TY - JOUR
T1 - Treatment Effectiveness of Azithromycin and Doxycycline in Uncomplicated Rectal and Vaginal Chlamydia trachomatis Infections in Women
T2 - A Multicenter Observational Study (FemCure)
AU - Dukers-Muijrers, Nicole H. T. M.
AU - Wolffs, Petra F. G.
AU - de Vries, Henry
AU - Gotz, Hannelore M.
AU - Heijman, Titia
AU - Bruisten, Sylvia
AU - Eppings, Lisanne
AU - Hogewoning, Arjan
AU - Steenbakkers, Mieke
AU - Lucchesi, Mayk
AU - van der Loeff, Maarten F. Schim
AU - Hoebe, Christian J. P. A.
PY - 2019/12/1
Y1 - 2019/12/1
N2 - Background. Rectal infections with Chlamydia trachomatis (CT) are prevalent in women visiting a sexually transmitted infection outpatient clinic, but it remains unclear what the most effective treatment is. We assessed the effectiveness of doxycycline and azithromycin for the treatment of rectal and vaginal chlamydia in women.Methods. This study is part of a prospective multicenter cohort study (FemCure). Treatment consisted of doxycycline (100 mg twice daily for 7 days) in rectal CT-positive women, and of azithromycin (1 g single dose) in vaginally positive women who were rectally untested or rectally negative. Participants self-collected rectal and vaginal samples at enrollment (treatment time-point) and during 4 weeks of follow-up. The endpoint was microbiological cure by a negative nucleic acid amplification test at 4 weeks. Differences between cure proportions and 95% confidence intervals (CIs) were calculated.Results. We analyzed 416 patients, of whom 319 had both rectal and vaginal chlamydia at enrollment, 22 had rectal chlamydia only, and 75 had vaginal chlamydia only. In 341 rectal infections, microbiological cure in azithromycin-treated women was 78.5% (95% CI, 72.6%-83.7%; n = 164/209) and 95.5% (95% CI, 91.0%-98.2%; n = 126/132) in doxycycline-treated women (difference, 17.0% [95% CI, 9.6%-24.7%]; P <.001). In 394 vaginal infections, cure was 93.5% (95% CI, 90.1%-96.1%; n = 246/263) in azithromycin-treated women and 95.4% (95% CI, 90.9%-98.2%; n = 125/131) in doxycycline-treated women (difference, 1.9% [95% CI, -3.6% to 6.7%]; P = .504).Conclusions. The effectiveness of doxycycline is high and exceeds that of azithromycin for the treatment of rectal CT infections in women.
AB - Background. Rectal infections with Chlamydia trachomatis (CT) are prevalent in women visiting a sexually transmitted infection outpatient clinic, but it remains unclear what the most effective treatment is. We assessed the effectiveness of doxycycline and azithromycin for the treatment of rectal and vaginal chlamydia in women.Methods. This study is part of a prospective multicenter cohort study (FemCure). Treatment consisted of doxycycline (100 mg twice daily for 7 days) in rectal CT-positive women, and of azithromycin (1 g single dose) in vaginally positive women who were rectally untested or rectally negative. Participants self-collected rectal and vaginal samples at enrollment (treatment time-point) and during 4 weeks of follow-up. The endpoint was microbiological cure by a negative nucleic acid amplification test at 4 weeks. Differences between cure proportions and 95% confidence intervals (CIs) were calculated.Results. We analyzed 416 patients, of whom 319 had both rectal and vaginal chlamydia at enrollment, 22 had rectal chlamydia only, and 75 had vaginal chlamydia only. In 341 rectal infections, microbiological cure in azithromycin-treated women was 78.5% (95% CI, 72.6%-83.7%; n = 164/209) and 95.5% (95% CI, 91.0%-98.2%; n = 126/132) in doxycycline-treated women (difference, 17.0% [95% CI, 9.6%-24.7%]; P <.001). In 394 vaginal infections, cure was 93.5% (95% CI, 90.1%-96.1%; n = 246/263) in azithromycin-treated women and 95.4% (95% CI, 90.9%-98.2%; n = 125/131) in doxycycline-treated women (difference, 1.9% [95% CI, -3.6% to 6.7%]; P = .504).Conclusions. The effectiveness of doxycycline is high and exceeds that of azithromycin for the treatment of rectal CT infections in women.
KW - women
KW - Chlamydia trachomatis
KW - rectal
KW - treatment effectiveness
KW - NEISSERIA-GONORRHOEAE
KW - RETROSPECTIVE COHORT
KW - MEN
KW - EFFICACY
KW - THERAPY
U2 - 10.1093/cid/ciz050
DO - 10.1093/cid/ciz050
M3 - Article
C2 - 30689759
SN - 1058-4838
VL - 69
SP - 1946
EP - 1954
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 11
ER -