title: What is the appropriate treatment for the management of rectal Chlamydia trachomatis in men and women?
abstract: BACKGROUND
  There is no UK guidance specifically for the management of rectal Chlamydia trachomatis yet there is documented treatment failure with single-dose azithromycin suggesting that test of cure (TOC) and alternative treatment may be needed.
  
  
  OBJECTIVE
  To evaluate the efficacy of single-dose azithromycin compared with 1 week of doxycycline in the treatment of rectal C trachomatis.
  
  
  METHODS
  Data were collected prospectively on all patients diagnosed with rectal C trachomatis who received azithromycin 1 g stat between 1 January and 30 June 2010 and between 1 October 2010 and 31 March 2011 following a local change in treatment protocol to 1 week of doxycycline 100 mg twice a day. Information was collected on gender, concurrent sexually transmitted infections, treatment received, re-infection risk, re-treatment and TOC at 6 weeks.
  
  
  RESULTS
  11 patients (26.2%) had a positive TOC following treatment with stat azithromycin. The risk of re-infection was excluded in two, identifying nine of the 11 (81.8%) as treatment failures. Two patients had a positive TOC following treatment with 1 week of doxycycline, both were found to have a risk of re-infection. There was a significantly higher treatment failure rate in patients receiving azithromycin (p=0.0025).
  
  
  CONCLUSIONS
  A higher treatment failure rate was found following azithromycin for rectal C trachomatis than previously published. If azithromycin is used for treatment of rectal C trachomatis, TOC may be required or alternative treatment with doxycycline may be preferable, but further data are required.
authors.affiliation: Department of Genitourinary Medicine, Whittall Street Clinic, Whittall Street, Birmingham, B4 6DH, UK. emma.hathorn@nhs.net
authors.forename: Emma
authors.initials: E
authors.lastname: Hathorn
authors.forename: Catherine
authors.initials: C
authors.lastname: Opie
authors.forename: Penny
authors.initials: P
authors.lastname: Goold
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017963:Azithromycin / Q000008:administration & dosage; D002690:Chlamydia Infections / Q000188:drug therapy* / Q000382:microbiology*; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D004318:Doxycycline / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012002:Rectal Diseases / Q000188:drug therapy* / Q000382:microbiology*; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin; D004318:Doxycycline