2019 Ryan White HIV/AIDS Program CLINICAL CONFERENCE
Chlamydia Treatment
• Azithromycin vs Doxycycline • RCT data -CT urethritis treatment with azithro has a cure rate of <95%
120%
96%
95%
95%
90%
100%
( Schwebke, Manhart, Kissinger, Geisler) • Meta-analysis (Kong 2014) • Doxy > Azi 3% (urogenital) • Doxy > Azi 7% (sx urethral)
86%
77%
80%
Doxycycline
Azithromycin
60%
• Rectal Infection
40%
• Several retrospective studies (doxy>azi) • Retest in 3mo (reinfection)
20%
0%
Hillis1998 Schwebke, 2011
Manhart, 2013
Slide31of47FromKAWorkowski,MDatNewOrleans, LA,December4-7,2019,RyanWhiteHIV/AIDSProgramCLINICALCONFERENCE, IAS USA.
Chlamydia Treatment
• Doxy is highly efficacious - all sites in men and women • Azithromycin • efficacious in women and asymptomaticmen • lower efficacy in urethritis, poor efficacy in rectum, ?pharynx
• RCT (asymptomatic) -US, UK, Australia • CDC Guidelines Draft recommendations • Doxycycline 100 mg bid • Azithromycin 1 gram alternative regimen
Slide32of47FromKAWorkowski,MDatNewOrleans, LA,December4-7,2019,RyanWhiteHIV/AIDSProgramCLINICALCONFERENCE, IAS USA.
LGV inguinal syndrome
C .trachomatis L1, L2, L3 Herpetiform genital ulcers and/or papules Tender, fluctuant, inguinal lymphadenopathy (buboes)
Slide33of47FromKAWorkowski,MDatNewOrleans, LA,December4-7,2019,RyanWhiteHIV/AIDSProgramCLINICALCONFERENCE, IAS USA.
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