Lau Andrew, Hocking Jane S, Kong Fabian Y S
Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia.
Curr Opin Infect Dis. 2022 Feb 1;35(1):42-48. doi: 10.1097/QCO.0000000000000804.
Rectal chlamydia is a prevalent sexually transmissible infection in both men who have sex with men (MSM) and in women. Screening is recommended for MSM but remains controversial for women. The optimal treatment for rectal chlamydia is now conclusive but interpreting and managing positive results remains challenging. Infections among MSM are increasing and strategies are needed to reduce incident infections. This review summarizes recent developments for the screening and management of rectal chlamydia and its implications on reinfection.
Reinfections in MSM may be occurring due to resumption of sex soon after treatment whereas repeat infections in women may occur due to autoinoculation in the absence of sex. Doxycycline is now first-line treatment but its role in chemoprophylaxis remains unclear. False positive results remain an issue, but the development of viability assays may prove useful in future to determine true infections.
Doxycycline is the first-line treatment for rectal chlamydia and in women may prevent infections at the urogenital site. Viability assays can help to reduce antibiotic use once developed. The role of routine screening of rectal chlamydia in women remains unclear and this debate may soon include asymptomatic infections in MSM.
直肠衣原体感染在男男性行为者（MSM）和女性中都是一种常见的性传播感染。推荐对男男性行为者进行筛查，但对女性筛查仍存在争议。目前，直肠衣原体感染的最佳治疗方法已确定，但对阳性结果的解读和处理仍具有挑战性。男男性行为者中的感染正在增加，需要采取策略减少新发感染。本综述总结了直肠衣原体筛查和管理的最新进展及其对再感染的影响。
男男性行为者治疗后很快恢复性行为可能导致再感染，而女性在无性行为时可能因自体接种而发生重复感染。多西环素现在是一线治疗药物，但其在化学预防中的作用仍不明确。假阳性结果仍然是一个问题，但活力检测方法的开发可能在未来有助于确定真正的感染。
多西环素是直肠衣原体感染的一线治疗药物，对女性而言可能预防泌尿生殖部位感染。活力检测方法一旦开发出来，有助于减少抗生素的使用。对女性进行直肠衣原体常规筛查的作用仍不明确，这场争论可能很快会涉及男男性行为者中的无症状感染。
