Authors' Response to the E-Letter: “RE: Nonadherence to the Centers for Disease Control and Prevention Treatment Guidelines”

We appreciate the comment and acknowledge that not analyzing the annual pattern of STI treatment adherence, in particularly the transition from the 2015 to the 2021 CDC guidelines, is our study limitation. A more detailed analysis on preferred treatment regimens by years regarding guideline updates would be useful. We plan to include this in our future study.

It’s worth noting that we observed a dramatically high use of azithromycin over doxycycline for treating chlamydia over the entire study period, despite that both regimens were recommended in the 2015 guidelines and azithromycin was switched to an alternative option in the 2021 updates. We discussed several clinician-, patient-, and facility-level factors in the Discussion of this article that may explain this preference. For instance, it may indicate potential “delays in adopting updated guidelines in clinical practice”. We believe that further analysis incorporating guideline transitions and practice-level characteristics would enhance the findings and provide a deeper insight into the treatment patterns.