Journal article

Is it time to switch to doxycycline from azithromycin for treating genital chlamydial infections in women? Modelling the impact of autoinoculation from the gastrointestinal tract to the genital tract

Andrew P Craig, Fabian YS Kong, Laxmi Yeruva, Jane S Hocking, Roger G Rank, David P Wilson, Basil Donovan



BACKGROUND: Single-dose azithromycin is recommended over multi-dose doxycycline as treatment for chlamydial infection. However, even with imperfect adherence, doxycycline is more effective in treating genital and rectal infection. Recently, it has been suggested that autoinoculation from the rectum to the genitals may be a source of persistent chlamydial infection in women. We estimated the impact autoinoculation may have on azithromycin and doxycycline effectiveness. METHODS: We estimate treatment effectiveness using a simple mathematical model, incorporating data on azithromycin and doxycycline efficacy from recent meta-analyses, and data on prevalence of rectal infection in women with gen..

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Awarded by NHMRC

Funding Acknowledgements

JSH is supported by an NHMRC Senior Research Fellowship (APP1042907). The Kirby Institute is funded by the Australian Government, Department of Health. The views expressed in this publication do not necessarily represent the position of the Australian Government. The Kirby Institute is affiliated with UNSW Australia. The authors would like to thank Richard Gray, Quang Pham and Andrew Shattock for useful discussions. This manuscript was much improved thanks to comments from reviewers Henry de Vries and Matthew Beymer.