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- Title
Doxycycline Versus Azithromycin for the Treatment of Rectal Chlamydia in Men Who Have Sex With Men: A Randomized Controlled Trial.
- Authors
Dombrowski, Julia C; Wierzbicki, Michael R; Newman, Lori M; Powell, Jonathan A; Miller, Ashley; Dithmer, Dwyn; Soge, Olusegun O; Mayer, Kenneth H
- Abstract
Background Azithromycin and doxycycline are both recommended treatments for rectal Chlamydia trachomatis (CT) infection, but observational studies suggest that doxycycline may be more effective. Methods This randomized, double-blind, placebo-controlled trial compared azithromycin (single 1-g dose) versus doxycycline (100 mg twice daily for 7 days) for the treatment of rectal CT in men who have sex with men (MSM) in Seattle and Boston. Participants were enrolled after a diagnosis of rectal CT in clinical care and underwent repeated collection of rectal swabs for nucleic acid amplification testing (NAAT) at study enrollment and 2 weeks and 4 weeks postenrollment. The primary outcome was microbiologic cure (CT-negative NAAT) at 4 weeks. The complete case (CC) population included participants with a CT-positive NAAT at enrollment and a follow-up NAAT result; the intention-to-treat (ITT) population included all randomized participants. Results Among 177 participants enrolled, 135 (76%) met CC population criteria for the 4-week follow-up visit. Thirty-three participants (19%) were excluded because the CT NAAT repeated at enrollment was negative. Microbiologic cure was higher with doxycycline than azithromycin in both the CC population (100% [70 of 70] vs 74% [48 of 65]; absolute difference, 26%; 95% confidence interval [CI], 16–36%; P <.001) and the ITT population (91% [80 of 88] vs 71% [63 of 89]; absolute difference, 20%; 95% CI, 9–31%; P <.001). Conclusions A 1-week course of doxycycline was significantly more effective than a single dose of azithromycin for the treatment of rectal CT in MSM. Clinical Trials Registration NCT03608774.
- Subjects
WASHINGTON (State); MASSACHUSETTS; CHLAMYDIA infection diagnosis; DRUG efficacy; CONFIDENCE intervals; RECTAL diseases; DOXYCYCLINE; SEXUALLY transmitted diseases; RANDOMIZED controlled trials; COMPARATIVE studies; BLIND experiment; DESCRIPTIVE statistics; SEXUAL minorities; MEN who have sex with men; AZITHROMYCIN; STATISTICAL sampling; CHLAMYDIA infections; NUCLEIC acid amplification techniques; MICROBIAL sensitivity tests; EVALUATION
- Publication
Clinical Infectious Diseases, 2021, Vol 73, Issue 5, p824
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciab153