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- Title
Higher organism load associated with failure of azithromycin to treat rectal chlamydia.
- Authors
KONG, F. Y. S.; TABRIZI, S. N.; FAIRLEY, C. K.; PHILLIPS, S.; FEHLER, G.; LAW, M.; VODSTRCIL, L. A.; CHEN, M.; BRADSHAW, C. S.; HOCKING, J. S.
- Abstract
Repeat rectal chlamydia infection is common in men who have sex with men (MSM) following treatment with 1 g azithromycin. This study describes the association between organism load and repeat rectal chlamydia infection, genovar distribution, and efficacy of azithromycin in asymptomatic MSM. Stored rectal chlamydia-positive samples from MSM were analysed for organism load and genotyped to assist differentiation between reinfection and treatment failure. Included men had follow-up tests within 100 days of index infection. Lymphogranuloma venereum and proctitis diagnosed symptomatically were excluded. Factors associated with repeat infection, treatment failure and reinfection were investigated. In total, 227 MSM were included – 64 with repeat infections [28·2%, 95% confidence interval (CI) 22·4–34·5]. Repeat positivity was associated with increased pre-treatment organism load [odds ratio (OR) 1·7, 95% CI 1·4–2·2]. Of 64 repeat infections, 29 (12·8%, 95% CI 8·7–17·8) were treatment failures and 35 (15·4%, 95% CI 11·0–20·8) were reinfections, 11 (17·2%, 95% CI 8·9–28·7) of which were definite reinfections. Treatment failure and reinfection were both associated with increased load (OR 2·0, 95% CI 1·4–2·7 and 1·6, 95% CI 1·2–2·2, respectively). The most prevalent genovars were G, D and J. Treatment efficacy for 1 g azithromycin was 83·6% (95% CI 77·2–88·8). Repeat positivity was associated with high pre-treatment organism load. Randomized controlled trials are urgently needed to evaluate azithromycin's efficacy and whether extended doses can overcome rectal infections with high organism load.
- Subjects
VICTORIA; AZITHROMYCIN; CHLAMYDIA infection treatment; MEN who have sex with men; DISEASE relapse; DRUG efficacy; RANDOMIZED controlled trials; THERAPEUTICS; ANTIBIOTICS; BACTERIAL growth; CHLAMYDIA infections; CHLAMYDIA trachomatis; MICROBIOLOGICAL techniques; RECTUM; RECTAL diseases; RELATIVE medical risk; RETROSPECTIVE studies; PHYSIOLOGY
- Publication
Epidemiology & Infection, 2016, Vol 144, Issue 12, p2587
- ISSN
0950-2688
- Publication type
journal article
- DOI
10.1017/S0950268816000996