Doxycycline and Azithromycin for Prevention of Chlamydial Persistence or Recurrence One Month After Treatment in Women: A Use-Effectiveness Study in Public Health Settings

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Background:To treat chlamydial infection, the Centers for Disease Control and Prevention recommends either a single dose of azithromycin or a 7-day course of doxycycline. Cost is a concern with the single-dose regimen; compliance is a concern with the multidose regimen.Goal:To compare the use-effectiveness of azithromycin and doxycycline for preventing persistence or recurrence ofChlamydia trachomatisinfection in women and to evaluate associated risk behaviors.Study Design:One hundred and ninety-six chlamydia-infected women and their sex partners were recruited into a randomized controlled trial of single-dose versus multidose regimens in seven public health clinics, with no incentives for enrollment, compliance, or follow-up. The outcome measure was a positive test forC. trachomatisby polymerase chain reaction testing at 1 month after treatment.Results:C. trachomatispositivity at 1 month was similar for women receiving single-dose (5.1%, 5/98) and multidose therapy (4.1%, 4/98). Reported compliance among 73 women taking multidose therapy was 94.5%. A twofold to threefold increased risk of chlamydial persistence or recurrence was observed among women who were ≤24 and white or who reported: a recent new partner, multiple partners, or a partner who may have had multiple partners at the time of enrollment or that not all partners were treated during the 1-month follow-up period after initiation of treatment.Conclusions:The use-effectiveness of single-dose and multidose therapy was comparably high. Observed rates of persistence or recurrence were consistent with reported rates of pharmacological treatment failure. However, all women withC. trachomatisdetected at 1 month had behavioral risk factors that may have contributed to reinfection.

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