International Journal of STD & AIDS > Volume 20, Number 1 > Pp. 16-18

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Original research articles

Treatment of asymptomatic rectal Chlamydia trachomatis: is single-dose azithromycin effective?

N M Steedman MA MRCP ^*  and A McMillan MD FRCP 

^* Department of Sexual Health, Countess of Chester NHS Foundation Trust, Liverpool Road, Chester CH2 1UL; Department of Genito-Urinary Medicine (retired), Lauriston Building, Lauriston Place, Edinburgh EH3 9HA, UK

Correspondence to: Dr N M Steedman Email: Nicola.Steedman{at}coch.nhs.uk

Rectal infection with Chlamydia trachomatis affects approximately 7% of men having sex with men (MSM), attending departments of Genito-Urinary (GU) Medicine [Manavi et al. Int J STD AIDS 2004;15:162–4], and the British Association for Sexual Health and HIV (BASHH) guidelines for the treatment of uncomplicated genital C. trachomatis infection include 1 g of single-dose oral azithromycin as a recommended regimen [BASHH 2006]. A retrospective analysis was performed on case-notes from all patients diagnosed with rectal C. trachomatis infection in the department of GU Medicine, Edinburgh for the one-year period from 1 June 2005. Of 101 new episodes of rectal chlamydial infection, only 9% were associated with anorectal symptoms. Excluding these, 85% of asymptomatic patients were treated with a single dose of azithromycin 1 g orally, with a calculated treatment failure rate of 13% (nine of 68). This suggests that single-dose azithromycin may be a less than effective treatment in asymptomatic rectal C. trachomatis infection. The potential treatment failure rate with this regimen emphasizes the need for a test of cure at the appropriate interval following treatment to ensure clearance of infection.

Key Words: Chlamydia trachomatis • rectal • azithromycin • treatment

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