Single dose (direct observed) azithromycin therapy for Neisseria gonorrhoeae and Chlamydia trachomatis in STD clinic attenders with genital dischargein Trinidad and Tobago

The purpose of this study was to determine the prevalence and to assess the efficacy of a single one gram oral dose of azithromycin under direct obser ved therapy of genital discharge due to Neisseria gonorrhoeae and Chlamydia trachomatis infections in STD clinic attenders in Trinidad and Tobago, All patients with genital discharge and their contacts were given one gram ora l dose of azithromycin under direct supervision after collection of urethra l and cervical swabs for N gonorrhoeae culture and smear and for C trachoma tis antigen detection by ELISA. Clinical and microbiological evaluation was done on those who returned after 7-10 days for follow-up. Of the 735 patie nts who were enrolled in the study, 319 (43.4%) had N gonorrhoeae and 100 ( 13.6%) had C trachomatis. Only 151 (36%) of the 419 patients with a pathoge nic isolate returned for clinical and microbiological assessment. The remai ning 268 (64%) of the 419 patients were lost to follow-up. One hundred and forty-three patients (94.7%) had total abatement of signs and symptoms afte r taking azithromycin. One patient (0.65%), who had both N gonorrhoeae and C trachomatis, improved clinically with the drug. Seven patients (six with N gonorrhoeae and one with C trachomatis)failed to respond clinically to az ithromycin. Microbiological eradication was achieved in 115 (100%) patients who had single infection with N gonorrhoeae and in 23 patients (96%) with C trachomatis infection. Of 12 patients with combined infections, N gonorrh oeae and C trachomatis were eradicated in 10 and 12 patients, respectively, after initial treatment. In two patients with combined infection, N gonorr hoeae continued to be isolated after treatment with azithromycin. A single one gram oral dose of azithromycin under direct supervison is useful in the treatment of uncomplicated genital infection with N gonorrhoeae and C trac homatis in STD clinic attenders in Trinidad.