{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T23:04:08Z","timestamp":1790809448584,"version":"4.1.0"},"reference-count":23,"publisher":"CSIRO Publishing","issue":"5","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,20]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This study investigated prescribing practices following changes in the Australian chlamydia treatment guidelines in 2022, which replaced doxycycline or azithromycin with doxycycline as first-line therapy for oropharyngeal or urogenital infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data from 61 clinics in the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance of STIs and blood-borne viruses (ACCESS) project (January 2015\u2013June 2025) from individuals aged 16\u201380\u00a0years with positive urogenital or pharyngeal chlamydia tests were analysed. An interrupted time series analysis (intervention point Q1 2022) assessed quarterly changes in the proportion of tests prescribed doxycycline and azithromycin within 14\u00a0days before and 31\u00a0days after positive tests. Anorectal infections were excluded as doxycycline was already the first line recommendation for this anatomical site.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 69,925 positive tests (53,202 (76.1%) at sexual health clinics (SHCs)) from 60,084 people were included. Doxycycline prescribing increased by 1.61 percentage points (95% CI, 1.47\u20131.75) per quarter before the guideline change; immediately increased by 13.5 percentage points (95% CI,\u00a08.58\u201318.4); then increased by 1.70 percentage points (95% CI,\u00a01.08\u20132.31) post-change. The proportion treated with azithromycin decreased by 0.62 percentage points (95% CI,\u00a0\u22120.79 to \u22120.44) per quarter pre-guideline change; immediately decreased at the change by 18.1 percentage points (95% CI, \u221222.75 to \u221213.52); then decreased 1.64 percentage points (95% CI,\u00a0\u22122.09 to \u22121.19) post-change. SHCs and general practices specialising in the care of gay and bisexual men showed greater pre-change increases in doxycycline prescribing, whereas general practice and community health accelerated post-change.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Doxycycline prescribing for chlamydia has increased with corresponding declines in azithromycin use following the 2022 Australian treatment guideline change. Setting-specific implementation strategies may accelerate evidence uptake for future guideline updates.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1071\/sh26148","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T22:27:02Z","timestamp":1790807222000},"source":"Crossref","is-referenced-by-count":0,"title":["Chlamydia prescribing trends in Australia before and after a national guideline update: a retrospective study of sentinel surveillance data, 2015\u20132025"],"prefix":"10.1071","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2296-7787","authenticated-orcid":true,"given":"Stephanie C.","family":"Munari","sequence":"first","affiliation":[{"name":"ABurnet Institute, Melbourne, Vic, Australia."},{"name":"BMelbourne School of Public Health, The University of Melbourne, Melbourne, Vic, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5580-360X","authenticated-orcid":true,"given":"Jane L.","family":"Goller","sequence":"additional","affiliation":[{"name":"BMelbourne School of Public Health, The University of Melbourne, Melbourne, Vic, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Lee","family":"Wilkinson","sequence":"additional","affiliation":[{"name":"ABurnet Institute, Melbourne, Vic, Australia."},{"name":"BMelbourne School of Public Health, The University of Melbourne, Melbourne, Vic, Australia."},{"name":"CSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9520-5724","authenticated-orcid":true,"given":"Jacqueline","family":"Coombe","sequence":"additional","affiliation":[{"name":"BMelbourne School of Public Health, The University of Melbourne, Melbourne, Vic, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria A. L.","family":"Polkinghorne","sequence":"additional","affiliation":[{"name":"ABurnet Institute, Melbourne, Vic, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3452-350X","authenticated-orcid":true,"given":"Michael W.","family":"Traeger","sequence":"additional","affiliation":[{"name":"ABurnet Institute, Melbourne, Vic, Australia."},{"name":"CSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Asselin","sequence":"additional","affiliation":[{"name":"ABurnet Institute, Melbourne, Vic, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1766-0657","authenticated-orcid":true,"given":"Eric P. F.","family":"Chow","sequence":"additional","affiliation":[{"name":"BMelbourne School of Public Health, The University of Melbourne, Melbourne, Vic, Australia."},{"name":"DMelbourne Sexual Health Centre, Bayside Health, Melbourne, Vic, Australia"},{"name":"ESchool of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0402-0506","authenticated-orcid":true,"given":"Rick","family":"Varma","sequence":"additional","affiliation":[{"name":"FSydney Sexual Health Centre, Sydney, NSW, Australia."},{"name":"GKirby Institute, University of New South Wales, Sydney, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Bell","sequence":"additional","affiliation":[{"name":"HCommunicable Disease Control Branch, Department of Health South Australia, Adelaide, SA, Australia."},{"name":"IAdelaide Sexual Health Centre and Royal Adelaide Hospital, Adelaide, SA, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9329-8501","authenticated-orcid":true,"given":"Jane S.","family":"Hocking","sequence":"additional","affiliation":[{"name":"BMelbourne School of Public Health, The University of Melbourne, Melbourne, Vic, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Hellard","sequence":"additional","affiliation":[{"name":"ABurnet Institute, Melbourne, Vic, Australia."},{"name":"JDepartment of Infectious Diseases, Alfred Hospital, Melbourne, Vic, Australia."},{"name":"KDepartment of Epidemiology and Preventive Medicine, Alfred Hospital, Monash University, Melbourne, Vic, Australia."},{"name":"LDoherty Institute and Melbourne School of Public Health, The University of Melbourne, Vic, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"67","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"2026093018265714400_R1","unstructured":"World Health Organization. Sexually transmitted infections (STIs). Geneva: World Health Organization; 2025. Available at https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/sexually-transmitted-infections-(stis) [updated 10 September 2025; cited 6 January 2026]"},{"key":"2026093018265714400_R2","unstructured":"Australian Centre for Disease Control. National Notifiable Diseases Surveillance System (NINDSS). Canberra: Australian Centre for Disease Control; 2026. Available at https:\/\/nindss.health.gov.au\/pbi-dashboard\/ [updated 5 January 2026; cited 5 January 2026]"},{"key":"2026093018265714400_R3","unstructured":"Australian STI Management Guidelines for Use in Primary Care. Chlamydia: Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM); 2024. Available at https:\/\/sti.guidelines.org.au\/sexually-transmissible-infections\/chlamydia\/ [updated April 2024; cited 20 October 2025]"},{"issue":"25","key":"2026093018265714400_R4","doi-asserted-by":"publisher","first-page":"2418","DOI":"10.1056\/NEJMoa2031631","article-title":"Azithromycin or doxycycline for asymptomatic rectal Chlamydia trachomatis.","volume":"384","author":"Lau","year":"2021","journal-title":"N Engl J Med"},{"issue":"12","key":"2026093018265714400_R5","doi-asserted-by":"publisher","first-page":"3103","DOI":"10.1093\/jac\/dkab335","article-title":"Efficacy of doxycycline versus azithromycin for the treatment of rectal chlamydia: a systematic review and meta-analysis.","volume":"76","author":"Chen","year":"2021","journal-title":"J Antimicrob Chemother"},{"issue":"2","key":"2026093018265714400_R6","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1093\/cid\/ciu220","article-title":"Azithromycin versus doxycycline for the treatment of genital chlamydia infection: a meta-analysis of randomized controlled trials.","volume":"59","author":"Kong","year":"2014","journal-title":"Clin Infect Dis"},{"issue":"5","key":"2026093018265714400_R7","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1136\/sextrans-2017-053161","article-title":"Detection of Chlamydia trachomatis in rectal specimens in women and its association with anal intercourse: a systematic review and meta-analysis.","volume":"94","author":"Chandra","year":"2018","journal-title":"Sex Transm Infect"},{"issue":"4","key":"2026093018265714400_R8","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1177\/0956462415615443","article-title":"2015 UK national guideline for the management of infection with Chlamydia trachomatis.","volume":"27","author":"Nwokolo","year":"2016","journal-title":"Int J STD AIDS"},{"issue":"6","key":"2026093018265714400_R9","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1177\/09564624251323678","article-title":"2025 European guideline on the management of Chlamydia trachomatis infections.","volume":"36","author":"White","year":"2025","journal-title":"Int J STD AIDS"},{"key":"2026093018265714400_R10"},{"issue":"11","key":"2026093018265714400_R11","doi-asserted-by":"publisher","DOI":"10.2196\/11028","article-title":"Monitoring the control of sexually transmissible infections and Blood-Borne Viruses: protocol for the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS).","volume":"7","author":"Callander","year":"2018","journal-title":"JMIR Res Protoc"},{"key":"2026093018265714400_R12","unstructured":"Australian STI Management Guidelines for Use in Primary Care. Chlamydia. Archived at Wayback machine (WebArchive.org). Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM); 2024. Available at https:\/\/web.archive.org\/web\/20220109023559\/https:\/\/sti.guidelines.org.au\/sexually-transmissible-infections\/chlamydia\/ [cited 20 October 2025]"},{"key":"2026093018265714400_R13","unstructured":"Australian STI Management Guidelines for Use in Primary Care. Australian STI Management Guidelines. Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM); 2024. Available at https:\/\/sti.guidelines.org.au [updated April 2024; cited 20 October 2025]"},{"issue":"6","key":"2026093018265714400_R14","doi-asserted-by":"publisher","first-page":"542","DOI":"10.1071\/SH23096","article-title":"The chlamydia care cascade of young people attending Australian general practices; a descriptive study to assess gaps in care.","volume":"20","author":"Jung","year":"2023","journal-title":"Sex Health"},{"issue":"1","key":"2026093018265714400_R15","doi-asserted-by":"publisher","first-page":"e35","DOI":"10.1093\/infdis\/jiaf107","article-title":"Routine treatment versus selective treatment for individuals reporting contact with sexual partners with chlamydia: a before-and-after study.","volume":"232","author":"Wijekoon","year":"2025","journal-title":"J Infect Dis"},{"issue":"9","key":"2026093018265714400_R16","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1097\/00007435-200209000-00001","article-title":"Azithromycin versus doxycycline for genital chlamydial infections: a meta-analysis of randomized clinical trials.","volume":"29","author":"Lau","year":"2002","journal-title":"Sex Transm Dis"},{"issue":"2","key":"2026093018265714400_R17","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1097\/OLQ.0000000000000088","article-title":"Comparing azithromycin and doxycycline for the treatment of rectal chlamydial infection: a retrospective cohort study.","volume":"41","author":"Khosropour","year":"2014","journal-title":"Sex Transm Dis"},{"issue":"2","key":"2026093018265714400_R18","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1097\/OLQ.0000000000000092","article-title":"Azithromycin for rectal chlamydia: is it time to leave azithromycin on the shelf?..Not yet.","volume":"41","author":"Jordan","year":"2014","journal-title":"Sex Transm Dis"},{"issue":"4","key":"2026093018265714400_R19","doi-asserted-by":"publisher","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":"J Antimicrob Chemother"},{"issue":"8","key":"2026093018265714400_R20","doi-asserted-by":"publisher","first-page":"1221","DOI":"10.1016\/S1473-3099(22)00148-7","article-title":"Doxycycline versus azithromycin for the treatment of anorectal Chlamydia trachomatis infection in women concurrent with vaginal infection (CHLAZIDOXY study): a multicentre, open-label, randomised, controlled, superiority trial.","volume":"22","author":"Peuchant","year":"2022","journal-title":"Lancet Infect Dis"},{"issue":"1","key":"2026093018265714400_R21","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1071\/SH22134","article-title":"Australian sexually transmitted infection (STI) management guidelines for use in primary care 2022 update.","volume":"20","author":"Ong","year":"2023","journal-title":"Sex Health"},{"issue":"2","key":"2026093018265714400_R22","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1097\/OLQ.0000000000002251","article-title":"Trends in chlamydia prescribing practices after changes to national treatment guidelines in the United States, 2016\u20132023.","volume":"53","author":"Khosropour","year":"2026","journal-title":"Sex Transm Dis"},{"issue":"2","key":"2026093018265714400_R23","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1089\/apc.2022.0190","article-title":"Adherence to New CDC Chlamydia treatment guidelines in adolescents: effective uptake and equitable implementation.","volume":"37","author":"Makeneni","year":"2023","journal-title":"AIDS Patient Care STDS"}],"container-title":["Sexual Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/connectsci.au\/sh\/article-pdf\/doi\/10.1071\/SH26148\/1972192\/sh26148.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/connectsci.au\/sh\/article-pdf\/doi\/10.1071\/SH26148\/1972192\/sh26148.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T22:27:05Z","timestamp":1790807225000},"score":1,"resource":{"primary":{"URL":"https:\/\/connectsci.au\/sh\/article\/23\/5\/SH26148\/275964\/Chlamydia-prescribing-trends-in-Australia-before"}},"subtitle":[],"editor":[{"given":"Michael","family":"Marks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,10,1]]},"references-count":23,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,10,20]]}},"URL":"https:\/\/doi.org\/10.1071\/sh26148","relation":{},"ISSN":["1448-5028","1449-8987"],"issn-type":[{"value":"1448-5028","type":"print"},{"value":"1449-8987","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,1]]},"article-number":"SH26148"}}