Chlamydia treatment
Advisory Alert
July 24, 2020
*Cette information est seulement disponible en anglais.
To: Local Health System Partners
FOR IMMEDIATE ATTENTION: Chlamydia treatment
Are you treating chlamydia according to current guidance?
Rates of chlamydia continue to rise and in Ontario, chlamydia remains the most frequently reported infectious disease. Treatment and management of all confirmed and probable cases of Chlamydia trachomatis is key.
The Canadian Guidelines of Sexually Transmitted Infections (CGSTI) offers both pathogen-specific and syndrome-specific recommendations for the screening, diagnosis, and treatment of sexually transmitted infections. The CGSTI recommends treating anogenital and conjunctival chlamydia in non-pregnant and non-lactating adults with doxycycline 100 mg PO BID for seven days or azithromycin 1 g PO in a single dose. However, health care practitioners are guided by the context and their clinical judgment when deciding on the appropriate treatment for a given infection. Azithromycin is preferred over doxycycline (in combination with ceftriaxone) when gonorrhea co-infection is suspected or confirmed, due to significant rates of tetracycline-resistant gonorrhea.
Health care providers are referred to the Canadian Guidelines on Sexually Transmitted Infections- Management and treatment of specific infections-Chlamydia and LGV. to determine the most appropriate evidence based treatment for patients.
Diagnosis and laboratory
Who to screen
- asymptomatic sexually active people under 25 years
- all pregnant individuals
- neonates born to mothers with chlamydia
- people with risk factors for sexually transmitted and blood-borne infection (STBBI)
Testing
- Culture testing is recommended for all symptomatic individuals prior to treatment.
- Urine (NAAT) testing to be used for screening of asymptomatic individuals.
- Rectal and pharyngeal samples are recommended for men who have sex with men, those who engage in sex work as well as their sexual contacts, and known sexual contacts of those infected with gonorrhea.
- It is recommended to concurrently test for chlamydia and gonorrhea.
Treatment
As per the guidelines, all non-pregnant and non-lactating individuals.
Preferred treatment
- *Doxycycline 100 mg PO BID for 7 days or
- Azithromycin 1 g PO in a single dose
Alternative treatment
- *Levofloxacin 500 mg PO once a day for 7 days
As per the guidelines, patients nine (9) to 18 years.
Preferred treatment
- * Doxycycline 5 mg/kg/day PO in divided doses (max.100mg BID) for 7 days or
- *Azithromycin 12-15 mg/kg (max. 1 g) PO in a single dose, if poor compliance is expected
Alternative treatment
- *Erythromycin base 40 mg/kg/day PO in divided doses (max. 500 mg QID for 7 days or 250 mg QID for 14 days
- *Sulfamethoxazole 75 mg/kg/day PO in divided doses (max.1 g BID) for 10 days
*Refer to the treatment section of the CGSTI for recommendations for pregnant or lactating individuals
Test of cure is recommended when:
- alternative treatment used (i.e. second-line treatment)
- patient is pregnant
- patient is prepubertal
- re-exposure may have occurred
- compliance is an issue
- previous treatment failed
- persistent symptoms post-treatment
- pharyngeal/rectal gonococcal infection
Additional resources:
- Summary of Recommendations for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Syphilis
- Discussing sexual health, harm reduction and STBBIs: A guide for service providers (CPHA)
Publicly funded medications
Publicly funded medications for the treatment of chlamydia or other sexually transmitted infections are available to health care providers by contacting the Public Health Sudbury & Districts’ Sexual Health Program at 705.522.9200, ext. 482. Alternatively, cases and contacts may be referred to the Sexual Health Clinic located in the Sudbury Elm Place (formerly the Rainbow Centre) for free treatment. The Sexual Health Program can also be contacted for specific questions related to chlamydia testing and treatment.
Chlamydia is a reportable disease under the Health Protection and Promotion Act. Chlamydia cases and their sexual contacts must be reported to Public Health Sudbury & Districts, as must any suspected or confirmed chlamydia treatment failures.
Thank you and please do not hesitate to contact our Sexual Health Program staff should you have any questions or comments.
Sincerely,
Original Signed By
Dr. Penny Sutcliffe
Medical Officer of Health and Chief Executive Officer
Encl.
Note: all Advisory Alerts are found on our website.
This item was last modified on July 24, 2020