Effects of azithromycin and doxycycline on the vaginal microbiota of women with urogenital Chlamydia trachomatis infection: a substudy of the Chlazidoxy randomized controlled trial

Dysbiotic bacterial communities within the vagina are associated with Chlamydia trachomatis infection. We compared the effect of treatment with azithromycin and doxycycline on the vaginal microbiota in a cohort of women with a urogenital C. trachomatis infection randomly assigned to one of these tre...

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Bibliographic Details
Published in:	Clinical microbiology and infection Vol. 29; no. 8; p. 1056
Main Authors:	Tamarelle, Jeanne, Penaud, Benjamin, Tyssandier, Benjamin, Guichoux, Erwan, de Barbeyrac, Bertille, Peuchant, Olivia
Format:	Journal Article
Language:	English
Published:	England 01-08-2023
Subjects:	Anti-Bacterial Agents - pharmacology Anti-Bacterial Agents - therapeutic use Azithromycin - pharmacology Azithromycin - therapeutic use Chlamydia Infections - drug therapy Chlamydia Infections - microbiology Chlamydia trachomatis - genetics Cross-Sectional Studies Doxycycline - pharmacology Doxycycline - therapeutic use Female Humans Microbiota RNA, Ribosomal, 16S - genetics Urinary Tract Infections - drug therapy Vagina - microbiology Community state types Vaginal microbiome 16S rRNA gene sequencing Chlamydia trachomatis treatment Antibiotics
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Summary:	Dysbiotic bacterial communities within the vagina are associated with Chlamydia trachomatis infection. We compared the effect of treatment with azithromycin and doxycycline on the vaginal microbiota in a cohort of women with a urogenital C. trachomatis infection randomly assigned to one of these treatments (Chlazidoxy trial). We analysed vaginal samples from 284 women (135 in the azithromycin group and 149 in the doxycycline group) collected at baseline and 6 weeks after treatment initiation. The vaginal microbiota was characterized using 16S rRNA gene sequencing and classified into community state types (CSTs). At baseline, 75% (212/284) of the women had a high-risk microbiota (CST-III or CST-IV). A cross-sectional comparison 6 weeks after treatment showed that 15 phylotypes were differentially abundant, but this difference was not reflected at the CST (p 0.772) or diversity level (p 0.339). Between baseline and the 6-week visit, α-diversity (p 0.140) and transition probabilities between CSTs were not significantly different between the groups, and no phylotype was differentially abundant. In women with urogenital C. trachomatis infection, the vaginal microbiota does not seem to be affected by azithromycin or doxycycline 6 weeks after treatment. Because the vaginal microbiota remains susceptible to C. trachomatis infection (with CST-III or CST-IV) after antibiotic treatment, women remain at risk of reinfection, which could originate from unprotected sexual intercourse or untreated anorectal C. trachomatis infection. This last consideration advocates for the use of doxycycline instead of azithromycin because of its higher anorectal microbiological cure rate.
ISSN:	1469-0691
DOI:	10.1016/j.cmi.2023.04.020