Seven days of doxycycline is an effective treatment for asymptomatic rectal <i>Chlamydia trachomatis</i> infection

Elgalib, Ali; Alexander, Sarah; Tong, C. Y. William; White, John Albert

doi:10.1258/ijsa.2011.011134

Cited by 32 publications

(29 citation statements)

References 15 publications

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“…Of these 15, four elected to be re-treated with doxycycline rather than have to return at 6 weeks for a test of cure (TOC). [8][9][10][11] Table 2 shows the results of the 11 TOCs. Four out of the nine TOCs were positive, but two had been at risk of re-infection (having reported sex with new partners).…”

Section: Resultsmentioning

confidence: 99%

“…Those who were RCt positive and who had been treated with azithromycin were invited/recalled for a test of cure at 6 weeks. [8][9][10][11] The number of polymerase chain reaction (PCR) amplification cycles for each RCt positive sample was obtained from the laboratory. The upper limit of amplification cycles that determines positivity in our laboratory is 40.…”

Section: Methodsmentioning

confidence: 99%

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Rectal Chlamydia in heterosexual women: more questions than answers

Ding

Challenor

2013

Int J STD AIDS

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The aim of this study was to observe the proportion of concurrent rectal Chlamydia (RCt) infection in women who have cervical Chlamydia (CCt) and to observe whether there was any correlation with receptive anal intercourse (RAI). Untreated CCt-positive women were invited to take part. Women chose either to have a physician-collected or self-taken rectal swab. Treatment was then commenced. 17 samples were physician-collected and 80 were self-collected. 75/97 (77.3%, 95% Confidence Interval [95%CI] 69.0-85.7%) were RCt positive. 25/97 (25.8%, 95%CI 17.1-34.5%) reported RAI. There was no difference in the positivity rate whether RAI was reported (80%) or not (76%) (P = 0.71); or whether swabs were physician-collected (65%) or self-taken (80%) (P = 0.17). Only one of those with RCt reported rectal symptoms. One woman had concurrent gonococcal infection. 34/97 (35%) had a history of past sexually transmitted infections. Verified contact attendance was 0.52 and 72% of verified contacts were Chlamydia positive. Reported RAI may not be helpful in guiding RCt testing. RCt infection in women may be more prevalent than previously thought. We do not know whether RCt infections are clinically significant or whether they may act as a reservoir for re-infection. RCt infections in women require further study.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Rectal Chlamydia in heterosexual women: more questions than answers

Ding

Challenor

2013

Int J STD AIDS

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“…7,8,10 Emerging data suggest increased failure rates with oral azithromycin compared to doxycycline when used for the treatment of rectal CT infections. [24][25][26][27] Suboptimal treatment efficacy with azithromycin against rectal infections could have important implications for women who may be infected with CT at both urogenital and rectal sites, especially if the latter go unrecognized due to absent testing. If treated with azithromycin, these women could potentially have successful clearance of the urogenital infection, but not necessarily the rectal infection.…”

Section: Discussionmentioning

confidence: 99%

High Prevalence of Rectal Gonorrhea and Chlamydia Infection in Women Attending a Sexually Transmitted Disease Clinic

Bazan

Reese

Esber

et al. 2015

Journal of Women's Health

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Background: Testing women for urogenital Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) is common in sexually transmitted disease (STD) clinics. However, women may not be routinely tested for rectal GC/CT. This may lead to missed infections in women reporting anal intercourse (AI). Methods: This was a retrospective review of all women who underwent rectal GC/CT testing from August 2012 to June 2013 at an STD clinic in Columbus, Ohio. All women who reported AI in the last year had a rectal swab collected for GC/CT nucleic acid amplification testing (n = 331). Using log-binomial regression models, we computed unadjusted and adjusted associations for demographic and behavioral factors associated with rectal GC/CT infection. Results: Participants (n = 331) were 47% African-American, with median age of 29 years. Prevalence of rectal GC was 6%, rectal CT was 13%, and either rectal infection was 19%. Prevalence of urogenital GC and CT was 7% and 13% respectively. Among women with rectal GC, 14% tested negative for urogenital GC. Similarly, 14% of women with rectal CT tested negative for urogenital CT. In unadjusted analyses, there was increased rectal GC prevalence among women reporting sex in the last year with an injection drug user, with a person exchanging sex for drugs or money, with anonymous partners, and while intoxicated/high on alcohol or illicit drugs. After multivariable adjustment, no significant associations persisted, but a trend of increased rectal GC prevalence was observed for women < 26 years of age ( p = 0.06) and those reporting sex while intoxicated/high on alcohol or drugs ( p = 0.05). For rectal CT, only age < 26 years was associated with prevalent infection in unadjusted models; this association strengthened after multivariable adjustment (prevalence ratio: 6.03; 95% confidence interval: 2.29-15.90). Conclusion: Nearly one in five women who reported AI in the last year had rectal GC or CT infection. Urogenital testing alone would have missed 14% of rectal infections. Standardized guidelines would increase rectal GC/CT testing in women and help detect missed infections.

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“…Three were retrospective studies of azithromycin or doxycycline for rectal CT infection in asymptomatic men who have sex with men (MSM) that reported estimated efficacy based on repeat rectal CT NAAT [11][12][13]. Drummond et al reported an estimated azithromycin efficacy of 94% in 85 MSM, although the study was limited by the long interval until repeat CT PCR (45% had repeat testing performed >12 weeks after azithromycin treatment) [11].…”

Section: Discussionmentioning

confidence: 99%

“…Steedman et al reported an estimated azithromycin efficacy of 87% in 68 MSM, but 8 of the 9 MSM with a repeat positive CT PCR postazithromycin reported sexual activity between treatment and repeat testing; in addition, 3 of 9 men with repeat positive CT had their repeat test performed ≤21 days posttherapy, introducing the possibility of a false-positive CT NAAT [12]. Elgalib et al reported an estimated doxycycline efficacy of 98.8% in 165 MSM, although the study was limited in that the majority of rectal CT-infected patients initially evaluated were excluded from the efficacy analysis and there was a long interval until repeat CT NAAT was performed (median 45 days) [13]. The fourth study of rectal CT therapy was a prospective observational study in MSM and women by Hathorn et al in which 42 subjects receiving azithromycin and 40 receiving doxycycline during different study phases had an estimated efficacy, adjusting for possible reinfection, of 79% and 100%, respectively, at 6 weeks posttherapy [14].…”

mentioning

confidence: 99%

Diagnosis and Management of UncomplicatedChlamydia trachomatisInfections in Adolescents and Adults: Summary of Evidence Reviewed for the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines

Geisler

2015

Clin Infect Dis.

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In preparation for the 2015 Centers for Disease Control and Prevention (CDC) Sexually Transmitted Diseases (STD) Treatment Guidelines, the CDC convened an advisory group in 2013 to examine recent abstracts and published literature addressing the epidemiology, diagnosis, and management of STDs. This article summarizes the key questions, evidence, and recommendations for the diagnosis and management of uncomplicated Chlamydia trachomatis (CT) infection in adolescents and adults that were considered in development of the 2015 CDC STD Treatment Guidelines. The evidence reviewed primarily focused on CT infection risk factors in women, clinical significance of oropharyngeal CT detection, acceptability and performance of CT testing on self-collected specimens in men, performance of CT point-of-care tests, efficacy of recommended and investigational CT infection treatments, and timing of test of cure following CT infection treatment in pregnant women.Keywords. chlamydia; diagnosis; management; CDC; guidelines.Chlamydia trachomatis (CT) infection is the most frequently reported bacterial sexually transmitted infection in the United States and remains highly prevalent, with >1.4 million cases reported to the Centers for Disease Control and Prevention (CDC) annually [1]. Young age is a strong predictor of CT infection, with the highest CT infection prevalence in persons <25 years of age [1]. Because the majority of CT infections are asymptomatic, detection of infection often relies on screening. The 2010 CDC Sexually Transmitted Diseases (STD) Treatment Guidelines recommends annual CT screening in all sexually active women 25 years of age or younger and also older women with risk factors (eg, those who have a new sex partner or multiple sex partners) [2]. Benefits of CT screening in women have been demonstrated in areas where screening programs have reduced rates of pelvic inflammatory disease (PID) [3,4], a precursor of infertility, and recent literature suggests a continued decline in PID rates in the United States [5].The approach to the diagnosis and management of uncomplicated CT infection in adolescents and adults includes (1) CT testing using nucleic acid amplification tests (NAATs); (2) treatment with CDC-recommended therapy to reduce complications and prevent transmission to others; (3) treatment of sexual partners to prevent reinfection of patients and complications in patients and partners; (4) risk-reduction counseling; (5) repeat CT testing a few months following treatment to identify repeat infection; and (6) in pregnant women at a minimum of 3 weeks following treatment to identify persisting or repeat infection so that repeat treatment can be provided promptly to reduce risk for maternal and neonatal morbidity.Following release of the 2010 CDC STD Treatment Guidelines [2], unanswered questions and topics requiring further study on the epidemiology, diagnosis, and management of uncomplicated CT infection remained. In preparation for the 2015 CDC STD Treatment Guidelines, the CDC convened an advisory group in...

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Seven days of doxycycline is an effective treatment for asymptomatic rectal Chlamydia trachomatis infection

Cited by 32 publications

References 15 publications

Rectal Chlamydia in heterosexual women: more questions than answers

Rectal Chlamydia in heterosexual women: more questions than answers

High Prevalence of Rectal Gonorrhea and Chlamydia Infection in Women Attending a Sexually Transmitted Disease Clinic

Diagnosis and Management of UncomplicatedChlamydia trachomatisInfections in Adolescents and Adults: Summary of Evidence Reviewed for the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines

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