Treatment of rectal chlamydia infection may be more complicated than we originally thought
Journal of Antimicrobial Chemotherapy April 2015 V.70 N.4 P.961-964
Jane S. Hocking, Fabian Y. S. Kong, Peter Timms, Wilhelmina M. Huston, and Sepehr N. Tabrizi
1Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, 3/207 Bouverie Street, Carlton, Victoria 3053, Australia
2University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, Queensland, 4558, Australia
3Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland 4059, Australia
4Murdoch Children’s Research Institute, Flemington Road, Parkville, Victoria 3052, Australia
5Department of Obstetrics and Gynaecology, University of Melbourne, The Royal Women’s Hospital, 20 Flemington Road, Parkville, Victoria 3052, Australia
*Corresponding author. Tel: +61-3-8344-0762; Fax: +61-3-9347-9824; E-mail: firstname.lastname@example.org
Rectal chlamydia diagnoses have been increasing among MSM and may also rise among women as anal sex rates increase among heterosexuals.
However, there is growing concern about treatment for rectal chlamydia with treatment failures of up to 22% being reported.
This article addresses factors that may be contributing to treatment failure for rectal chlamydia, including the pharmacokinetic properties of azithromycin and doxycycline in rectal tissue, the ability of chlamydia to transform into a persistent state that is less responsive to antimicrobial therapy, the impact of the rectal microbiome on chlamydia, heterotypic resistance, failure to detect cases of lymphogranuloma venereum and the performance of screening tests.
If we are to reduce the burden of genital chlamydia, treatment for rectal chlamydia must be efficacious.
This highlights the need for randomized controlled trial evidence comparing azithromycin with doxycycline for the treatment of rectal chlamydia.