Doxycycline: the universal treatment for anogenital chlamydia

Abstract

The results of the randomised trial in The Lancet Infectious Diseases by Olivia Peuchant and colleagues are welcomed and should come as no surprise. 1 Peuchant O Lhomme E Martinet P et al. Doxycycline versus azithromycin for the treatment of anorectal Chlamydia trachomatis infection in women concurrent with vaginal infection (CHLAZIDOXY study): a multicentre, open-label, randomised, controlled, superiority trial. Lancet Infect Dis. 2022; (published online May 9.)https://doi.org/10.1016/S1473-3099(22)00148-7 Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar After all, doxycycline is known to be more efficacious than azithromycin for the treatment of rectal chlamydia in men, 2 Lau A Kong FYS Fairley CK et al. Azithromycin or doxycycline for asymptomatic rectal Chlamydia trachomatis. N Engl J Med. 2021; 384: 2418-2427 Crossref PubMed Scopus (20) Google Scholar and randomised data from Peuchant and colleagues' study now confirm the same is true for women. However, the issue in women is slightly more intriguing, given around two-thirds of the women had not had anal sex and rectal infection was thought to come mainly from contamination or autoinoculation from the genital tract. 1 Peuchant O Lhomme E Martinet P et al. Doxycycline versus azithromycin for the treatment of anorectal Chlamydia trachomatis infection in women concurrent with vaginal infection (CHLAZIDOXY study): a multicentre, open-label, randomised, controlled, superiority trial. Lancet Infect Dis. 2022; (published online May 9.)https://doi.org/10.1016/S1473-3099(22)00148-7 Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar So one could reasonably ask, does persistence of chlamydial rectal infection really matter? We and the authors of this important trial think it does matter; additionally, we think that this finding should further support doxycycline as the treatment of choice for chlamydial infections in men and now in women at any anatomical site. Doxycycline versus azithromycin for the treatment of anorectal Chlamydia trachomatis infection in women concurrent with vaginal infection (CHLAZIDOXY study): a multicentre, open-label, randomised, controlled, superiority trialThe microbiological anorectal cure rate was significantly lower among women who received a single dose of azithromycin than among those who received a 1-week course of doxycycline. This finding suggests that doxycycline should be the first-line therapy for C trachomatis infection in women. Full-Text PDF