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Higher Neisseria gonorrhoeae bacterial load in coinfections with Chlamydia trachomatis compared with Neisseria gonorrhoeae single infections does not lead to more symptoms
  1. Helke A van Dessel1,
  2. Jeanne A M C Dirks1,
  3. Inge H M van Loo1,
  4. Brian M J W van der Veer1,
  5. Christian J P A Hoebe1,2,
  6. Nicole H T M Dukers-Muijrers2,3,
  7. Paul H M Savelkoul1,
  8. Petra Wolffs1
  1. 1 Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center+, Maastricht, Netherlands
  2. 2 Living Lab Public Health Mosa, Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Heerlen, Netherlands
  3. 3 Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
  1. Correspondence to Dr Jeanne A M C Dirks, Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center+, Maastricht 6229, Netherlands; jamc.dirks{at}

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Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) coinfections are commonly reported; in high-risk groups up to 40% of those infected with NG are also infected with CT.1 While coinfections might happen accidentally, it has been mathematically proven that it occurs much more frequently than can be expected from random chance alone.2 However, little is known about the effect of coinfections on pathogenesis, bacterial load, transmission and disease severity. Prior studies in this field are scarce and with contradictory results.1 To address this knowledge gap we looked at the effect of NG/CT coinfections on the NG bacterial load, and how coinfections with CT influence symptom severity of NG infections.

To test this, we assessed the bacterial load and symptoms in all NG-positive samples of patients visiting the South Limburg STI clinic in the Netherlands between January 2012 and January 2022. These 3226 NG-positive samples consisted of 1175 anorectal swabs (88% male), 1014 oropharyngeal swabs (82% male), 688 male urine and 349 female vaginal swabs (table 1). CT coinfections occurred in 16.8% (table 1).

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Table 1

Bacterial NG load in NG+/CT- samples (n=2683) and …

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  • HAvD and JAMCD are joint first authors.

  • Handling editor Anna Maria Geretti

  • Contributors JAMCD, HAvD and BMJWvdV carried out the experiments. CJPAH and NHTMD-M provided the samples. HAvD and JAMCD wrote the manuscript with support from NHTMD-M, CJPAH, IHMvL and PW. IHMvL, PW, CJPAH and PHMS conceived and supervised the project.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.