Chlamydial Genitourinary Infections Medication

  • Author: Kelley Struble, DO; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Jan 17, 2012
 

Medication Summary

Treatment of genitourinary chlamydial infection clearly is indicated when the infection is diagnosed or suspected. Treatment also is indicated for sex partners of the index case if the time of the last sexual encounter was within 60 days of onset, and it should be considered for longer periods for the last sexual partner. Treatment of chlamydia is indicated for patients being treated for gonorrhea, as well.

The Centers for Disease Control and Prevention (CDC) updated treatment guidelines for gonococcal infection and associated conditions, which were published in the April 13, 2007, issue of the Morbidity and Mortality Weekly Report.[8] Fluoroquinolone antibiotics are no longer recommended to treat gonorrhea in the United States. The recommendation was based on analysis of new data from the CDC's Gonococcal Isolate Surveillance Project (GISP). The data from GISP showed the proportion of gonorrhea cases in heterosexual men that were fluoroquinolone-resistant (QRNG) reached 6.7%, an 11-fold increase from 0.6% in 2001.

This limits treatment of gonorrhea to drugs in the cephalosporin class (eg, ceftriaxone 125 mg IM once as a single dose or a single PO dose of cefixime 400 mg).[9] Fluoroquinolones may be an alternative treatment option for disseminated gonococcal infection if antimicrobial susceptibility can be documented.

For more information, see the CDC's Antibiotic-Resistant Gonorrhea Web site; the CDC’s Updated Gonococcal treatment recommendations (April 2007); or Medscape Medical News on CDC Issues - New Treatment Recommendations for Gonorrhea.

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Antibiotics

Class Summary

Therapy should cover all likely pathogens in the context of this clinical setting.

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Azithromycin (Zithromax)

 

Relatively new member of the macrolide family of antimicrobials. Related to erythromycin, it is considered by many to be the treatment of choice of C trachomatis genitourinary infection because it may be administered as a 1-dose treatment, which improves adherence to treatment.

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Doxycycline (Doryx, Vibramycin)

 

Well absorbed tetracycline antimicrobial. When administered for 1 wk, appears to be as effective as single-dose azithromycin for genitourinary chlamydial infections. Although the course is longer (7 d versus 1 dose) than azithromycin, the cost is less and it has been used in clinical practice for a much longer time.

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Erythromycin (E.E.S., E-Mycin, Eryc, Ery-Tab, Erythrocin)

 

Macrolide antimicrobial agent that generally is considered the recommended treatment for chlamydial genitourinary infection only during pregnancy.

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Ampicillin (Principen, Omnipen, Marcillin)

 

Like erythromycin, amoxicillin is considered a recommended treatment for genitourinary chlamydial infection only in pregnant women.

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Contributor Information and Disclosures
Author

Kelley Struble, DO  Fellow, Department of Infectious Diseases, University of Oklahoma College of Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Larry I Lutwick, MD  Professor of Medicine, State University of New York Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus

Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Rhett L Jackson, MD  Associate Professor and Vice Chair for Education, Department of Medicine, Director, Internal Medicine Residency Program, University of Oklahoma College of Medicine; Assistant Chief, Medicine Service, Oklahoma City Veterans Affairs Hospital

Rhett L Jackson, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine and American Medical Association

Disclosure: Nothing to disclose.

Renuka Heddurshetti, MD  Fellow in Infectious Diseases, Department of Internal Medicine, State University of New York at Brooklyn

Renuka Heddurshetti, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Jeffrey Blitstein, MD  Staff Physician, Department of Internal Medicine, Division of Infectious Disease, VA New York Harbor Health Care System at Brooklyn

Disclosure: Nothing to disclose.

Specialty Editor Board

John M Leedom, MD  Professor Emeritus of Medicine, Keck School of Medicine of the University of Southern California

John M Leedom, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References

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  2. Centers for Disease Control and Prevention. Department of Health and Human Services. Sexually Transmitted Disease Surveillance, 2007. Available at http://www.cdc.gov/std/pubs/. Accessed December 2008.

  3. World Health Organization. Chlamydia Trachomatis. Initiative for Vaccine Research. Accessed June 2009. Available at http://www.who.int/vaccine_research/diseases/soa_std/en/index.html.

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  23. Martin DH, Mroczkowski TF, Dalu ZA. A controlled trial of a single dose of azithromycin for the treatment of chlamydial urethritis and cervicitis. The Azithromycin for Chlamydial Infections Study Group. N Engl J Med. Sep 24 1992;327(13):921-5. [Medline].

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