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Geisler WM, Hocking JS, Darville T, Batteiger BE, Brunham RC. Diagnosis and Management of Uncomplicated Chlamydia trachomatis Infections in Adolescents and Adults: Summary of Evidence Reviewed for the 2021 Centers for Disease Control and Prevention Sexually Transmitted Infections Treatment Guidelines. Clin Infect Dis 2022; 74:S112-S126. [PMID: 35416965 PMCID: PMC9006972 DOI: 10.1093/cid/ciac126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To prepare for the development of the 2021 Centers for Disease Control and Prevention (CDC) sexually transmitted infections treatment guidelines, the CDC convened a committee of expert consultants in June 2019 to discuss recent abstracts and published literature on the epidemiology, diagnosis, and management of sexually transmitted infections.This paper summarizes the key questions, evidence, and recommendations for the diagnosis and management of uncomplicated Chlamydia trachomatis (CT) infections in adolescents and adults that were reviewed and discussed for consideration in developing the guidelines. The evidence reviewed mostly focused on efficacy of doxycycline and azithromycin for urogenital, rectal, and oropharyngeal CT infection, CT risk factors in women, performance of CT nucleic acid amplification tests on self-collected meatal specimens in men, and performance of newer CT point-of-care tests.
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Affiliation(s)
- William M Geisler
- Division of Infectious Diseases, Department of Medicine and Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jane S Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Toni Darville
- Department of Pediatrics and Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Byron E Batteiger
- Department of Medicine and Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Robert C Brunham
- Vaccine Research Laboratory, University of British Columbia Centre for Disease Control, Vancouver, Canada
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2
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Lourtet-Hascoet J, Mine L, Spindler L, Pilmis B, Aubert M, El Mituialy A, Vieillefond V, de Parades V, Le Monnier A. Epidemiology of symptomatic infective anoproctitis in a population of men having sex with men (MSM). Infection 2022; 50:933-940. [PMID: 35212944 DOI: 10.1007/s15010-022-01766-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/28/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Anoproctitis due to Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are Sexual Transmitted Infections (STIs) reported in MSM population. This study describes clinical and microbiological epidemiology of infective anoproctitis in MSM population. METHODS All patients with symptomatic anoproctitis consulting at the proctology Institute of Saint-Joseph's Hospital, Paris, were included. Detection of CT/NG was performed by PCR GeneXpertR and other STIs pathogens Mycoplasma sp., HSV, CMV and T. pallidum were detected by multiplex PCR Allplex (mPCR). RESULTS Symptoms most frequently reported were pain, rectal bleeding and purulent flow in 66%, 52% and 49% of cases, respectively. On the 311 rectal samples collected, 171 (55.2%) were positive to CT/NG. Among the 194 used for mPCR, 148 were positive to STIs pathogens (76.2%) including 106 samples (71.6%) positive in coinfections. Among NG infections, 22.6% of the strains were resistant to azithromycin and 26.8% to tetracyclines. CONCLUSIONS Anorectal infections in this MSM population showed a high prevalence of not only CT/NG but also other pathogens involved in STIs. The high level of coinfections confirms the requirement of accurate PCR tests to improve diagnosis. This study describing increasing antibiotic resistances for NG strains confirms the updating of international guidelines on antibiotic treatments recommendations.
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Affiliation(s)
- J Lourtet-Hascoet
- Clinical Microbiology Department, GH Paris Saint-Joseph, 185, rue R. Losserand, 75014, Paris, France.
| | - L Mine
- Clinical Microbiology Department, GH Paris Saint-Joseph, 185, rue R. Losserand, 75014, Paris, France
| | - L Spindler
- Department of Medical-Surgical Proctology, Léopold Bellan Institute, GH Paris Saint-Joseph, Paris, France
| | - B Pilmis
- Clinical Microbiology Department, GH Paris Saint-Joseph, 185, rue R. Losserand, 75014, Paris, France
| | - M Aubert
- Department of Medical-Surgical Proctology, Léopold Bellan Institute, GH Paris Saint-Joseph, Paris, France
| | - A El Mituialy
- Department of Medical-Surgical Proctology, Léopold Bellan Institute, GH Paris Saint-Joseph, Paris, France
| | | | - V de Parades
- Department of Medical-Surgical Proctology, Léopold Bellan Institute, GH Paris Saint-Joseph, Paris, France
| | - A Le Monnier
- Clinical Microbiology Department, GH Paris Saint-Joseph, 185, rue R. Losserand, 75014, Paris, France
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Chen LF, Wang TC, Chen FL, Hsu SC, Hsu CW, Bai CH, Hsu YP. Efficacy of doxycycline versus azithromycin for the treatment of rectal chlamydia: a systematic review and meta-analysis. J Antimicrob Chemother 2021; 76:3103-3110. [PMID: 34529798 DOI: 10.1093/jac/dkab335] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/12/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Chlamydia trachomatis infection is the most common sexually transmitted infectious disease and carries a risk of complications. However, the optimal treatment for rectal chlamydial infection remains unclear. OBJECTIVES To compare the efficacy of doxycycline and azithromycin for the treatment of rectal chlamydia by undertaking a systematic review and meta-analysis of published data. METHODS We searched PubMed, EMBASE, Cochrane Library, Web of Science and clinicaltrials.gov databases from inception to 7 July 2021 for randomized controlled trials (RCTs) and observational studies that compared the efficacy of doxycycline and single-dose azithromycin on rectal chlamydia cure rates. Data were synthesized using a random-effects model, and subgroup analysis was conducted. RESULTS All included studies were conducted in developed countries. Two RCTs and nine observational studies, with a total of 2457 patients, were analysed. Doxycycline had a higher microbiological cure rate than azithromycin (risk ratio = 1.21; 95% CI = 1.15-1.28; P < 0.05). Pooled results from two RCTs also revealed a higher microbiological cure rate for doxycycline than azithromycin (risk ratio = 1.27; 95% CI = 1.20-1.35; P < 0.05). The results remained consistent in subgroups of different study designs, countries and sexes. CONCLUSIONS On the basis of our findings, we recommend doxycycline rather than azithromycin as a first-line treatment for rectal chlamydia in developed countries. More RCTs from developing countries are warranted.
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Affiliation(s)
- Liang-Fu Chen
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ting-Cheng Wang
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Fu-Lun Chen
- Department of Internal Medicine, Division of Infectious Diseases, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Shih-Chang Hsu
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chin-Wang Hsu
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chyi-Huey Bai
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yuan-Pin Hsu
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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4
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Kang-Birken SL. Challenges in Treating Chlamydia trachomatis, Including Rectal Infections: Is It Time to Go Back to Doxycycline? Ann Pharmacother 2021; 56:330-338. [PMID: 34218681 DOI: 10.1177/10600280211029945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate recent publications on efficacy of single-dose azithromycin and 7-day doxycycline when treating Chlamydia trachomatis. DATA SOURCES A literature search of MEDLINE, EMBASE, PubMed, and Cochrane library was conducted (1990 to June 13, 2021) using the terms: Chlamydia trachomatis, genital chlamydia, rectal chlamydia, extragenital chlamydia, azithromycin, doxycycline, and treatment guidelines. ClinicalTrials.gov was searched to identify ongoing trials. STUDY SELECTION AND DATA EXTRACTION English language studies, including controlled studies, retrospective analyses, systematic reviews, meta-analyses, and case reports, reporting microbiological or clinical outcomes in adolescents and adults were considered. DATA SYNTHESIS Systemic reviews and meta-analyses of randomized trials reported azithromycin efficacy of 96% to 97% in genital chlamydia. However, reports of treatment failure have emerged, especially among symptomatic males, with an increased risk of microbiological failure after azithromycin than doxycycline (relative risk = 2.45; 95% CI = 1.36-4.41). Retrospective analyses and prospective observational cohort studies reported lower efficacy range following azithromycin than doxycycline (74%-87% vs 92%-100%, respectively) in rectal chlamydia. First randomized controlled trial comparing azithromycin and doxycycline reported significantly higher microbiological cure following doxycycline, with absolute difference of 26% (95% CI = 16%-36%; P < 0.001). The proposed 2021 Centers for Disease Control and Prevention treatment guidelines designate doxycycline as the preferred agent for treatment at any site. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE A growing body of evidence for treatment failure following azithromycin, especially in rectal chlamydia supports updating current practice. CONCLUSIONS Doxycycline continues to achieve high efficacy in genital and rectal chlamydia. Clinicians should consider efficacy with convenience of dosing regimen, medication compliance, and sexual behavior risks when treating chlamydia infections.
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Affiliation(s)
- S Lena Kang-Birken
- University of the Pacific, Thomas J. Long School of Pharmacy, Stockton, CA, USA.,Cottage Health System, Santa Barbara, CA, USA
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5
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Blanco JL, Fuertes I, Bosch J, De Lazzari E, Gonzalez-Cordón A, Vergara A, Blanco-Arevalo A, Mayans J, Inciarte A, Estrach T, Martinez E, Cranston RD, Gatell JM, Alsina-Gibert M. Effective treatment of Lymphogranuloma venereum proctitis with Azithromycin. Clin Infect Dis 2021; 73:614-620. [PMID: 33462582 DOI: 10.1093/cid/ciab044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Lymphogranuloma venereum (LGV) is a sexually transmitted infection caused by Chlamydia trachomatis (CT) serovars L1, L2, and L3 and is endemic among men who have sex with men (MSM) in Europe. We evaluated weekly oral Azithromycin 1 g for 3 weeks as a treatment for LGV proctitis. METHODS This is an open clinical trial with convenience allocation according to treating physician preferences. Adults with clinical proctitis received a single dose of 1 g of intramuscular ceftriaxone and were subsequently allocated to receive (i) Doxycycline 100 mg twice daily for 21 days (Doxycycline-group) or, (ii) Azithromycin 1 g orally once weekly for 3 weeks (Azithromycin-group). LGV-cure, (primary endpoint) was defined as resolution of symptoms at week 6 (clinical cure, LGV-CC), with an additional supporting negative rectal PCR at week 4 (microbiological cure; LGV-MC), if available. FINDINGS One hundred and twenty-five individuals with LGV clinical proctitis were included. All were MSM and 96% were HIV-positive. Eighty-two were in the Azithromycin-group and 43 in the Doxycycline-group. LGV-cure on a modified intention-to-treat analysis (primary endpoint), occurred in 80 of 82 (98%) in the Azithromycin-group versus 41 of 43 (95%) in Doxycycline-group [treatment difference (95% CI) 2.2% (-3.2; 13.2)]. LGV-MC occurred in 70 of 72 (97%) vs 15 of 15 (100%) in Azithromycin-group and Doxycycline-group, respectively [treatment difference (95% CI) -2.8% (-9.6; 17.7)]. Adverse events were similar in both treatment groups. INTERPRETATION Our findings support extended azithromycin dosing as an alternative treatment option for symptomatic LGV proctitis and provides the rationale for future randomized trials.
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Affiliation(s)
- José L Blanco
- Infectious Diseases Department - ISGlobal. Hospital Clinic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Irene Fuertes
- Dermatology Department - ISGlobal. Hospital Clinic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Jordi Bosch
- Microbiology Department - ISGlobal. Hospital Clinic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Elisa De Lazzari
- Infectious Diseases Department - ISGlobal. Hospital Clinic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Ana Gonzalez-Cordón
- Infectious Diseases Department - ISGlobal. Hospital Clinic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Andrea Vergara
- Microbiology Department - ISGlobal. Hospital Clinic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Alejandro Blanco-Arevalo
- Infectious Diseases Department - ISGlobal. Hospital Clinic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Josep Mayans
- Infectious Diseases Department - ISGlobal. Hospital Clinic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Alexy Inciarte
- Infectious Diseases Department - ISGlobal. Hospital Clinic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Teresa Estrach
- Microbiology Department - ISGlobal. Hospital Clinic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Esteban Martinez
- Infectious Diseases Department - ISGlobal. Hospital Clinic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Ross D Cranston
- Infectious Diseases Department - ISGlobal. Hospital Clinic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Josep M Gatell
- Honorary Professor of Medicine. University of Barcelona. Senior Global Medical Director. ViiV Healthcare Barcelona. Spain
| | - Merce Alsina-Gibert
- Dermatology Department - ISGlobal. Hospital Clinic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
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6
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Hammerschlag MR, Sharma R. Azithromycin in the treatment of rectogenital Chlamydia trachomatis infections: end of an era? Expert Rev Anti Infect Ther 2020; 19:487-493. [PMID: 33034227 DOI: 10.1080/14787210.2021.1834850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Azithromycin was recommended as the first-line therapeutic regimen for treatment of genital infections in men and women by the Centers for Disease Control in 1998. A series of studies of azithromycin for treatment of rectal chlamydial infection in men who have sex with men (MSM) found that azithromycin was significantly less effective than doxycycline. AREAS COVERED Literature on treatment of rectal C. trachomatis from 2000 through May 2020 was searched using PubMed. Retrospective and observational studies were identified documenting the frequency and treatment of rectal chlamydial infection in MSM, heterosexual men and women that reported lower efficacy of single-dose azithromycin compared to doxycycline. Literature on possible reasons for the lower efficacy were also reviewed including studies of antibiotic resistance, impact of organism load, and persistent infection in rectal specimens and pharmacokinetics and pharmacodynamics of azithromycin in rectal tissue. EXPERT OPINION The available data suggests that single-dose azithromycin is not as effective as azithromycin for the treatment of rectal infection in MSM and women. Most of these data have been retrospective or from observational studies. Final recommendations will depend on the outcome of prospective, randomized, treatment studies. We may also need to examine other dosage regimens for azithromycin.
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Affiliation(s)
- Margaret R Hammerschlag
- Division of Pediatric Infectious Diseases, Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Roopali Sharma
- Department of Pharmacy Practice, Touro College of Pharmacy, New York, NY, USA.,Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
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7
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Dukers-Muijrers NHTM, Wolffs PFG, De Vries H, Götz HM, Heijman T, Bruisten S, Eppings L, Hogewoning A, Steenbakkers M, Lucchesi M, Schim van der Loeff MF, Hoebe CJPA. Treatment Effectiveness of Azithromycin and Doxycycline in Uncomplicated Rectal and Vaginal Chlamydia trachomatis Infections in Women: A Multicenter Observational Study (FemCure). Clin Infect Dis 2020; 69:1946-1954. [PMID: 30689759 PMCID: PMC6853690 DOI: 10.1093/cid/ciz050] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/17/2019] [Indexed: 12/19/2022] Open
Abstract
Background Rectal infections with Chlamydia trachomatis (CT) are prevalent in women visiting a sexually transmitted infection outpatient clinic, but it remains unclear what the most effective treatment is. We assessed the effectiveness of doxycycline and azithromycin for the treatment of rectal and vaginal chlamydia in women. Methods This study is part of a prospective multicenter cohort study (FemCure). Treatment consisted of doxycycline (100 mg twice daily for 7 days) in rectal CT–positive women, and of azithromycin (1 g single dose) in vaginally positive women who were rectally untested or rectally negative. Participants self-collected rectal and vaginal samples at enrollment (treatment time-point) and during 4 weeks of follow-up. The endpoint was microbiological cure by a negative nucleic acid amplification test at 4 weeks. Differences between cure proportions and 95% confidence intervals (CIs) were calculated. Results We analyzed 416 patients, of whom 319 had both rectal and vaginal chlamydia at enrollment, 22 had rectal chlamydia only, and 75 had vaginal chlamydia only. In 341 rectal infections, microbiological cure in azithromycin-treated women was 78.5% (95% CI, 72.6%–83.7%; n = 164/209) and 95.5% (95% CI, 91.0%–98.2%; n = 126/132) in doxycycline-treated women (difference, 17.0% [95% CI, 9.6%–24.7%]; P < .001). In 394 vaginal infections, cure was 93.5% (95% CI, 90.1%–96.1%; n = 246/263) in azithromycin-treated women and 95.4% (95% CI, 90.9%–98.2%; n = 125/131) in doxycycline-treated women (difference, 1.9% [95% CI, –3.6% to 6.7%]; P = .504). Conclusions The effectiveness of doxycycline is high and exceeds that of azithromycin for the treatment of rectal CT infections in women. Clinical Trials Registration NCT02694497.
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Affiliation(s)
- Nicole H T M Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases, and Environmental Health, Heerlen, South Limburg Public Health Service, The Netherlands.,Department of Medical Microbiology, Care and Public Health Research Institute, Maastricht University Medical Center, The Netherlands
| | - Petra F G Wolffs
- Department of Medical Microbiology, Care and Public Health Research Institute, Maastricht University Medical Center, The Netherlands
| | - Henry De Vries
- Department of Infectious Diseases, Public Health Service of Amsterdam, The Netherlands.,Amsterdam Infection and Immunity Institute, Amsterdam University Medical Center, The Netherlands.,National Institute of Public Health and the Environment, Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - Hannelore M Götz
- National Institute of Public Health and the Environment, Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, Bilthoven, The Netherlands.,Department Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, The Netherlands.,Department of Public Health, Erasmus Medical Center-University Medical Center Rotterdam, The Netherlands
| | - Titia Heijman
- Department of Infectious Diseases, Public Health Service of Amsterdam, The Netherlands
| | - Sylvia Bruisten
- Department of Infectious Diseases, Public Health Service of Amsterdam, The Netherlands.,Amsterdam Infection and Immunity Institute, Amsterdam University Medical Center, The Netherlands
| | - Lisanne Eppings
- Department of Sexual Health, Infectious Diseases, and Environmental Health, Heerlen, South Limburg Public Health Service, The Netherlands
| | - Arjan Hogewoning
- Department of Infectious Diseases, Public Health Service of Amsterdam, The Netherlands.,Amsterdam Infection and Immunity Institute, Amsterdam University Medical Center, The Netherlands
| | - Mieke Steenbakkers
- Department of Sexual Health, Infectious Diseases, and Environmental Health, Heerlen, South Limburg Public Health Service, The Netherlands
| | - Mayk Lucchesi
- Department of Medical Microbiology, Care and Public Health Research Institute, Maastricht University Medical Center, The Netherlands
| | - Maarten F Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam, The Netherlands.,Amsterdam Infection and Immunity Institute, Amsterdam University Medical Center, The Netherlands
| | - Christian J P A Hoebe
- Department of Sexual Health, Infectious Diseases, and Environmental Health, Heerlen, South Limburg Public Health Service, The Netherlands.,Department of Medical Microbiology, Care and Public Health Research Institute, Maastricht University Medical Center, The Netherlands
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Lu Z, Hou M, Li D, Cheng J, Deng H, Yan J. Azithromycin combined with doxycycline in non-gonococcal urethritis. Exp Ther Med 2020; 20:3887-3894. [PMID: 32905367 DOI: 10.3892/etm.2020.9125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 05/13/2020] [Indexed: 11/12/2022] Open
Abstract
Non-gonococcal urethritis (NGU) is one of the most common sexually transmitted diseases caused by chlamydia or mycoplasma. The present study aimed to explore the clinical efficacy of azithromycin combined with doxycycline in patients with NGU and its effect on serum levels of inflammatory cytokine interleukin-6 (IL-6). A total of 98 patients with non-gonococcal urethritis were prospectively selected, of which 46 patients were assigned to an azithromycin group (treated with azithromycin alone), while the rest were assigned to a combination group (treated with azithromycin and doxycycline). The conditions of the patients were evaluated and compared between the two groups. The treatment efficacy in patients in the combination group was significantly better than that in the azithromycin group, and the time to symptom relief, period of medication, recurrence rate within 1 year of withdrawal and level of serum IL-6 in the combination group were significantly lower than those in the azithromycin group. The quality of life of patients in the combination group was significantly improved compared to those in the azithromycin group. However, there was no significant difference in the incidence of adverse reactions between the two groups. Azithromycin combined with doxycycline was revealed to be more effective than azithromycin monotherapy for NGU.
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Affiliation(s)
- Zhongming Lu
- Department of Dermatology, Shengzhou People's Hospital, Shengzhou Branch Hospital of The First Affiliated Hospital of Zhejiang University, Shaoxing, Zhejiang 312400, P.R. China
| | - Manli Hou
- Department of Dermatology, Zaozhuang Hospital, Zaozhuang Mining Group, Zaozhuang, Shandong 277100, P.R. China
| | - Dandan Li
- Department of Gynecology, Shengzhou People's Hospital, Shengzhou Branch Hospital of The First Affiliated Hospital of Zhejiang University, Shaoxing, Zhejiang 312400, P.R. China
| | - Jing Cheng
- Department of Dermatology, Shaoxing Shangyu People's Hospital, Shaoxing, Zhejiang 312300, P.R. China
| | - Huazhou Deng
- Department of Doctor-Patient Office, Shengzhou People's Hospital, Shengzhou Branch Hospital of The First Affiliated Hospital of Zhejiang University, Shaoxing, Zhejiang 312400, P.R. China
| | - Jianping Yan
- Department of Dermatology, Xinchang People's Hospital, Shaoxing, Zhejiang 312500, P.R. China
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9
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Marangoni A, Zalambani C, Marziali G, Salvo M, Fato R, Foschi C, Re MC. Low-dose doxycycline induces Chlamydia trachomatis persistence in HeLa cells. Microb Pathog 2020; 147:104347. [PMID: 32561420 DOI: 10.1016/j.micpath.2020.104347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/04/2020] [Accepted: 06/11/2020] [Indexed: 02/03/2023]
Abstract
Chlamydia persistence is a viable but non-replicative stage, induced by several sub-lethal stressor agents, including beta-lactam antibiotics. So far, no data about the connection between doxycycline and chlamydial persistence has been described in literature. We investigated the ability of doxycycline to induce C. trachomatis (CT) persistence in an in vitro model of epithelial cell infection (HeLa cells), comparing the results with the well-established model of penicillin-induced persistence. The effect of doxycycline was explored on 10 different CT strains by analysing (i) the presence of aberrant inclusions, (ii) chlamydial recovery, (iii) the expression of different chlamydial genes (omcB, euo, Ct110, Ct604, Ct755, HtrA) and (iv) the effects on epithelial cell viability. For each strain, the presence of foreign genomic islands responsible of tetracycline resistance was excluded. We found that low doses of doxycycline can induce a condition of CT persistence. For concentrations of doxycycline equal to 0.03-0.015 mg/L, CT inclusions are smaller and aberrant and CT cycle is characterized by the presence of viable but non-dividing RBs with the complete abolishment of chlamydial cytotoxic effect. Infectious EBs can be recovered after removal of the drug. During doxycycline-induced persistence, the expression of the late gene omcB is decreased, indicating the blocking of RB-to-EB conversion. Conversely, as for penicillin G, a significant up-regulation of the stress response HtrA gene is found in doxycycline-treated cells. This study provides a novel in vitro cell model to examine the characteristics of doxycycline-induced persistent CT infection.
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Affiliation(s)
- Antonella Marangoni
- University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Microbiology Unit, Via Massarenti 9, Bologna, Italy
| | - Chiara Zalambani
- University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Microbiology Unit, Via Massarenti 9, Bologna, Italy
| | - Giacomo Marziali
- University of Bologna, FaBiT Department, Via Irnerio 48, Bologna, Italy
| | - Melissa Salvo
- University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Microbiology Unit, Via Massarenti 9, Bologna, Italy
| | - Romana Fato
- University of Bologna, FaBiT Department, Via Irnerio 48, Bologna, Italy
| | - Claudio Foschi
- University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Microbiology Unit, Via Massarenti 9, Bologna, Italy.
| | - Maria Carla Re
- University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Microbiology Unit, Via Massarenti 9, Bologna, Italy
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10
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Gannon-Loew KE, Holland-Hall C. A review of current guidelines and research on the management of sexually transmitted infections in adolescents and young adults. Ther Adv Infect Dis 2020; 7:2049936120960664. [PMID: 33598210 PMCID: PMC7863142 DOI: 10.1177/2049936120960664] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 08/28/2020] [Indexed: 11/19/2022] Open
Abstract
Adolescents and young adults are at high risk for sexually transmitted infections (STIs). Providers have the responsibility to accurately manage these infections to prevent medical complications and the spread of STIs. This article will review the epidemiology, screening recommendations, diagnostic tests, and treatment guidelines for STIs most commonly encountered in this population: Chlamydia trachomatis, Neisseria gonorrhoeae, Herpes simplex virus, and Trichomonas vaginalis, as well as the sexually associated infection bacterial vaginosis. This review will discuss ongoing research that explores ways to improve the management of STIs in adolescents and young adults.
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Affiliation(s)
| | - Cynthia Holland-Hall
- Nationwide Children’s Hospital, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
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Cornelisse VJ, Wright EJ, Fairley CK, McGuinness SL. Sexual safety and HIV prevention in travel medicine: Practical considerations and new approaches. Travel Med Infect Dis 2018; 28:68-73. [PMID: 30562582 DOI: 10.1016/j.tmaid.2018.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 12/12/2018] [Accepted: 12/14/2018] [Indexed: 11/25/2022]
Abstract
Travellers who engage in sexual contact with a new sexual partner abroad may be at high risk of HIV and other sexually transmitted infections (STIs), but these risks can be reduced through appropriate planning during the pre-travel clinic visit. Here we discuss strategies available to the clinician to maximise travellers' sexual safety during travel. Strategies may include immunizations, condoms, HIV pre-exposure prophylaxis (PrEP), HIV post-exposure prophylaxis (PEP), self-initiated treatment of symptomatic bacterial STIs, post-exposure prophylaxis for bacterial STIs and hormonal contraception. We discuss the role of these different strategies for travellers, and provide resources to assist clinicians in making clinical decisions and in educating travellers about sexual safety.
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Affiliation(s)
- Vincent J Cornelisse
- Central Clinical School, Monash University, Melbourne, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia; Department of Infectious Diseases, The Alfred Hospital, Alfred Health, Melbourne, Australia.
| | - Edwina J Wright
- Central Clinical School, Monash University, Melbourne, Australia; Department of Infectious Diseases, The Alfred Hospital, Alfred Health, Melbourne, Australia
| | - Christopher K Fairley
- Central Clinical School, Monash University, Melbourne, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Sarah L McGuinness
- Department of Infectious Diseases, The Alfred Hospital, Alfred Health, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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