Rectal chlamydia is a frequent sexually transmitted infection in men who have sex with men. Despite the high prevalence of the infection, there are no clear recommendations for its treatment, which is due to the insufficient number of randomized trials.
A double-blind study including men who have sex with men and have asymptomatic rectal chlamydia was performed.
Inclusion in the study took place in 5 clinics in Australia.
Patients were randomized to doxycycline 100 mg twice daily for 7 days or azithromycin 1 g (single dose).
It is noted that the asymptomatic patient population was not chosen randomly, 85% of patients with rectal chlamydia have an asymptomatic course. According to clinical guidelines, therapy of symptomatic infection is longer.
The primary endpoint A negative rectal chlamydia test result (microbiological cure) at 4 weeks was chosen.
- From August 2016 to August 2019, the study included 625 men randomized to doxycycline and azithromycin at a 1:1 ratio.
- Microbiological cure was observed in 96.9% of patients receiving doxycycline, compared with 76.4% of patients receiving azithromycin. The difference between the groups reached 19.9%.
- According to the safety analysis, side effects such as diarrhea, nausea and vomiting occurred in 33.8% of patients in the doxycycline group and 45.1% of patients in the azithromycin group. The difference between the groups was 11.3%.
A 7-day course of doxycycline is superior to a single dose of azithromycin in the treatment of asymptomatic rectal chlamydia in men who have sex with men.
Source: Andrew Lau, Fabian Y.S. Kong, Christopher K. Fairley, et al.
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