Chlamydia%20-%20uncomplicated%20anogenital%20infection Treatment

Syndromic Management

In areas where resources allow for lab tests to screen women

• Empiric therapy should be considered when:
  • Prevalence of C trachomatis is high in the patient population and the patient is unlikely to return for treatment

In areas where lab tests to screen women are not available

• The justification for empiric treatment becomes stronger as the prevalence of chlamydial infections in the patient population becomes higher
  • Patients with positive risk assessment and vaginal discharge should be offered treatment for chlamydial cervicitis

General Antibiotic Principles for C trachomatis Infections

• For improved compliance, single-agent treatment for C trachomatis is recommended
• In patients presenting with buboes, the decision to treat for LGV, granuloma inguinale and chancroid depends on the local prevalence of these diseases

Preferred Agents

• Azithromycin and Doxycycline are equally successful in treating genital chlamydia infection with cure rates of 97% and 98% respectively

Azithromycin

• Recommended agent for anogenital chlamydial infection
• Preferred treatment if noncompliance is suspected since it is given as a single dose
• Recommended agent for pregnant patients with genital chlamydia infection

Doxycycline

• Recommended agent for both anogenital infection and LGV
• Preferred 1st-line treatment for non-pregnant LGV-positive patients
• Long history of extensive successful use in the treatment of C trachomatis, but must be given x 7 days
• Patients allergic to Doxycycline may be given Azithromycin or Erythromycin

Alternative Agents

Penicillins

• Amoxicillin
  
  • Alternative agent for anogenital infection
  • Recommended alternative agent for pregnant women
  • May cause latency and re-emergence of infection rather than eradication as shown by in vitro studies

Macrolide

• Erythromycin
  
  • Alternative agent for anogenital infection and LGV
  • Less efficacious than Azithromycin or Doxycycline primarily due to GI side effects that lessen patient’s compliance
  • Alternative regimen for pregnant women except for the estolate salt which may cause drug-related hepatotoxicity

Quinolones

• Levofloxacin
  
  • Effective alternative treatment for anogenital infection

• Ofloxacin
  
  • Alternative agent for anogenital infection with similar efficacy to Azithromycin and Doxycycline

Tetracyclines

• Alternative agents for uncomplicated genital chlamydia infection