Observed Treatment Responses to Short-Course Doxycycline Therapy for Rectal Lymphogranuloma Venereum in Men Who Have Sex With Men

Simons, Rebecca; Candfield, Sophie; French, Patrick; White, John Albert

doi:10.1097/olq.0000000000000772

Cited by 19 publications

(11 citation statements)

References 18 publications

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“… People whose NAAT result was positive for rectal chlamydia and have acute proctitis with bloody rectal discharge, tenesmus, or perianal or mucosal ulcers should receive 21 days of doxycycline (to cover both D-K and L1-L3 serovars). Those with a positive rectal chlamydia NAAT result and mild or no symptoms may be treated with doxycycline for 7 days . Asymptomatic sex partners who have had contact with a patient with LGV within the 60 days before symptom onset should be treated empirically with 100 mg of doxycycline orally twice a day for 7 days …”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Diagnosis and Treatment of Sexually Transmitted Infections

Tuddenham

Hamill

Ghanem

2022

JAMA

131

136

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In 2019, an estimated 2.55 million new sexually transmitted infections (STIs) were reported in the US, 1 with a projected direct medical cost of approximately $1.1 billion for gonorrhea, chlamydia, and syphilis in 2018. 2 In 2018, there were approximately 67.6 million prevalent infections in the US, suggesting that an estimated 1 in 5 adults had an STI. 3 People with STIs are at greater risk of transmitting HIV to others. Among people without HIV, STIs increase rates of HIV acquistion. 4,5 STIs also increase rates of infertility, chronic pelvic pain, ectopic pregnancy, miscarriage, fetal death, and congenital and neonatal infections. [6][7][8][9] This review summarizes current evidence regarding the epidemiology, diagnosis, treatment, and prevention of gonorrhea, chlamydia, syphilis, Mycoplasma genitalium, trichomoniasis, and genital herpes. For the purposes of clarity, in this article, the terms male and female refer to those assigned male or female at birth, respectively (see eTable 1 in the Supplement for additional clinician resources). MethodsWe searched PubMed and Cochrane databases using Medical Subject Headings for English-language studies of the epidemiology, diagnosis, and treatment of gonorrhea, chlamydia (including lymphogranuloma venereum), syphilis, Mycoplasma genitalium, trichomoniasis, and herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) between October 1, 2010, and October 31, 2021. We manually searched the references of selected articles for additional relevant studies (including older studies). Randomized clinical trials, meta-analyses, systematic reviews, and national and international clinical practice guidelines were prioritized for inclusion. Of 1896 reports identified, 81 were included, consisting of 8 randomized trials, 7 meta-analyses, 27 systematic reviews, 5 clinical practice guidelines, 28 observational studies, 3 modeling studies, and 3 retrospective case series. IMPORTANCE Approximately 1 in 5 adults in the US had a sexually transmitted infection (STI) in 2018. This review provides an update on the epidemiology, diagnosis, and treatment of gonorrhea, chlamydia, syphilis, Mycoplasma genitalium, trichomoniasis, and genital herpes.OBSERVATIONS From 2015 to 2019, the rates of gonorrhea, chlamydia, and syphilis increased in the US; from 1999 to 2016, while the rates of herpes simplex virus type 1 (HSV-1) and HSV-2 declined. Populations with higher rates of STIs include people younger than 25 years, sexual and gender minorities such as men and transgender women who have sex with men, and racial and ethnic minorities such as Black and Latinx people. Approximately 70% of infections with HSV and trichomoniasis and 53% to 100% of extragenital gonorrhea and chlamydia infections are asymptomatic or associated with few symptoms. STIs are associated with HIV acquisition and transmission and are the leading cause of tubal factor infertility in women. Nucleic acid amplification tests have high sensitivities (86.1%-100%) and specificities (97.1%-100%) for the diagnosis of gonorrhea, chlamydia,...

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Section: Methodsmentioning

confidence: 99%

“…Those with a positive rectal chlamydia NAAT result and mild or no symptoms may be treated with doxycycline for 7 days. 31 Asymptomatic sex partners who have had contact with a patient with LGV within the 60 days before symptom onset should be treated empirically with 100 mg of doxycycline orally twice a day for 7 days. 15…”

Section: Mycoplasma Genitaliummentioning

confidence: 99%

Diagnosis and Treatment of Sexually Transmitted Infections

Tuddenham

Hamill

Ghanem

2022

JAMA

131

136

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“…The recommended 21-day course of doxycycline is based on long-standing clinical practice and is highly effective, with an estimated cure rate of >98.5% ( 555 , 556 ). Shorter courses of doxycycline might be effective on the basis of a small retrospective study of MSM with rectal LGV, 50% of whom were symptomatic, who received a 7- to 14-day course of doxycycline and had a 97% cure rate ( 558 ). Randomized prospective studies of shorter-course doxycycline for treating LGV are needed.…”

Section: Diseases Characterized By Genital Anal or Perianal Ulcersmentioning

confidence: 99%

Sexually Transmitted Infections Treatment Guidelines, 2021

Workowski¹,

Bachmann²,

Chan³

et al. 2021

MMWR Recomm. Rep.

1,615

2,621

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These guidelines for the treatment of persons who have or are at risk for sexually transmitted infections (STIs) were updated by CDC after consultation with professionals knowledgeable in the field of STIs who met in Atlanta, Georgia, June 11-14, 2019. The information in this report updates the 2015 guidelines. These guidelines discuss 1) updated recommendations for treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis; 2) addition of metronidazole to the recommended treatment regimen for pelvic inflammatory disease; 3) alternative treatment options for bacterial vaginosis; 4) management of Mycoplasma genitalium; 5) human papillomavirus vaccine recommendations and counseling messages; 6) expanded risk factors for syphilis testing among pregnant women; 7) one-time testing for hepatitis C infection; 8) evaluation of men who have sex with men after sexual assault; and 9) two-step testing for serologic diagnosis of genital herpes simplex virus. Physicians and other health care providers can use these guidelines to assist in prevention and treatment of STIs. BOX 1. The Five P's approach for health care providers obtaining sexual histories: partners, practices, protection from sexually transmitted infections, past history of sexually transmitted infections, and pregnancy intention Additional information about external condoms is available at https://www.cdc.gov/condomeffectiveness. Internal CondomsCondoms for internal vaginal use, also known as female condoms, are available worldwide (e.g., the FC2 Female Condom, Reddy condom, Cupid female condom, and Woman's condom) (31,32). Use of internal condoms can provide protection from acquisition and transmission of STIs, although data are limited. Internal condoms are more costly compared with external condoms; however, they offer the advantage of being controlled by the receptive partner as an STI and HIV prevention method, and the newer versions might be acceptable to all persons. Although the internal condom also has been used during receptive anal intercourse, efficacy associated with this practice remains unknown (33). Additional information about the internal condom is available at http://www.ashasexualhealth. org/pdfs/Male_and_Female_Condoms.pdf. Cervical DiaphragmsIn observational studies, diaphragm use has been demonstrated to protect against cervical gonorrhea, chlamydia, and trichomoniasis (34). However, a trial examining the effect of a diaphragm plus lubricant on HIV acquisition among women in Africa reported no additional protective effect when compared with the use of male condoms alone. Likewise, no difference by study arm in the rate of acquisition of chlamydia, gonorrhea, or herpes occurred (35,36). Diaphragms should not be relied on as the sole source of protection against HIV and other STIs.

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“… Doxycycline 100 mg twice a day orally for 21 days (1,B) (Table ) Azithromycin in single‐ or multiple‐dose regimens or shorter course of doxycycline (100 mg twice a day orally for 7–14 days) has also been proposed, but consistent and concluding evidence is lacking to currently recommend these drug regimens as first‐line options (2,D) . If alternative treatment regimens are used, it is advised to perform a test of cure (TOC) (2,D). There is no indication nor evidence that HIV co‐infection requires a different therapeutic approach. …”

Section: Therapymentioning

confidence: 99%

“… Doxycycline 100 mg twice a day orally for 21 days is the first‐line recommended therapy (1,C) There is some data on alternative (shorter) treatment regimens for asymptomatic LGV (2,D) . If alternative treatment regimens are used, it is advised to perform a TOC (2,D). …”

Section: Therapymentioning

confidence: 99%