Active substances: Doxycycline
Infections with these other serovars have generally been treated with 100 mg doxycycline twice daily for 7 days, which has been shown from meta-analysis 33 to have a pooled efficacy of 99.
The efficacy of azithromycin 1 g for rectal chlamydia infection has been questioned, and randomized trials comparing this with doxycycline for rectal chlamydia are needed.
Persistent rectal LGV infection despite 10 days of doxycycline treatment has also been reported 18.
These reports underscore the value of genotyping positive rectal chlamydia specimens from MSM because the identification of LGV-associated variants will indicate the need for a longer course of doxycycline to ensure cure.
Although our meta-analysis showed that most rectal LGV infections were cured with a 21-day course of doxycycline, clinical failures have been reported with this regimen. He subsequently achieved clinical resolution with moxifloxacin 18.
There have also been reports of LGV buboes in MSM that have not resolved clinically after treatment with doxycycline for 21 days.
In some cases, abscess formation and rupture with sinus formation have occurred despite this course of treatment 21. When abscesses are present, treatment failure might reflect poor penetration of antimicrobial drugs.
Several national guidelines recommend that LGV infections be clinically observed until completely resolved and that routine test of cure is not necessary if a 21-day course of doxycycline has been completed 5. Our study findings support these recommendations.
Further research is required to define the determinants of LGV invasiveness and pathogenesis 37. Several points should be considered when interpreting the results of our study.
We identified only 9 studies that specifically reported microbial cure rates for MSM with rectal LGV, 4 of which were conference abstracts rather than published papers.
The overall pooled efficacy of doxycycline was based on results for a total of 282 men.
Although this combined number of cases is limited, the pooling together of otherwise small, individual studies provides a more precise estimate of doxycycline efficacy with tighter CIs than was previously available for each of the separate component studies Table 1.
Only 4 studies were prospective, and several were retrospective studies. We did not identify any randomized controlled trials.