title: Treatment of rectal chlamydia infection may be more complicated than we originally thought.
abstract: 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.
authors.affiliation: Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, 3/207 Bouverie Street, Carlton, Victoria 3053, Australia jhocking@unimelb.edu.au.
authors.forename: Jane S
authors.initials: JS
authors.lastname: Hocking
authors.affiliation: Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, 3/207 Bouverie Street, Carlton, Victoria 3053, Australia.
authors.forename: Fabian Y S
authors.initials: FY
authors.lastname: Kong
authors.affiliation: University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, Queensland, 4558, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Timms
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland 4059, Australia.
authors.forename: Wilhelmina M
authors.initials: WM
authors.lastname: Huston
authors.affiliation: Murdoch Children's Research Institute, Flemington Road, Parkville, Victoria 3052, Australia Department of Obstetrics and Gynaecology, University of Melbourne, The Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria 3052, Australia.
authors.forename: Sepehr N
authors.initials: SN
authors.lastname: Tabrizi
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use*; D002690:Chlamydia Infections / Q000188:drug therapy*; D004318:Doxycycline / Q000627:therapeutic use*; D005260:Female; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D012002:Rectal Diseases / Q000188:drug therapy*; D012725:Sexual Behavior; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin; D004318:Doxycycline
keywords: azithromycin; doxycycline; treatment failure