infectious

Genital Chlamydia Infection (Uncomplicated)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources5 sources

CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Chlamydial Infections - Chlamydial Infection During Pregnancy, Alternative Regimen, with the amoxicillin dose from Egyptian National Drug Formulary - Antimicrobial 2023, Amoxicillin monograph (printed page 330): "Immediate release: 500 mg to 1 g every 8 to 12 hours." The formulary monograph carries no chlamydia indication; the seven-day course in pregnancy is from the CDC guideline, which is not held in this corpus. · BASHH Clinical Effectiveness Group, Update on the treatment of Chlamydia trachomatis infection, September 2018 · BASHH National Guideline for the Management of Chlamydia trachomatis 2018 · CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Chlamydial Infections - Chlamydial Infection During Pregnancy, Alternative Regimen · Egyptian National Drug Formulary - Antimicrobial 2023 (ofloxacin monograph)

Verified against4 documents

CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Chlamydial Infections - Chlamydial Infection During Pregnancy, Alternative Regimen, with the amoxicillin dose from Egyptian National Drug Formulary - Antimicrobial 2023, Amoxicillin monograph (printed page 330): "Immediate release: 500 mg to 1 g every 8 to 12 hours." The formulary monograph carries no chlamydia indication; the seven-day course in pregnancy is from the CDC guideline, which is not held in this corpus.
BASHH Clinical Effectiveness Group, Update on the treatment of Chlamydia trachomatis infection, September 2018
CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Chlamydial Infections - Chlamydial Infection During Pregnancy, Alternative Regimen
Chlamydia - disease-level clinical article (chlamydia-genital-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (11)

Most people with the infection have no symptoms at all and act as silent carriers
Cervicitis usually causes vaginal discharge, bleeding, belly pain, and pain on urination, though most women have little or nothing [abdominal pain · bleeding · vaginal discharge]
Bleeding after sex or between periods can be a presenting complaint of cervical infection [abnormal uterine bleeding]
Pelvic infection can bring nausea, vomiting, fever, chills, low back pain, painful sex, and painful urination on top of belly pain [abdominal pain · back pain · burning on passing urine · chills · fever · nausea · vomiting]
In men, painful urination with discharge that may only show up after stripping the penis or in the morning suggests urethritis [burning on passing urine]
Women with urethral infection may have frequency and burning that gets mistaken for a bladder infection
Pain in the upper right belly or with breathing can signal liver-capsule inflammation (Fitz-Hugh-Curtis) from a pelvic infection
One-sided testicular pain and swelling with fever points to epididymitis [fever · testicular pain]
Rectal pain, discharge, and bleeding after receptive anal sex suggest LGV-related proctitis [bleeding]
Burning urination, urinary trouble, pelvic pain, and painful ejaculation suggest prostate infection [abdominal pain · pelvic pain]
Painless, star-shaped genital ulcers followed by groin lymph node swelling point to lymphogranuloma venereum [genital ulcers · lymphadenopathy]

Signs — what you find (8)

Pus-like cervical discharge with bleeding that is easily triggered from the cervix occurs in only a minority of cases [bleeding · pus]
Urine testing in urethritis shows white cells without organisms turning up on culture or stain
Liver enzymes usually stay normal in Fitz-Hugh-Curtis perihepatitis, unlike most other causes of right-upper-belly pain [abdominal pain]
Fluid expressed from the prostate can show a raised white-cell count under the microscope
About a third of men who develop reactive arthritis after chlamydial urethritis have the full joint-urethra-eye triad
Newborn eye infection shows redness of the surface without pus, with a cobbled look to the conjunctiva [redness]
Infant pneumonia from this organism causes little or no fever, fast breathing, and a distinctive staccato-type cough [cough · tachypnoea]
Crackles can be heard on the chest in infant chlamydial pneumonia, but wheeze is unusual [crackles · wheeze]

Tests (10)

Nucleic acid amplification testing is the reference-standard test for genital chlamydia
A vaginal swab is preferred for testing women; urine can substitute but may miss more cases
Swabs need a wire or plastic shaft with a dacron, rayon, or cytobrush tip - other tip materials can interfere with detection
Culture is rarely used since the organism is hard to grow, except for rectal samples where other tests are hard to read
Trachoma is the only form of this infection diagnosed on clinical grounds alone; the rest need lab confirmation
A full blood count is warranted whenever pelvic inflammatory disease is a possibility
Pregnancy testing matters because pregnancy blocks the use of doxycycline for treatment
Sexual partners need testing for chlamydia as part of the standard workup
A positive urine leukocyte esterase test in men points to gonorrhea or chlamydia once a bladder infection is excluded
When no testing is on hand, treatment proceeds on clinical grounds alone

If not this — what else fits (8)

Painful urination can also come from gonorrhea, genital herpes, or an ordinary urinary tract infection
Belly pain in this setting should also raise appendicitis, cholecystitis, or simple constipation
Pelvic pain differentials include endometriosis, ovarian cysts, and adenomyosis
Vaginal discharge can also stem from bacterial vaginosis, trichomonas, gonorrhea, yeast infection, a retained foreign body, or Mycoplasma or Ureaplasma
Rectal discharge can also come from inflammatory bowel disease or gonorrhea
Eye redness and discharge differentials include a viral cause, allergy, and gonococcal infection
Bleeding after sex or between periods should also raise cervical cancer, a cervical or uterine polyp, cervical ectropion, a fibroid, or pregnancy
Genital ulcers should also raise herpes, syphilis, chancroid, or granuloma inguinale

SourceStatPearls "Chlamydia" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Quinolone alternative when doxycycline and azithromycin cannot be used

MAIN TREATMENT - choose one

DOXYCYCLINE

1st line

Strength100 mg

Formoral.solid

Adult dose and duration

100 mg twice daily x 7 days

Paediatric dose

Not for children under 8 - the Egyptian formulary reserves doxycycline below that age for severe, potentially life-threatening infection. The under-12 cut often quoted is BNF convention rather than a rule from either source here, and note the endemic typhus entry does dose younger children, because a rickettsial illness is exactly the life-threatening case the formulary means. Genital chlamydia is not.

Dose source

BASHH Clinical Effectiveness Group, Update on the treatment of Chlamydia trachomatis infection, September 2018

Why

First line at every site - urogenital, pharyngeal and rectal. Single-dose azithromycin lost that place because it under-treats rectal infection and selects for macrolide resistance in Mycoplasma genitalium, which co-infects 3-15% of these patients.

Cautions

CONTRAINDICATED in pregnancy and breastfeeding. Use the extended azithromycin course on the row below - 1 g then 500 mg daily for 2 days. NOT a 1 g single dose: BASHH withdrew single-dose azithromycin for chlamydia at any site in 2018.
Take with a full glass of water while sitting or standing upright to prevent severe esophageal ulceration.
Avoid direct sunlight exposure due to photosensitivity risk.
Abstain from sexual contact until 7 days after starting treatment and until sexual partners are treated. This one is from the 2015 BASHH chlamydia guideline rather than the 2018 treatment update cited here.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
FARCODOXIN 100MG 10 CAPS.	PHARCO	11.00 EGP (1.10/unit)
DOXY M.R.100 MG 10 CAPS.	ADWIA	12.00 EGP (1.20/unit)
GRANUDOXY 100MG 10 F.C. TAB.	GLOBAL NAPI PHARMACEUTICALS > PIERRE FRANCE	12.00 EGP (1.20/unit)
DOXYDOX 100 MG 10 CAPS.	EIPICO	23.00 EGP (2.30/unit)
DOXYMYCIN 100 MG 10 CAPS.	EL NILE.	30.00 EGP (3.00/unit)
TABOCINE 100MG 10 CAPS.	TABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA	46.00 EGP (4.60/unit)
VIBRAMYCIN 100MG 10 CAPS.	PFIZER	65.00 EGP (6.50/unit)

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line

Dose source

Chlamydia - disease-level clinical article (chlamydia-genital-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions

RED FLAG - Do a pregnancy test prior to initiating doxycycline therapy, due to the pregnancy contraindication.

AZITHROMYCIN

2nd line

Strength500 mg

Formoral.solid

Adult dose and duration

1 g orally as a single dose on day 1, followed by 500 mg once daily for 2 days (alternative regimen for pregnant women or tetracycline allergy/intolerance). x 3 days

Paediatric dose

Paediatric dosing for genital chlamydia is not addressed in this BASHH adult guideline; specialist paediatric evaluation is required.

AWaRe

WATCH group - carries resistance cost. Egyptian EML 2025.

Dose source

BASHH Clinical Effectiveness Group, Update on the treatment of Chlamydia trachomatis infection, September 2018

Why

For the patient who cannot take a tetracycline - allergy, intolerance, or pregnancy. The old 1 g single dose is no longer recommended for chlamydia at any site. This extended course also covers Mycoplasma genitalium if it is there.

Cautions

Lower microbiological cure than doxycycline in RECTAL infection. BASHH names rectal only - there is no urethral claim in the source.
Common gastrointestinal side effects include nausea, abdominal pain, and diarrhea.
In pregnancy the total 2 g course is unlikely to cause harm but the data are thin, and she should be told that. Test of cure is recommended in pregnancy, and no earlier than 3 weeks after treatment in rectal infection.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
AZATRIBACT 500MG 3 CAPS.	RIVA PHARMA S.A.E.	13.50 EGP (4.50/unit)
GIGAZOCIN 500MG 5 CAPS.	EGPI > PIONEER	27.50 EGP (5.50/unit)
SYSTYMYCIN 500MG 3 CAPS.	EGPI > NOVELL PHARMA	21.50 EGP (7.17/unit)
AZITHROMASH 500 MG 3 F.C. TABS.	MASH PREMIERE	48.00 EGP (16.00/unit)
AZALIDE 500MG 3 CAPS.	UP PHARMA	52.00 EGP (17.33/unit)
AZROLID 500 MG 6 F.C.TABS.	AMRIYA	126.00 EGP (21.00/unit)
ZERAMERATE 500 MG	EGPI > GAMMA PHARMA	28.50 EGP
DISTABCIN 500 MG 3 DISPERSIBLE TABS.	EGPI	43.50 EGP
ZITHRODOSE 100MG/5ML SUSP. 15ML? strength differs? different route - not oral solid	EL-OBOUR > AVERROES PHARMA-EGYPT	12.00 EGP
ZITHROPHATE 200MG/5ML SUSP. 15ML? strength differs? different route - not oral solid	ORGANO PHARMA > NOVELL PHARMA	12.75 EGP

AMOXICILLIN

3rd line

Strength500 mg

Formoral.solid

Adult dose and duration

500 mg three times daily (alternative regimen in pregnancy) x 7 days

Paediatric dose

Dosing in infants and young children requires specialist pediatric evaluation.

Dose source

Why

Doxycycline is contraindicated in pregnancy; Amoxicillin 500 mg TID for 7 days is an alternative regimen to preferred single-dose Azithromycin in pregnant women (CDC 2021).

Cautions

Test of cure in pregnancy. BASHH recommends one but names no interval; the four-week figure often quoted is convention, and for rectal infection the one interval BASHH does give is no earlier than 3 weeks after treatment ends.
Contraindicated in patients with severe penicillin hypersensitivity.
Not a BASHH regimen. BASHH gives pregnant women the extended azithromycin course above; amoxicillin is the CDC alternative, for the patient who can take neither.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
AMOXYCILLIN 500MG 10 CAPS B.P.2013	ARAB DRUG COMPANY (ADCO)	6.50 EGP (0.65/unit)
AMOXICILLIN 500MG 12 CAPS. USP 28	OCTOBER PHARMA	8.10 EGP (0.67/unit)
AMOXIL 500MG 12 CAPS.	MUP > SMITHKLINE BEECHAM	9.00 EGP (0.75/unit)
AMOXICID 500 MG 12 CAPS.	CID	9.50 EGP (0.79/unit)
E-MOX 500 MG 16 CAPS.	EIPICO	15.60 EGP (0.97/unit)
HICONCIL 500MG 12 CAPS.	PHARCO	11.60 EGP (0.97/unit)
BIOMOX 500MG 12 CAPS.	SEDICO	19.50 EGP (1.62/unit)
IBIAMOX 500 MG 12 CAPS.	AMOUN	45.00 EGP (3.75/unit)
HICILLIN 125MG/5ML SUSP. 80ML? strength differs? different route - not oral solid	EL NASR	3.00 EGP
AMOXIL FORT 250MG/5ML SUSP. 60ML? strength differs? different route - not oral solid	MUP > SMITHKLINE BEECHAM	5.50 EGP

QUINOLONE ALTERNATIVE WHEN DOXYCYCLINE AND AZITHROMYCIN CANNOT BE USED

OFLOXACIN

Quinolone alternative when doxycycline and azithromycin cannot be used

3rd line

Strength300 mg

Formoral.solid

Adult dose and duration

300 mg every 12 hours x 7 days

Paediatric dose

No paediatric dose for chlamydia in the sources opened; this is an adult option.

Dose source

Egyptian National Drug Formulary - Antimicrobial 2023 (ofloxacin monograph) - verbatim: "Cervicitis/urethritis: Oral: Nongonococcal (due to Chlamydia trachomatis) (alternative agent): 300 mg every 12 hours for 7 days"

Why

The card offers a tetracycline, a macrolide and a penicillin, and nothing for the patient who cannot take any of them. The Egyptian formulary lists chlamydial cervicitis and urethritis under ofloxacin and gives the seven-day dose directly.

Cautions

Do not use in anyone who has reacted to ofloxacin or to any other quinolone.
Avoid in pregnancy and while breastfeeding - use azithromycin instead.
Tell the patient to stop the tablets and come back if a tendon becomes painful or swollen.
The dose has to be spread out or reduced when kidney function is significantly impaired.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
FLOXA WEST 300MG 14 F.C.TAB.	WESTERN PHARMACEUTICALS INDUSTRIES > WESTERN PHARMA	19.20 EGP (1.37/unit)

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.