DOXYCYCLINE AND AZITHROMYCIN FOR PREVENTION OF CHLAMYDIAL PERSISTENCEOR RECURRENCE ONE MONTH AFTER TREATMENT IN WOMEN - A USE-EFFECTIVENESS STUDY IN PUBLIC-HEALTH SETTINGS

Background: To treat chlamydial infection, the Centers for Disease Con trol 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 pre venting persistence or recurrence of Chlamydia trachomatis infection i n women and to evaluate associated risk behaviors. Study Design: One h undred and ninety-six chlamydia-infected women and their sex partners were recruited into a randomized controlled trial of single-dose versu s multidose regimens in seven public health clinics, with no incentive s for enrollment, compliance, or follow-up. The outcome measure was a positive test for C. trachomatis by polymerase chain reaction testing at 1 month after treatment. Results: C. trachomatis positivity at 1 mo nth was similar for women receiving single-dose (5.1%, 5/98) and multi dose therapy (4.1%, 4/98). Reported compliance among 73 women taking m ultidose therapy was 94.5%. A twofold to threefold increased risk of c hlamydial persistence or recurrence nias observed among women who were less than or equal to 24 and white or who reported: a recent new part ner, multiple partners, or a partner who may have had multiple partner s at the time of enrollment or that not all partners were treated duri ng the 1-month follow-up period after initiation of treatment. Conclus ions: The use-effectiveness of single-dose and multidose therapy was c omparably high. Observed rates of persistence or recurrence were consi stent with reported rates of pharmacological treatment failure. Howeve r, all women with C. trachomatis detected at 1 month had behavioral ri sk factors that may have contributed to reinfection.