7-day Doxycycline Regimen May Be New 'first-line' Treatment For Rectal ...

7-day doxycycline regimen may be new ‘first-line’ treatment for rectal chlamydia in MSM June 23, 2021 1 min read ByEamon N. Dreisbach Add topic to email alerts Receive an email when new articles are posted on Please provide your email address to receive an email when new articles are posted on . Subscribe Added to email alerts You've successfully added to your alerts. You will receive an email when new content is published. Click Here to Manage Email Alerts You've successfully added to your alerts. You will receive an email when new content is published. Click Here to Manage Email Alerts Back to Healio We were unable to process your request. Please try again later. If you continue to have this issue please contact [email protected]. Back to Healio Save Share

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A week-long regimen of doxycycline was superior to a single-dose of azithromycin for the treatment of rectal chlamydia among men who have sex with men, or MSM, according to study results.

Perspective from Carlos del Rio, MD

The randomized, double-blind trial, which was published in The New England Journal of Medicine, included 625 men from five clinics in Australia.

“Our results suggest that doxycycline should replace azithromycin as the first-line treatment for rectal chlamydia. Clinicians should use doxycycline as first-line treatment for chlamydia infection at any infection site — including for urogenital and rectal infections, particularly given that most women with a urogenital infection will also have rectal chlamydia,” Jane Hocking, MPH, PhD, NHMRC professorial fellow at the Melbourne School of Population and Global Health, told Healio. “However, azithromycin will still have a place for treating chlamydia infection in pregnant women where doxycycline is contraindicated, in those with an allergy to doxycycline and for those where there are serious concerns about adherence to a 7-day regimen.”

Hocking and colleagues randomly assigned 314 of the men 100 mg of doxycycline twice daily for 7 days and 311 of the men a 1 g single dose of azithromycin. They assessed whether the participants were cured of chlamydia at 4 weeks via nucleic acid amplification test (NAAT).

At 4 weeks, test results were available for 290 (92.4%) of men who were given doxycycline and 297 (95.5%) of men who were given azithromycin. According to the researchers, 96.9% (n = 281/290; 95% CI, 94.9%-98.9%) of men in the doxycycline group and 76.4% (n = 227/297; 95% CI, 73.8%-79.1%) of men in the azithromycin group were cured.

Hocking said that one of the study’s major limitations was that it included only MSM.

However, “rectal chlamydia organism load is similar between the sexes, and observational data show similar treatment efficacy in men and women — suggesting our results will also apply to women,” Hocking said. “Only men with asymptomatic chlamydia were eligible to participate, but given over 85% of rectal chlamydia in men is asymptomatic, our results will apply to the majority of those with infection.”

Perspective

Back to Top Carlos del Rio, MD Carlos del Rio, MD

The study by Lau and colleagues from Melbourne, Australia, is an important randomized controlled trial that will undoubtedly influence the STD treatment guidelines. Current CDC guidelines recommend doxycycline or azithromycin as first-line agents for treating rectal chlamydia infection. However, observational data suggest that doxycycline is more effective than azithromycin.

The findings from this study are similar to those of a smaller study recently published in Clinical Infectious Diseases in which microbiologic cure occurred in 100% of those who received doxycycline and 74% of those who received azithromycin. I think these two studies conclusively prove that 1 week of doxycycline is more effective than a single dose of azithromycin for the treatment.

Reference:

Dombrowski JC, et al. Clin Infect Dis. 2021;doi:10.1093/cid/ciab153.

Carlos del Rio, MD Infectious Disease News Editorial Board Member Distinguished professor of medicine Executive associate dean Emory University School of Medicine Disclosures: Del Rio reports no relevant financial disclosures. Published by:

Sources/Disclosures

Source:

Lau A, et al. N Engl J Med. 2021;doi:10.1056/NEJMoa2031631.

Disclosures: Hocking reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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doxycycline chlamydia sexually transmitted infection sexually transmitted disease azithromycin Add topic to email alerts Receive an email when new articles are posted on Please provide your email address to receive an email when new articles are posted on . Subscribe Added to email alerts You've successfully added to your alerts. You will receive an email when new content is published. Click Here to Manage Email Alerts You've successfully added to your alerts. You will receive an email when new content is published. Click Here to Manage Email Alerts Back to Healio We were unable to process your request. Please try again later. If you continue to have this issue please contact [email protected]. Back to Healio