Uncomplicated Chlamydial Infections

Chlamydial urethritis is characterized by urethral discharge of mucopurulent or purulent material and sometimes by dysuria or urethral pruritis. Asymptomatic infections are common. All patients who have urethritis should be evaluated for the presence of gonococcal and chlamydial infection. Treatment should be initiated as soon as possible after diagnosis. Single-dose regimens have the advantage of improved compliance and permit DOT. The medication should be provided in the clinic or healthcare provider's office. Recommended regimens include azithromycin 1 g orally in a single dose or doxycycline 100 mg orally twice a day for 7 days. Again, the 2 g single oral dose of azithromycin has not been recommended, due to its increased expense and frequency of gastrointestinal intolerance. Alternative regimens include erythromycin base 500 mg orally four times a day for 7 days, erythromycin ethylsuccinate 800 mg orally four times a day for 7 days, ofloxacin 300 mg twice a day for 7 days, or levofloxacin 500 mg once daily for 7 days. Patients should be instructed to return for evaluation if symptoms persist or recur after completion of therapy (105).

The results of clinical trials indicate that azithromycin and doxycycline are equally efficacious for treatment of chlamydial infection (106,107). These investigations were conducted primarily in populations in which follow-up was encouraged and adherence to a 7-day regimen was good. Azithromycin should be used to treat patients for whom adherence is in question, and is more costeffective because a single dose and DOT can be used. Doxycycline costs less than azithromycin, and it has been used extensively for a longer period. Erythromycin is less efficacious than either azithromycin or doxycycline due to gastrointestinal side effects and lower adherence. Ofloxacin is similar in efficacy to doxycycline and azithromycin, but it is more expensive to use and offers no advantage with regard to the dosage regimen. Partner tracing and notification along with education regarding the use and efficacy of condoms remain a mainstay of prevention of gonorrheal and chlamydial infection.

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