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Rectal Chlamydia — SCE Infectious Diseases MCQ

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EasySTIsRectal ChlamydiaSCE Infectious Diseases

A 28-year-old man presents to the sexual health clinic with perianal pruritus and mucoid discharge. He is MSM and HIV positive. Proctoscopy shows inflamed rectal mucosa with follicular changes. NAAT from a rectal swab is positive for Chlamydia trachomatis (non-LGV serovar D–K). What is the recommended treatment?

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Correct answer: D — Doxycycline 100 mg BD for 7 days

Rectal chlamydial infection with non-LGV serovars (D–K) is treated with Doxycycline 100 mg BD for 7 days. This differs from LGV proctitis (serovars L1–L3) which requires 21 days of Doxycycline. LGV typing should be requested on all rectal chlamydia-positive samples to guide treatment duration. Azithromycin 1 g single dose has inferior efficacy for rectal chlamydia compared to Doxycycline and is no longer recommended as first-line for rectal infection.

Reference: BASHH 2018 – Chlamydia guidelines; NICE CKS 2024 – Chlamydia