{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T01:04:22Z","timestamp":1785546262847,"version":"3.56.0"},"reference-count":32,"publisher":"Cambridge University Press (CUP)","issue":"12","license":[{"start":{"date-parts":[[2016,5,16]],"date-time":"2016-05-16T00:00:00Z","timestamp":1463356800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["journals.cambridge.org"],"crossmark-restriction":true},"short-container-title":["Epidemiol. Infect."],"published-print":{"date-parts":[[2016,9]]},"abstract":"<jats:title>SUMMARY<\/jats:title><jats:p>Repeat rectal chlamydia infection is common in men who have sex with men (MSM) following treatment with 1 g azithromycin. This study describes the association between organism load and repeat rectal chlamydia infection, genovar distribution, and efficacy of azithromycin in asymptomatic MSM. Stored rectal chlamydia-positive samples from MSM were analysed for organism load and genotyped to assist differentiation between reinfection and treatment failure. Included men had follow-up tests within 100 days of index infection. Lymphogranuloma venereum and proctitis diagnosed symptomatically were excluded. Factors associated with repeat infection, treatment failure and reinfection were investigated. In total, 227 MSM were included \u2013 64 with repeat infections [28\u00b72%, 95% confidence interval (CI) 22\u00b74\u201334\u00b75]. Repeat positivity was associated with increased pre-treatment organism load [odds ratio (OR) 1\u00b77, 95% CI 1\u00b74\u20132\u00b72]. Of 64 repeat infections, 29 (12\u00b78%, 95% CI 8\u00b77\u201317\u00b78) were treatment failures and 35 (15\u00b74%, 95% CI 11\u00b70\u201320\u00b78) were reinfections, 11 (17\u00b72%, 95% CI 8\u00b79\u201328\u00b77) of which were definite reinfections. Treatment failure and reinfection were both associated with increased load (OR 2\u00b70, 95% CI 1\u00b74\u20132\u00b77 and 1\u00b76, 95% CI 1\u00b72\u20132\u00b72, respectively). The most prevalent genovars were G, D and J. Treatment efficacy for 1 g azithromycin was 83\u00b76% (95% CI 77\u00b72\u201388\u00b78). Repeat positivity was associated with high pre-treatment organism load. Randomized controlled trials are urgently needed to evaluate azithromycin's efficacy and whether extended doses can overcome rectal infections with high organism load.<\/jats:p>","DOI":"10.1017\/s0950268816000996","type":"journal-article","created":{"date-parts":[[2016,5,16]],"date-time":"2016-05-16T11:17:21Z","timestamp":1463397441000},"page":"2587-2596","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":34,"title":["Higher organism load associated with failure of azithromycin to treat rectal chlamydia"],"prefix":"10.1017","volume":"144","author":[{"given":"F. Y. S.","family":"KONG","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. N.","family":"TABRIZI","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. K.","family":"FAIRLEY","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"PHILLIPS","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"FEHLER","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"LAW","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. A.","family":"VODSTRCIL","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"CHEN","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. S.","family":"BRADSHAW","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. S.","family":"HOCKING","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2016,5,16]]},"reference":[{"key":"S0950268816000996_ref8","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0037778","article-title":"Chlamydia trachomatis incidence and re-infection among young women \u2013 behavioural and microbiological characteristics","volume":"7","author":"Walker","year":"2012","journal-title":"PLoS ONE"},{"key":"S0950268816000996_ref16","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1007\/BF01975843","article-title":"Azithromycin levels in plasma and gastric tissue, juice and mucus","volume":"10","author":"Harrison","year":"1991","journal-title":"European Journal of Clinical Microbiology and Infectious Disease"},{"key":"S0950268816000996_ref3","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1097\/QAI.0b013e3181c3ef29","article-title":"Rectal gonorrhea and chlamydia reinfection is associated with increased risk of HIV seroconversion","volume":"53","author":"Bernstein","year":"2010","journal-title":"Journal of Acquired Immune Deficiency Syndrome"},{"key":"S0950268816000996_ref9","doi-asserted-by":"crossref","first-page":"1296","DOI":"10.1016\/S0140-6736(05)67529-0","article-title":"Infection with Chlamydia trachomatis after mass treatment of a trachoma hyperendemic community in Tanzania: a longitudinal study","volume":"366","author":"West","year":"2005","journal-title":"Lancet"},{"key":"S0950268816000996_ref11","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1159\/000314998","article-title":"Decreased susceptibility to azithromycin and doxycycline in clinical isolates of Chlamydia trachomatis obtained from recurrently infected female patients in India","volume":"56","author":"Bhengraj","year":"2010","journal-title":"Chemotherapy"},{"key":"S0950268816000996_ref7","unstructured":"Australian Sexual Health Alliance. Australian STI management guidelines for use in primary care, 2014."},{"key":"S0950268816000996_ref26","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1136\/sti.2008.031773","article-title":"Rectal chlamydia \u2013 a reservoir of undiagnosed infection in men who have sex with men","volume":"85","author":"Annan","year":"2009","journal-title":"Sexually Transmitted Infections"},{"key":"S0950268816000996_ref18","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1093\/jac\/dku493","article-title":"Treatment of rectal chlamydia infection may be more complicated than we originally thought","volume":"70","author":"Hocking","year":"2015","journal-title":"Journal of Antimicrobial Chemotherapy"},{"key":"S0950268816000996_ref1","volume-title":"Global incidence and prevalence of selected curable sexually transmitted infections \u2013 2008","year":"2012"},{"key":"S0950268816000996_ref32","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1099\/00221287-132-4-1055","article-title":"Interaction of Chlamydia trachomatis with human genital epithelium in culture","volume":"132","author":"Moorman","year":"1986","journal-title":"Microbiology"},{"key":"S0950268816000996_ref20","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1136\/sextrans-2011-050385","article-title":"Azithromycin antimicrobial resistance and genital Chlamydia trachomatis infection: duration of therapy may be the key to improving efficacy","volume":"88","author":"Horner","year":"2012","journal-title":"Sexually Transmitted Infections"},{"key":"S0950268816000996_ref24","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1136\/sextrans-2011-050062","article-title":"Chlamydia trachomatis serovars in community-based HIV-positive and HIV-negative men who have sex with men in Sydney, Australia","volume":"87","author":"Templeton","year":"2011","journal-title":"Sexually Transmitted Infections"},{"key":"S0950268816000996_ref17","first-page":"361","article-title":"Determination of azithromycin in gastric biopsy samples","volume":"37","author":"Kirchhoff","year":"1999","journal-title":"International Journal of Clinical Pharmacology and Therapeutics"},{"key":"S0950268816000996_ref30","unstructured":"Holt, M , Gay Community Periodic Surveys: National Report 2010. Sydney, 2011."},{"key":"S0950268816000996_ref28","doi-asserted-by":"crossref","first-page":"488","DOI":"10.3201\/eid1903.121028","article-title":"Lymphogranuloma venereum in men screened for pharyngeal and rectal infection, Germany","volume":"19","author":"Haar","year":"2013","journal-title":"Emerging Infectious Diseases"},{"key":"S0950268816000996_ref2","unstructured":"National Notifiable Diseases Surveillance System. Number of notifications of chlamydial infections, Australia, by age group and sex, 2014 (http:\/\/www9.health.gov.au\/cda\/source\/cda-index.cfm). Accessed February 2015."},{"key":"S0950268816000996_ref22","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1097\/OLQ.0b013e3181fc6944","article-title":"Chlamydia trachomatis genotypes among men who have sex with men in Australia","volume":"38","author":"Twin","year":"2011","journal-title":"Sexually Transmitted Diseases"},{"key":"S0950268816000996_ref13","doi-asserted-by":"crossref","first-page":"2060","DOI":"10.1128\/JCM.02308-09","article-title":"Development and evaluation of an ompA quantitative real-time PCR assay for Chlamydia trachomatis serovar determination","volume":"48","author":"Stevens","year":"2010","journal-title":"Journal of Clinical Microbiology"},{"key":"S0950268816000996_ref27","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1071\/SH07068","article-title":"Clinical significance of questionnaire-elicited or clinically reported anorectal symptoms for rectal Neisseria gonorrhoeae and Chlamydia trachomatis amongst men who have sex with men [Erratum appears in Sex Health 2008; 5: 211]","volume":"5","author":"Lister","year":"2008","journal-title":"Sex Health"},{"key":"S0950268816000996_ref21","doi-asserted-by":"crossref","first-page":"1350","DOI":"10.1086\/323998","article-title":"Quantitative culture of Chlamydia trachomatis: relationship of inclusion-forming units produced in culture to clinical manifestations and acute inflammation in urogenital disease","volume":"184","author":"Geisler","year":"2001","journal-title":"Journal of Infectious Diseases"},{"key":"S0950268816000996_ref15","volume-title":"Guidelines for the management of sexually transmitted infections","year":"2003"},{"key":"S0950268816000996_ref6","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1258\/ijsa.2010.010302","article-title":"European guideline for the management of Chlamydia trachomatis infections","volume":"21","author":"Lanjouw","year":"2010","journal-title":"International Journal of STD AIDS"},{"key":"S0950268816000996_ref5","doi-asserted-by":"crossref","first-page":"1290","DOI":"10.1093\/jac\/dku574","article-title":"The efficacy of azithromycin and doxycycline for the treatment of rectal chlamydia infection: a systematic review and meta-analysis","volume":"70","author":"Kong","year":"2015","journal-title":"Journal of Antimicrobial Chemotherapy"},{"key":"S0950268816000996_ref19","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1136\/sextrans-2014-051633","article-title":"Spontaneous pharyngeal Chlamydia trachomatis RNA clearance. A cross-sectional study followed by a cohort study of untreated STI clinic patients in Amsterdam, The Netherlands","volume":"91","author":"van Rooijen","year":"2015","journal-title":"Sexually Transmitted Infections"},{"key":"S0950268816000996_ref10","doi-asserted-by":"crossref","first-page":"1628","DOI":"10.1093\/infdis\/jiu670","article-title":"The epidemiology of organism load in genital Chlamydia trachomatis infection \u2013 a systematic review","volume":"211","author":"Vodstrcil","year":"2015","journal-title":"Journal of Infectious Diseases"},{"key":"S0950268816000996_ref4","first-page":"1","article-title":"Sexually transmitted diseases treatment guidelines, 2015","volume":"64","year":"2015","journal-title":"Morbidity and Mortality Weekly Report"},{"key":"S0950268816000996_ref29","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1097\/OLQ.0b013e3181788313","article-title":"Absence of lymphogranuloma venereum strains among rectal Chlamydia trachomatis outer membrane protein A genotypes infecting women and men who have sex with men in Birmingham, Alabama","volume":"35","author":"Geisler","year":"2008","journal-title":"Sexually Transmitted Diseases"},{"key":"S0950268816000996_ref14","doi-asserted-by":"crossref","first-page":"2844","DOI":"10.1128\/JCM.00128-11","article-title":"Evaluation of high-resolution typing methods for Chlamydia trachomatis in samples from heterosexual couples","volume":"49","author":"Bom","year":"2011","journal-title":"Journal of Clinical Microbiology"},{"key":"S0950268816000996_ref31","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1128\/JCM.02631-12","article-title":"Influence of temperature, medium, and storage duration on Chlamydia trachomatis DNA detection by PCR","volume":"51","author":"van Dommelen","year":"2013","journal-title":"Journal of Clinical Microbiology"},{"key":"S0950268816000996_ref23","doi-asserted-by":"crossref","first-page":"3548","DOI":"10.1128\/JCM.01713-12","article-title":"Chlamydia trachomatis strains show specific clustering for men who have sex with men compared to heterosexual populations in Sweden, the Netherlands, and the United States","volume":"50","author":"Christerson","year":"2012","journal-title":"Journal of Clinical Microbiology"},{"key":"S0950268816000996_ref25","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1136\/sextrans-2012-050915","article-title":"Anorectal and inguinal lymphogranuloma venereum among men who have sex with men in Amsterdam, the Netherlands: trends over time, symptomatology and concurrent infections","volume":"89","author":"de Vrieze","year":"2013","journal-title":"Sexually Transmitted Infections"},{"key":"S0950268816000996_ref12","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1086\/428290","article-title":"Evaluation of antimicrobial resistance and treatment failures for Chlamydia trachomatis: a meeting report","volume":"191","author":"Wang","year":"2005","journal-title":"Journal of Infectious Diseases"}],"container-title":["Epidemiology and Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0950268816000996","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,6,13]],"date-time":"2022-06-13T19:48:14Z","timestamp":1655149694000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0950268816000996\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,5,16]]},"references-count":32,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2016,9]]}},"alternative-id":["S0950268816000996"],"URL":"https:\/\/doi.org\/10.1017\/s0950268816000996","relation":{},"ISSN":["0950-2688","1469-4409"],"issn-type":[{"value":"0950-2688","type":"print"},{"value":"1469-4409","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,5,16]]},"assertion":[{"value":"Copyright \u00a9 Cambridge University Press 2016\u00a0","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}}]}}