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Original research
Oropharyngeal Chlamydia trachomatis in women; spontaneous clearance and cure after treatment (FemCure)
  1. Nicole H T M Dukers-Muijrers1,2,
  2. Petra Wolffs3,
  3. Mayk Lucchesi3,
  4. Hannelore M Götz4,5,6,
  5. Henry De Vries7,8,
  6. Maarten Schim van der Loeff7,9,
  7. Sylvia M Bruisten7,8,
  8. Christian J P A Hoebe2,3,10
  1. 1 Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
  2. 2 Department of Sexual Health, Infectious Diseases, and Environmental Health, Public Health Service South Limburg, Heerlen, Limburg, The Netherlands
  3. 3 Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
  4. 4 Department of Public Health, Sexual Health Centre, Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands
  5. 5 Department of Public Health, Erasmus MC—University Medical Center Rotterdam, Rotterdam, The Netherlands
  6. 6 Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
  7. 7 Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
  8. 8 Department of Dermatology, Amsterdam Institute for Infection and Immunity (AI&II), location Academic Medical Centre, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
  9. 9 Department of Internal Medicine, Amsterdam Institute for Infection and Immunity (AI&II), location Academic Medical Centre, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
  10. 10 Department of Social Medicine, University of Maastricht, Maastricht, The Netherlands
  1. Correspondence to Dr Nicole H T M Dukers-Muijrers, Department of Health Promotion, University of Maastricht, CAPHRI, Maastricht, The Netherlands; nicole.dukers{at}


Objectives Women attending STI clinics are not routinely tested for oropharyngeal Chlamydia trachomatis (CT) infections. We aimed to assess spontaneous clearance of oropharyngeal CT and cure after antibiotic treatment in women.

Methods Women with vaginal or rectal CT (n=560) were recruited at STI clinics in 2016–2017, as part of the FemCure study (prospective cohort study). We included participants’ data from week −1, that is, the diagnosis at initial visit, when clinics applied selective oropharyngeal testing. At week −1, a total of 241 women were oropharyngeally tested (30 positive) and 319 were untested. All FemCure participants provided nurse-collected oropharyngeal samples at study enrolment, that is, week 0, just prior to treatment (n=560), and after treatment at weeks 4 (n=449), 8 (n=433) and 12 (n=427). Samples were tested by nucleic acid amplification test, and at week 0 also by viability testing by viability PCR. Proportions of oropharyngeal CT test results were presented to represent spontaneous clearance and cure.

Results Of 30 women diagnosed with oropharyngeal CT at week −1, fifteen (50%) were negative at week 0 after a median of 9 days, that is, ‘spontaneous clearance’. At week 0, a total of 560 participants were tested, and 46 (8.8%) were oropharyngeal CT positive; 12 of them (26.1%) had viable CT. Of the 46 positive, 36 women had an oropharyngeal test after treatment; 97.2% (35/36) were negative at week 4, that is, ‘cure’. Of all women with follow-up visits, the proportion of oropharyngeal CT positive was between 0.5% and 1.6% between weeks 4 and 12. Of those not tested at week −1 (n=319), 8.5% (n=27) were oropharyngeal positive at week 0.

Conclusions The clinical importance of oropharyngeal CT in women is debated. We demonstrated that spontaneous clearance of oropharyngeal CT among women is common; of those who did not clear for CT, three-quarters had non-viable CT. After regular treatment with azithromycin or doxycycline, cure rate (97%) of oropharyngeal CT is excellent.

Trial registration number NCT02694497.

  • Chlamydia trachomatis
  • infection
  • oral sex
  • treatment
  • women

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  • Handling editor Jonathan Ross

  • Contributors NHTMDM coordinated the study, performed the statistical analyses, wrote and drafted the paper. NHTMDM, CJPAH, PW, HMG, SMB, MSvdL and HDV designed the study. ML and PW coordinated the laboratory data collection and testing. All authors were involved in the study design, critically edited the manuscript and approved the final manuscript.

  • Funding This study is funded by a grant from the governmental organisation Netherlands Organization for Health Research and Development (ZonMW Netherlands) (registration numbers 50-53000-98-109 and 52-2008-002).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval All participants provided written informed consent. This study was approved by the Medical Ethics Review Committee from the Maastricht University Medical Center, Maastricht, Netherlands (NL51358.068.15/METC153020, 20-01-2016) and monitored by the Clinical Trial Centre Maastricht.

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

  • Data availability statement Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Please send an email to