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Ocular but not urogenital<jats:italic>Ct<\/jats:italic>strains contain mutations in the synthase that abrogate tryptophan synthesis. Here, we discovered that the genomes of serial isolates from a woman with recurrent, treated<jats:italic>Ct<\/jats:italic>STIs over many years were identical with a novel synthase mutation. This likely allowed long-term<jats:italic>in vivo<\/jats:italic>persistence where active infection resumed only when tryptophan became available. Our findings indicate an emerging adaptive host-pathogen evolutionary strategy for survival in the urogenital tract that will prompt the field to further explore chlamydial persistence, evaluate the genetics of mutant<jats:italic>Ct<\/jats:italic>strains and fitness within the host, and their implications for disease pathogenesis.<\/jats:p>","DOI":"10.1128\/mbio.01464-19","type":"journal-article","created":{"date-parts":[[2019,7,15]],"date-time":"2019-07-15T10:56:08Z","timestamp":1563188168000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":24,"title":["Clinical Persistence of Chlamydia trachomatis Sexually Transmitted Strains Involves Novel Mutations in the Functional \u03b1\u03b2\u03b2\u03b1 Tetramer of the Tryptophan Synthase Operon"],"prefix":"10.1128","volume":"10","author":[{"given":"Naraporn","family":"Somboonna","sequence":"first","affiliation":[{"name":"Center for Immunobiology and Vaccine Development, University of California San Francisco Benioff Children\u2019s Hospital Oakland Research Institute, Oakland, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noa","family":"Ziklo","sequence":"additional","affiliation":[{"name":"Center for Immunobiology and Vaccine Development, University of California San Francisco Benioff Children\u2019s Hospital Oakland Research Institute, Oakland, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas E.","family":"Ferrin","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Chemistry, University of California, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung","family":"Hyuk Suh","sequence":"additional","affiliation":[{"name":"Center for Immunobiology and Vaccine Development, University of California San Francisco Benioff Children\u2019s Hospital Oakland Research Institute, Oakland, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Dean","sequence":"additional","affiliation":[{"name":"Center for Immunobiology and Vaccine Development, University of California San Francisco Benioff Children\u2019s Hospital Oakland Research Institute, Oakland, California, USA"},{"name":"Department of Bioengineering, University of California Berkeley and University of California San Francisco Joint Graduate Group, Berkeley and San Francisco, California, USA"},{"name":"Department of Medicine and Pediatrics, University of California, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","unstructured":"World Health Organization. 2016. 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