Kirsty S Smith1, Rebecca Guy, Jennifer Danielewski, Sepehr N Tabrizi, Christopher K Fairley, Anna M McNulty, William Rawlinson, Marion Saville, Suzanne M Garland, Basil Donovan, John M Kaldor, Jane S Hocking. 1. From the *Kirby Institute, UNSW Australia, Sydney; †Murdoch Childrens Research Institute; ‡Department of Microbiology and Infectious Diseases, The Royal Women's Hospital; §Department of Obstetrics and Gynaecology, University of Melbourne; ¶Melbourne Sexual Health Centre; ∥Central Clinical School, Monash University, Melbourne; **Sydney Sexual Health Centre; ††School of Public Health and Community Medicine, UNSW Australia; ‡‡Serology and Virology Division, (SAViD) SEALS Microbiology, Prince of Wales Hospital; §§SOMS and BABS, UNSW Australia, Sydney; ¶¶VCS Pathology; and ∥∥Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
Abstract
BACKGROUND: Repeat chlamydia detection after treatment is common, and there is concern that treatment failure may be a cause. METHODS: Within a randomized trial, we established a prospective cohort of 600 participants with anogenital chlamydia diagnoses (200 each of women, heterosexual men, and men who have sex with men [MSM]). Participants were invited for repeat testing at 3 months and to complete a behavioral survey at 4 months. Positive samples were analyzed for organism DNA load and genovar. We estimated repeat chlamydia positivity, reinfection and treatment failure rates, and investigated the biological and behavioral factors associated with a repeat positive test. RESULTS: A total of 290 participants (100 women, 89 heterosexual men, 101 MSM) were retested at 1 to 4 months, with 43 repeat positives, including 26 classed as reinfection and 9 as treatment failures. Comparing MSM with heterosexual men and women combined, repeat positivity was higher (20.8% vs 11.6%, P = 0.04), and treatment failure was higher (6.9% vs 1.1%, P = 0.01), but there was no difference in reinfection rates (11.9% vs 7.4%, P = 0.21). Among MSM, the odds of repeat positivity increased by 90% with each additional log organism load in the original specimen (baseline) (adjusted odds ratio, 1.9; 95% confidence interval, 1.1-3.2). Among heterosexuals, the odds of repeat positivity decreased by 10% with each additional week delay in being retested for chlamydia (adjusted odds ratio, 0.9; 95% confidence interval, 0.8-0.9). CONCLUSIONS: Positive retests were more common among MSM than heterosexuals. Treatment failure was more common in MSM with rectal chlamydia, reinforcing concerns about azithromycintreatment failure.
RCT Entities:
BACKGROUND:Repeat chlamydia detection after treatment is common, and there is concern that treatment failure may be a cause. METHODS: Within a randomized trial, we established a prospective cohort of 600 participants with anogenital chlamydia diagnoses (200 each of women, heterosexual men, and men who have sex with men [MSM]). Participants were invited for repeat testing at 3 months and to complete a behavioral survey at 4 months. Positive samples were analyzed for organism DNA load and genovar. We estimated repeat chlamydia positivity, reinfection and treatment failure rates, and investigated the biological and behavioral factors associated with a repeat positive test. RESULTS: A total of 290 participants (100 women, 89 heterosexual men, 101 MSM) were retested at 1 to 4 months, with 43 repeat positives, including 26 classed as reinfection and 9 as treatment failures. Comparing MSM with heterosexual men and women combined, repeat positivity was higher (20.8% vs 11.6%, P = 0.04), and treatment failure was higher (6.9% vs 1.1%, P = 0.01), but there was no difference in reinfection rates (11.9% vs 7.4%, P = 0.21). Among MSM, the odds of repeat positivity increased by 90% with each additional log organism load in the original specimen (baseline) (adjusted odds ratio, 1.9; 95% confidence interval, 1.1-3.2). Among heterosexuals, the odds of repeat positivity decreased by 10% with each additional week delay in being retested for chlamydia (adjusted odds ratio, 0.9; 95% confidence interval, 0.8-0.9). CONCLUSIONS: Positive retests were more common among MSM than heterosexuals. Treatment failure was more common in MSM with rectal chlamydia, reinforcing concerns about azithromycin treatment failure.
Authors: J A Danielewski; S Phillips; F Y S Kong; K S Smith; J S Hocking; R Guy; C K Fairley; S M Garland; S N Tabrizi Journal: Eur J Clin Microbiol Infect Dis Date: 2017-02-20 Impact factor: 3.267
Authors: Nicole H T M Dukers-Muijrers; Ymke J Evers; Christian J P A Hoebe; Petra F G Wolffs; Henry J C de Vries; Bernice Hoenderboom; Marianne A B van der Sande; Janneke Heijne; Jeffrey D Klausner; Jane S Hocking; Jan van Bergen Journal: BMC Infect Dis Date: 2022-03-14 Impact factor: 3.090
Authors: Guilherme Almeida Rosa da Silva; Heloisa Loureiro de Sá Neves Motta; Erik Friedrich Alex de Souza; Pedro Afonso Nogueira Moises Cardoso; José Henrique Pilotto; Walter Araujo Eyer-Silva; Luiz Cláudio Pereira Ribeiro; Mônica Soares Dos Santos; Marcelo Costa Velho Mendes de Azevedo; Jorge Francisco da Cunha Pinto; Rogerio Neves Motta; Fernando Raphael de Almeida Ferry Journal: Rev Inst Med Trop Sao Paulo Date: 2018-10-25 Impact factor: 1.846