Current principles of antibiotic therapy in the management of patients with chlamydial infection
- Authors: Kruglova L.S.1,2, Rubtsova L.A.1,3, Kruglova M.S.4
-
Affiliations:
- Central State Medical Academy of the Administrative Directorate of the President of the Russian Federation
- Institute of Plastic Surgery and Cosmetology
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
- Issue: Vol 32, No 10 (2025)
- Pages: 39-44
- Section: Clinical experience
- URL: https://journals.rcsi.science/2073-4034/article/view/380896
- DOI: https://doi.org/10.18565/pharmateca.2025.10.39-44
- ID: 380896
Cite item
Abstract
Given the increasing global incidence of urogenital chlamydial infection caused by Chlamydia trachomatis and the challenges of its diagnosis, choosing an effective therapy is particularly important. Currently, doxycycline is the first-line drug, supported by its pharmacokinetic advantages: its ability to create and maintain long-term concentrations in the tissues of the urogenital tract and rectum necessary for successful eradication of the pathogen. High efficacy, favorable tolerability profile, and ability to treat extragenital foci of infection make Doxycycline EXPRESS the drug of choice for the treatment and post-exposure prophylaxis of chlamydial infection.
About the authors
Larisa S. Kruglova
Central State Medical Academy of the Administrative Directorate of the President of the Russian Federation;
Email: kruglovals@mail.ru
ORCID iD: 0000-0002-5044-5265
Dr. Sci. (Med.), Professor, Head of the Department of Dermatovenereology and Cosmetology, Rector
Russian Federation, МоскваLyubov A. Rubtsova
Central State Medical Academy of the Administrative Directorate of the President of the Russian Federation; Institute of Plastic Surgery and Cosmetology
Author for correspondence.
Email: lubovrubtz@gmail.com
ORCID iD: 0000-0001-5245-0394
Russian Federation, Moscow; Moscow
Maria S. Kruglova
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Email: kruglovamashulka@gmail.com
ORCID iD: 0000-0002-3190-7460
Russian Federation, Moscow
References
- World Health Organization. Sexually transmitted infections (STIs): fact sheet. 2023. URL: https://www.who.int/news-room/fact-sheets/detail/sexually-transmitted-infections-(stis) (accessed: 15.10.2024).
- О состоянии санитарно-эпидемиологического благополучия населения в Российской Федерации в 2023 году: Государственный доклад. Федеральная служба по надзору в сфере защиты прав потребителей и благополучия человека (Роспотребнадзор). М., 2024. 300 с. [On the state of sanitary and epidemiological well-being of the population in the Russian Federation in 2023: State report. Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor). Moscow, 2024. 300 p. (In Russ.)].
- Unemo M., Bradshaw C.S., Hocking J.S. Sexually transmitted infections: challenges ahead. Lancet Infect Dis. 2017;17(8):e235-e279. https://dx.doi.org/10.1016/S1473-3099(17)30310-9
- Workowski K.A., Bachmann L.H., Chan P.A. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1-187. https://dx.doi.org/10.15585/mmwr.rr7004a1
- Cunningham K.A., Beagley K.W. Male genital tract chlamydial infection: implications for pathology and infertility. Biol Reprod. 2008;79(2):180-189. https://dx.doi.org/10.1095/biolreprod.108.067835
- Хламидийная инфекция. Клинические рекомендации Минздрава РФ. 2024. 42 с. [Chlamydial infection. Clinical guidelines of the Ministry of Health of the Russian Federation. 2024. 42 p. (In Russ.)].
- Воспалительные болезни женских тазовых органов. Клинические рекомендации Миндзрава РФ. 2024. 49 с. [Inflammatory diseases of the female pelvic organs. Clinical guidelines of the Ministry of Health of the Russian Federation. 2024. 49 p. (In Russ.)].
- Chlamydia control in Europe: evidence-based guidance for public health authorities. European Centre for Disease Prevention and Control (ECDC). – Stockholm: ECDC, 2022. URL: https://www.ecdc.europa.eu/en/publications-data/chlamydia-control-europe-evidence-based-guidance-public-health-authorities (accessed: 15.10.2024).
- Agwuh K.N., MacGowan A. Pharmacokinetics and pharmacodynamics of the tetracyclines including glycylcyclines. J Antimicrob Chemother. 2006;58(2):256-265. https://dx.doi.org/10.1093/jac/dkl224
- Спичак И.В., Нефедова А.В. Современные аспекты фармакотерапии урогенитального хламидиоза: фокус на комплаенс. Антибиотики и химиотерапия. 2022;67(1-2):45-52. [Spichak I.V., Nefedova A.V. Modern aspects of pharmacotherapy of urogenital chlamydia: focus on compliance. Antibiotics and chemotherapy. 2022;67(1-2):45-52. (In Russ.)].
- Rowley J., Hoorn S.V., Korenromp E. Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016. Bull World Health Organ. 2019;97(8):548-562. https://dx.doi.org/10.2471/BLT.18.228486
- Haaland R.E., Bader A.M., Domogala D. Pharmacokinetics of single dose doxycycline in the rectum, vagina, and urethra: implications for prevention of bacterial sexually transmitted infections. EBioMedicine. 2024;101:104990. https://dx.doi.org/10.1016/j.ebiom.2024.104990.https://doi.org/10.1016/j.ebiom.2024.105037
- Workowski K.A., Bachmann L.H. Centers for Disease Control and Prevention’s sexually transmitted diseases infection guidelines. Clin Infect Dis. 2022;74(Suppl. 2):S89-S94. https://dx.doi.org/10.1093/cid/ciac043.https://doi.org/10.1093/cid/ciab1055
- Sokoll P.R., Vanhove A., Wesson P. Efficacy of postexposure prophylaxis with doxycycline (Doxy-PEP) in reducing sexually transmitted infections: a systematic review and meta-analysis. Sex Transm Infect. 2025;101(1):59-67. https://doi.org/10.1136/sextrans-2024-056208
- Dukers-Muijrers N.H.T.M., Schachter J., Wolffs P.F.G. Controversies and evidence on Chlamydia testing and treatment in asymptomatic women and men who have sex with men: a narrative review. BMC Infect Dis. 2022;22(1):255. https://dx.doi.org/10.1186/s12879-022-07173-0
- Mohammadzadeh F., Dolatian M., Jorjani M. Urogenital Chlamydia trachomatis treatment failure with azithromycin: A meta-analysis. Int J Reprod Biomed. 2019;17(9):603-620. https://dx.doi.org/10.18502/ijrm.v17i9.5093
- Dombrowski J.C., Wierzbicki M.R., Newman L.M. Doxycycline Versus Azithromycin for the Treatment of Rectal Chlamydia in Men Who Have Sex With Men: A Randomized Controlled Trial. Clin Infect Dis. 2021;73(5):824-831. https://dx.doi.org/10.1093/cid/ciab153
- Lau A., Kong F.Y.S., Fairley C.K. Azithromycin or Doxycycline for Asymptomatic Rectal Chlamydia trachomatis. N Engl J Med. 2021;384(25):2418-2427. https://dx.doi.org/10.1056/NEJMoa2031631
- Peuchant O., Lhomme E., Krêt M. Randomized, open-label, multicenter study of azithromycin compared with doxycycline for treating anorectal Chlamydia trachomatis infection concomitant to a vaginal infection (CHLAZIDOXY study). Medicine (Baltimore). 2019;98(7):e14572. https://dx.doi.org/10.1097/MD.0000000000014572
- Dukers-Muijrers N., Wolfs P.F.G., De Vries H. Treatment effectiveness of azithromycin and doxycycline in uncomplicated rectal and vaginal Chlamydia trachomatis infections in women: a multicenter observational study (FemCure). Clin Infect Dis. 2019;69(11):1946–1954. https://dx.doi.org/10.1093/cid/ciz050
- Peuchant O., Lhomme E., Martinet P. Doxycycline versus azithromycin for the treatment of anorectal Chlamydia trachomatis infection in women concurrent with vaginal infection (CHLAZIDOXY study): a multicentre, open-label, randomised, controlled, superiority trial. Lancet Infect Dis. 2022;22(8):1221-1230. https://dx.doi.org/10.1016/S1473-3099(22)00148-7
- Páez-Canro C., Alzate J.P., González L.M. Antibiotics for treating urogenital Chlamydia trachomatis infection in men and non-pregnant women. Cochrane Database System Rev. 2019;1:CD010871. https://dx.doi.org/10.1002/14651858.CD010871.pub2
- Dukers-Muijrers N.H.T.M., Wolfs P.F.G., de Vries H.J.C. Viable bacterial load is key to azithromycin treatment failure in rectally Chlamydia trachomatis infected women (FemCure). J Infect Dis. 2019;220(8):1389–1390. https://dx.doi.org/10.1093/infdis/jiz321
- Dukers-Muijrers N., Janssen K.J.H., Hoebe C. Spontaneous clearance of Chlamydia trachomatis accounting for bacterial viability in vaginally or rectally infected women (FemCure). Sex Transm Infect. 2020;96(7):541–548. https://dx.doi.org/10.1136/sextrans-2019-054310
- Janssen K.J.H., Wolfs P.F.G., Hoebe C. Determinants associated with viable genital or rectal Chlamydia trachomatis bacterial load (FemCure). Sex Transm Infect. 2021;98(1):17–22. https://dx.doi.org/10.1136/sextrans-2020-054819
- Dukers-Muijrers N., Schim van der Loeff M., Wolfs P. Incident urogenital and anorectal Chlamydia trachomatis in women: the role of sexual exposure and autoinoculation: a multicentre observational study (FemCure). Sex Transm Infect. 2022;98(6):391-396. https://dx.doi.org/10.1136/sextrans-2021-055032
- Tamarelle J., Penaud B., Tyssandier B. Effects of azithromycin and doxycycline on the vaginal microbiota of women with urogenital Chlamydia trachomatis infection: a substudy of the Chlazidoxy randomized controlled trial. Clin Microbiol Infect. 2023;29(8):1056-1062. https://dx.doi.org/10.1016/j.cmi.2023.04.020
- Tamarelle J., Ma B., Gajer P. Nonoptimal vaginal microbiota after azithromycin treatment for Chlamydia trachomatis infection. J Infect Dis. 2020;221(4):627-635. https://dx.doi.org/10.1093/infdis/jiz499
- Käding N., Schmidt N., Scholz C. Impact of First-Line Antimicrobials on Chlamydia trachomatis-Induced Changes in Host Metabolism and Cytokine Production. Front Microbiol. 2021;12:676747. https://dx.doi.org/10.3389/fmicb.2021.676747
- Yetkin-Arik B., Vogels I.M.C., Nowak-Sliwinska P. The role of glycolysis and mitochondrial respiration in the formation and functioning of endothelial tip cells during angiogenesis. Sci Rep. 2019;9:12608. https://dx.doi.org/10.1038/s41598-019-48676-2
- Shima K., Kaufhold I., Eder T. Regulation of the mitochondrion-fatty acid axis for the metabolic reprogramming of Chlamydia trachomatis during treatment with β-lactam antimicrobials. mBio. 2021;12(2):e00023-21. https://dx.doi.org/10.1128/mBio.00023-21
- URL: https://www.vidal.ru/drugs/doxycycline-express?ysclid=mj7gag0bl5935524061
- Аль-Шукри А.С., Коломийцева М.Р., Петров С.Б. Доксициклин в лечении инфекций мочевыводящих путей. Consilium Medicum. 2024;26(7):471–477. [Al-Shukri A.S., Kolomiytseva M.R., Petrov S.B. Doxycycline in the treatment of urinary tract infections. Consilium Medicum. 2024;26(7):471–477. (In Russ.)].
Supplementary files
