• Nicole H T M Dukers-Muijrers, Petra F G Wolffs, Henry De Vries, Hannelore M Götz, Titia Heijman, Sylvia Bruisten, Lisanne Eppings, Arjan Hogewoning, Mieke Steenbakkers, Mayk Lucchesi, Maarten F Schim van der Loeff, and HoebeChristian J P ACJPADepartment of Sexual Health, Infectious Diseases, and Environmental Health, Heerlen, South Limburg Public Health Service, The Netherlands.Department of Medical Microbiology, Care and Public Health Research Institute, Maastricht Uni.
• Department of Sexual Health, Infectious Diseases, and Environmental Health, Heerlen, South Limburg Public Health Service, The Netherlands.
• Clin. Infect. Dis. 2019 Nov 13; 69 (11): 1946-1954.

BackgroundRectal 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.MethodsThis 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.ResultsWe 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).ConclusionsThe effectiveness of doxycycline is high and exceeds that of azithromycin for the treatment of rectal CT infections in women.Clinical Trials RegistrationNCT02694497.© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America.

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