Abstract
BackgroundSingle-dose azithromycin is recommended over multi-dose doxycycline as treatment for chlamydial infection. However, even with imperfect adherence, doxycycline is more effective in treating genital and rectal infection. Recently, it has been suggested that autoinoculation from the rectum to the genitals may be a source of persistent chlamydial infection in women. We estimated the impact autoinoculation may have on azithromycin and doxycycline effectiveness.MethodsWe estimate treatment effectiveness using a simple mathematical model, incorporating data on azithromycin and doxycycline efficacy from recent meta-analyses, and data on prevalence of rectal infection in women with genital chlamydial infection.ResultsWhen the possibility of autoinoculation is taken into account, we calculate that doxycycline effectiveness may be 97% compared to just 82% for azithromycin.ConclusionsConsideration should be given to re-evaluating azithromycin as the standard treatment for genital chlamydia in women.
Highlights
Single-dose azithromycin is recommended over multi-dose doxycycline as treatment for chlamydial infection
Single-dose azithromycin has been recommended over a week-long doxycycline course as treatment for genital chlamydial infection, primarily because of concern about lack of adherence for the longer doxycycline course
It has recently been proposed that autoinoculation of chlamydia from the gastrointestinal (GI) tract to the genital tract is possible in women, and that the GI tract may be a niche for persistent infection [7,8,9]
Summary
Single-dose azithromycin is recommended over multi-dose doxycycline as treatment for chlamydial infection. The difference may be greater: another systematic review estimated treatment efficacies of 82.9% for azithromycin and 99.6% for doxycycline [4], with different delivery mechanisms being suggested as a possible reason for the difference [5].
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