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Determinants associated with viable genital or rectal Chlamydia trachomatis bacterial load (FemCure)
  1. Kevin J H Janssen1,
  2. Petra F G Wolffs1,
  3. Christian J P A Hoebe1,2,3,
  4. Titia Heijman4,
  5. Hannelore M Götz5,6,7,
  6. Sylvia M Bruisten4,8,
  7. Maarten Schim van der Loeff4,9,
  8. Henry J de Vries4,6,8,
  9. Nicole H T M Dukers-Muijrers1,2,9
  1. 1Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
  2. 2Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, Heerlen, Limburg, The Netherlands
  3. 3Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
  4. 4Department of Infectious Diseases, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands
  5. 5Department of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond (GGD Rotterdam), Rotterdam, The Netherlands
  6. 6National Institute of Public Health and the Environment (RIVM), Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, Bilthoven, The Netherlands
  7. 7Department of Public Health, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
  8. 8Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam Institute for Infection and Immunity (AII), location Academic Medical Centre, Amsterdam, The Netherlands
  9. 9Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
  1. Correspondence to Dr Nicole H T M Dukers-Muijrers, Health Promotion, Maastricht University Faculty of Health Medicine and Life Sciences, Maastricht 6400AA, The Netherlands; nicole.dukers{at}


Background Chlamydia trachomatis (CT) is routinely diagnosed by nucleic acid amplification tests (NAATs), which are unable to distinguish between nucleic acids from viable and non-viable CT organisms.

Objectives We applied our recently developed sensitive PCR (viability PCR) technique to measure viable bacterial CT load and explore associated determinants in 524 women attending Dutch sexual health centres (STI clinics), and who had genital or rectal CT.

Methods We included women participating in the FemCure study (Netherlands, 2016–2017). At the enrolment visit (pre-treatment), 524 were NAAT positive (n=411 had genital and rectal CT, n=88 had genital CT only and n=25 had rectal CT only). We assessed viable rectal and viable genital load using V-PCR. We presented mean load (range 0 (non-viable) to 6.5 log10 CT/mL) and explored potential associations with urogenital symptoms (coital lower abdominal pain, coital blood loss, intermenstrual bleeding, altered vaginal discharge, painful or frequent micturition), rectal symptoms (discharge, pain, blood loss), other anatomical site infection and sociodemographics using multivariable regression analyses.

Results In genital (n=499) CT NAAT-positive women, the mean viable load was 3.5 log10 CT/mL (SD 1.6). Genital viable load was independently associated with urogenital symptoms—especially altered vaginal discharge (Beta=0.35, p=0.012) and with concurrent rectal CT (aBeta=1.79; p<0.001). Urogenital symptoms were reported by 50.3% of women; their mean genital viable load was 3.6 log10 CT/mL (vs 3.3 in women without symptoms). Of 436 rectal CT NAAT-positive women, the mean rectal viable load was 2.2 log10 CT/mL (SD 2.0); rectal symptoms were reported by 2.5% (n=11) and not associated with rectal viable load.

Conclusion Among women diagnosed with CT in an outpatient clinical setting, viable genital CT load was higher in those reporting urogenital symptoms, but the difference was small. Viable genital load was substantially higher when women also had a concurrent rectal CT.

Trial registration number NCT02694497.

  • Chlamydia trachomatis
  • women
  • anogenital conditions
  • bacterial infection

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  • Handling editor Jane S Hocking

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  • Contributors KJHJ and NHTMD-M drafted the paper. NHTMD-M coordinated the study, performed the statistical analyses, wrote the final draft and supervised the study. NHTMD-M, CJPAH and PFGW designed the study. PFGW and SMB coordinated laboratory data collection and testing (study). All authors critically edited the manuscript and approved the final manuscript.

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

  • Disclaimer The funding sources had no role in the writing or publication of this paper.

  • 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 Ethical Review Committee (IRB) from the Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands (NL51358.068.15/METC153020, 20-01-2016). This study was monitored by the Clinical Trial Centre Maastricht (Maastricht University).

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

  • Data availability statement Data from the FemCure study are available on reasonable request.

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