PT  - JOURNAL ARTICLE
AU  - Nicole H T M Dukers-Muijrers
AU  - Maarten Schim van der Loeff
AU  - Petra Wolffs
AU  - Sylvia M Bruisten
AU  - Hannelore M Götz
AU  - Titia Heijman
AU  - Helene Zondag
AU  - Mayk Lucchesi
AU  - Henry De Vries
AU  - Christian J P A Hoebe
TI  - Incident urogenital and anorectal <em>Chlamydia trachomatis</em> in women: the role of sexual exposure and autoinoculation: a multicentre observational study (FemCure)
AID  - 10.1136/sextrans-2021-055032
DP  - 2022 Sep 01
TA  - Sexually Transmitted Infections
PG  - 427--437
VI  - 98
IP  - 6
4099  - http://sti.bmj.com/content/98/6/427.short
4100  - http://sti.bmj.com/content/98/6/427.full
SO  - Sex Transm Infect2022 Sep 01; 98
AB  - 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.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.