Chlamydia Treatment In Adults, Pregnancy, Newborn & Infants

Introduction

Chlamydia Treatment

Before talking about the treatment of a sexually transmitted disease called chlamydia infection, we must know that prevention is the most critical step before any treatment.

Prevention is achieved by using a condom, and it is the most effective way to reduce the risk of chlamydial infection).

Condoms should be used with each new sexual intercourse and with infected sex partners who were diagnosed with a sexually transmitted disease before.

Also, regular evaluation and examination for sexually transmitted diseases with each new partner can prevent chlamydial infections and other infections such as gonorrhoea and syphilis, which are commonly associated with chlamydial infection.

Nowadays, sexually transmitted diseases are treated easily by using antibiotics with different regimens to apply; it can be used in a single dose or multiple doses over several days.

Treatment of chlamydia infection takes from 5 to 10 days to clear the infection.

Also, the type of antibiotic that is used in the therapy differs according to the site of the infection (mainly urogenital in adults, the eyes in the newborn, which is referred to as ophthalmia neonatorum, and the lungs in case of infant pneumonia). Other important factors include pregnancy, and the severity of the infection because severely infected pregnant women may require hospitalisation.

Azithromycin and doxycycline are two antibiotics commonly used nowadays. Additionally, there are alternative antibiotics that can treat chlamydial infection, but instructions and the dosage are much more important than the type of antibiotic itself.

During the time of the therapy, the patient should abstain from sexual intercourse until completing the antibiotic therapy for two reasons:

  • First, to prevent the transmission of chlamydial infection to their sex partner.
  • Second, in case a sex partner is infected with chlamydia trachomatis , reinfection can be prevented during the period of the therapy.

Test-of-cure is not recommended in case of urogenital chlamydial infection (infection of urethra or vagina), but in case of pregnant females test-of-cure is advised 3-4 weeks after treatment because of severe consequences and complications for both mothers and infants.

CDC-Recommended regimens to treat chlamydial infection:

A single and large dose of Azithromycin (1 g) orally. Or Doxycycline twice a day per one week at a dose of 100 mg orally.

Alternative regimens:

  • Erythromycin base at an oral dose of 500mg, four times a day for one week.
  • Erythromycin ethylsuccinate at an oral dose of 800mg, four times a day for one week.
  • Levofloxacin at an oral dose of 500 mg daily for one week.
  • Ofloxacin at an oral dose of 300mg two times a day for one week.

Azithromycin and doxycycline are commonly used, but erythromycin is considered an alternative regimen or comes in the second position because of the side effect of the drug that causes gastrointestinal upsets.

The risk of reinfection is not uncommon. This is not due to the infection’s contagiousness but due to the act of sexual activity with multiple sex partners. Thus, as mentioned before, prevention with a condom is much more important than the treatment itself.

Treatment of sexual partners

In addition, treatment of sexual partners is essential to prevent reinfection of the diseased person and infection of other persons who have sex with him/her.

The first step in the treatment of a sexual partner is to do an evaluation and examination of the last sexual partner within 60 days or less.

If the sexual partner refuses to come, he/she may receive the treatment without the need for evaluation or examination. However, if the infection persists after receiving the treatment, evaluation and examination are mandatory because of the probability of co-infection with other organisms as in case of syphilis or gonorrhoea, or resistance of chlamydia trachomatis to the antibiotic that is currently used. Thus, you may need to change the type of antibiotic based on culture (one of many types of investigation at hand).

Treatment of the sex partner is the same as the patient presented and diagnosed with chlamydial infection with the same dosage and instructions.

And, as mentioned before, there should be no sexual intercourse during the period of treatment and until the disappearance of symptoms.

In the case of treating pregnant females, some drugs are contraindicated in pregnancy because of their side effects on mothers and infants.

Azithromycin is the safest treatment recommended for pregnant women, but doxycycline is contraindicated, especially after the third month of pregnancy.

Levofloxacin and ofloxacin are contraindicated during breastfeeding.

In spite of urogenital chlamydial infection in non-pregnant women, test-of-cure (repeated cultures) is indicated 3- 4 weeks after the treatment.

Treatment of ophthalmia neonatorum

Ophthalmia neonatorum is one of the complications that occur if the pregnant women are left untreated; it features an infection of eyes that is acquired during the passage of the newborn through the birth canal.

Recommended regimens for treatment of ophthalmia neonatorum:

Erythromycin 4 times per day for 2 weeks (50 mg/kg/day ) orally. Or Azithromycin once daily for 3 days.

in addition to systemic antibiotics (that are taken orally), topical antibiotics can be used, but they are not relevant for this treatment compared to systemic antibiotics. Thus, they are not recommended.

The side effects of these drugs are much more common in infants less than 6 months. So, parents must seek medical advice in case of disturbing symptoms during the period of the therapy.

The most common side effect is infantile hypertrophic pyloric stenosis, which means an increase in the size of the muscle that controls the outlet of the stomach preventing the passage of food from the stomach to the intestine. This problem leads to repetitive and sudden vomiting, refusal of feeding and persistent crying. It’s similar to a pipe blocked with a large stone that leads to the accumulation of water behind it.

Nowadays, silver nitrate eye drops are used routinely for all newborns for prophylaxis against chlamydial infection, especially in developing countries.

Erythromycin is recommended as the first line for treatment.

Treatment of chlamydial pneumonia

Untreated chlamydial infection in pregnant females can lead to other complications instead of ophthalmia neonatorum as chlamydial pneumonia which means inflammation of the lungs due to infection by chlamydia trachomatis that acquired during passage through birth canal.

Mothers typically come to the doctor complaining of repetitive cough in infants aged 1-3 months with a history of chlamydial infection during pregnancy.

CDC-Recommended regimen for treatment of chlamydial pneumonia:

Erythromycin base or Erythromycin ethylsuccinate 4 times per day for 2 weeks (50 mg/kg/day ) orally. Or Azithromycin suspension once daily for 3 days.

Treatment of pelvic inflammatory disease

The most severe and important complications of untreated or persistent or repeated infection in women is pelvic inflammatory disease, which means inflammation to some organs located in the female pelvis, including the ovaries, fallopian tubes, uterus and peritoneum.

It is considered severe because it ends in fibrosis of these organs, and ultimately affects fertility.

Fibrosis looks like strings made of fibrous tissue wrapping the organs and interfering with their functions.

Patients should receive the treatment before fibrosis (formation of fibrous tissue around the organs), during the period of inflammation. Thereafter, the inflammation will subside, and fibrosis will not occur.

Treatment of pelvic inflammatory disease takes 14 days by antibiotics that taken orally or parenteral (through needles) according to the severity of the infection.

CDC-Recommended oral antibiotics for treatment of pelvic inflammatory disease:

Ofloxacin (Floxin) (400 mg) orally twice daily for 14 days. Or Levofloxacin (Levaquin) (500 mg) orally once daily for 14 days with or without metronidazole (Flagyl) 500 mg orally twice daily for 14 days.

CDC-Recommended parenteral antibiotics for treatment of pelvic inflammatory disease:

Cefotetan (Cefotan) 2 g IV(intravenous at the hospital )every 12 hours. Or Cefoxitin 2 g IV(intravenous at the hospital) every six hours.

Plus Doxycycline 100 mg orally or IV (intravenous) every 12 hours.

Also, pregnant women may complicated by pelvic inflammatory disease; if the pregnant woman has infected, hospitalisation is a must and treatment through the parenteral pathway is considered.

Sexually transmitted diseases may occur in infants and children as well due to sexual abuse.

Treatment of chlamydial infection in children and infants differ according to age and weight.

CDC recommends Erythromycin as the first line of treatment in infants and children who weigh less than 45KG (4 times per day for 2 weeks) and Azithromycin for infants and children who weigh 45kg or more but are younger than 8 years (single dose 1g orally).

FOR INFANTS AND CHILDREN AGED 8 YEARS OR MORE:

CDC recommends

Azithromycin single dose (1 g) orally. Or Doxycycline twice per day for 7 days ( 100 mg ) orally.