends for the general treatment of chlamydia. However, it is on the list of antibiotics that the CDC recommends for the treatment of chlamydia in pregnant women. So if you are pregnant, your doctor may prescribe amoxicillin to treat chlamydia.

Im Pregnant How Does Gonorrhea Affect My Baby

If you are pregnant and have gonorrhea, you can give the infection to your baby during delivery. This can cause serious health problems for your baby. If you are pregnant, it is important that you talk to your health care provider so that you get the correct examination, testing, and treatment, as necessary. Treating gonorrhea as soon as possible will make health complications for your baby less likely.

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Does Taking Antibiotics To Prevent Stis Work

While there is very limited research on the topic, some findings support the concept of using an antibiotic called doxycycline preventatively.

Doxycycline prevents bacteria from reproducing and effectively treats various bacterial infections, including pneumonia, gum disease, skin infections and some STIs. Doxycycline is also used to prevent malaria infection. There is no evidence to suggest that using any other antibiotics than doxycycline would prevent STIs.

Research has largely been carried out with gay men who have multiple sexual partners and dont use condoms, as they represent the group at highest risk for recurrent bacterial STIs.

A small US pilot study randomised 30 gay men living with HIV, who had had syphilis twice or more since their HIV diagnosis, to one of two groups. Men who took 100mg of doxycycline by mouth daily were 73% less likely to test positive for gonorrhoea, chlamydia or syphilis during 48 weeks of follow-up, compared to men who had been provided with monetary incentives to remain STI free. There was no significant difference in reported risk behaviours between the two groups. This is an example of doxycycline pre-exposure prophylaxis, or doxyPrEP.

The gonorrhoea finding was not surprising: around half of the French and UK strains of gonorrhoea, and around a quarter of those in the US, are resistant to tetracycline antibiotics . However, these antibiotics are not usually used in the treatment of gonorrhoea because of the high rates of resistance.

When To See A Doctor

If you have symptoms that are associated with gonorrhea, have multiple sexual partners, or have been told by a partner that you have been exposed to gonorrhea, see your doctor.

Your doctor can order lab tests to determine whether or not you have gonorrhea or another STD, and prescribe appropriate treatment.

Gonorrhea requires a medical diagnosis and must be treated in a timely manner.

Because it is a bacterial infection, it requires antibiotics. Since it is a common infection, there are some strains of gonorrhea that are becoming drug-resistant.

If your doctor prescribes antibiotics for gonorrhea, do not stop taking them until you have taken the entire courseeven if you feel betterunless instructed to by your doctor.

Stopping antibiotics before you have taken the whole course can lead to a regrowth of the infection, or can lead to the development of a drug-resistant infection.

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Diseases Characterized By Urethritis And Cervicitis

IM = intramuscularly.

Reprinted from Centers for Disease Control and Prevention. 1998 Guidelines for the treatment of sexually transmitted diseases. MMWR Morb Mortal Wkly Rep 1998 47:1111.

*Mucopurulent cervicitis should be treated according to the guidelines for chlamydial and gonococcal infections.

Estimated cost to the pharmacist based on average wholesale prices in Red book. Montvale, N.J.: Medical Economics Data, 1999. Cost to the patient will be higher, depending on prescription filling fee.

Several regimens for the management of patients with nongonococcal urethritis are outlined in Table 2. Oral azithromycin is recommended as single-dose therapy.57 Improved compliance and the ability to observe therapy are advantages associated with single-dose regimens.

Why No Mention Of The Single

The evidence basis for the change to doxycycline for treatment of chlamydia co-infection coverage is substantially weaker. It is also decidedly mute on the risks of partial or non-compliance with treatment. The question then becomes: How profound is the treatment effect and how does it balance against its risks?

The guideline states, as evidence for the doxycycline switch:

A recent investigation comparing children who received twice-yearly azithromycin with children who received placebo found that the guts resistome, a reservoir of antimicrobial resistance genes in the body, had increased determinants of macrolide and nonmacrolide resistance, including beta-lactam antibiotics, among children receiving azithromycin .3 A higher proportion of macrolide resistance in nasopharyngeal Streptococcus pneumoniae was demonstrated in communities receiving mass administration of oral azithromycin .4 Azithromycin resistance has been demonstrated in another STI, Mycoplasma genitalium, and sexually transmissible enteric pathogens 5-7. In addition, evidence supports increasing concern for the efficacy of azithromycin to treat chlamydial infections, especially rectal infections 8,9.

That really leaves the meta-analysis8 to answer our question: how best do we protect the reproductive health of our patients in the setting of diagnostic uncertainty?

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Chlamydia Antibiotics: Azithromycin Vs Doxycline

A test was conducted on data between 1975 and 2001 to find and compare the efficacy and differences between Azithromycin and Doxycycline. The patients were randomly given dosages of either Azithromycin or Doxycycline in the prescribed quantities of one 1g dosage of Azithroymycin and two dosages of 100mg twice a day for a week with no patient getting both. The tests were conducted on 1543 patients for checking the microbial efficacy of the drugs and on 1717 patients for checking any adverse effects of the drug. Cure rates of about 98% were found out for both the Chlamydia Antibiotics proving the efficacy of both as equally compelling.

However, azithromycin is more convinent as it is just 1 dose antibiotic. Overall one dosage of Azithromycin has proved to be very impactful in comparison to the multiple dosages of Doxycycline.

Signs & Symptoms

Chlamydia is known to be a silent or asymptomatic disease and about 50% of infected men and 60% of infected women dont show any signs or symptoms initially.

Women are prone to be more asymptomatic than men. This means women generally show no symptoms and act as carriers of the diseases.

However women are at greater risk from long term complications and hence it is important to get treated.

Chlamydia in Women

Chlamydia in Men

References:

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Gonorrhea / Adolescents And Adults

Ceftriaxone 500 mg* IM in a single dose for persons weighing < 150kg

If chlamydial infection has not been excluded, treat for chlamydia with doxycycline 100 mg orally 2 times/day for 7 days.

* For persons weighing 150 kg, 1 g ceftriaxone should be administered.

Gentamicin 240 mg IM in a single dose

PLUS

Azithromycin 2 g orally in a single dose

Cefixime* 800 mg orally in a single dose

* If chlamydial infection has not been excluded, providers should treat for chlamydia with doxycycline 100 mg orally 2 times/day for 7 days.

Ceftriaxone 500 mg* IM in a single dose for persons weighing < 150kg

If chlamydial infection is identified when pharyngeal gonorrhea testing is performed, treat for chlamydia with doxycycline 100 mg orally 2 times/day for 7 days.

* For persons weighing 150 kg, 1 g ceftriaxone should be administered.

Any person with pharyngeal gonorrhea should return 714 days after initial treatment for a test of cure by using either culture or NAAT however, testing at 7 days might result in an increased likelihood of false-positive tests. If the NAAT is positive, effort should be made to perform a confirmatory culture before retreatment, especially if a culture was not already collected. All positive cultures for test of cure should undergo antimicrobial susceptibility testing.

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Will I Need To Go Back To The Clinic

If you take your antibiotics correctly, you may not need to return to the clinic.

However, you will be advised to go back for another chlamydia test if:

• you had sex before you and your partner finished treatment
• you forgot to take your medication or didnt take it properly
• your symptoms dont go away

If youre under 25 years of age, you should be offered a repeat test for chlamydia 3 to 6 months after finishing your treatment because youre at a higher risk of catching it again.

Doxycycline Resistance And T Pallidum

Although serological failure, defined as a lack of 4-fold decline in rapid plasma reagin titres following therapy, was observed in patients treated with doxycycline , no resistance study that could explain treatment failure was conducted and currently a unique study concerns doxycycline resistance of T. pallidum. In this study, Xiao et al. investigated the presence of the G1058C point mutation in the 16S rRNA gene associated with decreased susceptibility to doxycycline and found no mutation among 2253 whole blood specimens sampled from Chinese patients with secondary or latent syphilis between 2013 and 2015.

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Treatments For Gonorrhea And Chlamydia

Since both STDs are caused by a bacterial infection, the treatment is a regimen of oral antibiotics.

Some strains of gonorrhea in the US have become antibiotic resistant, sometimes called super gonorrhea. Therefore, a medical physician will decide on the best course of antibiotics.

The most commonly recommended antibiotics for both chlamydia and gonorrhea are:

The infection should clear after one to two weeks.

You should never stop taking antibiotics until the recommended course is finished, even if you think the infection cleared or you are feeling better.

If you do not finish the antibiotics, the infection can come back and be resistant to the antibiotics you were taking.

Additionally, since antibiotic resistant strains of bacteria are already more common, if your symptoms continue after a few days of taking antibiotics, consult your doctor. They may switch you to a different strain of antibiotics.

Some people report home remedies for chlamydia and gonorrhea easing their symptoms, but the only effective treatment for both STDs are antibiotics.

Gonorrhea and chlamydia are curable by taking the appropriate medication as directed however, repeat infections are common.

You and your sexual partner should always be tested after three months of completing treatment, especially if you are unsure whether your partner received treatment.

Why Doctors Dont Recommend This Yet

In most instances, healthcare professionals treat STIs based either on symptoms that you present with, the results of laboratory tests, or both. As STIs dont always have symptoms , it is recommended that people who have sex that puts them at risk test frequently and treat any STIs as soon as they are detected. It is also important to make sure that recent partners are treated.

Taking antibiotics prophylactically is not recommended yet, mainly due to major concerns about the development of antimicrobial resistance. Taking a drug and then catching an infection that easily develops resistance to it could further raise rates of resistance to that drug in the wider community. Resistance means that medications that were once effective at treating certain bacterial infections lose their ability to do so. Essentially, the bacterium outsmarts the medication, rendering it ineffective.

Resistant strains circulate within the population, resulting in the failure of treatments that had previously worked even in people not using antibiotics to prevent STIs. Gonorrhoea has evaded multiple classes of antibiotics, and few options remain available. Most recently, it has become resistant to azithromycin and therefore, this antibiotic is no longer recommended for treatment.

However, when it comes to using specific antibiotics to prevent specific STIs, its not all bad news see more under What about resistance?

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Doxycycline: New Treatment Of Choice For Genital Chlamydia Infections

In the 1998 Canadian Sexually Transmitted Disease Guidelines, azithromycin replaced doxycycline as treatment of choice for chlamydia infection. Azithromycin was also listed before doxycycline for non-gonococcal urethritis , muco-purulent cervicitis and as co-treatment with cefixime for uncomplicated gonorrhea. Sexual contacts are traditionally treated with the same medication as index cases. In the 1998 and 2002 US guidelines, however, azithromycin and doxycycline were equivalent first-line treatments for these conditions . From 1998, azithromycin was provided free of charge from BCCDC for the treatment of laboratory-confirmed cases of genital chlamydia infections and their contacts.

Important research findings dictate a return to doxycycline as the treatment of choice for uncomplicated urethral, cervical, and oral chlamydia infections, for NGU and MPC, and as co-treatment for uncomplicated gonorrhea.

Efficacy

In research studies, doxycycline and azithromycin have been shown to be equivalent for the treatment of genital chlamydia infection. A meta-analysis of randomized clinical trials showed equal efficacy with no difference in adverse events.

Effectiveness

Antimicrobial resistance

Cost

A course of azithromycin costs the British Columbia health care system $18.15, whereas a course of doxycycline is $4.06. Cost should not be a factor when the more expensive medication is more effective but, in this case, the cheaper medication is equal or superior.

How Is Gonorrhea Treated

Health care providers treat gonorrhea with an antibiotic. It is given as a shot in the doctors office. It is important to get tested again 3 months after treatment to make sure the infection is cured .

All sexual partners from the past 2 months need treatment too, even if they dont have signs of gonorrhea.

If someone still has symptoms after treatment, they may need treatment with different antibiotics. Or they may have been infected with gonorrhea again.

You should not have sex again until:

• at least 7 days after you and your sexual partner take the antibiotics
• you and your sexual partner do not have signs of gonorrhea

People can get gonorrhea again if:

• Their partners arent treated.

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Doxycycline Resistance And M Genitalium

Information on antimicrobial susceptibility of M. genitalium is scarce because of the limited number of strains isolated from clinical samples. Studies reporting MICs of doxycycline usually found low MIC values, i.e. 5 strains with MICs ranging from0.008 to 0.031 mg/L and 14 strains with MICs ranging from 0.06 to 0.12 mg/L . However, an in vitro antimicrobial susceptibility testing study conducted using both broth dilution and quantitative PCR showed an MIC range of 0.0631 mg/L indicating that the strains displayed reduced susceptibility to doxycycline but that these isolates remained rare. Finally, a recent larger study showed that 2 isolates out of 103 displayed MIC> 8 mg/L while for other isolates, MICs ranged from< 0.125 to 2 mg/L. However, doxycycline MICs did not correlate with treatment outcomes in this study. As far as molecular detection of mutations mediating resistance is concerned, macrolides and fluoroquinolones were mainly studied and to our knowledge, tetracycline resistance-associated mutations have not so far been identified in M. genitalium. Altogether, MICs mostly indicated susceptibility of M. genitalium to doxycycline and the rare isolates with reduced susceptibility cannot explain the poor efficacy of doxycycline in the treatment of M. genitalium infections., Considering the emergence of MDR M. genitalium strains, it thus appears important to elucidate reasons other than poor patient compliancefor the poor efficacy of doxycycline.