Article Text

Download PDFPDF
Original article
Suboptimal adherence to doxycycline and treatment outcomes among men with non-gonococcal urethritis: a prospective cohort study
  1. Christine M Khosropour1,
  2. Lisa E Manhart1,2,
  3. Danny V Colombara1,
  4. Catherine W Gillespie1,6,
  5. M Sylvan Lowens5,
  6. Patricia A Totten3,
  7. Matthew R Golden3,5,
  8. Jane Simoni4
  1. 1Department of Epidemiology, University of Washington, Seattle, Washington, USA
  2. 2Department of Global Health, University of Washington, Seattle, Washington, USA
  3. 3Department of Medicine, University of Washington, Seattle, Washington, USA
  4. 4Department of Psychology, University of Washington, Seattle, Washington, USA
  5. 5Public-Health Seattle and King County STD Program, Seattle, Washington, USA
  6. 6Children's National Medical Center, Washington, District of Columbia, USA
  1. Correspondence to Dr Lisa Manhart, UW Center for AIDS and STD, 325 9th Avenue, Seattle, WA 98104, USA; lmanhart{at}


Objective Doxycycline, one of two recommended therapies for non-gonococcal urethritis (NGU), consists of a 7-day course of therapy (100 mg BID). Since suboptimal adherence may contribute to poor treatment outcomes, we examined the association between self-reported imperfect adherence to doxycycline and clinical and microbiologic failure among men with NGU.

Methods Men aged ≥16 years with NGU attending a Seattle, WA, sexually transmitted diseases clinic were enrolled in a double-blind, parallel-group superiority trial from January 2007 to July 2011. Men were randomised to active doxycycline/placebo azithromycin or placebo doxycycline/active azithromycin. Imperfect adherence was defined as missing ≥1 dose in 7 days. Urine was tested for Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), and Ureaplasma urealyticum-biovar 2 (UU-2) using nucleic acid amplification tests. Clinical failure (symptoms and ≥5 PMNs/HPF or discharge) and microbiologic failure (positive tests for CT, MG, and/or UU-2) were determined after 3 weeks.

Results 184 men with NGU were randomised to active doxycycline and provided data on adherence. Baseline prevalence of CT, MG and UU-2 was 26%, 13% and 27%, respectively. 28% of men reported imperfect adherence, and this was associated with microbiologic failure among men with CT (aRR=9.33; 95% CI 1.00 to 89.2) and UU-2 (aRR=3.08; 95% CI 1.31 to 7.26) but not MG. Imperfect adherence was not significantly associated with clinical failure overall or for any specific pathogens, but it was more common among imperfectly adherent men with CT (aRR=2.63; 0.93–7.41, p=0.07).

Conclusions Adherence may be important for microbiologic cure of select pathogens. Factors other than adherence should be considered for CT-negative men with persistent NGU.


Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.