BACKGROUND: United States guidelines recommend azithromycin or doxycycline for chlamydia (Chlamydia trachomatis [CT]) treatment. These therapies are similarly efficacious for urogenital infections when outcomes are measured 7 to 42 days after treatment, although doxycycline may be superior for rectal infections. Some investigators have suggested that persistent rectal infections may lead to autoinfection of the urogenital tract, potentially resulting in higher rates of recurrent infection in azithromycin-treated women. METHODS: We used Washington State surveillance data to identify women 14 years or older with urogenital CT (1992-2015) treated with azithromycin or doxycycline. We defined persistent/recurrent CT as a repeat positive CT test result 14 to 180 days after treatment of the initial infection. We used log binomial regression to estimate the adjusted relative risk (aRR) of persistent/recurrent infection associated with treatment with azithromycin versus doxycycline. RESULTS: From 1992 to 2015, there were 268,596 reported cases of urogenital CT, including 168,301 (63%) who received azithromycin and 66,432 (25%) who received doxycycline. The risk of persistent/recurrent urogenital CT was 6.7% and 4.7% in azithromycin- and doxycycline-treated cases, respectively (P < 0.001). Adjusting for age, race/ethnicity, year, pregnancy status, jurisdiction reporting, reason for examination, and gonorrhea coinfection, azithromycin-treated women were significantly more likely to have persistent/recurrent urogenital CT than doxycycline-treated women (aRR, 1.24; 95% confidence interval [CI], 1.19-1.30). Adjusting the retesting window to 21 to 180 days (aRR, 1.24; 95% CI, 1.19-1.30) and 28 to 180 days (aRR, 1.25; 95% CI, 1.19-1.30) did not alter our primary findings. CONCLUSIONS: Persistent/recurrent urogenital CT may be more common among women treated with azithromycin than with doxycycline. The reason for this difference is uncertain and is an important area of future investigation.
BACKGROUND: United States guidelines recommend azithromycin or doxycycline for chlamydia (Chlamydia trachomatis [CT]) treatment. These therapies are similarly efficacious for urogenital infections when outcomes are measured 7 to 42 days after treatment, although doxycycline may be superior for rectal infections. Some investigators have suggested that persistent rectal infections may lead to autoinfection of the urogenital tract, potentially resulting in higher rates of recurrent infection in azithromycin-treated women. METHODS: We used Washington State surveillance data to identify women 14 years or older with urogenital CT (1992-2015) treated with azithromycin or doxycycline. We defined persistent/recurrent CT as a repeat positive CT test result 14 to 180 days after treatment of the initial infection. We used log binomial regression to estimate the adjusted relative risk (aRR) of persistent/recurrent infection associated with treatment with azithromycin versus doxycycline. RESULTS: From 1992 to 2015, there were 268,596 reported cases of urogenital CT, including 168,301 (63%) who received azithromycin and 66,432 (25%) who received doxycycline. The risk of persistent/recurrent urogenital CT was 6.7% and 4.7% in azithromycin- and doxycycline-treated cases, respectively (P < 0.001). Adjusting for age, race/ethnicity, year, pregnancy status, jurisdiction reporting, reason for examination, and gonorrhea coinfection, azithromycin-treated women were significantly more likely to have persistent/recurrent urogenital CT than doxycycline-treated women (aRR, 1.24; 95% confidence interval [CI], 1.19-1.30). Adjusting the retesting window to 21 to 180 days (aRR, 1.24; 95% CI, 1.19-1.30) and 28 to 180 days (aRR, 1.25; 95% CI, 1.19-1.30) did not alter our primary findings. CONCLUSIONS: Persistent/recurrent urogenital CT may be more common among women treated with azithromycin than with doxycycline. The reason for this difference is uncertain and is an important area of future investigation.
Authors: Fabian Yuh Shiong Kong; Sepehr N Tabrizi; Christopher Kincaid Fairley; Lenka A Vodstrcil; Wilhelmina M Huston; Marcus Chen; Catriona Bradshaw; Jane S Hocking Journal: J Antimicrob Chemother Date: 2015-01-29 Impact factor: 5.790
Authors: Jennifer Gratrix; Ameeta E Singh; Joshua Bergman; Caroline Egan; Sabrina S Plitt; Justin McGinnis; Christopher A Bell; Steven J Drews; Ron Read Journal: Clin Infect Dis Date: 2014-10-21 Impact factor: 9.079
Authors: Christina B Hosenfeld; Kimberly A Workowski; Stuart Berman; Akbar Zaidi; Jeri Dyson; Debra Mosure; Gail Bolan; Heidi M Bauer Journal: Sex Transm Dis Date: 2009-08 Impact factor: 2.830
Authors: D H Martin; T F Mroczkowski; Z A Dalu; J McCarty; R B Jones; S J Hopkins; R B Johnson Journal: N Engl J Med Date: 1992-09-24 Impact factor: 91.245
Authors: F Y S Kong; S N Tabrizi; M Law; L A Vodstrcil; M Chen; C K Fairley; R Guy; C Bradshaw; J S Hocking Journal: Clin Infect Dis Date: 2014-04-11 Impact factor: 9.079
Authors: D Jang; J Sellors; M Howard; J Mahony; E Frost; D Patrick; C Bouchard; J Dubois; L Scholar; M Chernesky Journal: Sex Transm Infect Date: 2003-06 Impact factor: 3.519
Authors: Geneviève A F S van Liere; Nicole H T M Dukers-Muijrers; Luuk Levels; Christian J P A Hoebe Journal: Clin Infect Dis Date: 2017-06-15 Impact factor: 9.079
Authors: Christine M Khosropour; Olusegun O Soge; Robert Suchland; Gina Leipertz; Anna Unutzer; Rushlenne Pascual; Kevin Hybiske; Lindley A Barbee; Lisa E Manhart; Julia C Dombrowski; Matthew R Golden Journal: J Infect Dis Date: 2019-07-02 Impact factor: 5.226
Authors: William M Geisler; Jane S Hocking; Toni Darville; Byron E Batteiger; Robert C Brunham Journal: Clin Infect Dis Date: 2022-04-13 Impact factor: 9.079
Authors: Christine M Khosropour; Julia C Dombrowski; Lucia Vojtech; Dorothy L Patton; Lee Ann Campbell; Lindley A Barbee; Michaela C Franzi; Kevin Hybiske Journal: Sex Transm Dis Date: 2021-12-01 Impact factor: 2.830
Authors: Jodie Dionne-Odom; Akila Subramaniam; Kristal J Aaron; William M Geisler; Alan T N Tita; Jeanne Marrazzo Journal: Am J Obstet Gynecol MFM Date: 2020-08-18