Chlamydia is a common bacterial sexually transmitted infection (STI) caused by the organism Chlamydia trachomatis. It is one of the most frequently reported bacterial STIs globally and is curable with antibiotic medication. Since infection often presents without noticeable symptoms, it can lead to serious complications like pelvic inflammatory disease or infertility if left untreated. Seeking professional diagnosis and treatment is important for personal health and preventing further transmission. This article offers general information on treatment, but you must consult a healthcare provider for diagnosis and a prescription.
Standard Medication Regimens
The treatment for uncomplicated Chlamydia infection relies on specific oral antibiotics designed to eradicate the Chlamydia trachomatis bacteria. The current preferred first-line medication is Doxycycline, which is highly effective against the bacteria at various infection sites. The standard regimen involves taking a 100 mg dose twice a day for a full seven days to ensure complete bacterial clearance. This extended duration provides superior efficacy, especially for infections occurring in the rectum or pharynx.
Azithromycin is a commonly used antibiotic, typically considered an alternative or second-line option for uncomplicated genital infections. It is administered as a single, 1-gram oral dose, making it useful when a healthcare provider is concerned about adherence to the seven-day Doxycycline regimen. However, Azithromycin has a lower success rate compared to Doxycycline for rectal infections.
Doxycycline is contraindicated for pregnant individuals. In these cases, Azithromycin 1 gram as a single dose is the recommended treatment, or Amoxicillin 500 mg taken three times a day for seven days may be used as an alternative. The choice of antibiotic is based on the infection site, adherence potential, and individual patient circumstances.
Treatment Efficacy and Follow-Up Testing
A successful cure is defined as the complete eradication of the Chlamydia trachomatis organism from the body. To achieve this, patients must take all prescribed antibiotic pills exactly as directed by the healthcare provider, without stopping early. Missing doses or failing to complete the entire course can lead to treatment failure and potentially contribute to antibiotic resistance.
For most individuals treated with Doxycycline or Azithromycin, a routine “Test of Cure” (TOC)—a repeat test to confirm the infection is gone—is not typically recommended. This is because the tests used (NAATs) can sometimes detect fragments of dead bacteria for several weeks, leading to a false positive result. However, a TOC is specifically recommended for pregnant individuals four weeks after treatment due to the potential for lower cure rates and the severe consequences of persistent infection.
The most important follow-up step for all treated individuals is re-screening for reinfection approximately three months after treatment completion. Reinfection rates are notably high, and this retest is necessary regardless of whether the patient believes their sexual partners were treated. This re-screening period is designed to detect a new infection rather than a failure of the initial treatment.
Preventing Reinfection After Treatment
Successfully treating the individual patient is only one part of the strategy to eliminate the infection and prevent its recurrence. A crucial step is ensuring that all recent sexual partners are evaluated, tested, and presumptively treated, even if they show no symptoms. This process is often facilitated by “Expedited Partner Therapy” (EPT), where the patient is given medication or a prescription to deliver to their partner(s) without a prior medical examination.
To avoid immediate reinfection, abstinence from all forms of sexual activity—oral, anal, and vaginal—is required. The patient must abstain for seven days after completing a multi-day regimen like Doxycycline, or seven days following a single-dose treatment with Azithromycin. Abstinence should continue until all sexual partners have completed their full course of treatment and the patient’s symptoms, if any, have resolved.
Treating all partners from the 60 days preceding the patient’s diagnosis is the standard approach to minimize the risk of immediate reinfection. Failure to treat a partner is the biggest risk factor for recurrent Chlamydia infection in women, which increases their risk for long-term reproductive complications. Partner treatment, whether through EPT or a clinical visit, is an integral part of the overall treatment plan.