title: Mass drug administration of azithromycin for trachoma reduces the prevalence of genital Chlamydia trachomatis infection in the Solomon Islands.
abstract: Chlamydia trachomatis is the most common bacterial sexually transmitted infection and is frequently asymptomatic; ocular C. trachomatis strains cause trachoma. Mass drug administration (MDA) of azithromycin for trachoma might also reduce the prevalence of genital C. trachomatis. In a survey conducted in the Solomon Islands in 2014, prior to MDA, the prevalence of genital C. trachomatis was 20.3% (95% CI 15.9% to 25.4%). We conducted a survey to establish the impact of MDA with azithromycin on genital C. trachomatis.
  
  
  
  Women attending three community outpatient clinics, predominantly for antenatal care, 10 months after MDA with azithromycin given for trachoma elimination, were enrolled in this survey. Self-taken high vaginal swabs were for C. trachomatis and Neisseria gonorrhoeae using the BD Probetec strand displacement assay.
  
  
  
  298 women were enrolled. C. trachomatis infection was diagnosed in 43 women (14.4%, 95% CI 10.6% to 18.9%) and N. gonorrhoeae in 9 (3%, 95% CI 1.4% to 5.7%). The age-adjusted OR for C. trachomatis infection was consistent with a significant decrease in the prevalence of C. trachomatis following MDA (OR 0.58, 95% CI 0.37 to 0.94, p=0.027). There was no change in the prevalence of N. gonorrhoeae between following MDA (OR 0.51, 95% CI 0.22 to 1.22, p=0.13).
  
  
  
  This study demonstrated a 40% reduction in the age-adjusted prevalence of genital C. trachomatis infection following azithromycin MDA for trachoma elimination.
authors.affiliation: Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, UK.
authors.forename: M
authors.identifier: 0000-0002-7585-4743
authors.initials: M
authors.lastname: Marks
authors.affiliation: Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Bottomley
authors.affiliation: Nursing Division, Honiara City Council, Honiara, Solomon Islands.
authors.forename: H
authors.initials: H
authors.lastname: Tome
authors.affiliation: National Referral Hospital, Honiara, Solomon Islands.
authors.forename: R
authors.initials: R
authors.lastname: Pitakaka
authors.affiliation: Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Butcher
authors.affiliation: Eye Health Department, Ministry of Health and Medical Services, Honiara, Solomon Islands.
authors.forename: O
authors.initials: O
authors.lastname: Sokana
authors.affiliation: Department of STI and HIV Prevention, Ministry of Health and Medical Services, Honiara, Solomon Islands.
authors.forename: H
authors.initials: H
authors.lastname: Kako
authors.affiliation: Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, UK.
authors.forename: A W
authors.initials: AW
authors.lastname: Solomon
authors.affiliation: Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, UK.
authors.forename: D C
authors.initials: DC
authors.lastname: Mabey
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use*; D017963:Azithromycin / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use*; D002690:Chlamydia Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D002692:Chlamydia trachomatis / Q000187:drug effects*; D005260:Female; D006306:Health Surveys; D006801:Humans; D008403:Mass Screening; D008542:Melanesia / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D014141:Trachoma / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D014626:Vaginal Smears; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin
keywords: AZITHROMYCIN; CHLAMYDIA TRACHOMATIS; NEISSERIA GONORRHOEA