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What is the most appropriate treatment for rectal Chlamydia trachomatis infection?
  1. E Hathorn1,
  2. D Ward2,
  3. P Goold1
  1. 1 Department of Genitourinary Medicine, Whittall Street Clinic, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  2. 2 Medical School, University of Birmingham, Birmingham, UK
  1. Correspondence to Dr E Hathorn, Department of Genitourinary Medicine, Whittall Street Clinic, University Hospitals Birmingham NHS Foundation Trust, Birmingham B4 6DH, UK; emma.hathorn{at}

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The updated UK national guideline for the management of Chlamydia trachomatis (CT) is due to be published, and will for the first time include specific recommendations for the treatment of rectal infection. Azithromycin and doxycycline were thought to be equally efficacious for the treatment of genital CT, but a recent meta-analysis found a benefit of up to 7% in favour of doxycycline.1 We previously published the findings of a prospective observational study that found a higher treatment failure rate with azithromycin compared with doxycycline therapy for rectal CT infection (26.2% vs 0%, p=0.0025).2

We retrospectively reviewed our data on all patients attending a large, inner city sexual health clinic who were diagnosed with rectal CT from 1 October 2010 to 1 June 2014 following the change in local first-line treatment from azithromycin 1 g stat to doxycycline 100 mg twice daily for 7 days. One thousand one hundred and sixty-four rectal CT infections were identified; of which, 739 (63.5%) were treated with doxycycline. Test of cure (TOC) was performed in 532 (72%) cases, and 26 (4.9%) were positive. Five patients with positive TOC were classified as treatment failures after risk of reinfection and non-compliance with treatment were excluded. The treatment failure rate of doxycycline for rectal CT in those who returned for a TOC was 0.9% (5/532) compared with 0% that we previously reported.2

Our data continue to support the recommendation of preferential use of doxycycline over azithromycin for the treatment of rectal CT. Furthermore, these findings suggest that TOC does not need to be performed in patients treated for rectal CT with doxycycline therapy if risk of reinfection and non-compliance with treatment have been excluded.



  • Contributors All authors contributed to the acquisition, analysis and interpretation of data, and writing and approval of the final letter.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.