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Background Rectal chlamydia is a common bacterial sexually transmissible infection among men who have sex with men. Data from randomized, controlled trials are needed to guide treatment. M...

Background The resumption of sexual activity shortly after commencing treatment for sexually transmitted infections (STIs) is poorly described despite contributing to onward transmission. With azithromycin remaining an option for rectal Chlamydia trachomatis, resuming sex too early after treatment may contribute to antimicrobial resistance because of exposure of newly acquired STIs to subinhibitory concentrations. Methods Clinical and sexual behavioral data were collected from men participating in a trial assessing treatment efficacy for rectal chlamydia. Data were collected at recruitment and weekly for 3 weeks after commencing treatment. Outcome measures were resumption of any sexual activity or condomless receptive anal sex within 1, 2, or 3 weeks after commencing treatment. Generalized linear regression was used to calculate adjusted risk ratios (aRR) to identify associated factors. Results Almost 1 in 10 men (9.5%; 95% confidence interval [CI], 7.2-12.1) resumed condomless receptive anal sex within 1 week of commencing treatment. This was associated with current preexposure prophylaxis use (aRR, 3.4; 95% CI, 2.5-4.8]) and having 9 or more sexual partners in the last 3 months (aRR, 3.2; 95% CI, 1.6-5.0). Most men (75.0%; 95% CI, 71.3-78.5) resumed any sexual activity within 3 weeks; this was associated with a greater number of sexual partners (4-8 partners; aRR, 1.2; 95% CI, 1.1-1.5; ≥9 partners; aRR, 1.5; 95% CI, 1.3-1.7). Conclusions Resuming condomless receptive anal sex early after treatment may facilitate onward transmission and promote antimicrobial resistance for STIs. Although azithromycin remains a treatment option, this analysis highlights the need for new health promotion messages regarding early resumption of sex and continued surveillance for antimicrobial resistance.

Background Rectal chlamydia is the most commonly diagnosed bacterial sexually transmissible infection among men who have sex with men (MSM) and there is increasing concern about rectal chlamydia in women. The absence of randomised controlled trial (RCT) evidence means there is ongoing debate about the most efficacious treatment. Methods We conducted a double-blind double-dummy RCT to compare the efficacy of azithromycin 1g singledose with 7-days doxycycline 100mg twice daily for the treatment of asymptomatic rectal chlamydia. MSM diagnosed with asymptomatic rectal chlamydia infection at five sexual health clinics in Australia were randomly assigned to receive either doxycycline or azithromycin. Primary outcome was rectal chlamydia microbiological cure defined as a negative nucleic acid amplification test at four weeks. Logistic regression was used to calculate the difference in microbial cure within a modified intention to treat population that excluded L2 serovar diagnoses post-recruitment. Results We enrolled 625 men and randomly assigned 314 to doxycycline and 311 to azithromycin between August 2016 and August 2019. Primary outcome data were available for 290 (92%) assigned to doxycycline and 297 (96%) assigned to azithromycin. In the modified intention to treat population, the observed microbiological cure was 281/290 (96.9%; 95%CI: 94.9, 98.9) for doxycycline and 227/297 (76.4%; 95%CI: 73.8, 79.1) for azithromycin, with an adjusted risk difference of 19.9% (95% CI: 14.6, 25.3; p Conclusions The efficacy of doxycycline was found to be substantially superior to azithromycin in the treatment of asymptomatic rectal chlamydia infection among MSM. Doxycycline must replace azithromycin as firstline treatment for symptomatic rectal chlamydia.

Background Sri Lanka is a developing country with a high rate of cardiovascular mortality. It is still largely dependent on thrombolysis for primary management of acute myocardial infarction. The aim of this study was to present current data on the presentation, management, and outcomes of acute ST-segment-elevation myocardial infarction (STEMI) at a tertiary-care hospital in Sri Lanka. Methods Eighty-one patients with acute STEMI presenting to a teaching hospital in Peradeniya, Sri Lanka, were included in this observational study. Results Median interval between symptom onset and hospital presentation was 60 min (mean 212 min). Thrombolysis was performed in 73% of patients. The most common single reason for not performing thrombolysis was delayed presentation. Median door-to-needle time was 64 min (mean, 98 min). Only 16.9% of patients received thrombolysis within 30 min, and none underwent primary PCI. Over 98% of patients received aspirin, clopidogrel, and a statin on admission. Intravenous and oral beta blockers were rarely used. Follow-up data were available for 93.8% of patients at 1 year. One-year mortality rate was 12.3%. Coronary intervention was performed in only 7.3% of patients post infarction. Conclusion Late presentation to hospital remains a critical factor in thrombolysis of STEMI patients in Sri Lanka. Thrombolysis was not performed within 30 min of admission in the majority of patients. First-contact physicians should receive further training on effective thrombolysis, and there is an urgent need to explore the ways in which PCI and post-infarction interventions can be incorporated into treatment protocols.