Is azithromycin adequate treatment for asymptomatic rectal chlamydia?

Int J STD AIDS. 2011 Aug;22(8):478-80. doi: 10.1258/ijsa.2011.010490. Epub 2011 Jul 8.


Rectal chlamydia is a common sexually transmissible infection (STI) in men who have sex with men (MSM) that is predominantly asymptomatic. The recommended treatment of azithromycin 1 g as a single oral dose has not been subject to randomized trials and so its efficacy is unknown. We conducted a retrospective case-note review of all MSM diagnosed at the Sydney Sexual Health Centre with asymptomatic rectal chlamydia in 2009. We identified 116 MSM who received azithromycin; 85 (73%) attended for the recommended re-test at varying times (median 78 days, range 21-372 days). Of the men who returned, 11 (13%) had a persistently positive result; we reviewed behavioural data to classify these men as probable re-infections (6/11) or possible treatment failures (5/11), suggesting an efficacy of 94%. Until a randomized controlled trial (RCT) is conducted, patients with rectal chlamydia should be encouraged to attend for a re-test at 6-12 weeks.

MeSH terms

  • Adult
  • Anti-Bacterial Agents / therapeutic use*
  • Asymptomatic Infections / therapy*
  • Azithromycin / therapeutic use*
  • Chlamydia Infections / diagnosis
  • Chlamydia Infections / drug therapy*
  • Chlamydia trachomatis*
  • Homosexuality, Male
  • Humans
  • Male
  • Middle Aged
  • Rectal Diseases / diagnosis
  • Rectal Diseases / drug therapy*
  • Retrospective Studies
  • Treatment Outcome


  • Anti-Bacterial Agents
  • Azithromycin