Managing Rectal Chlamydia Trachomatis in Men and Women
Background There is no UK guidance specifically for the management of rectal Chlamydia trachomatis yet there is documented treatment failure with single-dose azithromycin suggesting that test of cure (TOC) and alternative treatment may be needed.
Objectives To evaluate the efficacy of single-dose azithromycin compared with 1 week of doxycycline in the treatment of rectal C trachomatis.
Methods Data were collected prospectively on all patients diagnosed with rectal C trachomatis who received azithromycin 1 g stat between 1 January and 30 June 2010 and between 1 October 2010 and 31 March 2011 following a local change in treatment protocol to 1 week of doxycycline 100 mg twice a day. Information was collected on gender, concurrent sexually transmitted infections, treatment received, re-infection risk, re-treatment and TOC at 6 weeks.
Results 11 patients (26.2%) had a positive TOC following treatment with stat azithromycin. The risk of re-infection was excluded in two, identifying nine of the 11 (81.8%) as treatment failures. Two patients had a positive TOC following treatment with 1 week of doxycycline, both were found to have a risk of re-infection. There was a significantly higher treatment failure rate in patients receiving azithromycin (p=0.0025).
Conclusions A higher treatment failure rate was found following azithromycin for rectal C trachomatis than previously published. If azithromycin is used for treatment of rectal C trachomatis, TOC may be required or alternative treatment with doxycycline may be preferable, but further data are required.
A meta-analysis of randomised control trials comparing azithromycin with doxycycline for urethral and cervical Chlamydia trachomatis infections concluded that they were equally efficacious in achieving microbial cure. There have been no randomised controlled trials comparing antibiotic therapy for rectal C trachomatis infection, yet screening of men who have sex with men (MSM) is now common practice. Data are conflicting on the rate of treatment failure following a single dose of azithromycin (6–13%) with a higher clearance rate of 98.8% reported following 1 week of doxycycline. These studies looked at treatment response in MSM; there are no data on antibiotic efficacy in women with rectal C trachomatis.
We aimed to evaluate the efficacy of single-dose azithromycin compared with 1 week of doxycycline in the treatment of rectal chlamydia in men and women attending a large genitourinary medicine clinic in Birmingham, UK.
Abstract and Introduction
Abstract
Background There is no UK guidance specifically for the management of rectal Chlamydia trachomatis yet there is documented treatment failure with single-dose azithromycin suggesting that test of cure (TOC) and alternative treatment may be needed.
Objectives To evaluate the efficacy of single-dose azithromycin compared with 1 week of doxycycline in the treatment of rectal C trachomatis.
Methods Data were collected prospectively on all patients diagnosed with rectal C trachomatis who received azithromycin 1 g stat between 1 January and 30 June 2010 and between 1 October 2010 and 31 March 2011 following a local change in treatment protocol to 1 week of doxycycline 100 mg twice a day. Information was collected on gender, concurrent sexually transmitted infections, treatment received, re-infection risk, re-treatment and TOC at 6 weeks.
Results 11 patients (26.2%) had a positive TOC following treatment with stat azithromycin. The risk of re-infection was excluded in two, identifying nine of the 11 (81.8%) as treatment failures. Two patients had a positive TOC following treatment with 1 week of doxycycline, both were found to have a risk of re-infection. There was a significantly higher treatment failure rate in patients receiving azithromycin (p=0.0025).
Conclusions A higher treatment failure rate was found following azithromycin for rectal C trachomatis than previously published. If azithromycin is used for treatment of rectal C trachomatis, TOC may be required or alternative treatment with doxycycline may be preferable, but further data are required.
Introduction
A meta-analysis of randomised control trials comparing azithromycin with doxycycline for urethral and cervical Chlamydia trachomatis infections concluded that they were equally efficacious in achieving microbial cure. There have been no randomised controlled trials comparing antibiotic therapy for rectal C trachomatis infection, yet screening of men who have sex with men (MSM) is now common practice. Data are conflicting on the rate of treatment failure following a single dose of azithromycin (6–13%) with a higher clearance rate of 98.8% reported following 1 week of doxycycline. These studies looked at treatment response in MSM; there are no data on antibiotic efficacy in women with rectal C trachomatis.
We aimed to evaluate the efficacy of single-dose azithromycin compared with 1 week of doxycycline in the treatment of rectal chlamydia in men and women attending a large genitourinary medicine clinic in Birmingham, UK.
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