TOPLINE

Implementing clinic guidelines recommending doxycycline over azithromycin for rectal chlamydia corresponded with a significant decline in recurrent or persistent rectal chlamydia infections among men who have sex with men (MSM).

METHODOLOGY

• Researchers conducted a controlled interrupted time series analysis using electronic health record data from the Public Health-Seattle & King County Sexual Health Clinic from January 2012 through December 2024.
• A total of 211 recurrent or persistent rectal chlamydia infections and 222 recurrent or persistent rectal gonorrhea infections were identified among MSM, defined as a second positive test 14-90 days after initial diagnosis.
• Analysis examined 3 time periods: preimplementation (January 2012 through June 2016), clinic implementation phase (July 2016 through September 2021), and fully implemented period (October 2021 through December 2024), which coincided with updated national guidelines.
• Recurrent or persistent gonorrhea infections served as a control group to account for changes in testing patterns and sexual behavior unrelated to the treatment guideline change.

TAKEAWAY

• The trend in recurrent/persistent rectal chlamydia declined 14.7% after full implementation vs before implementation (P = .004).
• The rectal chlamydia trend declined 16.9% more than the rectal gonorrhea trend after full implementation (P = .011).
• No significant immediate reduction in recurrent/persistent infections occurred after either implementation period.
• During the clinic implementation phase, Hispanic or Latino individuals had lower odds of receiving azithromycin (odds ratio [OR], 0.52; P < .001).

IN PRACTICE

"This study builds on the existing [randomized clinical trials] demonstrating the effectiveness of doxycycline over azithromycin for the treatment of rectal [chlamydia] by estimating the impact of the implementation of new prescribing guidelines on reducing subsequent [recurrent/persistent rectal chlamydia]," wrote the authors of the study.

SOURCE

The study was led by Mary Bridget Waters, Department of Epidemiology, University of Washington, Seattle. It was published online on August 11 in Open Forum Infectious Diseases.

LIMITATIONS

The study limitations included reliance on health record data, single-center design, and inability to distinguish between recurrent infections (new exposures) and persistent infections (treatment failures).

DISCLOSURES

The study was supported by grants from the National Institutes of Health and the National Institute of Allergy and Infectious Diseases. The authors reported receiving grants, research support, and honoraria from Hologic, Inc; Gilead Sciences; and several other resources.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.