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Higher organism load associated with failure of azithromycin to treat rectal chlamydia
- Source :
- Epidemiol Infect
- Publication Year :
- 2016
- Publisher :
- Cambridge University Press (CUP), 2016.
-
Abstract
- SUMMARYRepeat rectal chlamydia infection is common in men who have sex with men (MSM) following treatment with 1 g azithromycin. This study describes the association between organism load and repeat rectal chlamydia infection, genovar distribution, and efficacy of azithromycin in asymptomatic MSM. Stored rectal chlamydia-positive samples from MSM were analysed for organism load and genotyped to assist differentiation between reinfection and treatment failure. Included men had follow-up tests within 100 days of index infection. Lymphogranuloma venereum and proctitis diagnosed symptomatically were excluded. Factors associated with repeat infection, treatment failure and reinfection were investigated. In total, 227 MSM were included – 64 with repeat infections [28·2%, 95% confidence interval (CI) 22·4–34·5]. Repeat positivity was associated with increased pre-treatment organism load [odds ratio (OR) 1·7, 95% CI 1·4–2·2]. Of 64 repeat infections, 29 (12·8%, 95% CI 8·7–17·8) were treatment failures and 35 (15·4%, 95% CI 11·0–20·8) were reinfections, 11 (17·2%, 95% CI 8·9–28·7) of which were definite reinfections. Treatment failure and reinfection were both associated with increased load (OR 2·0, 95% CI 1·4–2·7 and 1·6, 95% CI 1·2–2·2, respectively). The most prevalent genovars were G, D and J. Treatment efficacy for 1 g azithromycin was 83·6% (95% CI 77·2–88·8). Repeat positivity was associated with high pre-treatment organism load. Randomized controlled trials are urgently needed to evaluate azithromycin's efficacy and whether extended doses can overcome rectal infections with high organism load.
- Subjects :
- Adult
Male
Risk
0301 basic medicine
medicine.medical_specialty
Adolescent
Victoria
Epidemiology
030106 microbiology
Chlamydia trachomatis
Azithromycin
medicine.disease_cause
Asymptomatic
Men who have sex with men
Sexual and Gender Minorities
Young Adult
03 medical and health sciences
Internal medicine
medicine
Humans
Proctitis
Aged
Retrospective Studies
Chlamydia
business.industry
Lymphogranuloma venereum
Rectum
Odds ratio
Chlamydia Infections
Middle Aged
medicine.disease
Original Papers
Bacterial Load
Anti-Bacterial Agents
Rectal Diseases
Infectious Diseases
Immunology
medicine.symptom
business
medicine.drug
Subjects
Details
- ISSN :
- 14694409 and 09502688
- Volume :
- 144
- Database :
- OpenAIRE
- Journal :
- Epidemiology and Infection
- Accession number :
- edsair.doi.dedup.....ee6002ad6961fed37d9feb3350d940a9