RT Journal Article SR Electronic T1 Incident urogenital and anorectal Chlamydia trachomatis in women: the role of sexual exposure and autoinoculation: a multicentre observational study (FemCure) JF Sexually Transmitted Infections JO Sex Transm Infect FD BMJ Publishing Group Ltd SP 427 OP 437 DO 10.1136/sextrans-2021-055032 VO 98 IS 6 A1 Nicole H T M Dukers-Muijrers A1 Maarten Schim van der Loeff A1 Petra Wolffs A1 Sylvia M Bruisten A1 Hannelore M Götz A1 Titia Heijman A1 Helene Zondag A1 Mayk Lucchesi A1 Henry De Vries A1 Christian J P A Hoebe YR 2022 UL http://sti.bmj.com/content/98/6/427.abstract 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.