期刊
SEXUALLY TRANSMITTED INFECTIONS
卷 90, 期 1, 页码 3-7出版社
BMJ PUBLISHING GROUP
DOI: 10.1136/sextrans-2013-051174
关键词
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资金
- University of Washington (UW) Sexually Transmitted Infections and Topical Microbicides Cooperative Research Center [NIH/NIAID U19 AI31448]
- Center for AIDS Research [P30 AI027757]
- National Institutes of Health [NIH/NIAID R01 AI072728]
- UW STD/AIDS Research Training Fellowship program [NIH/NIAID T32 AI07140]
- [K24 MH093243]
Objective Doxycycline, one of two recommended therapies for non-gonococcal urethritis (NGU), consists of a 7-day course of therapy (100 mg BID). Since suboptimal adherence may contribute to poor treatment outcomes, we examined the association between self-reported imperfect adherence to doxycycline and clinical and microbiologic failure among men with NGU. Methods Men aged >= 16 years with NGU attending a Seattle, WA, sexually transmitted diseases clinic were enrolled in a double-blind, parallel-group superiority trial from January 2007 to July 2011. Men were randomised to active doxycycline/placebo azithromycin or placebo doxycycline/active azithromycin. Imperfect adherence was defined as missing >= 1 dose in 7 days. Urine was tested for Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), and Ureaplasma urealyticum-biovar 2 (UU-2) using nucleic acid amplification tests. Clinical failure (symptoms and >= 5 PMNs/HPF or discharge) and microbiologic failure (positive tests for CT, MG, and/or UU-2) were determined after 3 weeks. Results 184 men with NGU were randomised to active doxycycline and provided data on adherence. Baseline prevalence of CT, MG and UU-2 was 26%, 13% and 27%, respectively. 28% of men reported imperfect adherence, and this was associated with microbiologic failure among men with CT (aRR=9.33; 95% Cl 1.00 to 89.2) and UU-2 (aRR=3.08; 95% Cl 1.31 to 7.26) but not MG. Imperfect adherence was not significantly associated with clinical failure overall or for any specific pathogens, but it was more common among imperfectly adherent men with CT (aRR=2.63; 0.93-7.41, p=0.07). Conclusions Adherence may be important for microbiologic cure of select pathogens. Factors other than adherence should be considered for CT-negative men with persistent NGU.
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