management of chlamydia infection

Last edited 06/2021 and last reviewed 06/2021

Chlamydia infection should be managed at a specialist genitourinary medicine (GUM) clinic. The GUM clinic will be able to screen for further sexually transmitted diseases and undertake contact tracing.

Treatment of first choice for uncomplicated genital chlamydia infections in an adult is doxycycline 100mg twice daily for 7 days (1)

Second line/ pregnant/breastfeeding/ allergy/intolerance in adult:

• azithromycin 1g stat for one day; then 500mg once daily for two days (total course 3 days)

Contact tracing of the patient's sexual partners is less frequently achieved than for gonococcal infections. If traced, antibiotic therapy is similarly recommended.

Key points:

• opportunistically screen all sexually active patients aged 15 to 24 years for chlamydia annually and on change of sexual partner
• if positive, treat index case, refer to GUM and initiate partner notification, testing and treatment
• as single dose azithromycin has led to increased resistance in GU infections, doxycycline should be used first line for chlamydia and urethritis
• advise patient with chlamydia to abstain from sexual intercourse until doxycycline is completed or for 7 days after treatment with azithromycin (14 days after azithromycin started and until symptoms resolved if urethritis)
• if chlamydia, test for reinfection at 3 to 6 months following treatment if under 25 years; or consider if over 25 years and high risk of re-infection
• second line, pregnant, breastfeeding, allergy, or intolerance: azithromycin is most effective.
• as lower cure rate in pregnancy, test for cure at least 3 weeks after end of treatment.
• consider referring all patients with symptomatic urethritis to GUM as testing should include Mycoplasma genitalium and Gonorrhoea.
• if M.genitalium is proven, use doxycycline followed by azithromycin using the same dosing regimen and advise to avoid sex for 14 days after start of treatment and until symptoms have resolved

Reference:

• Public Health England (June 2021). Managing common infections: guidance for primary care