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Poster Presentations
PS02 – POSTER VIEWING SESSION – TUESDAY
Tuesday, July 16, 2019 5:45 PM – 7:00 PM
P464 Treatment failure in rectal Chlamydia trachomatis azithromycin treated women driven by high viable bacterial load (FemCure)
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  1. Nicole Dukers-Muijrers1,
  2. Petra Wolffs2,
  3. Henry De Vries3,
  4. Hannelore Götz4,
  5. Titia Heijman5,
  6. Kevin Janssen6,
  7. Sylvia Bruisten7,
  8. Arjan Hogewoning7,
  9. Mieke Steenbakkers8,
  10. Mayk Lucchesi2,
  11. Maarten Schim Van Der Loeff7,
  12. Christian Hoebe1
  1. 1Public Health Service South Limburg, Maastricht University Medical Center (MUMC), Sexual Health, Infectious Diseases and Environmental Health, Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Heerlen, Netherlands
  2. 2Maastricht University Medical Center (MUMC), Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht, Netherlands
  3. 3Public Health Service Amsterdam, Amsterdam University Medical Center (UMC), National Institute of Public Health and the Environment (RIVM), Infectious Diseases, Infection and Immunity Institute (AI and II), Epidemiology and Surveillance Unit, Amsterdam, Netherlands
  4. 4Municipal Public Health Service Rotterdam Rijnmond, Public Health/Sexual Health, Rotterdam, Netherlands
  5. 5Public Health Service Amsterdam, Sexual Health, Amsterdam, Netherlands
  6. 6Maastricht University Medical Centre (MUMC), Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastrcicht, Netherlands
  7. 7Public Health Service Amsterdam, Amsterdam University Medical Center (UMC), Infectious Diseases, Infection and Immunity (AI and II), Amsterdam, Netherlands
  8. 8Public Health Service South Limburg, Sexual Health, Infectious Diseases and Environmental Health, Heerlen, Netherlands

Abstract

Background Rectal infections with Chlamydia trachomatis (CT) are prevalent in women visiting a STI outpatient clinic. While azithromycin is the most used treatment, microbiological treatment failure in rectal CT is common and its drivers remain unclear.

Methods This study is part of a prospective multicentre cohort study (FemCure). Current analyses included 112 women clinically-diagnosed (by nucleic acid amplification test [NAAT]) with rectal and vaginal CT, who not vomited and denied rectal and vaginal unprotected sex. Four weeks after azithromycin treatment (1g single dose) participants self-collected vaginal and rectal samples. Samples were tested for CT-DNA (NAAT) and viable CT-load (viability polymerase chain reaction [V-PCR]). We evaluated two endpoints: (1) failure by NAAT-positivity and (2) failure by V-PCR-positivity. Enrolment-risk-factors associated with failure were assessed using multivariable logistic regression; i.e., age, education, migratory-background, previous CT, NAAT Cq-value [marker CT-DNA load], culture, viable CT [V-PCR positive], viable load [log10 copies/ml], vaginal CT.

Results (1) Failure by NAAT (21.4%; 24/112) was independently associated with both rectal and vaginal NAAT Cq-values; both aOR: 0.8 per unit decrease in the NAAT Cq-value (95%CI:0.7–0.9, p<0.01). Of the 49 women with a rectal or vaginal Cq-value ≥36 at clinic-diagnosis (43.8% of patients), 8.1% had rectal failure, compared to 31.7% when having Cq values <=36 (p<0.01). (2) Failure by V-PCR (16.1%;18/112) was independently associated with the rectal viable load; aOR: 1.7 per log10 copies/ml increase (95%CI:1.3–2.3). Of the 47 (42.0%) women without a viable rectal CT at diagnosis, 4.3% had failure, compared to 24.6% when having viable rectal CT at diagnosis (p<0.01). Vaginal failure by NAAT was 7.1% (8/112); failure by V-PCR was 2.7% (3/112).

Conclusion In an outpatient clinical setting, azithromycin rectal CT microbiological treatment failure was common and associated with higher pre-treatment (viable) loads. The lower azithromycin treatment failure in patients with NAAT Cq-values≥36 or non-viable rectal CT might result in different treatment choices.

Disclosure No significant relationships.

  • chlamydia

https://doi.org/10.1136/sextrans-2019-sti.546

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