[Question #13030] Chlamydia treatment when pregnant
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2 months ago
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Hi Dr,
Appreciate all you do here.
Unfortunately, my partner and I have both been diagnosed with chlamydia and she is currently 6-7 weeks pregnant. She was prescribed azithromicin 1g (2x500mg each taken over a few hours to minimize discomfort). Both times she took the 500mg she vomited shortly afterwards. After reporting this to her Dr, she has been prescribed 200mg azithromicin twice per day instead, for one week, which she is able to stomach (nearly finished her course). Would this regime be near 100% effective in treating the chlamydia? If ineffective, what should we do? We suspect we've been passing the chlamydia back and forth and that she likely caught it early April. How concerned should we be about damage to her and the baby from chlamydia and the heavy antibiotics? I have been prescribed doxycilin 100mg twice daily for two weeks as the one-week course I had previously may have failed (am now one week in). When should we re-test? When would it be safe for us to resume having sex? Feeling very anxious about our situation.
Many thanks.
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Edward W. Hook M.D.
2 months ago
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Welcome to the Forum and thanks for your questions. I’m sorry to hear of your partner’s difficulties with her azithromycin. The drug itself can cause GI upset as can early pregnancy. Chlamydia at this stage of pregnancy can typically be treated without consequences for the child. Unfortunately, there are not any solid data on the effectiveness of 200 mg taken twice daily for a keep although it’s logical that it should be effective. The important thing here is that she have follow up testing a. week or, better yet, two weeks after the last dose ( the drug stays in the blood stream for a long time after dosing).
Given both your difficulties with treatment, in this setting I’d be conservative and wait until you’ve both finished your treatment before resuming unprotected sex. You can retest for assurance a few days after you complete the doxycycline even if it’s too early for her to retest.
Sorry you’re having a difficult time. EWH
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2 months ago
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Thank you for the prompt response Dr. I’d read in another question something around azithromicin remaining effective if vomiting is after half an hour (absorbs quickly). My partner mentioned she took 500mg, vomited around half an hour later then an hour or so after that took the other 500mg and was able to keep that down. She then started the 2x200mg a day regime. Does that additional information increase your confidence regarding the chlamydia being cured at all? She only weighs 45kg and I’m not sure if that also may have an impact? She’s had no noticeable symptoms whilst I’ve had some ground and testicle pain (seems to have resolved). I’ve now completed 7 days doxy and commencing the second week from tomorrow. Would condom protected sex be safe now or should we also stop that until a week after we’ve finished our antibiotic courses?
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Edward W. Hook M.D.
2 months ago
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Certainly the more azithromycin she can keep down, the better the prospects are for eradicating the infection. Her low weight also suggests she'll have higher drug levels which is a good thing in terms of prospects for cure.
Condoms, when worn throughout intercourse from beginning to end reduce the likelihood of (re-)infection almost completely. My tendency would be to be conservative about resuming intercourse but I may be being overly conservative.
As you know, we provide up to 3 responses to each client's questions. You have one follow-up remaining. EWH
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2 months ago
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Hi Dr, speaking with my partner it seems she didn’t actually vomit up the pills and meant dry retching. So initially she’d had 2x zithromicin 500mg about an hour or two apart and kept them down. Her dr also prescribed her amoxicillin 2x200 per day (not zithro). Confusion due to English being her second language. Would she be clear? Is there any point to the amoxicillin? My final questions are when exactly we can both retest and expect the result to reliable? I will continue the second week of doxicillin starting tomorrow. When can we resume being intimate without any risk of reinfecting? Thanks very much for your assistance
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Edward W. Hook M.D.
2 months ago
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These are questions which do not deal with usual circumstances. As such, my replies are based on my considerable experience and extrapolation of the available literature which is what we prefer.
IFinal responses:
Dry retching suggests that the medication was absorbed. That is a good thing. Whether all of the medication was all absorbed however cannot be assured. I would still go with the twice daily treatment plan.
The amoxycillin regimen you describe is an alternative therapy for chlamydia but does not work quite as well as the azithromycin. If she is keeping down her azithromycin I would consider the amoxicillin optional
I've already addressed the topic of when you can retest above. I would wait at least a week after completion of therapy for either of you before re-testing and for your partner, preferably 2 weeks after she completes her azithromycin.
Your question about resuming intercourse has also been already answered. The optimal way to be entirely sure is to use condoms until you have each had negative follow-up tests.
This completes this thread. There is little more to be said. EWH
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