BIOSKETCH AND RESEARCH INTERESTSWilliam M. Geisler, MD, MPH, is Professor of Medicine in the Division of Infectious Diseases at UAB. He completed his medical school training at the University of Tennessee followed by an internal medicine residency at the University of Michigan. He then completed an infectious diseases fellowship at the University of Washington at which time he also obtained an MPH in Epidemiology.
Dr. Geisler has an established chlamydia research program at UAB funded by federal and non-federal sources that studies the epidemiology, clinical manifestations, diagnosis, treatment, natural history, immunology, and genetics of genital Chlamydia trachomatis infection and its outcomes. A major goal of his research has been to contribute to the development of a chlamydia vaccine. He has over 17 years of clinical experience in the evaluation and management of sexually transmitted infections (STIs) and provides STI education and training through the Alabama-North Carolina STD/HIV Prevention Training Center. He is also on the editorial board of Sexually Transmitted Diseases and has served as an expert consultant for the CDC and WHO. In addition, he is the Clinical Associate Director of the UAB Medical Scientist Training Program.
Dr. Geisler recently published the results of a randomized controlled trail comparing oral azithromycin (1 g in one dose orally) to doxycycline (100 mg oral dose twice daily for 7 days) for the treatment of urogenital chlamydia infection among adolescents in youth correctional facilities (which minimized the possibility of chlamydia re-exposure from untreated partners, limited exposure from new partners, and enhanced treatment adherence). Treatment in both arms was directly observed. The efficacy of azithromycin was found to be 97% while the efficacy of doxycycline was 100%. The authors concluded that the non-inferiority of azithromycin to doxycycline was not established in this setting.
ABSTRACT
Background: Urogenital Chlamydia trachomatis infection remains prevalent and causes substantial reproductive morbidity. Recent studies have raised concern about the efficacy of azithromycin for the treatment of chlamydia infection.
Methods: We conducted a randomized trial comparing oral azithromycin with doxycycline for the treatment of urogenital chlamydia infection among adolescents in youth correctional facilities, to evaluate the noninferiority of azithromycin (1 g in one dose) to doxycycline (100 mg twice daily for 7 days). The treatment was directly observed. The primary end point was treatment failure at 28 days after treatment initiation, with treatment failure determined on the basis of nucleic acid amplification testing, sexual history, and outer membrane protein A (OmpA) genotyping of C. trachomatis strains.
Results: Among the 567 participants enrolled, 284 were randomly assigned to receive azithromycin, and 283 were randomly assigned to receive doxycycline. A total of 155 participants in each treatment group (65% male) made up the per-protocol population. There were no treatment failures in the doxycycline group. In the azithromycin group, treatment failure occurred in 5 participants (3.2%; 95% confidence interval, 0.4 to 7.4%). The observed difference in failure rates between the treatment groups was 3.2 percentage points, with an upper boundary of the 90% confidence interval of 5.9 percentage points, which exceeded the prespecified absolute 5-percentage-point cutoff for establishing the noninferiority of azithromycin.
Conclusions: In the context of a closed population receiving directly observed treatment for urogenital chlamydia infection, the efficacy of azithromycin was 97%, and the efficacy of doxycycline was 100%. The noninferiority of azithromycin was not established in this setting. (Funded by the National Institute of Allergy and Infectious Diseases; ClinicalTrials.gov number, NCT00980148.).
PMID: 26699167
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