Chlamydia - Treatments
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If you have chlamydia, treatment with antibiotics will get rid of the infection. You won't need any other treatment.
Key messages about treatment for chlamydia
- Antibiotics are medicines that kill bacteria. They can get rid of chlamydia in most people.
- The antibiotics usually used are called azithromycin and doxycycline. Research shows they work well.
- You take azithromycin as a single dose. So you may find this medicine is the most convenient to use.
- Some antibiotics may affect a baby in the womb. If you're a woman and you're pregnant, there are other antibiotics you can take.
- It's important not to have sex until you and your partner have both been treated for chlamydia. That includes having oral sex and having sex using a condom. Otherwise you could pass the infection on again.
- There hasn't been enough research to show whether you can get chlamydia infection again after you've finished antibiotic treatment
- If you have chlamydia, anyone you've had sex with recently may also have it. Your doctor or nurse will want to make sure that your recent partner or partners also get treatment. You may be asked to contact your last partner and anyone else you've had sex with in the past few months. Or you can ask the staff at your sexual health clinic to do it for you.
We've looked closely at the research and ranked the treatments into categories according to whether they work.
Treatments for men and for women who aren't pregnant
Treatments that work
The three antibiotics azithromycin, doxycycline and tetracycline work just as well as each other to get rid of chlamydia. Antibiotics are drugs that kill bacteria (germs). There are many types of antibiotics.
You can take azithromycin (brand name Zithromax) as a single dose. If you're taking doxycycline or tetracycline, you'll need to take them for seven days. Doctors usually prescribe doxycycline and azithromycin for treating chlamydia.
There's good evidence that these antibiotics work for chlamydia. One summary of the research (called a systematic review) included 12 good-quality studies (called randomised controlled trials) that looked at taking antibiotics for chlamydia. The summary included a total of 1,543 people. It showed that about 8 in 10 to 9 in 10 people with chlamydia were cured after taking either azithromycin or doxycycline.[2] Other research has shown that tetracycline works just as well.[3]
The advantage of azithromycin is that it works after taking a single dose. But you'll need to wait seven days after having treatment before having sex again. That's to be sure the treatment has time to work. With the other medicines, you need to wait until you've finished taking the tablets.[1]
The side effects of these antibiotics are usually mild.[2] The most common ones are:
- Getting an upset stomach
- Getting stomach pain
- Having diarrhoea
- Feeling sick.
Occasionally, people taking doxycycline or tetracycline get a skin rash when they are outside in sunlight. Doctors call this photosensitivity.
Treatments that are likely to work
Another antibiotic that's likely to work for chlamydia is erythromycin (brand names Erymax and Erythrocin). Doctors sometimes prescribe it. You need to take erythromycin for 14 days.
But there hasn't been enough research on erythromycin as for azithromycin, doxycycline and tetracycline. Three small studies (randomised controlled trials) found that taking erythromycin cured between 7 in 10 and 10 in 10 people with chlamydia.[4] [5] [6]
Common side effects of erythromycin include feeling sick, vomiting and having diarrhoea. Some women find the side effects of erythromycin worse than those of other antibiotics.[7]
Treatments that need further study
There are many other antibiotics, but they haven't been studied enough for us to say whether they work for chlamydia. These include amoxicillin, ampicillin, clarithromycin, lymecycline, minocycline, ofloxacin, pivampicillin and rifampicin.
Treatments for women who're pregnant
There's been much less research on chlamydia treatment for pregnant women than for other groups of people with chlamydia infection. And it isn't always clear whether taking medicines will prevent infection in your baby, even if they seem to clear up your infection.[7]
If you're pregnant, you shouldn't take doxycycline or tetracycline because they can damage your baby's teeth and bones before birth.
Treatments that are likely to work
There's some good evidence that azithromycin, erythromycin and amoxicillin are likely to work for pregnant women who have chlamydia.[7]
But researchers are unsure about the safety of azithromycin if you're pregnant or breastfeeding.[7] [1] You'll probably be offered either erythromycin or amoxicillin. Neither of these drugs is harmful in pregnancy. You usually take erythromycin or amoxicillin for seven days.
You're more likely to get bad side effects with erythromycin than with amoxicillin.[7] Common side effects of both drugs are:
- Feeling sick
- Vomiting
- Having diarrhoea.
Amoxicillin belongs to a group of antibiotics called pencillins. Some people have an allergic reaction to these medicines and can't take them. Often the first sign that you're having an allergic reaction is a rash. Occasionally this allergic reaction can be dangerous and make the person having the reaction go into shock.
You're more likely to have an allergic reaction if you have allergies such as eczema and asthma. You should see a doctor at once if you are think you're having a reaction to penicillin drugs.
Researchers aren't sure whether amoxicillin stops newborn babies getting infected, even though their mothers seem to be cured of chlamydia.[7]
If you are pregnant, you'll need to have another test for chlamydia three to five weeks after treatment. That's because the drugs that are safe in pregnancy don't always work as well as the ones you can use when you're not pregnant. So your doctor will do a test to be certain that the drugs have worked.[1]
Treatments that need further study
One good-quality study (called a randomised controlled trial) looked at how well an antibiotic called clindamycin worked for pregnant women with chlamydia. It found that clindamycin worked better than a dummy treatment (placebo) at curing chlamydia in pregnant women.[7] But there hasn't been enough research for us to say that clindamycin is likely to work.
References
- British Association of Sexual Health and HIV. 2006 UK national guideline for the management of genital tract infection with Chlamydia trachomatis. British Association of Sexual Health and HIV. Available at http://www.bashh.org/guidelines/2006/chlamydia_0706.pdf (accessed 29 October 2007).
- Lau C-Y, Qureshi AK. Azithromycin versus doxycycline for genital chamydial infections: a meta-analysis of randomised clinical trials. Sexually Transmitted Diseases. 2002; 29: 497-502.
- Lassus A, Virrankoski T, Kanerva L. Comparison between rifampicin and tetracycline in the treatment of nongonococcal urethritis in males with special reference to Chlamydia trachomatis. European Journal of Sexually Transmitted Diseases. 1984; 2: 15-17.
- Worm AM, Hoff G, Kroon S, et al. Roxithromycin compared with erythromycin against genitourinary chlamydial infections. Genitourinary Medicine. 1989; 65: 35-38.
- Worm AM, Avnstorp C, Petersen CS. Erythromycin against chlamydia trachomatis infections: a double blind study comparing 4- and 7-day treatment in men and women. Danish Medical Bulletin. 1985; 32: 269-271.
- Linnemann CCJ, Heaton CL, Ritchey M. Treatment of Chlamydia trachomatis infections: comparison of 1- and 2-g doses of erythromycin daily for seven days. Sexually Transmitted Diseases. 1997; 14: 102-106.
- Brocklehurst P, Rooney G. Interventions for treating genitalinfection in pregnancy (Cochrane review). In: The Cochrane Library, Issue 3, 2002. Update Software, Oxford, UK.
Glossary
- bacteria
- Bacteria are tiny organisms. There are lots of different types. Some are harmful and can cause disease. But some bacteria live in your body without causing any harm.
- antibiotics
- These medicines are used to help your immune system fight infection. There are a number of different types of antibiotics that work in different ways to get rid of bacteria, parasites and other infectious agents. Antibiotics do not work against viruses.
- systematic reviews
- A systematic review is a thorough look through published research on a particular topic. Only studies that have been carried out to a high standard are included. A systematic review may or may not include a meta-analysis, which is when the results from individual studies are put together.
- randomized controlled trials
- Randomized controlled trials are medical studies that test how well a treatment works. Patients are split into groups at random. One group is given the treatment being tested (for example, an antidepressant pill). Another group (called the comparison or control group) is given a different treatment or a placebo (a pretend treatment that has no effect). Researchers then compare the effects of the different treatments.
- diarrhoea
- Diarrhoea is when you have loose, watery stools and you need to go to the toilet far more often than usual. Doctors say you have diarrhoea if you need to go to the toilet more than three times a day.
- allergic reaction
- You have an allergic reaction when your immune system overreacts to a substance that is normally harmless. You can be allergic to particles in the air you are breathing, like pollen (which causes hay fever) or to chemicals on your skin, like detergents (which can cause a rash). People can also have an allergic reaction to drugs, like penicillin.
- eczema
- Eczema is a very itchy rash. It may be dark and bumpy and release fluid. Scratching makes it worse. You can get eczema anywhere on your body, but it is most common on the wrists, the insides of the elbows and the backs of the knees. If you have asthma or allergies you are more likely to get eczema than someone who doesn't have these conditions.
- asthma
- Asthma is a disease of the lungs. It makes you wheeze, cough and feel short of breath. Asthma attacks are caused by inflammation and narrowing of your airways, which makes it hard for air to pass in and out of your lungs.
- randomised controlled trials
- Randomised controlled trials are medical studies designed to test whether a treatment works. Patients are split into groups. One group is given the treatment being tested (for example, an antidepressant drug) while another group (called the comparison or control group) is given an alternative treatment. This could be a different type of drug or a dummy treatment (a placebo). Researchers then compare the effects of the different treatments.
- placebo
- A placebo is a 'pretend' or dummy treatment that contains no active substances. A placebo is often given to half the people taking part in medical research trials, for comparison with the 'real' treatment. It is made to look and taste identical to the drug treatment being tested, so that people in the studies do not know if they are getting the placebo or the 'real' treatment. Researchers often talk about the 'placebo effect'. This is where patients feel better after having a placebo treatment because they expect to feel better. Tests may indicate that they actually are better. In the same way, people can also get side effects after having a placebo treatment. Drug treatments can also have a 'placebo effect'. This is why, to get a true picture of how well a drug works, it is important to compare it against a placebo treatment.
© BMJ Publishing Group Limited ("BMJ Group") 2007. All rights reserved
This information does not replace medical advice. If you are concerned you might have a medical problem please ask your Boots pharmacy team in your local Boots store, or see your doctor.
