Materiały źródłowe

• #1 Chlamydial Infections – STI Treatment GuidelinesMinusSASstats

  https://www.cdc.gov/std/treatment-guidelines/chlamydia.htm

  Treating persons with C. trachomatis prevents adverse reproductive health complications and continued sexual transmission. Furthermore, treating their sex partners can prevent reinfection and infection of other partners. Treating pregnant women usually prevents transmission of C. trachomatis to neonates during birth. Treatment should be provided promptly for all persons with chlamydial infection; treatment delays have been associated with complications (e.g., PID) in a limited proportion of women (810). […] Recommended Regimens for Chlamydial Infection Among Adolescents and Adults: Doxycycline 100 mg orally 2 times/day for 7 days. […] Alternative Regimens: Azithromycin 1 g orally in a single dose OR Levofloxacin 500 mg orally once daily for 7 days. […] A meta-analysis and a Cochrane systematic review evaluated data from randomized clinical trials of azithromycin versus doxycycline for treating urogenital chlamydial infection determined that microbiologic treatment failure among men was higher for azithromycin than for doxycycline (748, 749).

• #2 Chlamydia: Causes, Symptoms, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/4023-chlamydia

  Chlamydia infections are treatable and curable. However, its symptoms are often unnoticeable. Its important to receive treatment for chlamydia as soon as possible. Left untreated, chlamydia can lead to serious complications and cause permanent damage to your reproductive organs. […] Chlamydia can be cleared up with antibiotics in about a week or two. But dont stop taking your medication just because your symptoms improve. Ask your provider about what follow-up is needed to be sure your infection is gone after youve finished taking your medicine. Chlamydia infection can recur. […] The most common antibiotics used to treat chlamydia infections are: Doxycycline. Usually taken over seven days, is preferred. Azithromycin. Usually taken as a single dose, is recommended as the first choice in pregnancy.

• #2 Chlamydial Infections – STI Treatment GuidelinesMinusSASstats

  https://www.cdc.gov/std/treatment-guidelines/chlamydia.htm

  Available evidence supports that doxycycline is efficacious for C. trachomatis infections of urogenital, rectal, and oropharyngeal sites. […] Although azithromycin maintains high efficacy for urogenital C. trachomatis infection among women, concern exists regarding effectiveness of azithromycin for concomitant rectal C. trachomatis infection, which can occur commonly among women and cannot be predicted by reported sexual activity. […] Doxycycline is also available in a delayed-release 200-mg tablet formulation, which requires once-daily dosing for 7 days and is as effective as doxycycline 100 mg twice daily for 7 days for treating urogenital C. trachomatis infection in men and women. […] Among persons receiving multidose regimens, medication should be dispensed with all doses involved, on-site and in the clinic, and the first dose should be directly observed.

• #3 Therapeutic Options for Chlamydia trachomatis Infection: Present and Future

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9686482/

  Ct treatment is based on antibiotics prescription. […] Azithromycin is a semisynthetic molecule with antibacterial activity, which is derived from erythromycin. […] The WHO recommends azithromycin, as well as doxycycline, as first-line drugs for the treatment of Ct. […] Importantly, following the International Union Against Sexually Transmitted Infections (IUSTI) guidelines, azithromycin is being used as the first-line therapy for this infection in addition to doxycycline. […] Despite this choice, doxycycline is associated with higher efficacy, and Centers for Disease Control and Prevention (CDC) guidelines recommend a doxycycline regimen as the first treatment, with some exceptions. […] Generally, in cases of uncomplicated genital infection, the guidelines highlight that doxycycline is the treatment with higher efficacy and it must be used as first-line therapy, the others are alternative options to use in case of drug contra-indication, resistance, or other reasons.

• #3 Chlamydial Infections – STI Treatment GuidelinesMinusSASstats

  https://www.cdc.gov/std/treatment-guidelines/chlamydia.htm

  To maximize adherence with recommended therapies, on-site, directly observed single-dose therapy with azithromycin should always be available for persons for whom adherence with multiday dosing is a considerable concern. […] Recommended Regimen for Chlamydial Infection During Pregnancy: Azithromycin 1 g orally in a single dose. […] Alternative Regimen: Amoxicillin 500 mg orally 3 times/day for 7 days. […] Because of concerns regarding chlamydia persistence after exposure to penicillin-class antibiotics that has been demonstrated in animal and in vitro studies, amoxicillin is listed as an alternative therapy for C. trachomatis for pregnant women (828, 829). […] Recommended Regimen for Chlamydial Infection Among Neonates: Erythromycin base or ethylsuccinate 50 mg/kg body weight/day orally, divided into 4 doses daily for 14 days.

• #3 Therapeutic Options for Chlamydia trachomatis Infection: Present and Future

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9686482/

  For genital chlamydial infection in pregnant women, azithromycin 1 g orally as a single dose is recommended. […] The recommended treatment for lymphogranuloma venereum (LGV) is doxycycline; in case of contraindication, azithromycin may be considered. […] For ophthalmia neonatorum, particularly in conjunctivitis, the use of azithromycin over erythromycin is recommended. […] It must be highlighted that treatment options, in some countries, are based on associated costs, rather than on biological behavior, therefore, adverse events may occur. […] In order to avoid the adverse outcomes of Ct treatment, the therapeutic agents properties must be explored, as well as the host infection establishment. […] The main reasons for treatment failure are poor compliance with treatment, the test of the cure performed too early, and the fact that the partner(s) of the infected ones are not informed and subsequently, not treated.

• #3 Therapeutic Options for Chlamydia trachomatis Infection: Present and Future

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9686482/

  Therefore, based on the evidence, there is a need for the development of novel drugs in order to successfully combat Ct infection. […] Some authors have investigated the role of Corallopyronin A, an antimicrobial compound synthesized by Corallococcus coralloides. […] Additionally, there have been efforts to develop natural anti-chlamydial treatments based on extracts. […] Since 2020, as the antibiotic resistance issue has remained critical, some authors developed studies with potential non-antibiotic weapons. […] Interestingly, drug repurposing, a strategy commonly investigated for cancer treatment, has also been explored in this field. […] Notwithstanding all these new strategies for treating Ct infection, further comprehensive studies are needed in order to improve the translation of these research results into clinical practice.

• #4 Chlamydial and Gonococcal Infections: Screening, Diagnosis, and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0400/p388.html

  Preferred chlamydia treatment is a seven-day course of doxycycline, 100 mg taken by mouth twice per day. […] Doxycycline should be used to treat chlamydia in nonpregnant people. […] Although spontaneous clearance of chlamydial infections is possible, people with positive test results should always be treated. […] The recommended treatment for non-pregnant people is now doxycycline, 100 mg, twice per day for seven days. […] Treatment regimens are reviewed in Table 7. […] If symptoms do not resolve or a test is persistently positive in a situation in which reinfection seems unlikely, an infectious disease specialist and local health department should be consulted in case of possible antimicrobial resistance. […] If seeking care in person is not possible, expedited partner therapy is a strategy in which sex partners of a person diagnosed with a chlamydial or gonococcal infection within the past 60 days can be prescribed treatment without being seen by the physician. […] Partners should be evaluated and treated empirically with a nonlymphogranuloma venereum chlamydial infection regimen.

• #4 Chlamydial Infections – STI Treatment GuidelinesMinusSASstats

  https://www.cdc.gov/std/treatment-guidelines/chlamydia.htm

  Although data regarding use of azithromycin for treating neonatal chlamydial infection are limited, available data demonstrate that a short therapy course might be effective (834). […] Recommended Regimen for Chlamydial Pneumonia Among Infants: Erythromycin base or ethylsuccinate 50 mg/kg body weight/day orally divided into 4 doses daily for 14 days. […] Alternative Regimen: Azithromycin suspension 20 mg/kg body weight/day orally, 1 dose daily for 3 days. […] Follow-up of infants is recommended to determine whether the initial treatment was effective.

• #4 Therapeutic Options for Chlamydia trachomatis Infection: Present and Future

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9686482/

  Indeed, the more effective way to control and eradicate Ct infection is through a vaccination plan that must comprise the individuals before they became sexually active, to maximize immunity, reducing Ct prevalence, and consequently, eradicating the infection. […] However, Ct vaccine development has proven to be a challenge throughout the years. […] In conclusion, this review highlights the need for a public health intervention with Ct screening to better treat this infection which could have serious complications for human health.

• #5 Genitourinary chlamydia infection

  https://dermnetnz.org/topics/genitourinary-chlamydia

  Individuals receiving treatment for genitourinary chlamydia infection should abstain from sex for at least 7 days. […] Treatment for uncomplicated urogenital chlamydia infection includes: Doxycycline 100 mg twice daily for 7 days: 98% cure, Single-dose azithromycin 1 g: 9297% cure. […] Treatment for uncomplicated rectal chlamydia infection includes: Doxycycline 100 mg twice daily for 7 days, Single-dose azithromycin 1 g followed by proof-of-cure testing. […] Doxycycline 100 mg twice daily for 7 days is used as a treatment for asymptomatic chlamydia infection at extra-genital sites. […] Proctitis, epididymo-orchitis, and pelvic inflammatory disease due to chlamydia infection are treated by an extended course of empiric antimicrobial therapy while waiting for test results. […] The management of chlamydia infection includes a full sexual health check to look for other STIs and the notification, treatment, and testing of sexual contacts.

• #5 Genitourinary chlamydia infection

  https://dermnetnz.org/topics/genitourinary-chlamydia

  If the patient is pregnant or has rectal chlamydia, a proof-of-cure test with a NAAT should be performed at least 4 weeks after the completion of treatment. If taken earlier, a false-positive result may occur due to remnant chlamydial DNA. Re-testing is recommended in 3 months as re-infection is extremely common.

• #6 Treatment challenges for urogenital and anorectal Chlamydia trachomatis | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-015-1030-9

  While true antimicrobial resistance to Chlamydia trachomatis is a rare occurrence, repeat chlamydia infections continue to be reported following treatment with a single 1 g dose of azithromycin or week long doxycycline with considerable more concern about azithromycin treatment failure. […] Current data suggests that there may are differences in the efficacy of the drugs between rectal and non-rectal sites of infection and factors such as immune response, drug pharmacokinetics, organism load, auto-inoculation from rectum to cervix in women and the genital microbiome may play a role in treatment failure. […] The treatment guidelines for uncomplicated urogenital CT infections in the United States, Europe and Australia all consistently recommend a single 1 g dose of azithromycin as the first line treatment. However the recommendations for the treatment of anorectal infections are less uniform with the US recommending single dose azithromycin while Europe and Australia recommending one week of doxycycline (100 mg twice daily) as first line therapy.

• #7 Chlamydia treatment guidelines – Melbourne Sexual Health Centre (MSHC)

  https://www.mshc.org.au/health-professionals/treatment-guidelines/chlamydia-treatment-guidelines

  Chlamydia is a very common bacterial STI which can be passed on during sex without a condom or other barrier method. […] Chlamydia is notifiable to the Victorian Health Department by laboratories. […] Uncomplicated genital or pharyngeal infection: Doxycycline 100mg PO, twice daily for 7 days OR Azithromycin 1g PO, stat. […] Anorectal infection: Doxycycline 100mg PO, twice daily for 7 days. […] Doxycycline is superior to azithromycin for anorectal chlamydia. […] Pelvic inflammatory disease: Refer to Pelvic inflammatory disease treatment guidelines. […] Epididymo-orchitis: Refer to Epididymo-orchitis treatment guidelines. […] Pregnant women: Azithromycin 1g PO, stat. […] Doxycycline is contra-indicated. […] Other alternative antibiotics if azithromycin is contra-indicated: Amoxycillin 500mg PO, 3 times a day for 7 days OR Erythromycin ethylsuccinate (EES) 800mg PO, 4 times a day for 7 days OR Erythromycin ethylsuccinate (EES) 400mg PO, 4 times a day for 14 days.

• #7 Chlamydia treatment guidelines – Melbourne Sexual Health Centre (MSHC)

  https://www.mshc.org.au/health-professionals/treatment-guidelines/chlamydia-treatment-guidelines

  Partner notification should be discussed with patients diagnosed with chlamydia as sex with untreated chlamydia infected partners can result in repeat infection. […] Treatment for chlamydia is not routinely offered to asymptomatic individuals reporting contact with chlamydia because a proportion will be negative for chlamydia. […] However, treatment can be offered if the patient prefers, has symptoms, or is unlikely to return for the test result or treatment. […] Individuals should abstain from sex with their partners until 7 days after both have received treatment. […] Patient delivered partner therapy (PDPT) for chlamydia treatment is available to those partners who are unable to attend.

• #8 Chlamydia | STI Guidelines Australia

  https://sti.guidelines.org.au/sexually-transmissible-infections/chlamydia/

  Uncomplicated genital or pharyngeal infection: Doxycycline 100 mg PO, BD 7 days […] Anorectal infection: Doxycycline 100 mg PO, BD for 7 days if asymptomatic, but 21 days if symptomatic […] Azithromycin 1 g PO, stat. and repeat in 12-24 hours […] Immediate treatment is not recommended for all sexual contacts of chlamydia but offer testing of exposed anatomical sites and await results […] If contact treatment is initiated, use recommended treatment. Only use azithromycin if adherence likely to be poor or matches index case treatment […] For symptomatic anorectal infection, see testing and treatment recommendations […] Consider seeking specialist advice before treating any complicated presentation […] Pregnant people: Azithromycin 1 g PO, stat […] If both principal treatment options unsuitable, seek specialist advice

• #8 Chlamydia | STI Guidelines Australia

  https://sti.guidelines.org.au/sexually-transmissible-infections/chlamydia/

  With gonorrhoea, treatment should be given for both infections i.e. ceftriaxone 500 mg IMI, stat. in 2 mL 1% lignocaine PLUS doxycycline 100 mg PO, BD 7 days if asymptomatic, but 21 days if symptomatic […] 100% of patients diagnosed with chlamydia are treated with an appropriate antibiotic regimen.

• #9 University of Illinois Chicago

  https://dig.pharmacy.uic.edu/faqs/2022-2/january-2022-faqs/what-are-the-updated-treatment-recommendations-for-chlamydia-and-gonococcal-infections/

  The CDC recommendations for chlamydia and gonococcal infections in 2015 and 2021 are summarized in the Table. A key change is the removal of azithromycin as a recommended regimen for chlamydia as well as its removal in combination with ceftriaxone for gonococcal infections. […] For patients diagnosed with chlamydia, prompt treatment is warranted, and treatment of sexual partners is recommended. Recent evidence indicates that doxycycline is effective for urogenital, rectal, and oropharyngeal chlamydia infections, and it is now the preferred option to azithromycin. […] Although azithromycin continues to be sufficiently effective for urogenital chlamydial infections, it has been found to be less effective in rectal chlamydial infections. […] A 2021 systematic review in patients with rectal chlamydia found a higher microbiological cure rate with doxycycline than azithromycin.

• #9 University of Illinois Chicago

  https://dig.pharmacy.uic.edu/faqs/2022-2/january-2022-faqs/what-are-the-updated-treatment-recommendations-for-chlamydia-and-gonococcal-infections/

  In cases where there is significant concern for adherence, the 1-dose azithromycin regimen can be considered; however, the guidelines suggest that posttreatment testing may be necessary due to lower efficacy with azithromycin treatment. […] Pregnant women should not be treated with doxycycline; azithromycin remains the treatment of choice for pregnant patients with test of cure 4 weeks after completion of therapy. […] Updated treatment recommendations are available for chlamydia and gonococcal infections. These guidelines significantly reduce the use of azithromycin and remove several alternative options for chlamydia infections.

• #10 Chlamydia (Chlamydial Genitourinary Infections) Guidelines: WHO Guidelines on the Treatment of Chlamydia trachomatis Infection

  https://emedicine.medscape.com/article/214823-guidelines

  WHO recommendations for the treatment of uncomplicated genital chlamydia are as follows: Azithromycin 1 g orally as a single dose or Doxycycline 100 mg orally twice a day for 7 days or one of these alternatives: tetracycline 500 mg orally 4 times a day for 7 days, erythromycin 500 mg orally twice a day for 7 days, or ofloxacin 200-400 mg orally twice a day for 7 days. […] In anorectal chlamydial infection, the WHO recommends doxycycline 100 mg orally twice a day for 7 days over azithromycin 1 g orally as a single dose. […] WHO recommendations for the treatment of chlamydial infection in pregnancy are as follows: Azithromycin recommended over erythromycin, Azithromycin recommended over amoxicillin, Amoxicillin recommended over erythromycin, Azithromycin 1 g orally as a single dose or Amoxicillin 500 mg orally 3 times a day for 7 days or Erythromycin 500 mg orally twice a day for 7 days.

• #10 Chlamydia (Chlamydial Genitourinary Infections) Guidelines: WHO Guidelines on the Treatment of Chlamydia trachomatis Infection

  https://emedicine.medscape.com/article/214823-guidelines

  WHO recommendations for the treatment of lymphogranuloma venereum (LGV) are as follows: In adults and adolescents with LGV, the guidelines suggest doxycycline 100 mg orally twice daily for 21 days over azithromycin 1 g orally weekly for 3 weeks. Good practice dictates treatment of LGV, particularly for men who have sex with men and for people with HIV infection. When doxycycline is contraindicated, azithromycin should be provided. When neither treatment is available, erythromycin 500 mg orally 4 times a day for 21 days is an alternative. Doxycycline should not be used in pregnant women.

• #11 Chlamydia and LGV guide: Treatment and follow-up – Canada.ca

  https://www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-transmitted-infections/canadian-guidelines/chlamydia-lgv/treatment-follow-up.html

  Treatment and follow-up of Chlamydia trachomatis infections (including lymphogranuloma venereum (LGV)). […] The following treatment options are recommended in the absence of contraindication. Consult product monographs for contraindications and side effects. […] Caution: Refer to the health advisory issued by Health Canada about azithromycin and risk of cardiovascular complications and death. […] Preferred treatment: Doxycycline 100 mg PO BID for 7 days or Azithromycin 1 g PO in a single dose. […] Note: Azithromycin may be preferred when poor compliance is anticipated. […] For pregnant and lactating people: Azithromycin 1 g PO in a single dose or Amoxicillin 500 mg PO TID for 7 days or Erythromycin 2 g/day PO in divided doses for 7 days or Erythromycin 1g/day PO in divided doses for 14 days.

• #11 Chlamydia and LGV guide: Treatment and follow-up – Canada.ca

  https://www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-transmitted-infections/canadian-guidelines/chlamydia-lgv/treatment-follow-up.html

  Notes: Data are limited regarding the use of azithromycin in pregnancy, however many experts believe it has an acceptable risk-benefit profile. […] In pregnancy, use Erythromycin (non-estolate preparations) 500 mg PO QID for 21 days. […] Sexual partners of a LGV case (empirical): Doxycycline 100 mg PO BID for 7 days or Azithromycin 1g PO in a single dose. […] People diagnosed with C. trachomatis (LVG or non-LGV genotypes) and their partners should abstain from any sexual activity without barrier protection until treatment of the person and all current partners is complete. […] TOC for chlamydia is recommended when symptoms or signs persist post-therapy. […] Repeat screening is recommended three months post-treatment for all people with C. trachomatis infection because the risk of reinfection is high. […] Case finding and partner notification are critical to the prevention and control of C. trachomatis.

• #12 Chlamydia trachomatis – Wikipedia

  https://en.wikipedia.org/wiki/Chlamydia_trachomatis

  If treatment is necessary during pregnancy, levofloxacin, ofloxacin, tetracycline, and doxycycline are not prescribed. In the case of a patient who is pregnant, the medications typically prescribed are azithromycin, amoxicillin, and erythromycin. Azithromycin is the recommended medication and is taken as a 1 gram tablet taken by mouth as a single dose. […] If the infection has progressed, ascending the reproductive tract and pelvic inflammatory disease develops, damage to the fallopian tubes may have already occurred. In most cases, the C. trachomatis infection is then treated on an outpatient basis with azithromycin or doxycycline. Treating the mother of an infant with C. trachomatis of the eye, which can evolve into pneumonia, is recommended. The recommended treatment consists of oral erythromycin base or ethylsuccinate 50 mg/kg/day divided into four doses daily for two weeks while monitoring for symptoms of infantile hypertrophic pyloric stenosis (IHPS) in infants less than 6 weeks old. […] There have been a few reported cases of C. trachomatis strains that were resistant to multiple antibiotic treatments. However, as of 2018, this is not a major cause of concern as antibiotic resistance is rare in C. trachomatis compared to other infectious bacteria.

• #13 Chlamydia

  https://www.nhs.uk/conditions/chlamydia/

  Chlamydia is treated with antibiotics. This may be a single dose, or tablets you take for 7 to 14 days. […] Sometimes you may start treatment before the test results come back. […] You may need to be tested again after treatment to check you no longer have chlamydia. […] If you’re pregnant, you’ll be tested again 4 weeks after treatment. […] Avoid vaginal, anal or oral sex until you and your partner (if you have one) have finished treatment and tests show you no longer have chlamydia.

• #14 Chlamydia | NZ STI Guidelines

  https://sti.guidelines.org.nz/infections/chlamydia/

  Treatment options […] Doxycycline 100 mg orally twice daily for 7 days […] Azithromycin 1 g orally, as a single dose […] Only if doxycycline is contraindicated, or patient is highly likely to be non-adherent […] Doxycycline 100 mg orally twice daily for 7 days if asymptomatic […] Seek specialist advice if symptomatic, or refer to anorectal syndromes guideline […] Azithromycin 1 g orally, and repeat in 1 week […] Only if doxycycline is contraindicated, or patient is highly likely to be non-adherent […] Azithromycin 1 g orally, as a single dose […] Test of cure recommended 4 weeks after treatment completed […] If both treatment options unsuitable, seek specialist advice […] Ceftriaxone 1g in 3.5 mL 1% lignocaine, intramuscular injection, as a single dose […] PLUS […] Doxycycline 100 mg orally twice daily for 7 days

• #14 Chlamydia | NZ STI Guidelines

  https://sti.guidelines.org.nz/infections/chlamydia/

  Advise to abstain from sex or use condoms for 1 week from the start of treatment and until 1 week after sexual contact/s have been treated […] If a patient has an IUD, leave it in place and treat as recommended. Seek specialist advice as needed […] Seek specialist advice if symptomatic anorectal infection, as further testing and extended treatment may be required […] Consider HIV pre-exposure prophylaxis (PrEP) if rectal chlamydia is diagnosed in a male or transgender person who has anal sex with men.

• #15 Chlamydia Trachomatis | Children’s Mercy Kansas City

  https://www.childrensmercy.org/health-care-providers/evidence-based-practice/cpgs-cpms-and-eras-pathways/conjunctivitis-care-process-model/treatment-recommendations/chlamydia-trachomatis/

  Traditionally treatment with a 14 days course of erythromycin was recommended, however treatment considerations now include a short course of oral azithromycin. […] Based on current literature the Care Process Model team recommends the use of culture for detection of C. trachomatis in the neonate with suspected conjunctivitis. […] Excluding concerns for social or treatment compliance concerns, most neonates can be managed in the outpatient setting with follow-up with their primary care provider or Ophthalmology in 24 to 72, while awaiting eye culture results.

• #16 Treatment of Chlamydial Infections | IntechOpen

  https://www.intechopen.com/chapters/85774

  The recommended and alternative treatment options for urethritis due to C. trachomatis are the same as other uncomplicated chlamydia infections mentioned above. […] The recommended regimen for infantile chlamydial pneumonia is erythromycin base or ethyl succinate 50 mg/kg/day orally divided into four doses every day for 14 days.

• #16 Treatment of Chlamydial Infections | IntechOpen

  https://www.intechopen.com/chapters/85774

  The antibacterial drug of choice is oral azithromycin because it can be taken as a single dose, has a relatively long half-life, and is more concentrated in tissue than in plasma. […] The recommended regimen for C. trachomatis-related PID is doxycycline 100mg, orally, twice a day for 14 days combined with antibiotics active against gonococci. […] The recommended antibiotic regimen for pregnant and breastfeeding adults and adolescents with cervical, urethral, rectal, and oropharyngeal chlamydia is azithromycin 1 g orally given as a single-dose. […] The recommended treatment is a 7-day course of oral, twice a daily 100 mg doxycycline. […] The most effective antibiotic for the treatment of LGV is doxycycline but unlike uncomplicated chlamydia caused by serovars D-K, treatment of LGV needs a prolonged course of therapy.

• #17 RECOMMENDATIONS FOR TREATMENT OF CHLAMYDIAL INFECTIONS – WHO Guidelines for the Treatment of Chlamydia trachomatis – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK379708/

  In adults and adolescents with LGV, the WHO STI guideline suggests using doxycycline 100 mg orally twice daily for 21 days over azithromycin 1 g orally, weekly for 3 weeks. […] In neonates with chlamydial conjunctivitis, the WHO STI guideline recommends using oral azithromycin 20 mg/kg/day orally, one dose daily for 3 days, over erythromycin 50 mg/kg/day orally, in four divided doses daily for 14 days. […] For all neonates, the WHO STI guideline recommends topical ocular prophylaxis for the prevention of gonococcal and chlamydial ophthalmia neonatorum. […] For ocular prophylaxis, the WHO STI guideline suggests one of the following options for topical application to both eyes immediately after birth: tetracycline hydrochloride 1% eye ointment […] erythromycin 0.5% eye ointment […] povidone iodine 2.5% solution (water-based) […] silver nitrate 1% solution […] chloramphenicol 1% eye ointment.

• #18 Chlamydia: Symptoms, treatment, and causes

  https://www.medicalnewstoday.com/articles/8181

  The CDC recommend that people with chlamydia refrain from sex for 7 days. […] If a person has a diagnosis of chlamydia, they should inform any partners they have had sexual contact within the previous 60 days so that they, too, can seek testing and treatment. […] Sometimes, a doctor may also recommend treatment for gonorrhea because the bacteria that cause the two infections can occur together.

• #19 Chlamydia (Chlamydial Genitourinary Infections) Treatment & Management: Approach Considerations, Antibiotic Therapy, Prevention

  https://emedicine.medscape.com/article/214823-treatment

  The keys to management of chlamydial infections are (1) arriving at the correct diagnosis and (2) ensuring that the patient complies with treatment. […] Begin antibiotic therapy as soon as possible. Consider compliance, cost, and potential adverse effects. Consider treatment for possible gonorrhea coinfection. […] CDC recommends azithromycin and doxycycline as first-line drugs for the treatment of chlamydial infection. […] Medical treatment with these agents is 95% effective. […] For many years, standard therapy for uncomplicated genital tract infection has been doxycycline 100 mg orally twice daily for 7 days. However, azithromycin given as a single 1-g dose is as effective as a 7-day course of doxycycline. […] Azithromycin also has been shown to be effective in the treatment of nongonococcal urethritis, whether related to C trachomatis, genital mycoplasmas, or other organisms.

• #19 Chlamydia (Chlamydial Genitourinary Infections) Treatment & Management: Approach Considerations, Antibiotic Therapy, Prevention

  https://emedicine.medscape.com/article/214823-treatment

  Lower genital infections caused by Chlamydia can be treated with single-dose, directly observed treatment. […] The management of PID, even when gonorrhea is present, always should include therapy directed against C trachomatis, as well as N gonorrhoeae and anaerobic bacteria. […] Recommended parenteral regimens include cefoxitin or cefotetan along with a 14-day course of doxycycline or, alternatively, clindamycin plus gentamicin or ampicillin-sulbactam plus doxycycline. […] Treatment also is indicated for sexual partners of the index case if the time of the last sexual encounter was within 60 days of onset, and it should be considered for longer periods for the last sexual partner. […] Guidelines from the CDC recommend azithromycin 1 g orally as a single dose. Alternatives include amoxicillin 500 mg orally three times a day for 7 days as the preferred drug regimens for treating chlamydial infections in pregnancy. […] Test-of-cure to document chlamydial eradication (preferably via NAAT) 3-4 weeks after therapy completion is recommended.

• #20 Chlamydial Genital Infection

  https://patient.info/doctor/chlamydial-genital-infection

  Follow-up should be routine: […] To follow up on partner notification. […] To reinforce health education messages. […] To check adherence. […] To re-treat where necessary. […] To arrange repeat testing where indicated. […] Antibiotic treatment is effective in at least 95% of cases if the full course is taken. […] Outlook is generally good if treated early with full compliance.

• #20 Chlamydial Genital Infection

  https://patient.info/doctor/chlamydial-genital-infection

  Provide a clear explanation of the condition and its long-term implications for the patient and their partner(s). […] Key points include: […] Chlamydia is primarily sexually transmitted. […] Infection is very often asymptomatic and may have persisted for many months or even for years. […] No diagnostic test is 100% sensitive. […] Potential complications of not treating chlamydia. […] The importance of investigating and treating sexual partners. […] The importance of adhering with treatment. […] Antibiotic side-effects and interactions. […] Avoidance of sexual intercourse (genital, oral and anal sex) even with a condom for a week after finishing their antibiotics. […] In the UK, the 'look-back’ period for partner tracing is somewhat arbitrary but is taken as: […] Four weeks prior to developing symptoms where a male individual has urethral symptoms, and all contacts since developing symptoms. […] All contacts in the last six months of asymptomatic individuals and symptomatic women and men with symptoms other than urethral.

• #20 Chlamydial Genital Infection

  https://patient.info/doctor/chlamydial-genital-infection

  Those identified should be informed of their risk and offered treatment, contact tracing and STI testing. […] Where suitably trained, practice nurses or other trained healthcare professionals may be able to offer partner notification as effectively as GUM clinics. […] Do not think about chlamydia in isolation to other STIs; patients who have tested positive for chlamydia should be encouraged to undergo a full STI screen, including testing for HIV and hepatitis B. […] Sexual abuse must be considered in any child or young person with chlamydia, particularly when: […] A child is aged 13 years without clear evidence of vertical transmission during birth, or of blood contamination. […] A young person is aged 13-15 years without clear evidence of vertical transmission during birth, blood contamination, or that the STI was acquired from consensual sexual activity with another young person. […] A young person is aged 16-17 years without clear evidence of blood contamination or that the STI was acquired from consensual sexual activity.

• #21 Chlamydia trachomatis | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/chlamydia-trachomatis?content_id=CON-20245733

  Chlamydia trachomatis is treated with antibiotics. You will likely need to take a medicine for seven days, or you may be given a one-time dose of a medicine. […] In most cases, the infection clears up within 1 to 2 weeks after you take the antibiotic. But you can still spread the infection at first. So avoid sexual activity from when you start treatment until all your symptoms are gone. […] Your sexual partner or partners from the last 60 days also need screening and treatment even if they don’t have symptoms. Otherwise, the infection can be passed back and forth between sexual partners. Make sure to avoid sexual contact until all exposed partners are treated. […] Three months after treatment, the Centers for Disease Control and Prevention recommends getting tested for chlamydia again. This is to make sure people haven’t been reinfected with the bacteria, which can happen if sex partners aren’t treated, or new sex partners have the bacteria.

• #22 Chlamydia: Causes, Symptoms, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/4023-chlamydia

  Yes. Chlamydia can be treated and cured. Some sexually transmitted bacterial infections are starting to become resistant to antibiotics, though, and this makes them harder to treat. With this in mind, the best way to fight chlamydia is to prevent infections from spreading. […] Untreated chlamydia can put your health at risk. Make an appointment with your provider immediately if you notice any symptoms of chlamydia, and get regular STI screenings to avoid complications later. […] You should start to feel better within a week after you begin taking antibiotics. Be sure to continue taking your antibiotics until theyre gone, even if your symptoms improve. […] Dont have sex with anyone (intercourse, anal or oral) for at least seven days from when you began treatment. This gives the medication time to work so you dont infect your sexual partners. Once treatment is over, you should still practice safe sex and get tested for STIs as a part of your regular health maintenance.

• #23 About Genitourinary Medicine (GUM) 

  https://www.bashh.org/resources/15/chlamydia_2015/

  TOC is not routinely recommended for uncomplicated genital chlamydia infection, because residual, non-viable chlamydial DNA may be detected by NAAT for 3-5 weeks following treatment. […] The majority of sexually transmitted infection (STI) guidelines have until recently recommended a 1g single dose of azithromycin (SDA) or 7 days of doxycycline as standard treatment for uncomplicated urogenital and oral chlamydia infection. […] Doxycycline 100mg bd for 7 days is now recommended as first line treatment for uncomplicated urogenital, pharyngeal and rectal chlamydia infections, with test of cure (TOC) for diagnosed rectal infections.

• #24 Chlamydia – Clinical Features – Management – TeachMeObGyn

  https://teachmeobgyn.com/sexual-health/sexually-transmitted-infections/chlamydia/

  Antibiotic treatment is recommended for uncomplicated urogenital chlamydial infection: […] Doxycycline 100mg twice daily for 7 days or […] Azithromycin 1g single dose. […] Alternative treatment when doxycycline and azithromycin are contraindicated: […] Erythromycin 500mg twice daily for 10-14 days […] Ofloxacin 200mg bd or 400mg od for seven days. […] Patients are advised to avoid sexual intercourse and oral sex until they and/or their partner have completed treatment (or 7 days following azithromycin). […] Test of cure is not usually required unless the patient is pregnant, compliance was poor or when symptoms persist. If aged 25, repeat testing is recommended 3 months after treatment. […] Chlamydia in pregnancy is treated with antibiotics, however doxycycline and ofloxacin are contraindicated so azithromycin and erythromycin are the drugs of choice.

• #25 Chlamydia | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/chlamydia

  Chlamydia is effectively treated with antibiotics. […] If there are complications from chlamydia infection such as pelvic inflammatory disease (PID) a longer course of antibiotics may be required. […] Do not have sex for 7 days after you and your current partner have completed treatment. […] You can get reinfected with chlamydia if you have sex within the 7 days. […] After you have completed treatment, have another test for chlamydia in 3 months time (or 1 month’s time if you have anal chlamydia) to make sure you have not been re-infected. […] Chlamydia reinfection is common. Having chlamydia once does not stop you from getting it again. […] If you are not sure whether your sexual partner(s) will seek treatment, ask your doctor for extra chlamydia medication (or a prescription). You can give it to them so they can be treated as soon as possible.

• #26 Chlamydia – treatment, symptoms and statistics | healthdirect

  https://www.healthdirect.gov.au/chlamydia

  Chlamydia is a sexually transmitted infection (STI) that usually spreads through unprotected sex. […] Once diagnosed, chlamydia is easy to treat with antibiotics. […] Chlamydia is treated with antibiotics such as doxycycline or azithromycin. Usually, one dose is needed. If you develop a secondary infection, you may need to take antibiotics for longer. […] Your sexual partners will also need to be treated. If you are worried they will not seek treatment themselves, you can get them an antibiotics prescription yourself. This is called patient delivered partner therapy (PDPT). […] You are also recommended to avoid sex, even with a condom, until 7 days after you have started antibiotics, or until you have finished treatment and symptoms have gone whichever is later. […] Test again for chlamydia 3 months after you have finished treatment, to make sure you have not been reinfected. […] Remember, after you finish your treatment, you are not immune to chlamydia. You can catch it again.

• #27 Chlamydia Infections | Chlamydia | Chlamydia Symptoms | MedlinePlus

  https://medlineplus.gov/chlamydiainfections.html

  Chlamydia is a common sexually transmitted infection (STI). It is caused by bacteria called Chlamydia trachomatis. […] Antibiotics can cure it. […] Antibiotics will cure the infection. You may get a one-time dose of the antibiotics, or you may need to take medicine every day for 7 days. It is important to take all the medicine that your provider prescribed for you. Antibiotics cannot repair any permanent damage that the disease has caused. […] To prevent spreading the disease to your partner, you should not have sex until the infection has cleared up. If you got a one-time dose of antibiotics, you should wait 7 days after taking the medicine to have sex again. If you have to take medicine every day for 7 days, you should not have sex again until you have finished taking all of the doses of your medicine. […] It is common to get a repeat infection, so you need to get tested again about three months after treatment.

• #28 Expedited Partner Therapy (EPT) for infections due to Chlamydia trachomatis, Neisseria gonorrhoeae, and/or Trichomonas vaginalis Guidance for Health Professionals in Minnesota – MN Dept. of Health

  https://www.health.state.mn.us/diseases/stds/hcp/ept/eptguidance.html

  Expedited partner therapy (also known as EPT, expedited partner treatment, or partner-delivered partner treatment) is a harm reduction strategy and is defined as the practice of treating the sexual partners of patients diagnosed with certain qualifying sexually transmitted infections by providing antimicrobial treatment for the partner(s) without a formal medical examination by a health care provider. […] The CDC and/or MDH recommend that when partners of patients diagnosed with the following qualifying STIs are unable or unlikely to seek timely evaluation and treatment, EPT is recommended: Chlamydia. […] EPT is permissible in the above populations, however health care clinicians should make a good faith effort to educate the index patient and their partner(s) about the importance of timely medical evaluation, testing, and treatment using preferred treatment regimens, and use their best judgment to determine whether EPT is appropriate.

• #29 Expedited Partner Therapy (EPT) for infections due to Chlamydia trachomatis, Neisseria gonorrhoeae, and/or Trichomonas vaginalis Guidance for Health Professionals in Minnesota – MN Dept. of Health

  https://www.health.state.mn.us/diseases/stds/hcp/ept/eptguidance.html

  All patients should be educated to abstain from ANY sexual activity for 7 days after FINISHING their treatment regimen(s) even if their symptoms improve. […] EPT is considered standard of care and broadly endorsed by the interprofessional medical community in Minnesota, therefore prescriptions for EPT should be dispensed from Minnesota pharmacies when prescriptions are issued. […] EPT prescriptions should also be accompanied with educational materials for the partner that discuss: Treatment instructions, Warnings about medications, General health counseling, A statement advising that partner seek medical evaluation as soon as possible for HIV infection and any symptoms of STIs.

• #30 Chlamydia treatment failed twice: Why and next steps

  https://www.medicalnewstoday.com/articles/chlamydia-treatment-failed-twice

  Chlamydia treatment may fail twice due to bacterial resistance to antibiotics, such as doxycycline, issues with the absorption of medication into the body, or not following the full course of antibiotics. […] Chlamydia is a bacterial infection that doctors may treat by prescribing antibiotics, such as azithromycin, doxycycline, or levofloxacin. […] Possible reasons for treatment failure include bacterial resistance to antibiotic treatment, medication that does not absorb properly into the body, ineffective coverage of antibiotic medication, and interrupting or not taking antibiotic treatment for the full course. […] Bacterial resistance to azithromycin is a common cause of chlamydia treatment failure. […] In males, research has shown that treatment failure was higher with azithromycin than with doxycycline.

• #31 Infections caused by Chlamydia trachomatis (including lymphogranuloma venereum) and Mycoplasma genitalium | Enfermedades Infecciosas y Microbiología Clínica (English Edition)

  https://www.elsevier.es/en-revista-enfermedades-infecciosas-microbiologia-clinica-english-428-articulo-infections-caused-by-chlamydia-trachomatis-S2529993X1930125X

  Reinfection is the main cause of treatment failure and no genetic mutations that confer stable antibiotic resistance phenotypes have been documented. […] The need to monitor the development of resistance in C. trachomatis is hindered by the lack of standardised antimicrobial susceptibility tests, which currently require cell culture.

• #32 Urogenital Chlamydia trachomatis infection and therapy | IDR

  https://www.dovepress.com/the-effect-of-amoxicillin-pre-exposure-on-treatment-outcomes-and-antim-peer-reviewed-fulltext-article-IDR

  More cases of treatment failure were found in patients with previous amoxicillin exposure than in those without previous amoxicillin exposure in both the azithromycin-treated and minocycline-treated groups. […] The MICs of azithromycin, minocycline, and moxifloxacin were higher in CT clinical strains with amoxicillin pre-exposure than in those without. […] In our study, we found that the MICs of CT in the patients with previous exposure to amoxicillin were higher than in those without, which demonstrates that the application of amoxicillin in patients might make CT less susceptible to standard antibiotic regimens. […] Based on this study, it can be inferred that previous exposure to amoxicillin in CT-infected patients could inhibit the CT growth and decrease CT sensitivity to the recommended standard antibiotic treatment regimen. The persistent state of CT induced by amoxicillin is a likely explanation for treatment failure. Also, azithromycin plus moxifloxacin may be a promising treatment regimen for genital CT infection exhibiting failure in response to standard treatment.

• #33 Chlamydia treatment failed twice: Why and next steps

  https://www.medicalnewstoday.com/articles/chlamydia-treatment-failed-twice

  Therefore, doxycycline may be more effective than azithromycin for treating rectal infections in both males and females. […] Most cases of chlamydia infection after treatment are due to treatment failure but repeat infections. […] A test of cure (TOC) is a requirement as standard care of practice. […] Research suggests that treatment failure with azithromycin may occur between 5% and 23% of cases. […] If chlamydia treatment is ineffective, the next steps may involve asking sexual partners to get tested, asking sexual partners to go with them to receive treatment, getting a retest, and being open about all sexual partners within the last 2 months. […] If a chlamydial infection is persistent despite taking the above steps, a healthcare professional may recommend a combination therapy to treat a chronic chlamydia infection.

• #34 Chlamydia treatment failed twice: Why and next steps

  https://www.medicalnewstoday.com/articles/chlamydia-treatment-failed-twice

  If chlamydia treatment fails twice, it may be due to antibacterial resistance, lack of adherence to a treatment regimen, or issues with absorbing antibiotics into the body. […] It is also common to get chlamydia more than once, so it may be a repeat infection rather than treatment failure. […] Ensuring all recent sexual partners get prompt testing and treatment, taking all antibiotic treatments as a doctor prescribes, and abstaining from sex during treatment may all help prevent recurring infections.

• #35 Chlamydia Trachomatis | British Society for Immunology

  https://www.immunology.org/public-information/bitesized-immunology/pathogens-disease/chlamydia-trachomatis

  Chlamydia trachomatis (Ct) infection is the commonest bacterial sexually transmitted infection worldwide. […] Ct is diagnosed by urinary testing or genital swab. It is treated with antibiotic therapy, such as azithromycin or doxycycline. […] There is currently no vaccine for Ct. Much more research is needed to understand the balance between the immune response and the growth of the organism to develop more effective ways of controlling this infection and preventing the reproductive dysfunction that it is associated with.

• #36 About Chlamydia | Chlamydia | CDC

  https://www.cdc.gov/chlamydia/about/index.html

  In women, untreated chlamydia can cause pelvic inflammatory disease (PID). Some of the complications of PID are: Formation of scar tissue that blocks fallopian tubes, Ectopic pregnancy (pregnancy outside the womb), Infertility (not being able to get pregnant), Long-term pelvic/abdominal pain. […] Men rarely have health problems from chlamydia. The infection can cause a fever and pain in the tubes attached to the testicles. This can, in rare cases, lead to infertility. […] Untreated chlamydia may also increase your chances of getting or giving HIV.

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