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Incident urogenital and anorectal Chlamydia trachomatis in women: the role of sexual exposure and autoinoculation: a multicentre observational study (FemCure)
  1. Nicole H T M Dukers-Muijrers1,2,
  2. Maarten Schim van der Loeff3,4,
  3. Petra Wolffs5,
  4. Sylvia M Bruisten3,6,
  5. Hannelore M Götz7,8,9,
  6. Titia Heijman3,
  7. Helene Zondag3,
  8. Mayk Lucchesi5,
  9. Henry De Vries3,10,
  10. Christian J P A Hoebe2,5,11
  1. 1Department of Health Promotion, CAPHRI, University of Maastricht, Maastricht, The Netherlands
  2. 2Department of Sexual Health, Infectious Diseases, and Environment, Public Health Service South Limburg, Heerlen, The Netherlands
  3. 3Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
  4. 4Department of Internal Medicine, Amsterdam Infection & Immunity Institute (AII), Amsterdam University Medical Center (UMC), Amsterdam, The Netherlands
  5. 5Department of Medical Microbiology, CAPHRI, Maastricht University Medical Center, Maastricht, The Netherlands
  6. 6Department of Medical Microbiology, Amsterdam Infection & Immunity Institute (AII), Amsterdam University Medical Center (UMC), Amsterdam, Netherlands
  7. 7Department of Infectious Disease Control, Rotterdam Rijnmond Public Health Service, Rotterdam, The Netherlands
  8. 8Center for Infectious Diseases Control, Rijksinstituut voor Volksgezondheid en Milieu, Bilthoven, The Netherlands
  9. 9Department of Public Health, Erasmus MC—University Medical Center Rotterdam, Rotterdam, Netherlands
  10. 10Department of Dermatology, Amsterdam Infection & Immunity Institute (AII), Amsterdam University Medical Center (UMC), Amsterdam, The Netherlands
  11. 11Department of Social Medicine, CAPHRI, Maastricht University Medical Centre, Maastricht, Netherlands
  1. Correspondence to Dr Nicole H T M Dukers-Muijrers, Health Promotion (CAPHRI, University Maastricht); Infectious Diseases (Public Health Service South Limburg), Heerlen, Netherlands; nicole.dukers{at}ggdzl.nl

Abstract

Background Anorectal infections with Chlamydia trachomatis (CT) are common in women visiting STI outpatient clinics. We here evaluated the risk posed by sexual exposure and by alternate anatomical site infection for incident anorectal and urogenital CT.

Methods Prospective multicentre cohort study, FemCure. Participants were treated for CT, and after 4, 6, 8, 10 and 12 weeks, they self-collected anorectal and urogenital samples (swabs) for CT-DNA testing. We calculated the proportion with incident CT, that is, CT incidence (at weeks 6–12) by 2-week time-periods. Compared with no exposure (A), we estimated the risk of incident CT for (B) sexual exposure, (C) alternate site anatomic site infection and (D) both, adjusted for confounders and expressed as adjusted ORs with 95% CIs.

Results We analysed data of 385 participants contributing 1540 2-week periods. The anorectal CT incidence was 2.9% (39/1343) (95 CI 1.8 to 3.6); 1.3% (A), 1.3% (B), 27.8% (C) and 36.7% (D). The ORs were: 0.91 (95% CI 0.32 to 2.60) (B), 26.0 (95% CI 7.16 to 94.34) (C), 44.26 (95% CI 14.38 to 136.21) (D).

The urogenital CT incidence was 3.3% (47/1428) (95% CI 2.4 to 4.4); 0.7% (A), 1.9% (B), 13.9% (C) and 25.4% (D). The ORs were: 2.73 (95% CI 0.87 to 8.61) (B), 21.77 (95% CI 6.70 to 70 71) (C) and 49.66 (95% CI 15.37 to 160.41) (D).

Conclusions After initial treatment, an alternate anatomical site CT infection increased the risk for an incident CT in women, especially when also sex was reported. This may suggest a key role for autoinoculation in the re-establishment or persistence of urogenital and anorectal chlamydia infections.

  • epidemiology
  • azithromycin
  • chlamydia infections
  • women
  • risk factors

Data availability statement

Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Coded data are available to interested researchers on reasonable request. Please send an email to helen.sijstermans@ggdzl.nl.

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Data availability statement

Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Coded data are available to interested researchers on reasonable request. Please send an email to helen.sijstermans@ggdzl.nl.

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Footnotes

  • Handling editor Anna Maria Geretti

  • Twitter @GotzHannelore

  • Presented at This study has in part been presented (plenary; oral) at the STI & HIV 2021 World Congress (ISSTDR), July 2021, Amsterdam

    Abstract published. Dukers-Muijrers NPL08. Chlamydia control in women and men who have sex with men: controversies and evidence on (extra)genital testing and treatment. Sexually Transmitted Infections 2021;97:A2. Supplement http://dx.doi.org/10.1136/sextrans-2021-sti.8

  • Contributors NHTMD-M wrote the report and performed the statistical analyses. NHTMD-M and MSvdL designed the statistical analysis. PW, ML and SMB set up and performed the laboratory analyses. NHTMD-M, CJPAH, HMG and HDV supervised the study. All authors reviewed the results, provided guidance on the method, and drafted, reviewed and provided critical feedback on the report. NHTM-D is guarantor of the study

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

  • Competing interests None declared.

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

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