Background When a person, diagnosed with Chlamydia trachomatis (Ct), is being treated for Ct, STI Centres generally advise a short period of sexual abstinence; in most cases no test of cure is performed. These are considered best practices to cure Ct and prevent further spread, assuming high antibiotic efficacy. However, in about 5% of treated patients symptoms persist and among those retested 6–12 months later, 10% is Ct positive (again). Moreover, the efficacy of Azithromycin treatment for anorectal Ct is debated. The current study aims to increase understanding Ct treatment efficacy and to estimate time to cure cervicovaginal and anorectal Ct, using repeated measurements of laboratory, medical, and exposure parameters.
Methods Prospective study among 49 persons with cervicovaginal Ct (45 women) and/or anorectal Ct (four men, three women). After directly observed treatment with 1000 mg Azithromycin, each participant provided during 2 months 18 time-sequential self-taken samples for testing for rRNA (TMA), Ct bacterial load (quantitative PCR; Ct plasmid DNA), and type Ct (serovar), and three time-sequential questionnaires on potential exposure (behaviour) and symptoms. Steady partners were treated as well. Here, we report on the 905 rRNA tests in 49 patients.
Results Of all women with cervicovaginal Ct, the proportion rRNA positive was 100% at treatment, 54% at day 7, 11% at day 12 and 17% 2 months after treatment. For anorectal Ct, these rates were 100%, 57%, 29%, and 50%. In total 45% of persons with cervicovaginal Ct and 57% with anorectal Ct had at least one positive rRNA sample in the period between 2 weeks and 2 months after treatment. Three cases of anorectal Ct (negative Lymfogranuloma venerum (LGV) PCR) remained rRNA positive during 2 months and tested Ct negative after administration of doxycycline (testing 2 months later).
Conclusions The proportion of Ct rRNA positivity during follow-up was much higher than expected in the light of assumed high effectiveness of Azithromycin treatment. Time to cure depends on the extent rRNA indicates clinically relevant or persistent Ct infection; this will be determined considering other markers (eg, Ct DNA) and symptoms as well (research ongoing). The persistent anorectal Ct cases that resolved after doxycycline treatment, contribute to the notion that this might be better treatment in anorectal Ct, after exclusion of LGV. Current study contributes to evidence based patient management and Ct transmission reduction.
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