Managing Rectal Chlamydia Trachomatis in Men and Women
Managing Rectal Chlamydia Trachomatis in Men and Women
Rectal chlamydia testing using the geneprobe Aptima Combo nucleic acid amplification test is routinely offered at Whittall Street Clinic (University Hospitals Birmingham NHS Foundation Trust) to all men and women who report receptive anal intercourse. Patients with positive tests are recalled for treatment and contact tracing. Positive rectal nucleic acid amplification test samples from MSM are sent to Colindale for the exclusion of Lymphogranuloma venereum in line with current British Association of Sexual Health and HIV guidance.
A test of cure (TOC) at 6 weeks after the start of therapy was introduced after reports of azithromycin failure. A prospective observational study was performed for 6 months between 1 January 2010 and 30 June 2010, of all patients diagnosed with rectal C trachomatis who received azithromycin 1 g stat as first-line treatment (phase 1). The study was repeated between 1 October 2010 and 31 March 2011 when first-line treatment was switched to 7 days of doxycycline 100 mg twice a day (phase 2). Antibiotic therapy was the only change made to clinic protocol during the study periods. Both treatment regimens are first-line recommendations in the British Association of Sexual Health and HIV uncomplicated C trachomatis infection guidelines.
Data were gathered on gender, concurrent sexually transmitted infections, treatment received, TOC result, risk of re-infection, re-treatment and result of repeat TOC.
Treatment failure was defined as positive TOC with a risk of re-infection and non-compliance with treatment was excluded. This was assessed by the completion of a telephone questionnaire at 2 weeks post-treatment and a repeat full sexual history at attendance for TOC. Risk of re-infection was defined as any sexual contact (even with a condom) with a new partner or before their regular partner received epidemiological treatment or a negative test result.
Patients who did not receive antibiotics as per treatment protocol were excluded from the final analysis. This included patients diagnosed with L venereum. Statistical analysis was performed using the Fisher's exact test (two-tailed).
Methods
Rectal chlamydia testing using the geneprobe Aptima Combo nucleic acid amplification test is routinely offered at Whittall Street Clinic (University Hospitals Birmingham NHS Foundation Trust) to all men and women who report receptive anal intercourse. Patients with positive tests are recalled for treatment and contact tracing. Positive rectal nucleic acid amplification test samples from MSM are sent to Colindale for the exclusion of Lymphogranuloma venereum in line with current British Association of Sexual Health and HIV guidance.
A test of cure (TOC) at 6 weeks after the start of therapy was introduced after reports of azithromycin failure. A prospective observational study was performed for 6 months between 1 January 2010 and 30 June 2010, of all patients diagnosed with rectal C trachomatis who received azithromycin 1 g stat as first-line treatment (phase 1). The study was repeated between 1 October 2010 and 31 March 2011 when first-line treatment was switched to 7 days of doxycycline 100 mg twice a day (phase 2). Antibiotic therapy was the only change made to clinic protocol during the study periods. Both treatment regimens are first-line recommendations in the British Association of Sexual Health and HIV uncomplicated C trachomatis infection guidelines.
Data were gathered on gender, concurrent sexually transmitted infections, treatment received, TOC result, risk of re-infection, re-treatment and result of repeat TOC.
Treatment failure was defined as positive TOC with a risk of re-infection and non-compliance with treatment was excluded. This was assessed by the completion of a telephone questionnaire at 2 weeks post-treatment and a repeat full sexual history at attendance for TOC. Risk of re-infection was defined as any sexual contact (even with a condom) with a new partner or before their regular partner received epidemiological treatment or a negative test result.
Patients who did not receive antibiotics as per treatment protocol were excluded from the final analysis. This included patients diagnosed with L venereum. Statistical analysis was performed using the Fisher's exact test (two-tailed).