Azithromycin Treatment Failure for Chlamydia trachomatis Among Heterosexual Men With Nongonococcal Urethritis. Issue 10 (October 2016)

• Record Type: Journal Article
• Authors: Kissinger, Patricia J.; White, Scott; Manhart, Lisa E.; Schwebke, Jane; Taylor, Stephanie N.; Mena, Leandro; Khosropour, Christine M.; Wilcox, Larissa; Schmidt, Norine; Martin, David H.
• Is Part Of: Sexually transmitted diseases. Volume 43:Issue 10(2016)
• Publication Date: 2016-10
• Subjects: Sexually transmitted diseases -- Periodicals; Sexual health -- Periodicals; 616.951005
• DOI: 10.1097/OLQ.0000000000000489
• Languages: English
• ISSNs: 0148-5717

Abstract

Abstract : Background: Three recent prospective studies have suggested that the 1-g dose of azithromycin for Chlamydia trachomatis (Ct) was less effective than expected, reporting a wide range of treatment failure rates (5.8%–22.6%). Reasons for the disparate results could be attributed to geographic or methodological differences. The purpose of this study was to reexamine the studies and attempt to harmonize methodologies to reduce misclassification as a result of false positives from early test-of-cure (TOC) or reinfection as a result of sexual exposure rather than treatment failure. Methods: Men who had sex with women, who received 1-g azithromycin under directly observed therapy for presumptive treatment of nongonococcal urethritis with confirmed Ct were included. Baseline screening was performed on urethral swabs or urine, and TOC screening was performed on urine using nucleic acid amplification tests. Posttreatment vaginal sexual exposure was elicited at TOC. Data from the 3 studies were obtained and reanalyzed. Rates of Ct retest positive were examined for all cases, and a sensitivity analysis was conducted to either reclassify potential false positives/reinfections as negative or remove them from the analysis. Results: The crude treatment failure rate was 12.8% (31/242). The rate when potential false positives/reinfections were reclassified as negative was 6.2% (15/242) or when these were excluded from analysis was 10.9% (15/138). Conclusions: In these samples of men who have sex with women with Ct-related nongonococcal urethritis, azithromycin treatment failure was between 6.2% and 12.8%. This range of failure is lower than previously published but higher than the desired World Health Organization's target chlamydia treatment failure rate of < 5%. Abstract : Methods for 3 studies reporting diverse treatment failure rates for Chlamydia trachomatis using 1-g azithromycin were harmonized and data were reanalyzed. Treatment failure was 6.2% to 12.8%, higher than acceptable standards.