Approach

The main treatment goal is to eradicate the infection and follow up on sexual contacts. Delaying treatment may increase the risk of subsequent infertility.

Recommended treatment

Azithromycin or doxycycline are recommended first-line antibiotics.[4] Alternative antibiotics are erythromycin, ofloxacin, levofloxacin, or a delayed-release formulation of doxycycline.[4][25] Azithromycin is safe during pregnancy and may reduce the risk of premature delivery, but doxycycline and fluoroquinolones should be avoided in pregnant women. Alternatives during pregnancy include amoxicillin or erythromycin.[4] A Cochrane review of interventions for treating genital chlamydia infection in pregnancy concluded no difference in efficacy or pregnancy complications when comparing antibacterial agents (amoxicillin, erythromycin, clindamycin, azithromycin); however, azithromycin and clindamycin appear to have fewer side effects than erythromycin.[26]

If the risk for chlamydia infection is high, treatment should be started empirically before test results are known. Patients are advised to avoid sexual contact for 7 days after the treatment has started.

All sexual contacts within the past 60 days should be advised to seek investigation and treatment for chlamydia. [ Cochrane Clinical Answers logo ] At the very least, the index case should notify sexual contacts that they may have been exposed to chlamydia. In some US states the law permits expedited partner therapy (EPT), which is the practice of treating the sex partners of persons with sexually transmitted infections (STIs) without an intervening medical evaluation or professional prevention counseling.[27] CDC: expedited partner therapy external link opens in a new window This may be considered as an option to facilitate partner management among heterosexual men and women with chlamydia infection. The American College of Obstetricians and Gynecologists has issued a statement supporting EPT in the management of chlamydial and gonorrhea infections when the partner is unlikely or unable to otherwise receive in-person evaluation and appropriate treatment.[28]

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