2019 Ryan White HIV/AIDS Program CLINICAL CONFERENCE

Chlamydia Treatment

• Azithromycin vs Doxycycline • RCT data -CT urethritis treatment with azithro has a cure rate of <95%

120%

96%

95%

95%

90%

100%

( Schwebke, Manhart, Kissinger, Geisler) • Meta-analysis (Kong 2014) • Doxy > Azi 3% (urogenital) • Doxy > Azi 7% (sx urethral)

86%

77%

80%

Doxycycline

Azithromycin

60%

• Rectal Infection

40%

• Several retrospective studies (doxy>azi) • Retest in 3mo (reinfection)

20%

0%

Hillis1998 Schwebke, 2011

Manhart, 2013

Slide31of47FromKAWorkowski,MDatNewOrleans, LA,December4-7,2019,RyanWhiteHIV/AIDSProgramCLINICALCONFERENCE, IAS  USA.

Chlamydia Treatment

• Doxy is highly efficacious - all sites in men and women • Azithromycin • efficacious in women and asymptomaticmen • lower efficacy in urethritis, poor efficacy in rectum, ?pharynx

• RCT (asymptomatic) -US, UK, Australia • CDC Guidelines Draft recommendations • Doxycycline 100 mg bid • Azithromycin 1 gram alternative regimen

Slide32of47FromKAWorkowski,MDatNewOrleans, LA,December4-7,2019,RyanWhiteHIV/AIDSProgramCLINICALCONFERENCE, IAS  USA.

LGV inguinal syndrome

C .trachomatis L1, L2, L3 Herpetiform genital ulcers and/or papules Tender, fluctuant, inguinal lymphadenopathy (buboes)

Slide33of47FromKAWorkowski,MDatNewOrleans, LA,December4-7,2019,RyanWhiteHIV/AIDSProgramCLINICALCONFERENCE, IAS  USA.