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P464 Treatment failure in rectal Chlamydia trachomatis azithromycin treated women driven by high viable bacterial load (FemCure)

Sexually transmitted infections, 2019-07, Vol.95 (Suppl 1), p.A216 [Peer Reviewed Journal]

Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ. ;2019 Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ. ;ISSN: 1368-4973 ;EISSN: 1472-3263 ;DOI: 10.1136/sextrans-2019-sti.546

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  • Title:
    P464 Treatment failure in rectal Chlamydia trachomatis azithromycin treated women driven by high viable bacterial load (FemCure)
  • Author: Dukers-Muijrers, Nicole ; Wolffs, Petra ; Vries, Henry De ; Götz, Hannelore ; Heijman, Titia ; Janssen, Kevin ; Bruisten, Sylvia ; Hogewoning, Arjan ; Steenbakkers, Mieke ; Lucchesi, Mayk ; Loeff, Maarten Schim Van Der ; Hoebe, Christian
  • Subjects: Chlamydia ; Health risk assessment
  • Is Part Of: Sexually transmitted infections, 2019-07, Vol.95 (Suppl 1), p.A216
  • Description: BackgroundRectal infections with Chlamydia trachomatis (CT) are prevalent in women visiting a STI outpatient clinic. While azithromycin is the most used treatment, microbiological treatment failure in rectal CT is common and its drivers remain unclear.MethodsThis study is part of a prospective multicentre cohort study (FemCure). Current analyses included 112 women clinically-diagnosed (by nucleic acid amplification test [NAAT]) with rectal and vaginal CT, who not vomited and denied rectal and vaginal unprotected sex. Four weeks after azithromycin treatment (1g single dose) participants self-collected vaginal and rectal samples. Samples were tested for CT-DNA (NAAT) and viable CT-load (viability polymerase chain reaction [V-PCR]). We evaluated two endpoints: (1) failure by NAAT-positivity and (2) failure by V-PCR-positivity. Enrolment-risk-factors associated with failure were assessed using multivariable logistic regression; i.e., age, education, migratory-background, previous CT, NAAT Cq-value [marker CT-DNA load], culture, viable CT [V-PCR positive], viable load [log10 copies/ml], vaginal CT.Results(1) Failure by NAAT (21.4%; 24/112) was independently associated with both rectal and vaginal NAAT Cq-values; both aOR: 0.8 per unit decrease in the NAAT Cq-value (95%CI:0.7–0.9, p<0.01). Of the 49 women with a rectal or vaginal Cq-value ≥36 at clinic-diagnosis (43.8% of patients), 8.1% had rectal failure, compared to 31.7% when having Cq values <=36 (p<0.01). (2) Failure by V-PCR (16.1%;18/112) was independently associated with the rectal viable load; aOR: 1.7 per log10 copies/ml increase (95%CI:1.3–2.3). Of the 47 (42.0%) women without a viable rectal CT at diagnosis, 4.3% had failure, compared to 24.6% when having viable rectal CT at diagnosis (p<0.01). Vaginal failure by NAAT was 7.1% (8/112); failure by V-PCR was 2.7% (3/112).ConclusionIn an outpatient clinical setting, azithromycin rectal CT microbiological treatment failure was common and associated with higher pre-treatment (viable) loads. The lower azithromycin treatment failure in patients with NAAT Cq-values≥36 or non-viable rectal CT might result in different treatment choices.DisclosureNo significant relationships.
  • Publisher: London: BMJ Publishing Group LTD
  • Language: English
  • Identifier: ISSN: 1368-4973
    EISSN: 1472-3263
    DOI: 10.1136/sextrans-2019-sti.546
  • Source: AUTh Library subscriptions: ProQuest Central
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