Chlamydia

These materials are intended for general clinical education and guidance. They are not a substitute for a clinician’s knowledge, skill or judgment in treating patients.

Preferred treatments

• Doxycycline 100 mg PO bid for seven days
• If lymphogranuloma venereum (LGV) is present: Doxycycline 100 mg PO bid for 21 days

Alternative treatments

• Azithromycin 1 g PO in a single dose

Doxycycline is preferred due to higher microbiological cure rates in males and females with rectal chlamydia. Concurrent rectal C. trachomatis infection is common and often asymptomatic, even when there is no direct rectal contact, and it can spread to urogenital sites.

Treatments in pregnancy

• Preferred: Azithromycin 1 g PO in a single dose
• Alternative: Amoxicillin 500 mg PO tid for 7 days

Follow-up recommendations

• A test of cure is recommended if the patient is pregnant, there is suspected treatment failure or the course of antibiotics was incomplete
• NAAT should be performed at least four weeks after treatment if a test of cure is indicated
• Testing earlier than four weeks may lead to false-positive results due to residual genetic material but no active infection
• Re-screen all cases three months after treatment

Testing and treatment of sexual contacts

All partners who have had sexual contact with the index case in the past 60 days should be notified, tested and empirically treated. In addition to counselling the patient, notify your local public health authority (Toronto Public Health STI Program: 416-338-2373). Expedited partner therapy may be considered for contacts who are difficult to reach.

Testing at rectal and/or pharyngeal sites is recommended in MSM, people engaged in sex work, sexual contacts of a person with chlamydia, or as determined by risk assessment and symptoms. NAAT is the preferred specimen type.