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It’s not every day that you come across good news on a medical website, but today is that day. Chlamydia is treatable. Not only is it treatable—it’s easily treatable! In many cases, all it takes is a single dose of an antibiotic, and you’re chlamydia-free.
- If you have symptoms consistent with a chlamydial infection or a sexual partner has told you that they tested positive for chlamydia, you will receive treatment even before your test results come back. This is called presumptive or empiric therapy.
- This presumptive approach reduces the amount of time you may continue to spread the infection to others and is given because the medication is well-tolerated and inexpensive.
- First-line treatment for chlamydia is one of two antibiotics: azithromycin (brand name Zithromax) or doxycycline (brand name Vibramycin).
- Specific diseases caused by chlamydia require different durations of treatment.
Now, this isn’t the case for everybody. Some people may need different kinds of antibiotics for varying lengths of time—it all depends on the type of chlamydia that is infecting you, how extensive the infection is, and if the chlamydia has developed any sort of resistance to antibiotics. We’ll dive into all this in a moment but first, a quick refresher on what chlamydia is.
Chlamydia is a sexually transmitted infection (STI) caused by the bacteria Chlamydia trachomatis. According to the Centers for Disease Control and Prevention (CDC), it is the most common reportable bacterial infection in the United States, with approximately 1.7 million cases reported in 2017.
Chlamydia is spread through sexual contact, including contact with the anus, mouth, penis, or vagina of an infected person. Chlamydia most commonly infects the urethra or the cervix, but may also be found in the throat or rectum. It can also spread to the prostate, epididymis (coils of tubes behind the testicles), uterus, fallopian tubes, and ovaries, and it can cause pelvic inflammatory disease (PID) and other complications like infertility and increased risk of ectopic pregnancy in women.
Additionally, certain subtypes or serovars of chlamydia can cause the disease lymphogranuloma venereum (LGV), which is an infection of the lymphatic system. The same serovars may also infect the rectum and can cause serious complications, particularly in men who have sex with men (MSM). While the classic symptoms of chlamydia are burning with urination and vaginal or urethral discharge, chlamydia is asymptomatic in the majority of cases. This means that the best way to find out whether you have chlamydia is through screening, which simply involves collecting samples at your healthcare provider’s office.
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How is chlamydia treated?
There are three situations in which you may find yourself getting treated for chlamydia. These are:
- You have symptoms consistent with a chlamydial infection
- A sexual partner has contacted you and let you know that they tested positive for chlamydia
- You were screened for STIs and found out you have chlamydia, even though you may or may not be experiencing any symptoms
In these first two situations, treatment for chlamydia is often presumptive, or what is called empiric therapy. This means that you will receive treatment even before your test results come back. This is beneficial because it treats you sooner, reduces the need for you to return to your healthcare provider for an extra visit. It also reduces the amount of time you may continue to spread the infection to others.
Additionally, the treatment for chlamydia is generally well-tolerated and low-cost (or even free in some places), so the downsides of presumptive treatment are minimized. When you are treated presumptively for chlamydia, you may also be treated for gonorrhea, which frequently infects individuals along with chlamydia. This treatment for gonorrhea includes a one-time injection of an antibiotic called ceftriaxone (brand name Rocephin). Treatment for gonorrhea always includes azithromycin, even if chlamydia comes back negative.
First-line treatment for chlamydia is one of two antibiotics: azithromycin (brand name Zithromax) or doxycycline (brand name Vibramycin). If azithromycin is used, treatment is a one-time dose of 1 g. If doxycycline is used, treatment is seven days of 100 mg taken twice daily.
Alternative antibiotic options include two fluoroquinolone antibiotics called levofloxacin (brand name Levaquin) or ofloxacin (brand name Floxin) (Hsu, 2020). Dosing for levofloxacin is 500 mg once daily for seven days. Dosing for ofloxacin is 300 mg twice daily for seven days. However, these therapies may be more expensive and should only be used in certain patient populations.
Specific diseases caused by chlamydia require different durations of treatment.
- If an individual has epididymitis, doxycycline should instead be given for ten days.
- If an individual has LGV, doxycycline should be given for 21 days.
- If an individual has PID, doxycycline should be given for 14 days.
Other kinds of bacteria may cause PID, may be severe, and may require hospitalization. For this reason, various other antibiotics may be included as part of treatment, including metronidazole (brand name Flagyl) and ceftriaxone.
In modern times, there has been concern regarding the emergence of drug resistance or antibiotic resistance amongst certain bacteria. In particular, super drug-resistant gonorrhea, sometimes called “super gonorrhea,” has been capturing headlines. While strains of drug-resistant chlamydia have begun emerging in parts of the world, at this time it is still recommended that azithromycin or doxycycline are used as treatment.
Of note, patients who are HIV positive (positive for human immunodeficiency virus) should receive the same treatment as patients who are not HIV positive.
How is chlamydia treated in pregnant women?
Doxycycline, levofloxacin, and ofloxacin are all contraindicated in pregnant women and women who are lactating. Because of this, the recommended treatment is a one-time dose of azithromycin.
If azithromycin is not well-tolerated, alternative treatments include amoxicillin (brand name Amoxil) or one of several formulations of erythromycin.
Pregnant women who have been treated for chlamydia should return in three weeks to be retested to establish that they have been cured. They should also return in three months to evaluate for reinfection. Untreated chlamydia in pregnant women can lead to early rupture of the fluid sac containing the fetus and premature delivery. It can also lead to pneumonia or conjunctivitis (an eye infection) in the newborn.
What is reinfection with chlamydia? How can it be prevented?
Reinfection refers to a situation in which somebody has been treated for chlamydia, but they acquire chlamydia again in the future. It is recommended that patients return for testing after three months to see if they have been reinfected. In patients who have persistent symptoms or who were treated with an inferior antibiotic (such as amoxicillin or erythromycin), repeat testing should be done after three weeks to ensure the bacteria has been eradicated and that they have been cured.
Reinfection frequently occurs because of continued contact with an untreated sexual partner. Reinfection is not uncommon; in fact, 15-30% of women become reinfected with chlamydia. One way to avoid reinfection is to avoid having sex within seven days after starting antibiotic treatment. This will both help prevent the further spread of chlamydia and will reduce the risk that somebody will get chlamydia who could pass it back to you again. Another way to avoid reinfection is to make sure all of your sexual partners within 60 days are made aware that they might have chlamydia. This should prompt them to be tested and treated as well. In some areas of the country, public health workers may be available to assist in notifying sexual partners.
One practice that is intended to help treat sexual partners is called expedited partner therapy (EPT) or patient-delivered partner therapy (PDT or PDPT). This practice goes beyond just notifying partners that they might have chlamydia. With EPT, antibiotic treatment for a sexual partner is given to a patient or is directly called into a pharmacy for the partner, without a healthcare provider ever examining the partner. For example, if you are diagnosed with chlamydia, you may be given an extra dose of azithromycin to take home and give to your sexual partner, without your sexual partner ever needing to go to a healthcare provider. This is intended to increase treatment amongst sexual partners, decrease the rates of reinfection, and reduce the overall burden of disease in society.
What are the complications of untreated chlamydia?
If left untreated, chlamydia can lead to several complications in men and women. In men, chlamydia can infect the prostate and the epididymis, leading to pain. It can also be a cause of urethral strictures (narrowing of the urethra), can lead to issues in the rectum (such as narrowing or abnormal connections), and can trigger an immune response known as reactive arthritis or Reiter’s syndrome. In women, untreated chlamydia can spread to the reproductive organs causing PID, which can lead to infertility and increased risk of ectopic pregnancy. It can also spread to the lining of the liver, causing perihepatitis (also called Fitz-Hugh-Curtis syndrome) and adhesions and scarring around the organs in the abdomen.