Chlamydia Treatment
This chapter will summarize the different treatment options for chlamydia. Treatment is considered necessary to get rid of chlamydia. It is not customary to rely on the patient’s immune system to clear a chlamydia infection.
The good news is that chlamydia is a curable condition and usually can be cured with one dose of medication. Treatment for chlamydia can be given before or after establishing a diagnosis.
This chapter will present tables with concise information about the following:
The tables are followed by frequently asked real-life questions from patients, with answers from an expert doctor.
Let’s start.
Treatment for newly diagnosed
This table summarizes the treatment options for newly diagnosed chlamydia:
- Ideal treatment is first-line treatment
- Alternative therapy is used when first-line treatment is unavailable or medication cannot be used due to allergies.
| Ideal treatment | Alternative Treatment |
|---|
Newly diagnosed cases | Doxycycline 100 mg orally twice a day for 7 days | Levofloxacin 500 mg orally once daily for 7 days
(contraindicated if you are pregnant) |
| OR |
Azithromycin 1 g orally; single dose
|
OR |
Doxycycline 200 mg orally once daily for 7 days |
Treatment regimen for resistant cases of chlamydia
This table summarizes the treatment for resistant chlamydia, which is very rare.
Chlamydia is considered resistant if the patient had first-line treatment and stayed away from sex for seven days but is still symptomatic or tests positive three weeks after the treatment.
- First-line treatment: the medications to choose from first
- Alternative treatment: used when first-line treatment is unavailable or cannot be used due to allergies.
| First-line Treatment | Alternative Treatment |
|---|
Antibiotic-resistant cases | Levofloxacin 500 mg orally once daily for 7 days
(contraindicated if you are pregnant) | Josamycin 500 mg orally three times a day
for 7 days
or
1000 mg orally twice a day
for 7 days |
OR |
Ofloxacin 300 mg orally twice a day for 7 days
(contraindicated if you are pregnant) |
OR |
Erythromycin base 500 mg orally four times a day for 7 days |
Chlamydia treatment regimen for partners
This table summarizes chlamydia treatment for sexual partners of chlamydia-positive people.
This treatment is called expedited partner therapy (EPT). It is treatment that a sexual partner of an infected person can get without seeing a doctor or being getting tested.
*It is crucial to ask your partners about drug allergies before giving them the medication.
- First-line treatment: the list of medication to choose from first
- Alternative treatment: used when first-line treatment is unavailable or cannot be used due to allergies
| First-line Treatment | Alternative Treatment |
|---|
Partners’ treatment | Doxycycline 100 mg orally twice a day for 7 days | Levofloxacin 500 mg orally once daily for 7 days
(contraindicated if you are pregnant) |
| OR |
Azithromycin 1 g orally; single dose
|
OR |
Doxycycline 200 mg orally once daily for 7 days |
Oral and rectal chlamydia treatment
This table summarizes treatment for oral and rectal chlamydia, which is slightly different from other treatment and requires a longer treatment time.
- First-line treatment: the list of medication to choose from first
- Alternative treatment: used when first-line treatment is unavailable or cannot be used due to allergies
| First-line Treatment | Alternative Treatment |
|---|
Oral | Doxycycline 100 mg orally twice a day for 7 days | Azithromycin 1 g orally; single dose |
Rectal infection caused by non-LGV strain | Doxycycline 100 mg orally twice a day for 7 days | Azithromycin 1 g orally; single dose |
Rectal infection caused by non-LGV strain | Doxycycline 100 mg orally twice a day for 7 days | Azithromycin 1 g orally; single dose |
| | OR |
Levofloxacin 500 mg orally once daily for 7 days (contraindicated if you are pregnant) |
Frequently Asked Questions
In this section, our expert doctor will answer some common patient questions about chlamydia transmission in more depth. Dr. Fuzayloff has been a practicing physician at busy STD center in Midtown Manhattan, New York City, for over two decades.
Who can get chlamydia treatment? 
A wide range of people can get chlamydia treatment.
This is the full list:
- People who experience chlamydia symptoms
- People who have tested positive for chlamydia
- Partners of people who have tested positive for chlamydia
- People who had a sexual encounter with an infected person
- People who want treatment “just in case” because the possibility of having a disease makes them anxious (but it is not advisable to overreact)
Can I be treated for chlamydia before my test results come back?
Yes. This is called empiric treatment. It means that treatment is initiated without a final diagnosis based on assumptions and clinical experience. There is a consensus in medicine that empiric treatment can be provided to people:
- Who experience signs and symptoms of chlamydia—for instance, discharge from the genitals, painful and frequent urination, burning during urination, or bleeding from the genitals after sexual intercourse or between menstrual periods
- Who had a sexual encounter with an infected person (even if there are no symptoms)
- Who tested positive for gonorrhea (the incubation period is shorter than chlamydia and it is diagnosed earlier; it goes hand in hand with chlamydia in that 24% of heterosexual males and 38% of females who have chlamydia are also positive for gonorrhea)
- Whose has a sexual partner who is positive for chlamydia
- Who is very anxious about this specific STD (it is best to not use antibiotics without an objective reason; however, if you are extremely worried and anxious about your STD status, you can get the needed medication from our healthcare provider )
How effective is chlamydia treatment?
First-line medications have demonstrated satisfying results. According to the CDC, azithromycin has been shown to be effective in 97% of people with urogenital infection, and doxycycline has a 98% efficacy rate. Because the difference is only 1%, azithromycin is the drug of choice for urogenital infection. It is administered only once (in a single dose) by a doctor, so it is more convenient for the patient than doxycycline (two tablets per day for seven days). It is easier to avoid treatment failure with azithromycin because it is given in a single dose.
For oral and rectal chlamydia, doxycycline has demonstrated a slightly higher cure rate than azithromycin. Therefore, doxycycline is the drug of choice for treating oral and rectal chlamydia.
What is the chance of chlamydia being resistant to antibiotics?
With gold-standard chlamydia treatment , the chance of chlamydia resistance in the US is low:
- 97.4% response rate to doxycycline
- 94.3% response rate to azithromycin
The chance of having chlamydia that is resistant to an alternative treatment is unknown (we found no studies on this topic).
What is antibiotic resistance?
Antibiotic resistance is an altered response of the bacteria to the treatment. It has occurred when bacteria maintain their ability to survive and replicate after the antibiotic treatment that is supposed to kill them. Patients whose chlamydia is resistant to antibiotics continues to experience symptoms and/or remains chlamydia-positive on a culture (three days after treatment completion) or NAAT test (three weeks after treatment completion).
Antibiotic resistance is rarely observed with chlamydia treatment.
*If you happen to have resistant chlamydia, sensitivity testing can be performed to direct the treatment.
How soon after treatment do symptoms resolve?
Symptoms tend to resolve quite quickly. Pain and burning during urination resolve within a few days to a week and other symptoms, such as pelvic pain and pain in the testicles, may resolve within two weeks. Generally, symptoms will resolve within one to four weeks, depending on their severity.
How soon after the treatment can I have sex?
It is crucial to strictly avoid sexual contact for seven days after finishing the treatment, regardless of the treatment regimen. This rule should be followed by you and your sexual partner(s) to prevent the spread of infection and avoid acquiring another infection.
Can I get chlamydia treatment for my partner?
Yes. In 2006, the CDC approved expedited partner therapy (EPT). This therapy was designed for sexual partners of chlamydia-positive persons.
One oral dose of azithromycin is prescribed to the partner without a medical evaluation. This approach prevents further reinfection (which occurs in 11% of cases) and possible chlamydia-related complications among sexual partners.
Current CDC recommendations provide that EPT is limited to the number of sexual partners that a chlamydia-positive patient had within the last 60 days.
If you are providing EPT treatment to your partner:
- Ask about allergies to the medications
- Make them aware of possible side effects
- Be aware of their pregnancy or breastfeeding status
Who cannot get treatment for their partner?
EPT is not advised:
- For gay and lesbian people (because they have a higher risk of coinfection with another STD)
- If your partner is positive for gonorrhea, syphilis, or HIV
EPT-related information is available on this New York City website:
https://www1.nyc.gov/site/doh/providers/health-topics/expedited-partner-therapy.page
Do I need to be retested after chlamydia treatment?
No. No retesting is necessary after the treatment if you:
- Got the gold-standard treatment, and
- Had no sex for seven days after finishing the treatment
Retesting is necessary if you:
- Had an alternative treatment for chlamydia
- Are pregnant
- Have oral gonorrhea
The ultimate test of whether you’re cured, an NAAT, shouldn’t be done only three weeks after treatment because chlamydia genetic material may persist for that long.
Where can I be treated?
You have many options. You can visit a primary care doctor, gynecologist, urologist, or urgent care clinic . In our center in Manhattan, we offer in-person and remote consultations (by video conference) so you can get the optimal treatment right away and however you’re most comfortable.
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