Rectal and oropharyngeal C. Most tests, including NAAT and nucleic acid hybridization tests, are not FDA-cleared for use with rectal or oropharyngeal swab specimens, and chlamydia culture is not widely available for this purpose. However, NAATs have demonstrated improved sensitivity and specificity compared with culture for the detection of C. Recent evidence suggests that the liquid-based cytology specimens collected for Pap smears might be acceptable specimens for NAAT testing, although test sensitivity using these specimens might be lower than those resulting from the use of cervical swab specimens ; regardless, certain NAATs have been FDA-cleared for use on liquid-based cytology specimens.
Persons who undergo testing and are diagnosed with chlamydia should be tested for other STDs. Treatment Treating infected patients prevents sexual transmission of the disease, and treating all sex partners of those testing positive for chlamydia can prevent reinfection of the index patient and infection of other partners.
Treating pregnant women usually prevents transmission of C. Chlamydia treatment should be provided promptly for all persons testing positive for infection; delays in receiving chlamydia treatment have been associated with complications e. The following recommended treatment regimens and alternative regimens cure infection and usually relieve symptoms.
These studies were conducted primarily in populations in which follow-up was encouraged, adherence to a 7-day regimen was effective, and culture or EIA rather than the more sensitive NAAT was used for determining microbiological outcome. Azithromycin should always be available to treat patients for whom compliance with multiday dosing is uncertain. The clinical significance and transmissibility of C. In patients who have erratic health-care—seeking behavior, poor treatment compliance, or unpredictable follow-up, azithromycin might be more cost-effective in treating chlamydia because it enables the provision of a single-dose of directly observed therapy Erythromycin might be less efficacious than either azithromycin or doxycycline, mainly because of the frequent occurrence of gastrointestinal side effects that can lead to noncompliance.
Levofloxacin and ofloxacin are effective treatment alternatives but are more expensive and offer no advantage in the dosage regimen. Other quinolones either are not reliably effective against chlamydial infection or have not been evaluated adequately. To maximize compliance with recommended therapies, medications for chlamydial infections should be dispensed on site, and the first dose should be directly observed.
To minimize disease transmission to sex partners, persons treated for chlamydia should be instructed to abstain from sexual intercourse for 7 days after single-dose therapy or until completion of a 7-day regimen.
To minimize the risk for reinfection, patients also should be instructed to abstain from sexual intercourse until all of their sex partners are treated. Swallow right away without chewing. Do not save the mixture for later use. Drink a full glass 8 ounces of cool water right away. Do not crush, break, or open a delayed-release capsule or tablet.
Swallow the pill whole. You may need to split a doxycycline tablet to get the correct dose. Follow your doctor's instructions. Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.
If you take doxycycline to prevent malaria: Start taking the medicine 1 or 2 days before entering an area where malaria is common.
Continue taking the medicine every day during your stay and for at least 4 weeks after you leave the area. Use protective clothing, insect repellents, and mosquito netting around your bed to further prevent mosquito bites that could cause malaria.
Use this medicine for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics.
Doxycycline will not treat a viral infection such as the flu or a common cold. If you need surgery, tell the surgeon ahead of time that you are using doxycycline. The minimum inhibitory concentration MIC , the lowest antimicrobial concentration that inhibits visible bacterial growth in the laboratory, is used to assess antimicrobial susceptibility. Cefixime susceptibilities were not determined during — because cefixime temporarily was unavailable in the United States at that time.
During —, 15 0. Because increasing MICs can predict the emergence of resistance, lower cephalosporin MIC breakpoints were established by GISP for surveillance purposes to provide greater sensitivity in detecting declining gonococcal susceptibility than breakpoints defined by CLSI.
In the West, the percentage increased from 0. Among MSM, the percentage increased from 0. The CDC STD treatment guidelines 2 recommend that azithromycin or doxycycline be administered with a cephalosporin as treatment for gonorrhea. Among isolates collected during — that exhibited elevated cefixime MICs, Ceftriaxone as a single intramuscular injection of mg provides high and sustained bactericidal levels in the blood and is highly efficacious at all anatomic sites of infection for treatment of N.
A mg oral dose of cefixime does not provide bactericidal levels as high, nor as sustained as does an intramuscular mg dose of ceftriaxone, and demonstrates limited efficacy for treatment of pharyngeal gonorrhea 10, The significant increase in the prevalence of U. Thus, observed patterns might indicate early stages of the development of clinically significant gonococcal resistance to cephalosporins.
CDC anticipates that rising cefixime MICs soon will result in declining effectiveness of cefixime for the treatment of urogenital gonorrhea. Furthermore, as cefixime becomes less effective, continued use of cefixime might hasten the development of resistance to ceftriaxone, a safe, well-tolerated, injectable cephalosporin and the last antimicrobial that is recommended and known to be highly effective in a single dose for treatment of gonorrhea at all anatomic sites of infection.
Maintaining effectiveness of ceftriaxone for as long as possible is critical. Absorption of tetracyclines has been reported to be impaired by milk products, aluminum hydroxide gels, sodium bicarbonate, calcium and magnesium salts, laxatives containing magnesium and iron preparations.
The mechanisms responsible for decreased absorption appear to be chelation and an increase in gastric pH. In view of these results, it is advisable to instruct the patients to take doxycycline on an empty stomach. Recent research has shown no significant loss of effectiveness in oral contraceptives while using most tetracycline antibiotics including doxycycline , although many physicians still recommend the use of barrier contraception for people taking the drug to prevent unwanted pregnancy.
As with all tetracycline antibiotics, it is contraindicated in pregnancy through infancy and childhood up to eight years of age, due to the potential for disrupting bone and tooth development.
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