Treatment Effectiveness of Azithromycin and Doxycycline in Uncomplicated Rectal and Vaginal Chlamydia trachomatis Infections in Women: A Multicenter Observational Study (FemCure)

Dukers-Muijrers, Nicole H. T. M.; Wolffs, Petra; Vries, Henry De; Götz, Hannelore M; Heijman, Titia; Bruisten, Sylvia M.; Eppings, Lisanne; Hogewoning, Arjan; Steenbakkers, Mieke; Lucchesi, Mayk; Loeff, Maarten F. Schim van der; Hoebe, Christian J. P. A.

doi:10.1093/cid/ciz050

Cited by 49 publications

(48 citation statements)

References 31 publications

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“…Recently, our study groups showed a borderline significant association (P = 0.054) between lower vaginal Cq values, i.e. likely higher CT loads, and not reaching microbiological cure for vaginal CT in women treated with azithromycin [32]. Therefore, some women with concurrent vaginal and (untested) anorectal infections in our study may not be microbiologically cured when treated with azithromycin as they tend to have lower Cq values and therefore potentially higher CT loads [32].…”

Section: Discussionmentioning

confidence: 99%

Chlamydia trachomatis bacterial load, estimated by Cq values, in urogenital samples from men and women visiting the general practice, hospital or STI clinic

et al. 2019

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Background The bacterial load of Chlamydia trachomatis (CT) is assumed to play a role in transmission and sequelae. We assessed urogenital CT cycle quantification (Cq) values, as an indicator for CT load, of men and women diagnosed by general practitioners (GPs), hospital physicians and the STI clinic. Methods Urogenital CT-positive samples (n = 2,055 vaginal swabs, n = 77 cervical swabs, n = 1,519 urine samples and n = 19 urethral swabs) diagnosed by GPs, hospital physicians and the STI clinic from the Maastricht Medical Microbiology Laboratory were included (2012–2016). The outcome measure ‘urogenital Cq values’ was used as an inversely proportional measure for CT load. Among all patients, multivariate linear regression analyses were used to assess primary determinants for mean urogenital Cq values, stratified by sex. Additional clinical determinants were assessed among STI clinic patients. Results In men, mean urogenital Cq values were similar between GPs, hospital physicians and the STI clinic (32.7 and 33.5 vs. 32.7; p>0.05). Women visiting the GP had lower urogenital Cq values than women visiting the STI clinic (30.2 vs. 30.9; p = <0.001). Women visiting the hospital had higher urogenital Cq values than women visiting the STI clinic (32.4 vs. 30.9; p = <0.001). Among STI clinic women, urogenital Cq values were lower in women with concurrent anorectal CT and in rectally untested women compared to anorectal CT-negative women (30.7 and 30.6 vs. 33.9; p = <0.001). Conclusion Men visiting different STI care providers had similar urogenital Cq values, which could be an indicator for similar CT loads. The lower Cq values of women visiting the GP compared to women visiting the STI clinic could be an indicator for higher CT loads and likely higher transmission potential. Notably, urogenital Cq values of STI clinic women were much lower (>3 Cq) when STI clinic women also had anorectal CT. This finding could indicate higher urogenital CT loads and likely higher chances of transmission and sequelae.

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Section: Discussionmentioning

confidence: 99%

Chlamydia trachomatis bacterial load, estimated by Cq values, in urogenital samples from men and women visiting the general practice, hospital or STI clinic

et al. 2019

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“…(8) We cannot entirely rule out contamination of swabs during sampling, for example, contamination of a rectal swab with vaginal secretions, despite clear written and visual instructions. (9) In the FemCure study sample, women with high education, without a previous STI or non-Western migrant background were under-represented compared with CT infected STI clinic women 27. However, these characteristics were not associated with clearance overall, and therefore, we think that these differences do not impact the internal validity of the study.…”

Section: Discussionmentioning

confidence: 94%

“…In clinical practice, most women remain rectally untested, missing two-thirds of rectal CT infections when diagnosing vCT 24 25. It may be a problem when these rectally untested (but rCT positive) women are treated with azithromycin for their vCT, as azithromycin is less effective than doxycycline for rCT 26 27. In some of the Dutch STI clinics, and in some international guidelines, universal doxycycline treatment for CT infections in women has been adopted, potentially tackling the aforementioned issue.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous clearance ofChlamydia trachomatisaccounting for bacterial viability in vaginally or rectally infected women (FemCure)

Dukers-Muijrers¹,

Janssen

Hoebe

et al. 2020

Sex Transm Infect

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ObjectivesSpontaneous clearance of Chlamydia trachomatis (CT) infections can occur between diagnosis and treatment. We followed CT patients to assess clearance using a conventional definition (no total CT-DNA, assessed by routine quantitative PCR methods) and a definition accounting for viability, assessed by viability PCR testing.MethodsThree outpatient STI clinics included CT-diagnosed women (The Netherlands, 2016–2017, FemCure study); participants had vaginal CT (vCT) and rectal CT (rCT) (group A: n=155), vCT and were rectally untested (group B: n=351), single vCT (group C: n=25) or single rCT (group D: n=29). Follow-up (median interval 9 days) vaginal and rectal samples underwent quantitative PCR testing (detecting total CT-DNA). When PCR positive, samples underwent V-PCR testing to detect ‘viable CT’ (CT-DNA from intact CT organisms; V-PCR positive). ‘Clearance’ was the proportion PCR-negative patients and ‘clearance of viable CT’ was the proportion of patients testing PCR negative or PCR positive but V-PCR negative. We used multivariable logistic regression analyses to assess diagnosis group (A–D), age, days since initial CT test (diagnosis) and study site (STI clinic) in relation to clearance and clearance of viable CT.ResultsClearance and clearance of viable CT at both anatomic sites were for (A) 0.6% and 3.9%; (B) 5.4% and 9.4%; (C) 32.0% and 52.0% and (D) 27.6% and 41.4%, respectively. In multivariate analyses, women with single infections (groups C and D) had higher likelihood of clearance than women concurrently infected with vCT and rCT (p<0.001).Of rectally untested women (group B), 76.9% had total CT-DNA and 46.7% had viable CT (V-PCR positive) at the rectal site.ConclusionsOf untreated female vCT patients who had CT also at the rectal site, or who were rectally untested, only a small proportion cleared CT (in fact many had viable CT) at their follow-up visit (median 9 days). Among single site infected women clearance was much higher.Trial registration numberNCT02694497.

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“…Four weeks after treatment, 97.2% of women were negative for oropharyngeal CT. Proportions of cure were similar to those in azithromycin-treated vaginal CT (93.5% (95% CI 90.1% to 96.1%)), in doxycycline-treated vaginal CT (95.4% (95% CI 90.9% to 98.2%)) and in doxycycline-treated rectal CT (95.5% (95% CI 91.0% to 98.2%)); and higher than in azithromycintreated rectal CT (78.5% (95% CI 72.6% to 83.7%)). 17 One woman was positive at all follow-up visits until week 12; she had oropharyngeal viable CT at week 0 and was untested at week −1; she reported receptive oral sex during follow-up.…”

Section: Discussionmentioning

confidence: 97%

“…18 The proportion of positive women with viable oropharyngeal CT was 26.1% (12/46), which is lower than proportions of viable CT that we observed in vaginally (94.0%-96.4%) and in rectally CT-infected women (58.0%-66.5%). 17 Although the proportion with viable oropharyngeal CT is relatively small, it may represent relevant infections for ongoing transmission to a sexual partner via oral sex, 19 but possibly also to the own rectal site, via the gastrointestinal canal. 20 After treatment, following >425 women until week 12, only few women tested positive and most only at a single time point.…”

Section: Discussionmentioning

confidence: 99%

Oropharyngeal Chlamydia trachomatis in women; spontaneous clearance and cure after treatment (FemCure)

et al. 2020

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ObjectivesWomen attending STI clinics are not routinely tested for oropharyngeal Chlamydia trachomatis (CT) infections. We aimed to assess spontaneous clearance of oropharyngeal CT and cure after antibiotic treatment in women.MethodsWomen with vaginal or rectal CT (n=560) were recruited at STI clinics in 2016–2017, as part of the FemCure study (prospective cohort study). We included participants’ data from week −1, that is, the diagnosis at initial visit, when clinics applied selective oropharyngeal testing. At week −1, a total of 241 women were oropharyngeally tested (30 positive) and 319 were untested. All FemCure participants provided nurse-collected oropharyngeal samples at study enrolment, that is, week 0, just prior to treatment (n=560), and after treatment at weeks 4 (n=449), 8 (n=433) and 12 (n=427). Samples were tested by nucleic acid amplification test, and at week 0 also by viability testing by viability PCR. Proportions of oropharyngeal CT test results were presented to represent spontaneous clearance and cure.ResultsOf 30 women diagnosed with oropharyngeal CT at week −1, fifteen (50%) were negative at week 0 after a median of 9 days, that is, ‘spontaneous clearance’. At week 0, a total of 560 participants were tested, and 46 (8.8%) were oropharyngeal CT positive; 12 of them (26.1%) had viable CT. Of the 46 positive, 36 women had an oropharyngeal test after treatment; 97.2% (35/36) were negative at week 4, that is, ‘cure’. Of all women with follow-up visits, the proportion of oropharyngeal CT positive was between 0.5% and 1.6% between weeks 4 and 12. Of those not tested at week −1 (n=319), 8.5% (n=27) were oropharyngeal positive at week 0.ConclusionsThe clinical importance of oropharyngeal CT in women is debated. We demonstrated that spontaneous clearance of oropharyngeal CT among women is common; of those who did not clear for CT, three-quarters had non-viable CT. After regular treatment with azithromycin or doxycycline, cure rate (97%) of oropharyngeal CT is excellent.Trial registration numberNCT02694497.

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Treatment Effectiveness of Azithromycin and Doxycycline in Uncomplicated Rectal and Vaginal Chlamydia trachomatis Infections in Women: A Multicenter Observational Study (FemCure)

Cited by 49 publications

References 31 publications

Chlamydia trachomatis bacterial load, estimated by Cq values, in urogenital samples from men and women visiting the general practice, hospital or STI clinic

Chlamydia trachomatis bacterial load, estimated by Cq values, in urogenital samples from men and women visiting the general practice, hospital or STI clinic

Spontaneous clearance ofChlamydia trachomatisaccounting for bacterial viability in vaginally or rectally infected women (FemCure)

Oropharyngeal Chlamydia trachomatis in women; spontaneous clearance and cure after treatment (FemCure)

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