基于人群的研究比较了 1992 年至 2015 年华盛顿州女性泌尿生殖道沙眼衣原体感染的治疗结局。

A Population-Based Study to Compare Treatment Outcomes Among Women With Urogenital Chlamydial Infection in Washington State, 1992 to 2015.

出版信息

Sex Transm Dis. 2018 May;45(5):319-324. doi: 10.1097/OLQ.0000000000000764.

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5895502/

Abstract

BACKGROUND

United States guidelines recommend azithromycin or doxycycline for chlamydia (Chlamydia trachomatis [CT]) treatment. These therapies are similarly efficacious for urogenital infections when outcomes are measured 7 to 42 days after treatment, although doxycycline may be superior for rectal infections. Some investigators have suggested that persistent rectal infections may lead to autoinfection of the urogenital tract, potentially resulting in higher rates of recurrent infection in azithromycin-treated women.

METHODS

We used Washington State surveillance data to identify women 14 years or older with urogenital CT (1992-2015) treated with azithromycin or doxycycline. We defined persistent/recurrent CT as a repeat positive CT test result 14 to 180 days after treatment of the initial infection. We used log binomial regression to estimate the adjusted relative risk (aRR) of persistent/recurrent infection associated with treatment with azithromycin versus doxycycline.

RESULTS

From 1992 to 2015, there were 268,596 reported cases of urogenital CT, including 168,301 (63%) who received azithromycin and 66,432 (25%) who received doxycycline. The risk of persistent/recurrent urogenital CT was 6.7% and 4.7% in azithromycin- and doxycycline-treated cases, respectively (P < 0.001). Adjusting for age, race/ethnicity, year, pregnancy status, jurisdiction reporting, reason for examination, and gonorrhea coinfection, azithromycin-treated women were significantly more likely to have persistent/recurrent urogenital CT than doxycycline-treated women (aRR, 1.24; 95% confidence interval [CI], 1.19-1.30). Adjusting the retesting window to 21 to 180 days (aRR, 1.24; 95% CI, 1.19-1.30) and 28 to 180 days (aRR, 1.25; 95% CI, 1.19-1.30) did not alter our primary findings.

CONCLUSIONS

Persistent/recurrent urogenital CT may be more common among women treated with azithromycin than with doxycycline. The reason for this difference is uncertain and is an important area of future investigation.

摘要

背景

美国指南建议使用阿奇霉素或强力霉素治疗衣原体（沙眼衣原体 [CT]）感染。当治疗后 7 至 42 天评估结局时，这两种疗法对于泌尿生殖道感染的疗效相似，尽管强力霉素可能对直肠感染更有效。一些研究者认为，持续的直肠感染可能导致泌尿生殖道的自体感染，从而导致阿奇霉素治疗的女性中复发性感染的发生率更高。

方法

我们使用华盛顿州的监测数据来识别 14 岁及以上的泌尿生殖道 CT（1992-2015 年）患者，这些患者接受了阿奇霉素或强力霉素治疗。我们将持续/复发性 CT 定义为初始感染治疗后 14 至 180 天重复 CT 检测阳性的结果。我们使用对数二项式回归来估计与阿奇霉素治疗相比，强力霉素治疗相关的持续/复发性感染的调整后相对风险（aRR）。

结果

1992 年至 2015 年，共报告了 268596 例泌尿生殖道 CT，其中 168301 例（63%）接受了阿奇霉素治疗，66432 例（25%）接受了强力霉素治疗。阿奇霉素治疗和强力霉素治疗的病例中持续/复发性泌尿生殖道 CT 的风险分别为 6.7%和 4.7%（P<0.001）。调整年龄、种族/民族、年份、妊娠状态、管辖权报告、检查原因和淋病合并感染后，与强力霉素治疗的女性相比，阿奇霉素治疗的女性发生持续/复发性泌尿生殖道 CT 的可能性显著更高（aRR，1.24；95%置信区间 [CI]，1.19-1.30）。将重新检测的窗口期调整为 21 至 180 天（aRR，1.24；95%CI，1.19-1.30）和 28 至 180 天（aRR，1.25；95%CI，1.19-1.30）并未改变我们的主要发现。