Chlamydia is treated with a short course of antibiotics, and the infection typically clears completely within one to two weeks. Most people take pills by mouth and don’t need any follow-up procedures. The specific antibiotic your provider prescribes depends on where the infection is located and whether you’re pregnant.
The Standard Antibiotic Regimen
For uncomplicated chlamydia infections of the genitals or throat, doxycycline taken twice daily for seven days is the preferred treatment. This has become the go-to option because it has a slightly higher cure rate than the alternatives, particularly for rectal infections. You take it morning and evening with food and water.
A single-dose alternative, azithromycin (one gram taken all at once), used to be the first-line recommendation and is still effective for genital chlamydia. It’s convenient because you only take it once, but it doesn’t perform as well against rectal chlamydia. Your provider may still choose it depending on your situation, especially if completing a full week of pills is a concern.
Chlamydia remains highly susceptible to these standard antibiotics. National surveillance studies from countries including Japan, Spain, and Portugal have consistently found no meaningful resistance to the drugs used as first-line treatments. Sporadic cases of reduced susceptibility have been reported in lab settings, but clinically significant antibiotic resistance in chlamydia is extremely rare, unlike the growing resistance seen in gonorrhea.
Treatment During Pregnancy
Pregnant individuals need a different approach because doxycycline can affect fetal tooth development during the second and third trimesters. The recommended treatment during pregnancy is a single one-gram dose of azithromycin taken by mouth. If that’s not an option, amoxicillin three times daily for seven days is an alternative.
Erythromycin, which was previously used during pregnancy, is no longer recommended. It frequently causes gastrointestinal side effects severe enough that many people stop taking it before finishing the course, and more recent reviews have flagged a possible association between erythromycin use in pregnancy and adverse outcomes for the child.
What to Expect After Treatment
You should avoid sex for seven days after starting a seven-day course of doxycycline, or for seven days after taking a single dose of azithromycin. This waiting period gives the antibiotic enough time to fully clear the bacteria and prevents you from passing the infection to a partner.
A routine “test of cure” isn’t necessary for most people after standard treatment, since the antibiotics are so effective. However, you should get retested three months after your diagnosis. This isn’t to check whether the original treatment worked. It’s to catch reinfection, which is common because many people are re-exposed to an untreated partner or a new partner who carries the infection.
Getting Your Partner Treated
Treating your partner is a critical part of treating yourself. If your sexual partner isn’t also treated, you’re likely to get reinfected the next time you have sex. Anyone you’ve had sexual contact with in the 60 days before your diagnosis should be tested and treated.
In many states, a practice called Expedited Partner Therapy (EPT) allows your healthcare provider to write a prescription for your partner without examining them first. You simply bring the medication or prescription to your partner directly. The CDC considers EPT a useful option for partner management, particularly for male partners of women diagnosed with chlamydia. The legal status of EPT varies by state, so your provider can tell you whether it’s available where you live.
When the Infection Has Spread
Chlamydia that goes untreated can travel deeper into the reproductive tract and cause pelvic inflammatory disease (PID) in women. PID is a more serious infection that requires a longer and more aggressive treatment course, typically 14 days of antibiotics. In mild to moderate cases, this can still be managed with oral medications at home. More severe cases may require initial treatment with intravenous antibiotics in a hospital before switching to oral pills to finish the two-week course.
PID treatment uses a combination of antibiotics rather than a single drug, because by the time the infection has spread, multiple types of bacteria are often involved. The total treatment is harder on the body and takes longer to complete, which is one reason early detection and treatment of chlamydia matters so much. Left untreated, PID can lead to chronic pelvic pain, scarring of the fallopian tubes, and fertility problems.
Rectal Chlamydia
Chlamydia can infect the rectum through receptive anal sex or, in some cases, by spreading from a genital infection. Rectal chlamydia is specifically where the choice of antibiotic matters most. Doxycycline for seven days is clearly the better option here. Research suggests that azithromycin’s effectiveness drops for rectal infections, possibly because the drug doesn’t reach high enough concentrations in colorectal tissue. Lab studies have found that the bacteria can tolerate higher levels of azithromycin in colorectal cells compared to other cell types, which may explain why single-dose treatment sometimes fails at this site.
Chlamydia in Newborns
Babies born to mothers with untreated chlamydia can develop eye infections (conjunctivitis) or, less commonly, pneumonia. Chlamydia-related eye infections in newborns tend to appear after the first week of life and develop more gradually than other types of neonatal eye infections. Treatment requires oral antibiotics rather than just eye drops, because the bacteria can also be present in the baby’s nasal passages and lungs. Close monitoring is recommended for babies born to infected mothers even if they appear healthy at birth, since symptoms can take days or weeks to emerge.