Introduction BASHH guidelines advise either azithromycin 1g stat or doxycycline 100mg bd 7 days as first line treatment for uncomplicated Chlamydia infection. In practice, azithromycin 1g is favoured in many clinics due to perceptions of better adherence, tolerability and efficacy. Evidence has mounted of suboptimal efficacy of azithromycin, yet guidelines and practice remain unchanged. We routinely use doxycycline as first line treatment for Chlamydia infection. We sought to audit this practice, investigate rates of intolerance and adherence and explore treatment failure in those who had follow-up testing.

Methods For all patients treated for Chlamydia during Jan–Mar 2016 we extracted clinical and treatment information from notes and follow-up phone calls. We collated results of patients who had a repeat Chlamydia test performed within 6 months after treatment.

Results Data were available for 215 Chlamydia-positive patients: 82 heterosexual men, 66 MSM and 67 women; 96 were treated as symptomatic patients or Chlamydia contacts and 116 were recalled for treatment. Overall 92% were treated with doxycycline. From follow-up data only 3.0% reported failing to complete treatment, citing vomiting and forgetting to take tablets as reasons. 40% of patients had a repeat Chlamydia test within 6 months, with a 14% positivity rate. All such patients had either on-going sexual risk or evidence of failed PN.

Discussion Discontinuation rates and evidence of persistent infection are low with routine use of doxycycline for Chlamydia. Clinics reluctant to make a switch to first-line doxycycline for Chlamydia and NGU might find these data useful.