Doxycycline and azithromycin for prevention of chlamydial persistence or recurrence one month after treatment in women. A use-effectiveness study in public health settings

Sex Transm Dis. 1998 Jan;25(1):5-11. doi: 10.1097/00007435-199801000-00002.


Background: To treat chlamydial infection, the Centers for Disease Control and Prevention recommends either a single dose of azithromycin or a 7-day course of doxycycline. Cost is a concern with the single-dose regimen; compliance is a concern with the multidose regimen.

Goal: To compare the use-effectiveness of azithromycin and doxycycline for preventing persistence or recurrence of Chlamydia trachomatis infection in women and to evaluate associated risk behaviors.

Study design: One hundred and ninety-six chlamydia-infected women and their sex partners were recruited into a randomized controlled trial of single-dose versus multidose regimens in seven public health clinics, with no incentives for enrollment, compliance, or follow-up. The outcome, measure was a positive test for C. trachomatis by polymerase chain reaction testing at 1 month after treatment.

Results: C. trachomatis positivity at 1 month was similar for women receiving single-dose (5.1%, 5/98) and multidose therapy (4.1%, 4/98). Reported compliance among 73 women taking multidose therapy was 94.5%. A twofold to threefold increased risk of chlamydial persistence or recurrence was observed among women who were < or = 24 and white or who reported: a recent new partner, multiple partners, or a partner who may have had multiple partners at the time of enrollment or that not all partners were treated during the 1-month follow-up period after initiation of treatment.

Conclusions: The use-effectiveness of single-dose and multidose therapy was comparably high. Observed rates of persistence or recurrence were consistent with reported rates of pharmacological treatment failure. However, all women with C. trachomatis detected at 1 month had behavioral risk factors that may have contributed to reinfection.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Anti-Bacterial Agents / therapeutic use*
  • Azithromycin / therapeutic use*
  • Chlamydia Infections / prevention & control*
  • Chlamydia trachomatis*
  • Doxycycline / therapeutic use*
  • Female
  • Humans
  • Male
  • Public Health
  • Recurrence


  • Anti-Bacterial Agents
  • Azithromycin
  • Doxycycline