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

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).