{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T08:28:15Z","timestamp":1786436895709,"version":"build-2736575974"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"vor","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institutes of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R01AI161019"],"award-info":[{"award-number":["R01AI161019"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Prior to 2021, the US Centers for Disease Control and Prevention (CDC) recommended either doxycycline or azithromycin as first-line treatments for Chlamydia trachomatis (CT). By 2016, there was evidence showing that doxycycline was more effective than azithromycin for the treatment of rectal CT. This motivated the Public Health\u2014Seattle &amp; King County Sexual Health Clinic to update their clinic's protocol to treat rectal CT with exclusively doxycycline in mid-2016. The CDC later recommended this in July 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Leveraging health records from the clinic, we performed a controlled interrupted time series analysis to evaluate the impact of updated treatment guidelines at the clinic on recurrent\/persistent (RP) rectal chlamydia (RP-CT) infections among men who have sex with men using RP rectal gonorrhea (RP-GC) as a control outcome. We also evaluated if there were patient demographic and behavioral correlates associated with receipt of azithromycin before and after the change in clinic guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Our analysis revealed a significant relative trend change between RP-CT and RP-GC when comparing the period of full implementation to preimplementation, showing a 16.9% greater reduction in the quarterly trend of RP-CT cases compared to RP-GC cases. Self-identifying as White and with human immunodeficiency virus were positively associated with receiving azithromycin for treatment of rectal CT after the change in guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The significant reduction in the trend change for RP-CT versus RP-GC when comparing the fully implemented period of exclusive doxycycline to the preimplementation period demonstrates the impact of the new treatment guidelines in reducing incidence of RP-CT infections.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag484","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T11:16:11Z","timestamp":1786101371000},"source":"Crossref","is-referenced-by-count":0,"title":["Impact of Changes in Chlamydia Treatment Guidelines on Recurrent\/Persistent Rectal\n                    <i>Chlamydia trachomatis<\/i>\n                    Infections"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5624-5443","authenticated-orcid":false,"given":"Mary Bridget","family":"Waters","sequence":"first","affiliation":[{"name":"Department of Epidemiology, University of Washington , Seattle, Washington ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anjuli D","family":"Wagner","sequence":"additional","affiliation":[{"name":"Department of Global Health, University of Washington , Seattle, Washington ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim W","family":"Menza","sequence":"additional","affiliation":[{"name":"Public Health-Seattle & King County, HIV\/STI\/HCV Program , Seattle, Washington ,","place":["USA"]},{"name":"Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington , Seattle, Washington 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