Treatment of asymptomatic rectal <i>Chlamydia trachomatis</i>: is single-dose azithromycin effective?

Steedman, N; McMillan, A

doi:10.1258/ijsa.2008.008211

Cited by 50 publications

(48 citation statements)

References 7 publications

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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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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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“…In MSM, a recent study in the USA found a 13% treatment failure rate for anal chlamydia infections treated with azithromycin. 16 Even if patients are reminded about the need for re-testing by their clinician, patients may not consider themselves at risk or perceive testing as a priority, and thus there will be considerable variation in patient adherence to this recommendation. Studies have examined various strategies for increasing return for retesting after a chlamydia infection, including cash incentives, phone and letter reminders, motivational counselling, a brief recommendation by the clinician and sending urine samples in the mail.…”

Section: Discussionmentioning

confidence: 99%

Re-testing for chlamydia at sexual health services in Australia, 2004 - 08

et al. 2011

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Abstract. Objective:To describe the frequency of the 3-month test for re-infection among sexual health service patients in Australia. Methods: We assessed the re-testing rates at 30-120 days after chlamydia infection in men who have sex with men (MSM), heterosexual males and females attending sexual health services across Australia between 2004 and 2008. A c 2 -test was used to determine significant differences in re-testing rates according to demographic characteristics and trends over time. Results: In the 5-year period, 10 207 MSM, 28 530 heterosexual males and 31 190 heterosexual females were tested for chlamydia. Of those tested, 9057 (13.0%) were positive. The proportion of patients with chlamydia infection who were re-tested in 30-120 days was 8.6% in MSM, 11.9% in heterosexual males and 17.8% in heterosexual females. Among MSM, chlamydia re-testing rates were lower in men aged <30 years (8.4%) than 30 years (12.5%) (P = 0.04) and lower in travellers and migrants (2.9%) than non-travellers (9.9%) (P = 0.002). In heterosexual males, chlamydia re-testing rates were lower in men in regional and rural areas (10.5%) than metropolitan areas (13.5%) (P = 0.017). There was no increasing trend in re-testing rates between 2004 and 2008 (P = 0.787). Of the patients re-tested, 44.1% of MSM were positive, 21.0% of heterosexual males and 16.1% of females. Discussion: The high chlamydia positivity at 30-120 days support recommendations that call for a 3-month test for re-infection following a positive test. The low re-testing rates highlight the need for innovative strategies to increase re-testing.

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“…Drummond et al (55) reported that 6% of men treated for chlamydial rectal infections had apparent treatment failure, while a study by Hathorn and coworkers reported that 11 of 45 (21.4%) participants (male and females) treated for rectal infection and not at risk for reinfection had apparent treatment failure (56). Yet another study reported a 13% treatment failure rate in men with rectal infections (57). Interestingly, in the Hathorn study, the treatment failure with doxycycline was less frequent in the treatment of rectal infections (56).…”

Section: Implications Of Chlamydial Gi Infection For Persistent or Rementioning

confidence: 99%

Hidden in Plain Sight: Chlamydial Gastrointestinal Infection and Its Relevance to Persistence in Human Genital Infection

2014

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Although the concept of persistence in chlamydial infections has been recognized for about 80 years, there is still very little known about the mechanism by which this occurs. In this review, we revisit an old paradigm, long known to chlamydiologists and veterinarians, that in virtually all hosts of chlamydiae, including mammals and birds, chlamydiae reside in the gastrointestinal tract for long periods of time in the absence of clinical disease. Thus, if gastrointestinal infection occurs in most hosts, then it is very likely that gastrointestinal infection occurs in humans as well. We demonstrate that gastrointestinal infection does indeed occur in humans and propose that this anatomical site is the source of persistent infection in humans. The data in ruminants and animal models demonstrate that the immune system is unable to clear chlamydiae from the gut, so they can remain indefinitely, with continual shedding in feces. Clearly, many women become reinfected from an untreated partner; however, we propose that women, cured of genital infection, remain at risk for autoinoculation from the lower gastrointestinal tract. Moreover, there are substantial data demonstrating treatment failure of chlamydial infections, particularly with azithromycin. New data in the mouse model have shown that azithromycin is far less effective against chlamydial gastrointestinal infection than against genital infections. Therefore, it is possible that women cured of genital infection by antibiotics remain infected in the gastrointestinal tract and can become reinfected by autoinoculation from that site.

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Treatment of asymptomatic rectal Chlamydia trachomatis: is single-dose azithromycin effective?

Cited by 50 publications

References 7 publications

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

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

Re-testing for chlamydia at sexual health services in Australia, 2004 - 08

Hidden in Plain Sight: Chlamydial Gastrointestinal Infection and Its Relevance to Persistence in Human Genital Infection

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