How Is Chlamydia Treated
The following are the recommended treatment regimens for chlamydia according to the Guidelines for Sexually Transmitted Diseases, released in 2015, but still considered current. Only one regimen should be chosen.
- Azithromycin 1 gram orally as a single dose
- OR
- Ofloxacin 300 mg orally twice a day for 7 days.
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 didn’t take it properly
- your symptoms don’t go away
- you’re pregnant
If you’re under 25 years of age, you should be offered a repeat test for chlamydia 3 to 6 months after finishing your treatment because you’re at a higher risk of catching it again.
Doxycycline More Effective Than Azithromycin For Chlamydia
Trial finds doxycycline slightly more effective, but researchers not entirely convinced of its superiority.
Clinical research
National Cancer Institute / Science Photo Library
Standard treatment for chlamydia is a single dose of azithromycin or a weeks course of doxycycline twice daily. However, evidence suggests that azithromycin may not be as effective as doxycycline.
To establish efficacy, US researchers randomly assigned adolescents with urogenital Chlamydia trachomatis infection to azithromycin or doxycycline . The participants were residents at youth correctional facilities, which made the chances of reinfection low, say the researchers.
The efficacy of doxycycline was 100%, compared with 97% for azithromycin. The results meant that azithromycin was not deemed as clinically effective as doxycycline.
However, writing in TheNew England Journal of Medicine , the researchers say that the exceptional efficacy of doxycycline may be offset by poorer adherence to the week-long regimen in real-world settings.
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Chlamydial Infection Among Adolescents And Adults
Chlamydial infection is the most frequently reported bacterial infectious disease in the United States, and prevalence is highest among persons aged 24 years . Multiple sequelae can result from C. trachomatis infection among women, the most serious of which include PID, ectopic pregnancy, and infertility. Certain women who receive a diagnosis of uncomplicated cervical infection already have subclinical upper genital tract infection.
Asymptomatic infection is common among both men and women. To detect chlamydial infection, health care providers frequently rely on screening tests. Annual screening of all sexually active women aged < 25 years is recommended, as is screening of older women at increased risk for infection . In a community-based cohort of female college students, incident chlamydial infection was also associated with BV and high-risk HPV infection . Although chlamydia incidence might be higher among certain women aged 25 years in certain communities, overall, the largest proportion of infection is among women aged < 25 years .
What Is The Dosage Of Azithromycin For Chlamydia
The recommended dosage of azithromycin for chlamydia is 1 gram as a single dose. This dose may be taken morning or night and can be taken with or without food. Another name for azithromycin is Zithromax.
If you have taken your dose of azithromycin on an empty stomach and your stomach has become a bit upset or you feel sick, it is Ok to eat some food, which may help to settle it.
A 500mg dose of azithromycin is not recommended by guidelines to cure chlamydia. There is also a chance it may increase the risk of C. trachomatis bacteria becoming resistant to it. If you have only taken or only been prescribed a 500mg dose of azithromycin, you need to return to your doctor to get a 1 gram dose prescribed. You should never share your dose of azithromycin with another person.
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Doxycycline Trumps Azithromycin For Asymptomatic Rectal Chlamydia In Men Who Have Sex With Men
Judy Stone, MD
A 1-week course of doxycycline is more effective than single-dose azithromycin to treat rectal chlamydia in men who have sex with men , according to newly published results in the New England Journal of Medicine.
Chlamydia is the most commonly reported bacterial sexually transmitted infection in the United States, with 4 million cases reported in 2018, and 127 million globally. Most infections are asymptomatic.
Rates of rectal chlamydia among MSM screened for infection range from 3% to 10.5%.
The most recent Centers for Disease Control and Prevention chlamydia guidelines recommend either a single dose of azithromycin or doxycycline 100 mg twice daily for 7 days. These 2015 guidelines were based on a meta-analysis of urogenital chlamydia infections, which showed comparable efficacy of 97% or 98%, respectively.
Dr Jane S. Hocking
Study coauthor Jane S. Hocking, PhD, head of the Sexual Health Unit at the University of Melbourne’s School of Population and Global Health in Australia, told Medscape Medical News that “observational studies had suggested that azithromycin was about 20% less effective than doxycycline,” prompting this clinical trial.
The study, conducted at five sexual health clinics in Australia, was a double-blind, randomized, controlled trial of doxycycline or azithromycin .
Because 85% of infected men are asymptomatic, the study’s primary outcome was a negative nucleic acid amplification test at 4 weeks, confirming a microbiologic cure.
How Is Chlamydia Diagnosed
Chlamydia can be diagnosed with either a first-catch urine test or a swab collected from the endocervix or vagina in women, or a first-catch urine test or a swab collected from the urethra in men.
Self-collected vaginal swab testing is available and many women find this screening strategy highly acceptable.
- Geisler WM, Uniyal A, Lee JY, et al. Azithromycin versus Doxycycline for Urogenital Chlamydia trachomatis Infection. N Engl J Med. 2015 373:2512-2521. doi:10.1056/NEJMoa1502599
- Workowski, K, Bolan G. U.S. Department of Health and Human Services. Sexually Transmitted Diseases Treatment Guidelines, 2015. Morbidity and Mortality Weekly Report.
- WHO Guidelines for the Treatment of Chlamydia trachomatis. Geneva: World Health Organization 2016. 4, RECOMMENDATIONS FOR TREATMENT OF CHLAMYDIAL INFECTIONS. Available from:
- Chlamydia Treatment and Care. Centers for Disease Control and Prevention https://www.cdc.gov/std/chlamydia/treatment.htm
- Chlamydia Treatment Information Sheet. Wisconsin Department of Health Services.
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Is Azithromycin Better Than Doxycycline At Curing Chlamydia
STD guidelines still favor azithromycin over doxycycline for the treatment of chlamydia. This is because of the following reasons:
- Cure rates of azithromycin and doxycycline are similar, 97% and 98-100% respectively, according to a meta-analysis of 12 trials.
- Azithromycin is given as a single dose, doxycycline needs to be given for seven days, either as a once-daily or twice-daily dose.
- The dose of azithromycin can be easily supervised if need be it is much harder to supervise seven days of once daily or twice daily doxycycline treatment
- People are more likely to take a single dose of azithromycin than finish a seven-day course of doxycycline.
Recently, some reports have suggested that doxycycline may be more effective than azithromycin, particularly when medication adherence can be assured. There is also some concern that azithromycin may not be as effective for anogenital chlamydial infections.
Antibiotics For Treating Genital Chlamydia Trachomatis Infection In Men And Non
Review question
This systematic review assessed the effectiveness and safety of antibiotic treatment for Chlamydia trachomatis genital infection in terms of microbiological or clinical failure in men and non-pregnant women.
Background
CT is the most frequent cause of urinary tract and genital infections in women and men. However, women frequently show no symptoms when they are infected. CT infection can lead to complications or cause further problems in reproductive health in women , and men , or chronic pelvic pain. Clinical guidelines for treating CT do not recommend a preferred antibiotic treatment. This Cochrane review evaluates all randomised controlled studies , that included antibiotics for the treatment of genital CT infection that are recommended by the most up-to-date clinical guidelines.
Search date
We searched for studies published up to June 2018 that provided information about failure to eliminate the CT infection or improve the symptoms, presence of adverse events, antimicrobial resistance, and reinfection. as treatment outcomes
Study characteristics
Study funding sources
One study reported funding from academic grants, another four studies declared having received sponsorship or grants from pharmaceutical companies. The other studies declared that they were self-funded or did not mention funding at all.
Key results
Quality of evidence
To assess the efficacy and safety of antibiotic treatment for CT genital infection in men and non-pregnant women.
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Diagnosis And Treatment Of Chlamydia Trachomatis Infection
KARL E. MILLER, M.D., University of Tennessee College of Medicine, Chattanooga, Tennessee
Am Fam Physician. 2006 Apr 15 73:1411-1416.
Chlamydia trachomatis infection most commonly affects the urogenital tract. In men, the infection usually is symptomatic, with dysuria and a discharge from the penis. Untreated chlamydial infection in men can spread to the epididymis. Most women with chlamydial infection have minimal or no symptoms, but some develop pelvic inflammatory disease. Chlamydial infection in newborns can cause ophthalmia neonatorum. Chlamydial pneumonia can occur at one to three months of age, manifesting as a protracted onset of staccato cough, usually without wheezing or fever. Treatment options for uncomplicated urogenital infections include a single 1-g dose of azithromycin orally, or doxycycline at a dosage of 100 mg orally twice per day for seven days. The recommended treatment during pregnancy is erythromycin base or amoxicillin. The Centers for Disease Control and Prevention and the U.S. Preventive Services Task Force recommend screening for chlamydial infection in women at increased risk of infection and in all women younger than 25 years.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Azithromycin or doxycycline is recommended for the treatment of uncomplicated genitourinary chlamydial infection.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Azithromycin or doxycycline is recommended for the treatment of uncomplicated genitourinary chlamydial infection.
What Is Doxycycline What Is Azithromycin
Doxycycline is a tetracycline antibiotic used to treat many different types of infections, including respiratory tract infections due to Hemophilus influenzae, Streptococcus pneumoniae, or Mycoplasma pneumoniae. It is used also in the treatment of syphilis, acne, periodontal disease, non-gonococcal urethritis , Rocky Mountain spotted fever, typhus, chancroid, cholera, brucellosis, and anthrax.
Azithromycin is a macrolide antibiotic related to erythromycin and clarithromycin used to treat bacterial infections such as otitis media , tonsillitis, laryngitis, bronchitis, pneumonia, sinusitis, uncomplicated skin and skin structure infections, Mycobacterium avium complex, acute bacterial flare ups of chronic obstructive pulmonary disease , acute pelvic inflammatory disease, and several sexually transmitted infectious diseases such as non-gonococcal urethritis and cervicitis.
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Are Azithromycin And Doxycycline Safe To Use While Pregnant Or Breastfeeding
Doxycycline
- Tetracycline antibiotics, such as doxycycline, can have toxic effects on development of bone in the fetus. Therefore, tetracyclines are not recommended during pregnancy unless there is no other appropriate antibiotic.
- Doxycycline is secreted into breast milk but the extent of absorption by the breastfed infant is not known. Since tetracyclines can cause toxic effects on bone, the use of tetracyclines in nursing mothers is of concern. The physician must decide whether to recommend that a nursing mother discontinue nursing during treatment with tetracyclines or change to a different antibiotic.
Azithromycin
- There are no adequate studies of azithromycin in pregnant women. Azithromycin should only be used during pregnancy if it is clearly necessary.
- It is not known if azithromycin is secreted in breast milk.
When Can I Have Sex Again
If you had doxycycline, you shouldn’t have sex including vaginal, oral or anal sex, even with a condom until both you and your partner have completed treatment.
If you had azithromycin, you should wait 7 days after treatment before having sex .
This will help ensure you don’t pass on the infection or catch it again straight away.
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Chlamydial Infection Among Neonates
Prenatal screening and treatment of pregnant women is the best method for preventing chlamydial infection among neonates. C. trachomatis infection of neonates results from perinatal exposure to the mothers infected cervix. Initial C. trachomatis neonatal infection involves the mucous membranes of the eye, oropharynx, urogenital tract, and rectum, although infection might be asymptomatic in these locations. Instead, C. trachomatis infection among neonates is most frequently recognized by conjunctivitis that develops 512 days after birth. C. trachomatis also can cause a subacute, afebrile pneumonia with onset at ages 13 months. Although C. trachomatis has been the most frequent identifiable infectious cause of ophthalmia neonatorum, neonatal chlamydial infections, including ophthalmia and pneumonia, have occurred less frequently since institution of widespread prenatal screening and treatment of pregnant women. Neonates born to mothers at high risk for chlamydial infection, with untreated chlamydia, or with no or unconfirmed prenatal care, are at high risk for infection. However, presumptive treatment of the neonate is not indicated because the efficacy of such treatment is unknown. Infants should be monitored to ensure prompt and age-appropriate treatment if symptoms develop. Processes should be in place to ensure communication between physicians and others caring for the mother and the newborn to ensure thorough monitoring of the newborn after birth.
Doxycycline Barely Beats Azithromycin For Chlamydia
Tara Haelle
Azithromycin is less effective than doxycycline in treating chlamydia when treatment compliance is high, according to a randomized trial in the December 24 issue of the New England Journal of Medicine. With an efficacy of 97%, azithromycin failed to meet the standard of noninferiority compared with doxycycline, with an efficacy of 100%.
“It is unclear why all the treatment failures in our study occurred in azithromycin-treated participants,” write William M. Geisler, MD, MPH, from the University of Alabama at Birmingham Department of Medicine, and colleagues. They propose that resistance to the drug is an unlikely possibility, but that some patients did not have sufficient levels of azithromycin to eradicate chlamydia. “Even with sufficient levels, it is possible that some organisms are not eradicated in acute infection,” as a previous in vitro study suggested, they write.
Yet the use of a “unique adolescent population in correctional facilities” calls the current study’s generalizability into question, write Thomas C. Quinn, MD, and Charlotte A. Gaydos, DrPH, both from the Johns Hopkins University School of Medicine in Baltimore, Maryland, in an accompanying editorial.
Although two previous studies suggest anywhere from 3% to 28% of individuals miss at least one dose of doxycycline when taking it for chlamydia, another study suggested adherence is over-reported.
N Engl J Med. 2015 373:2512-2521, 2573-2575. Article abstract, Editorial extract/
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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?
Doxycycline Trumps Azithromycin For Asymptomatic Rectal Chlamydia
A 1-week course of doxycycline is more effective than single-dose azithromycin to treat rectal chlamydia in men who have sex with men , according to newly published results in the New England Journal of Medicine.
Chlamydia is the most commonly reported bacterial sexually transmitted infection in the United States, with 4 million cases reported in 2018, and 127 million globally. Most infections are asymptomatic.
Rates of rectal chlamydia among MSM screened for infection range from 3% to 10.5%.
The most recent Centers for Disease Control and Prevention chlamydia guidelines recommend either a single dose of azithromycin or doxycycline 100 mg twice daily for 7 days. These 2015 guidelines were based on a meta-analysis of urogenital chlamydia infections, which showed comparable efficacy of 97% or 98%, respectively.
Study coauthor Jane S. Hocking, PhD, head of the Sexual Health Unit at the University of Melbournes School of Population and Global Health in Australia, told Medscape Medical News that observational studies had suggested that azithromycin was about 20% less effective than doxycycline, prompting this clinical trial.
The study, conducted at five sexual health clinics in Australia, was a double-blind, randomized, controlled trial of doxycycline or azithromycin .
Because 85% of infected men are asymptomatic, the studys primary outcome was a negative nucleic acid amplification test at 4 weeks, confirming a microbiologic cure.
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Does Azithromycin Cure Chlamydia
Cure rates of 97% were reported in an analysis of 12 randomized clinical trials that investigated the use of azithromycin 1 gram for the treatment of chlamydia. That means for every 100 people with chlamydia who take azithromycin, 97 will be cured and 3 will not be cured.
This relies on the person with chlamydia taking azithromycin exactly as directed and not sharing the medication with anyone. Any sexual partners must be also treated.
Although azithromycin cures chlamydia in most people, it will not repair any permanent damage done to tissues by the disease.
If you have been symptomatic with chlamydia before treatment and your symptoms continue for more than a few days after receiving treatment, then ask to be re-evaluated by your health care provider.
Unfortunately, repeat infection with chlamydia is common. This means that even though azithromycin has cured your current infection with chlamydia, this does not mean you will not get chlamydia again. If your sexual partners have not been appropriately treated, you are at high-risk for reinfection. Having chlamydia multiple times puts women at high risk of fertility problems, ectopic pregnancy, and pelvic inflammatory disease. Infants born to mothers who are infected with chlamydia may develop chlamydial conjunctivitis and/or pneumonia. Chlamydial infection in infants can be treated with antibiotics.