Multiple drug-resistant Chlamydia trachomatis associated with clinical treatment failure. J Infect Dis 2000;181:1421-1427. 41

In vitro susceptibility testing and genotyping were done on urogenital isolates of Chlamydia trachomatis from 3 patients, 2 of whom showed evidence of clinical treatment failure with azithromycin and one of whom was the wife of a patient. All 3 isolates demonstrated multidrug resistance to doxycycline, azithromycin, and o¯oxacin at concentrations 14.0 mg/mL. Recur-rent disease due to relapsing infection with the same resistant isolate was documented on the basis of identical genotypes of both organisms. This ®rst report of clinically signi®cant mul-tidrug-resistant C. trachomatis causing relapsing or persistent infection may portend an emerg-ing problem to clinicians and public health of®cials. Chlamydia trachomatis, a nonmotile, gram-negative obligate intracellular bacterium, is primarily a human pathogen that causes inclusion conjunctivitis, lymphogranuloma venereum, and urogenital tract disease. Genital tract infection with C. trachomatis is asymptomatic in 50%±80 % of men and women [1, 2]. In men, symptomatic C. trachomatis infection may mani-fest as urethritis or epididymitis, whereas in women it ofte