Chlamydia is a common bacterial infection transmitted through sexual contact, often without noticeable symptoms. If this infection is present during gestation, prompt medical intervention is necessary. Chlamydia can be safely and effectively treated while pregnant using highly effective antibiotic options. Treatment is a routine part of prenatal care, ensuring the healthiest possible outcome for both the mother and the developing fetus.
Why Treatment During Pregnancy is Essential
Leaving a Chlamydia trachomatis infection untreated during pregnancy carries serious risks for both the mother and the newborn. The infection increases the likelihood of maternal complications, such as postpartum endometritis (infection of the uterine lining after childbirth). Untreated chlamydia also increases the risk of premature rupture of membranes and preterm labor or delivery, potentially leading to low birth weight.
Transmission to the baby during a vaginal birth is a primary concern. Up to 50% of infants born to mothers with untreated chlamydia may contract the infection. This perinatal transmission can result in neonatal conjunctivitis (ophthalmia neonatorum), an eye infection developing five to twelve days after birth.
Another risk is chlamydial pneumonia, a lung infection that may develop several weeks after delivery. Prompt prenatal treatment is the best method to prevent these severe complications in the infant.
Medications Safe for Expectant Mothers
The primary goal of treatment is to use an antibiotic with a proven safety profile for the fetus while achieving a high rate of cure. Current guidelines from the Centers for Disease Control and Prevention (CDC) recommend Azithromycin as the first-line therapy during pregnancy. It is administered as a single, one-gram oral dose, which promotes high compliance.
An alternative regimen for patients who cannot tolerate Azithromycin is Amoxicillin, taken as 500 milligrams orally three times a day for seven days. Although effective, this regimen requires adherence to multiple doses over a week. Erythromycin is sometimes used as a second alternative, but it is less preferred due to lower efficacy and higher rates of gastrointestinal side effects.
Several common chlamydia treatments must be avoided during gestation due to potential fetal harm. Doxycycline, the standard non-pregnancy treatment, is contraindicated during the second and third trimesters because it can cause permanent tooth discoloration. Fluoroquinolone antibiotics, such as Ofloxacin and Levofloxacin, are also contraindicated due to a potential risk for cartilage damage in the neonate.
All dosage instructions provided by a healthcare provider must be followed precisely to ensure the infection is fully eradicated. Adhering to the prescribed schedule is important for a successful cure. Pregnant individuals should never attempt to treat the infection using over-the-counter medications or by adjusting the dosage of a prescribed antibiotic.
Post-Treatment Testing and Preventing Reinfection
After completing the antibiotic course, a “test of cure” (TOC) is required to confirm the infection is gone. This is important for pregnant women because persistent infection can lead to severe maternal and neonatal outcomes. The TOC is typically performed using a nucleic acid amplification test (NAAT) approximately three to four weeks after treatment completion.
Testing before the three-week mark can yield a false positive result by detecting non-viable fragments of dead bacteria, potentially leading to unnecessary retreatment. If the TOC is positive, a second course of antibiotics, often using a different regimen like Amoxicillin, is typically prescribed.
Preventing reinfection is essential following initial treatment. All sexual partners from the previous 60 days must be evaluated, tested, and treated simultaneously to prevent the infection from cycling back. Patients should abstain from sexual intercourse for seven days following treatment, or until all partners have also been treated.
All pregnant women treated for chlamydia should be rescreened for reinfection three months after their initial treatment. This second test is necessary because high reinfection rates significantly elevate the risk for complications. Individuals who remain at a high risk for acquiring the infection may also be retested during the third trimester.