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Use of Chlamydia trachomatis high-resolution typing: an extended case study to distinguish recurrent or persistent infection from new infection
  1. Hannelore M Götz1,2,
  2. Reinier J M Bom3,
  3. Mireille E G Wolfers1,
  4. Johan Fennema4,
  5. Ingrid V F van den Broek5,
  6. Arjen G C L Speksnijder3,
  7. Sylvia M Bruisten3
  1. 1Division of Infectious Disease Control, Rotterdam-Rijnmond Public Health Service, Rotterdam, The Netherlands
  2. 2Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  3. 3Public Health Laboratory, Public Health Service of Amsterdam, Amsterdam, The Netherlands
  4. 4Department of Research, Online Research and Prevention Unit, Cluster of Infectious Diseases, Amsterdam Health Service, Amsterdam, The Netherlands
  5. 5Epidemiology & Surveillance Unit, Centre for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
  1. Correspondence to Dr Hannelore M Götz, Division of Infectious Disease Control, Rotterdam-Rijnmond Public Health Service, PO Box 70032, Rotterdam 3000 LP, The Netherlands; hm.gotz{at}


Objectives Repeated infections of Chlamydia trachomatis may be new infections or persistent infections due to treatment failure or due to unresolved infections in sexual partners. We aimed to establish the value of using high-resolution multilocus sequence typing (CT-MLST) to discriminate repeated C trachomatis infections.

Methods Paired C trachomatis positive samples (baseline (T0) and after 6 months (T1)) were selected from two Dutch screening implementation studies among young heterosexual people. Typing with six CT-MLST loci included the ompA gene. The uniqueness of strains was assessed using 256 reference CT-MLST profiles.

Results In 27 out of 34 paired cases, full sequence types were obtained. A multilocus (13 cases) or single locus variant (4 cases) was seen, indicating 17 new C trachomatis infections at T1. The ompA genovar was identical for 5 of 17 discordant cases. The 10 cases with concordant typing results were categorised as treatment failure (5 cases) versus persistent or recurrent infections (5 cases). Surprisingly, these concordant cases had C trachomatis strains that were either unique or found in small clusters. The median time between T0 and T1 did not differ between the concordant and discordant cases.

Conclusions High-resolution typing was superior in discriminating new infections compared with only using ompA genovar typing. Many cases (37%) showed exactly the same C trachomatis strain after 6 months. CT-MLST is not conclusive in distinguishing recurrent infections from treatment failure.

  • Chlamydia Trachomatis
  • Molecular Typing
  • Epidemiology (Molecular)

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