There are no evidence-based guidelines for the specific management of rectal Chlamydia trachomatis (CT)
infection. All men who have sex with men (MSM) diagnosed with asymptomatic rectal CT by
nucleic acid amplification test (NAAT) at a large London genitourinary (GU) medicine clinic between September 2006 and September 2009 were offered oral
doxycycline 100 mg twice daily for seven days and invited for a test of cure (TOC) by CT NAAT four weeks
after treatment. A total of 487 asymptomatic rectal CT
infections were diagnosed and analysis was restricted to 165 TOCs from men whose only treatment had been
doxycycline for seven days. The median time post-treatment for TOC was 45 days (interquartile range [IQR], 34-88). Only two patients tested CT-positive at follow-up. One had taken
doxycycline only for three days; the other attended for TOC 240 days after the completion of
doxycycline treatment and at this time presented with new symptoms in the context of ongoing high sexual risk. Our findings show that
doxycycline 100 mg twice daily for seven days is highly effective treatment for asymptomatic rectal CT
infection, achieving clearance of CT in 98.8% (163/165; 95% CI 95.4-99.9%) of cases. We advocate
doxycycline for seven days as first-line
therapy for asymptomatic rectal CT.