{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T11:34:14Z","timestamp":1790854454168,"version":"4.1.0"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Rectal chlamydia diagnoses have been increasing among MSM and may also rise among women as anal sex rates increase among heterosexuals. However, there is growing concern about treatment for rectal chlamydia with treatment failures of up to 22% being reported. This article addresses factors that may be contributing to treatment failure for rectal chlamydia, including the pharmacokinetic properties of azithromycin and doxycycline in rectal tissue, the ability of chlamydia to transform into a persistent state that is less responsive to antimicrobial therapy, the impact of the rectal microbiome on chlamydia, heterotypic resistance, failure to detect cases of lymphogranuloma venereum and the performance of screening tests. If we are to reduce the burden of genital chlamydia, treatment for rectal chlamydia must be efficacious. This highlights the need for randomized controlled trial evidence comparing azithromycin with doxycycline for the treatment of rectal chlamydia.<\/jats:p>","DOI":"10.1093\/jac\/dku493","type":"journal-article","created":{"date-parts":[[2014,12,6]],"date-time":"2014-12-06T04:45:50Z","timestamp":1417841150000},"page":"961-964","source":"Crossref","is-referenced-by-count":40,"title":["Treatment of rectal chlamydia infection may be more complicated than we originally thought"],"prefix":"10.1093","volume":"70","author":[{"given":"Jane S.","family":"Hocking","sequence":"first","affiliation":[{"name":"1 \u00a0Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, 3\/207 Bouverie Street, Carlton, Victoria 3053, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian Y. S.","family":"Kong","sequence":"additional","affiliation":[{"name":"1 \u00a0Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, 3\/207 Bouverie Street, Carlton, Victoria 3053, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Timms","sequence":"additional","affiliation":[{"name":"2 \u00a0University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, Queensland, 4558, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilhelmina M.","family":"Huston","sequence":"additional","affiliation":[{"name":"3 \u00a0Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland 4059, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sepehr N.","family":"Tabrizi","sequence":"additional","affiliation":[{"name":"4 \u00a0Murdoch Children's Research Institute, Flemington Road, Parkville, Victoria 3052, Australia"},{"name":"5 \u00a0Department of Obstetrics and Gynaecology, University of Melbourne, The Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria 3052, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2014,12,4]]},"reference":[{"key":"2022020120584806500_DKU493C1","volume-title":"Global Incidence and Prevalence of Selected Curable Sexually Transmitted Infections\u20142008","author":"WHO","year":"2012"},{"key":"2022020120584806500_DKU493C2","author":"National Notifiable Diseases Surveillance System","year":"2013"},{"key":"2022020120584806500_DKU493C3","author":"PHE"},{"key":"2022020120584806500_DKU493C4","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1186\/1471-2334-12-113","article-title":"The prevalence of Chlamydia trachomatis infection in Australia: a systematic review and meta-analysis","volume":"12","author":"Lewis","year":"2012","journal-title":"BMC Infect Dis"},{"key":"2022020120584806500_DKU493C5","doi-asserted-by":"crossref","first-page":"1781","DOI":"10.1016\/S0140-6736(13)62035-8","article-title":"Changes in sexual attitudes and lifestyles in Britain through the life course and over time: findings from the National Surveys of Sexual Attitudes and Lifestyles (Natsal)","volume":"382","author":"Mercer","year":"2013","journal-title":"Lancet"},{"key":"2022020120584806500_DKU493C6","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1186\/1471-2334-14-274","article-title":"High co-occurrence of anorectal chlamydia with urogenital chlamydia in women visiting an STI clinic revealed by routine universal testing in an observational study; a recommendation towards a better anorectal chlamydia control in women","volume":"14","author":"van Liere","year":"2014","journal-title":"BMC Infect Dis"},{"key":"2022020120584806500_DKU493C7","doi-asserted-by":"crossref","first-page":"1362","DOI":"10.1128\/IAI.01244-13","article-title":"\u2018Hidden in plain sight:\u2019 chlamydial gastrointestinal infection and its relevance to \u2018persistence\u2019 in human genital infections","volume":"82","author":"Rank","year":"2014","journal-title":"Infect Immun"},{"key":"2022020120584806500_DKU493C8","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1136\/sti.75.1.3","article-title":"From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection","volume":"75","author":"Fleming","year":"1999","journal-title":"Sex Transm Infect"},{"key":"2022020120584806500_DKU493C9","first-page":"44","article-title":"Sexually transmitted diseases treatment guidelines, 2010","volume":"59","author":"Workowski","year":"2010","journal-title":"MMWR"},{"key":"2022020120584806500_DKU493C10","doi-asserted-by":"crossref","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"},{"key":"2022020120584806500_DKU493C11","doi-asserted-by":"crossref","article-title":"The efficacy of azithromycin for the treatment of rectal chlamydia infection\u2014a systematic review and meta-analysis","author":"Kong","DOI":"10.1093\/jac\/dku574"},{"key":"2022020120584806500_DKU493C12","first-page":"244","article-title":"Azithromycin levels in cervical mucus and plasma after a single 1.0 g oral dose for chlamydial cervicitis","volume":"71","author":"Worm","year":"1995","journal-title":"Genitourin Med"},{"key":"2022020120584806500_DKU493C13","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1007\/BF01975844","article-title":"Gynecological tissue levels of azithromycin","volume":"10","author":"Krohn","year":"1991","journal-title":"Eur J Clin Microbiol Infect Dis"},{"issue":"Suppl A","key":"2022020120584806500_DKU493C14","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1093\/jac\/25.suppl_A.73","article-title":"The pharmacokinetics of azithromycin in human serum and tissues","volume":"25","author":"Foulds","year":"1990","journal-title":"J Antimicrob Chemother"},{"key":"2022020120584806500_DKU493C15","doi-asserted-by":"crossref","first-page":"370","DOI":"10.2165\/00003088-199325050-00003","article-title":"Azithromycin clinical pharmacokinetics","volume":"25","author":"Lalak","year":"1993","journal-title":"Clin Pharmacokinet"},{"key":"2022020120584806500_DKU493C16","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.1128\/CVI.00763-12","article-title":"Effect of HIV and chlamydia infection on rectal inflammation and cytokine concentrations in men who have sex with men","volume":"20","author":"Heiligenberg","year":"2013","journal-title":"Clin Vacc Immunol"},{"key":"2022020120584806500_DKU493C17","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/j.pharmthera.2014.03.003","article-title":"Azithromycin: mechanisms of action and their relevance for clinical applications","volume":"143","author":"Parnham","year":"2014","journal-title":"Pharmacol Ther"},{"key":"2022020120584806500_DKU493C18","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1097\/00007691-198206000-00001","article-title":"Doxycycline","volume":"4","author":"Cunha","year":"1982","journal-title":"Ther Drug Monit"},{"key":"2022020120584806500_DKU493C19","first-page":"100","article-title":"Concentration of doxycycline in bowel tissue and postoperative infections","author":"H\u00f6jer","year":"1975","journal-title":"Scand J Infect Dis Suppl"},{"key":"2022020120584806500_DKU493C20","doi-asserted-by":"crossref","first-page":"1843","DOI":"10.1128\/IAI.72.4.1843-1855.2004","article-title":"Chlamydial persistence: beyond the biphasic paradigm","volume":"72","author":"Hogan","year":"2004","journal-title":"Infect Immun"},{"key":"2022020120584806500_DKU493C21","doi-asserted-by":"crossref","first-page":"44","DOI":"10.3389\/fcimb.2014.00044","article-title":"Commonly prescribed \u03b2-lactam antibiotics induce C. trachomatis persistence\/stress in culture at physiologically relevant concentrations","volume":"4","author":"Kintner","year":"2014","journal-title":"Front Cell Infect Microbiol"},{"key":"2022020120584806500_DKU493C22","doi-asserted-by":"crossref","first-page":"1782","DOI":"10.1128\/AAC.02097-13","article-title":"Induction of the Chlamydia muridarum stress\/persistence response increases azithromycin treatment failure in a murine model of infection","volume":"58","author":"Phillips-Campbell","year":"2014","journal-title":"Antimicrob Agents Chemother"},{"key":"2022020120584806500_DKU493C23","doi-asserted-by":"crossref","first-page":"1787","DOI":"10.1128\/AAC.49.5.1787-1793.2005","article-title":"Bactericidal activity of first-choice antibiotics against gamma interferon-induced persistent infection of human epithelial cells by Chlamydia trachomatis","volume":"49","author":"Reveneau","year":"2005","journal-title":"Antimicrob Agents Chemother"},{"key":"2022020120584806500_DKU493C24","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1046\/j.1468-3083.2001.00342.x","article-title":"Electron microscopic evidence of persistent chlamydial infection following treatment","volume":"15","author":"Bragina","year":"2001","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"2022020120584806500_DKU493C25","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1016\/S1473-3099(14)70780-7","article-title":"Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data","volume":"14","author":"Van Boeckel","year":"2014","journal-title":"Lancet Infect Dis"},{"key":"2022020120584806500_DKU493C26","first-page":"402","article-title":"Primary and secondary syphilis\u2014United States, 2005\u20132013","volume":"63","author":"Patton","year":"2014","journal-title":"MMWR"},{"key":"2022020120584806500_DKU493C27","doi-asserted-by":"crossref","first-page":"15971","DOI":"10.1073\/pnas.2535394100","article-title":"Transcriptome analysis of chlamydial growth during IFN-\u03b3-mediated persistence and reactivation","volume":"100","author":"Belland","year":"2003","journal-title":"Proc Natl Acad Sci USA"},{"key":"2022020120584806500_DKU493C28","doi-asserted-by":"crossref","first-page":"71","DOI":"10.3389\/fcimb.2014.00071","article-title":"Morphologic and molecular evaluation of Chlamydia trachomatis growth in human endocervix reveals distinct growth patterns","volume":"4","author":"Lewis","year":"2014","journal-title":"Front Cell Infect Microbiol"},{"key":"2022020120584806500_DKU493C29","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":"Sex Transm Infect"},{"key":"2022020120584806500_DKU493C30","doi-asserted-by":"crossref","first-page":"e81236","DOI":"10.1371\/journal.pone.0081236","article-title":"Detection of anorectal and cervicovaginal Chlamydia trachomatis infections following azithromycin treatment: prospective cohort study with multiple time-sequential measures of rRNA, DNA, quantitative load and symptoms","volume":"8","author":"Dukers-Muijrers","year":"2013","journal-title":"PLoS One"},{"key":"2022020120584806500_DKU493C31","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":"Sex Transm Infect"},{"key":"2022020120584806500_DKU493C32","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":"Emerg Infect Dis"},{"key":"2022020120584806500_DKU493C33","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1136\/sti.2008.031773","article-title":"Rectal chlamydia\u2014a reservoir of undiagnosed infection in men who have sex with men","volume":"85","author":"Annan","year":"2009","journal-title":"Sex Transm Inf"},{"key":"2022020120584806500_DKU493C34","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1099\/jmm.0.023887-0","article-title":"Effects of antibiotics on Chlamydia trachomatis viability as determined by real-time quantitative PCR","volume":"60","author":"Peuchant","year":"2011","journal-title":"J Med Microbiol"},{"key":"2022020120584806500_DKU493C35","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1128\/AAC.43.1.163","article-title":"Pharmacokinetics in serum and leukocyte exposures of oral azithromycin, 1,500 milligrams, given over a 3- or 5-day period in healthy subjects","volume":"43","author":"Amsden","year":"1999","journal-title":"Antimicrob Agents Chemother"}],"container-title":["Journal of Antimicrobial Chemotherapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jac\/article-pdf\/70\/4\/961\/42354914\/jac_70_4_961.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jac\/article-pdf\/70\/4\/961\/42354914\/jac_70_4_961.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,1]],"date-time":"2022-02-01T21:05:53Z","timestamp":1643749553000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jac\/article\/70\/4\/961\/800399"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,12,4]]},"references-count":35,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2014,12,4]]},"published-print":{"date-parts":[[2015,4,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jac\/dku493","relation":{},"ISSN":["1460-2091","0305-7453"],"issn-type":[{"value":"1460-2091","type":"electronic"},{"value":"0305-7453","type":"print"}],"subject":[],"published-other":{"date-parts":[[2015,4]]},"published":{"date-parts":[[2014,12,4]]}}}