Chlamydia%20-%20uncomplicated%20anogenital%20infection Treatment
Principles of Therapy
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
Pharmacotherapy
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