Treatment Guideline Chart

Chlamydia is a Gram-negative obligate intracellular bacteria that causes sexually transmitted infection. Chlamydia trachomatis is the primary cause of pelvic inflammatory disease (PID) in women which may lead to ectopic pregnancy, infertility, or chronic pelvic pain. Most infected females are asymptomatic but some females may experience vaginal discharge, dysuria, lower abdominal pain, abnormal vaginal bleeding (postcoital or intermenstrual) or breakthrough bleeding, dyspareunia, conjunctivitis, proctitis and reactive arthritis.

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


Preferred Agents

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


  • 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


  • 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


  • 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


  • 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


  • Levofloxacin
    • Effective alternative treatment for anogenital infection
  • Ofloxacin
    • Alternative agent for anogenital infection with similar efficacy to Azithromycin and Doxycycline


  • Alternative agents for uncomplicated genital chlamydia infection
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