How Chlamydia Is Treated

Chlamydia is a sexually transmitted infection (STI) that must be treated with prescription antibiotics. When used properly, antibiotics can cure the disease and prevent further complications. Treatment, however, does not prevent infections in the future, and reinfection is common. There are both recommended and alternative antibiotic regimens, with specific recommendations for women who are or may be pregnant.

Over-the-Counter Therapies

Over-the-counter therapies are not effective against chlamydia and should not be used. Vaginal douching should be avoided as there is a risk that it could push the bacteria higher up in the female genital tract, increasing the risk of pelvic inflammatory disease (PID) and complications associated with it, such as infertility and chronic pelvic pain.

If you find chlamydia-related discharge bothersome, keep in mind that it will clear up rapidly with prescription treatment. Over-the-counter remedies will not help and could make you more uncomfortable.

Prescriptions (Non-Pregnant Adults)

A doctor may prescribe one of the two recommended treatments for non-pregnant adults who are not allergic to these medications:

  • Zithromax (azithromycin)—1 gram orally in a single dose
  • Vibramycin/Doryx (doxycycline)—100 mg orally twice a day for seven days

Both are considered to be equally effective for genital chlamydia infections, and there doesn't appear to be any significant resistance of chlamydia to either option. Proctitis (rectal chlamydia) may, however, respond better to doxycycline than azithromycin. Severe cases of proctitis are often treated as lymphogranuloma venereum (see below).

Alternatives are available, though they may not be as effective or may cause more side effects. These drugs should only be used by those who are allergic to or have had an adverse reaction to recommended antibiotics.

Alternative treatments for non-pregnant adults include:

  • EryC (erythromycin base)— 500 mg four times daily for seven days
  • E.E.S./EryPed (erythromycin ethylsuccinate)—800 mg four times a day for seven days
  • Levaquin (levofloxacin)—500 mg once daily for seven days
  • Floxin (ofloxacin)—300 mg twice a day for seven days

Erythromycin appears to be somewhat less effective than the other choices, but this is likely due to nausea and vomiting caused by the antibiotic (which causes people to skip doses) rather than lack of effectiveness.

When weighing your options, consider that:

  • Some people find the one-time dose of Zithromax to be the easiest choice. You may especially want to consider it if you tend to forget to take medication.
  • Prices of these drugs vary. Of the alternative treatments, for example, Floxin (ofloxacin) is usually the most expensive. 

For those who are not pregnant, no specific follow-up after treatment is recommended. If you continue to have any symptoms, however, you should see your doctor.

Prescriptions (Pregnant Women)

The recommended treatments for pregnant women differ from those above. If you are pregnant, you should not take doxycycline, ofloxacin, or levofloxacin. Doxycycline, for example, may affect bone development in the fetus and cause discoloration of teeth.

Zithromax (azithromycin), a 1-gram single, oral dose, is the only recommended treatment unless you are allergic to the medication or have experienced an adverse reaction after taking it. It is both safe and effective in pregnant women.

Alternative treatments should only be used by pregnant women who have an allergy or who have had an adverse reaction to Zithromax. Options include:

  • Amoxycillin—500 mg three times daily for seven days
  • EryC (erythromycin base)—500 mg daily four times daily for seven days
  • EryC (erythromycin base)—250 mg four times daily for 14 days
  • E.E.S./EryPed (erythromycin ethylsuccinate)—800 mg four times daily for seven days
  • E.E.S./EryPed (erythromycin ethylsuccinate)—400 mg four times daily for 14 days

A  2017 review of studies found similar cure rates among these options. Zithromax, however, appeared to cause fewer side effects than the erythromycin compounds. Nausea and vomiting due to erythromycin are common and may be exacerbated further by morning sickness during the first trimester.

Sexual Partner Considerations

When you are being treated for chlamydia, it is extremely important that your sexual partners (anyone you have had sex with during the 60-day period preceding your diagnosis) are treated as well. If they are not, you could end up passing the infection back and forth between you.

Do not share your antibiotic. Aside from the fact that it may not be recommended for your partner, your infection won't be eradicated without your full prescription.

You should also abstain from sex for seven days after the start of your treatment or until you have finished it. That will help keep you from infecting your sexual partners.

Even if you've finished your antibiotics, follow up with your doctor if your symptoms persist and continue to abstain from sex until she has examined you. If abstaining is not possible, make certain to use condoms for all sexual encounters, including oral sex.

Treatment of Complications

The complications of chlamydia often arise from an ongoing untreated infection, so the treatments mentioned above are of utmost importance. When complications occur, the chlamydia infection is treated with the same antibiotics mentioned above, but further treatments may be required as well.

Pelvic inflammatory disease (PID) that is mild may be treated just as an uncomplicated genital infection, but severe cases could require hospitalization and intravenous antibiotics. As it can also be difficult to tell whether the infection is caused by more than one microorganism, two antibiotics (and sometimes more) may be needed. PID may result in an abscess (a collection of pus which is walled off by the body), which may require drainage.

Treatments such as surgery to remove scar tissue may be needed for those who are facing infertility as the result of an infection. Since ectopic pregnancy is more common in women with PID, careful monitoring and treatment of tubal pregnancies, if they occur, is critical.

Chronic pelvic pain related to chlamydial infections in either women or men is difficult to treat, and it often requires a combination of modalities.

Newborns and Children

Chlamydia infection in newborns and children is far less common that infection in adults.

If a child is found to be infected with chlamydia, the first step (other than stabilizing the child) is to determine if the infection was transmitted during delivery or contracted afterward.

Newborns who develop eye infections or pneumonia (after contracting chlamydia from a mother with untreated chlamydia during a vaginal birth) require treatment with prescription antibiotics. With pneumonia, intravenous antibiotics are often needed.

Older children (mid-teens and up) should be treated as adults, but younger children, especially those who are prepubescent, should be evaluated by a physician skilled in evaluating STDs in children.

Infections in the first three years of life may be persistent infections from childbirth, but any infection in a child requires consideration of child sexual abuse.

Treatment of Other Types

Two other conditions caused by Chlamydia trachomatis are uncommon in the United States, but very common worldwide:

  • Lymphogranuloma venerium (LGV): Lymphogranuloma venereum is treated in the same way as standard genital chlamydia infections, but a longer course of therapy is used (21 days instead of seven). Other care may also be required to treat genital ulcers or abscessed inguinal nodes if they occur.
  • Trachoma: Trachoma is the leading cause of blindness worldwide and often requires aggressive treatment with antibiotic and surgery; addressing unsanitary living conditions is also necessary.

Lifestyle

Receiving a diagnosis of chlamydia is a good opportunity to look at your lifestyle and see if anything can be changed to reduce your risk. 

  • Take a moment to review safe sex practices.
  • Talk to your sexual partner(s) about their history of diagnoses as a matter of course.
  • Take note of the frequency of your health screenings. It's important for women to get their yearly Pap smears and, depending on age, annual chlamydia tests, for example.

The body doesn't develop any immunity to chlamydia as it does to some microorganisms, so reinfection is very common.

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