A Randomised Trial of Three Face‐Washing Methods for the Removal of Chlamydia trachomatis From the Faces of Children With Severe Active Trachoma

This is the authors' abstract. We don't add key points for this paper.

OBJECTIVES: A three-arm, open, parallel-group randomised trial compared three face-washing methods for cleaning Chlamydia trachomatis from the faces of children with severe active trachoma. The impact of face-washing on Chlamydia trachomatis on the hands of children and their caregivers and Chlamydia trachomatis duration on faces and hands were investigated as secondary objectives. METHODS: Children aged 1-7 years in Oromia, Ethiopia, were screened for active trachoma. We aimed to recruit 470 children with severe conjunctival inflammation; 141 were expected to have concurrent conjunctival infection and facial Chlamydia trachomatis , detected by qPCR. Those with severe inflammation were randomly assigned to water alone, water with soap or damp, microfibre towel protocols. Swabs (children's faces/hands, caregivers' hands) were collected pre-wash, post-wash, and at 1, 2, 4, 6 and 8 h. Conjunctival swabs were tested for ocular Chlamydia trachomatis infection; only infected children with facial Chlamydia trachomatis were included in primary analysis, comparing the proportion of faces without Chlamydia trachomatis after each washing method. RESULTS: Of 470 children screened with severe inflammation, 25 (5%) had conjunctival infection and facial Chlamydia trachomatis . All three protocols (n = 12 water only, n = 8 water and soap, n = 5 damp towel) reduced discharge, but none removed Chlamydia trachomatis from faces immediately post-wash. No major facial Chlamydia trachomatis load reduction was observed. Face-washing removed Chlamydia trachomatis from some children's and caregivers' hands, but loads were not significantly reduced where Chlamydia trachomatis persisted. Though Chlamydia trachomatis was transiently absent from one face at 1 h and four at 2 h post-wash, all baseline Chlamydia trachomatis -positive children retained it at 8 h. CONCLUSIONS: No evidence of differential or overall effectiveness of the three washing methods at removing facial Chlamydia trachomatis from children with trachoma was found. This finding is limited by a smaller-than-anticipated sample size, potentially hindering detection of subtle differences or overall effects. TRIAL REGISTRATION: ISRCTN registry: ISRCTN12814010 (April 2023).