Doxycycline provides higher odds of microbiological cure compared to azithromycin in cis-men with chlamydiaDoxycycline Shows Higher Cure Rates for Chlamydia in Men

International journal of STD & AIDS Published July 3, 2026 Study authors: Boujemaa Safa, Suri Gurparsad Singh, Kaur Gurleen PubMed ↗ DOI ↗ Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

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Key Takeaway

Consider doxycycline as a more effective option than azithromycin for microbiological cure in cis-men with chlamydia.

This systematic review and meta-analysis evaluated the efficacy of doxycycline versus azithromycin for treating chlamydial infections in cis-men. The analysis included a total sample size of 1172 patients to compare a 7-day doxycycline regimen against a single dose of azithromycin.

The primary finding was that doxycycline resulted in significantly higher odds of microbiological cure compared with azithromycin (OR = 2.525, 95% CI: 1.329-4.796, p = 0.005). Additionally, the authors synthesized evidence showing significant superiority of doxycycline for treating rectal infections and chlamydia-associated nongonococcal urethritis (p < 0.05). However, no significant difference was found between the two treatments regarding prostate infection cure (p = 0.745).

The authors noted moderate heterogeneity across the included studies. Furthermore, evidence for specific sites such as rectal and prostate infections is limited by small data sets. Safety profiles were not significantly different between groups. These findings suggest doxycycline may be a more effective primary choice for microbiological clearance in cis-men with chlamydia, though results for specific anatomical sites are constrained by data limitations.

How this fits prior evidence

This meta-analysis addresses the clinical management of chlamydial infections in cis-men. While previous coverage has discussed azithromycin's role in maternal infection reduction and its lack of effect on pneumococcal carriage in children, this study specifically compares doxycycline to azithromycin for chlamydial clearance. It provides evidence that doxycycline offers higher odds of cure (OR = 2.525) than azithromycin, filling a gap regarding optimal first-line treatment for these specific infection sites.

Researchers analyzed a large group of 1,172 men with chlamydial infections to compare two common treatments: doxycycline and azithromycin. The study looked at how well each medicine cleared the infection from different parts of the body.

The results showed that doxycycline had a higher success rate for clearing the overall infection compared to a single dose of azithromycin. Specifically, 93% of men taking doxycycline had a clear infection, while 81% of those taking azithromycin did. Doxycycline also showed better results for treating infections in the urethra and rectum.

While doxycycline performed better in several areas, there was no significant difference between the two drugs when treating prostate infections. Safety data showed that both medications were similarly tolerated by patients. Because some parts of the study had limited data, you should talk to a healthcare provider to determine the best treatment for your specific needs.

What this means for you:

Doxycycline may be more effective than azithromycin for clearing certain types of chlamydia infections in men.

Common questions

Is doxycycline more effective than azithromycin for chlamydia?

The study found that doxycycline had a higher success rate for clearing the overall infection compared to azithromycin. Specifically, 93% of patients on doxycycline achieved a cure, while 81% of those on azithromycin did. Doxycycline also showed better results for treating urethral and rectal infections.

Are there different results for prostate infections?

The study found no significant difference between doxycycline and azithromycin when it came to treating prostate infections. While other areas showed a preference for doxycycline, the data for prostate infections did not show one treatment was better than the other.

Are there different side effects between these two medications?

The study reported that there were no significant differences in adverse events between the two groups. Both medications appeared to be tolerated similarly by the men involved in the study, but you should consult a doctor regarding specific side effects.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedJul 2026

PMID41879336

View Original Abstract ↓

IntroductionTreatment for include azithromycin and doxycycline; however, comparative studies in cis-male populations remain limited. This systematic review and meta-analysis assessed the efficacy and safety of azithromycin versus doxycycline for treating chlamydial infections among cis-men.MethodsWe searched PubMed/MEDLINE, Embase, Web of Science, Scopus, Cochrane Central Register of Controlled Trials, CINAHL, and Google Scholar. Randomized controlled trials comparing doxycycline (100 mg twice daily for 7 days) with azithromycin (1 g single dose) in cis-men infected with were included. Risk of bias was assessed using the Cochrane RoB 2 tool and meta-analysis was reported in accordance with the PRISMA 2020 guidelines. The primary outcome was microbiological cure at last follow-up. Pooled effect estimates were calculated as odds ratios (ORs) with 95% confidence intervals (CIs) using the random-effects model. Subgroup, meta-regression, publication bias and sensitivity analyses were performed. The protocol was registered in PROSPERO (CRD42024535957).Results10 randomized controlled trials comprising 1172 cis-male participants were included. Overall, 560/602 (93%) participants treated with doxycycline and 504/627 (81%) treated with azithromycin achieved microbiological cure. Meta-analysis demonstrated significantly higher odds of cure with doxycycline compared with azithromycin (OR = 2.525, 95% CI = 1.329-4.796, = 0.005). Adverse events were not significantly different between groups ( = 0.757). Subgroup analysis showed significant superiority of doxycycline for rectal infection and chlamydia-associated nongonococcal urethritis ( < 0.05), but not for prostate infection ( = 0.745). Sensitivity analysis demonstrated strong reliability and no statistical evidence of publication bias ( > 0.05).ConclusionsDoxycycline demonstrated superior microbiological efficacy compared with azithromycin in cis-men with . However, moderate heterogeneity was detected across studies and data for rectal and prostate infections were limited. Consequently, further well-designed trials are required to confirm these findings.

Doxycycline provides higher odds of microbiological cure compared to azithromycin in cis-men with chlamydiaDoxycycline Shows Higher Cure Rates for Chlamydia in Men

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Doxycycline provides higher odds of microbiological cure compared to azithromycin in cis-men with chlamydiaDoxycycline Shows Higher Cure Rates for Chlamydia in Men

How this fits prior evidence

Common questions

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