Perspective from Carlos del Rio, MD
Disclosures: Hocking reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
June 23, 2021
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7-day doxycycline regimen may be new ‘first-line’ treatment for rectal chlamydia in MSM

Perspective from Carlos del Rio, MD
Disclosures: Hocking reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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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.

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

Hocking pullquote

“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.”