Chlamydia Treatment Guidelines

First-Line Treatment Options

The American College of Physicians recommends treating uncomplicated chlamydia in adults with either azithromycin 1 g orally as a single dose or doxycycline 100 mg orally twice daily for 7 days, both achieving 97-98% cure rates and being equally effective first-line options 1, 2
Azithromycin 1 g orally, single dose, is preferred when compliance is uncertain, as it allows directly observed therapy and eliminates adherence concerns 1, 2
Doxycycline 100 mg orally twice daily for 7 days is equally effective with lower cost and extensive clinical experience 1, 2

Erythromycin base 500 mg orally four times daily for 7 days can be used as an alternative treatment regimen 1, 2
Levofloxacin 500 mg orally once daily for 7 days is an alternative treatment option, but it offers no compliance advantage over doxycycline and has inferior evidence 1, 2

The American College of Obstetricians and Gynecologists recommends azithromycin 1 g orally, single dose, as the preferred treatment for chlamydia during pregnancy 1, 2
Amoxicillin 500 mg orally three times daily for 7 days is an acceptable alternative treatment for chlamydia during pregnancy 1, 2, 3

The Centers for Disease Control and Prevention recommend dispensing medication on-site when possible and directly observing the first dose to maximize compliance 1, 2
Patients must abstain from all sexual intercourse for 7 days after initiating treatment and until all sex partners are treated 1, 2, 3

The American College of Physicians recommends that test-of-cure is NOT recommended for non-pregnant patients treated with recommended regimens who are asymptomatic, as cure rates exceed 97% 1, 2
Mandatory reinfection screening at 3 months is recommended for all women with chlamydia, as reinfection rates reach 39% in some populations and carry elevated risk for pelvic inflammatory disease 1, 2, 3

The Centers for Disease Control and Prevention recommend treating for both chlamydia and gonorrhea concurrently with ceftriaxone 250 mg IM single dose plus azithromycin 1 g orally single dose, as coinfection rates are 20-40% 1, 3
All chlamydia patients should be tested for gonorrhea, syphilis, and HIV at the initial visit 1