{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T06:40:42Z","timestamp":1791614442556,"version":"4.3.4"},"reference-count":30,"publisher":"BMJ","issue":"6","funder":[{"name":"Organization for Health Research and Development","award":["registration number 50-53000-98-109 and 52-2008-00"],"award-info":[{"award-number":["registration number 50-53000-98-109 and 52-2008-00"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Anorectal infections with <jats:italic>Chlamydia trachomatis<\/jats:italic> (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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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\u201312) 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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).<\/jats:p><jats:p>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).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1136\/sextrans-2021-055032","type":"journal-article","created":{"date-parts":[[2022,1,17]],"date-time":"2022-01-17T18:25:28Z","timestamp":1642443928000},"page":"427-437","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Incident urogenital and anorectal <i>Chlamydia trachomatis<\/i> in women: the role of sexual exposure and autoinoculation: a multicentre observational study (FemCure)"],"prefix":"10.1136","volume":"98","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4896-758X","authenticated-orcid":false,"given":"Nicole H T M","family":"Dukers-Muijrers","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4903-7002","authenticated-orcid":false,"given":"Maarten","family":"Schim van der Loeff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petra","family":"Wolffs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4897-4261","authenticated-orcid":false,"given":"Sylvia M","family":"Bruisten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1236-6224","authenticated-orcid":false,"given":"Hannelore M","family":"G\u00f6tz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Titia","family":"Heijman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helene","family":"Zondag","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayk","family":"Lucchesi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry","family":"De Vries","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian J P A","family":"Hoebe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,1,17]]},"reference":[{"key":"2022101108551061000_98.6.427.1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(17)30310-9"},{"key":"2022101108551061000_98.6.427.2","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1093\/infdis\/jiz113","article-title":"Recurrent\/Intermittent vaginal and rectal chlamydial infection following treatment: a prospective cohort study among female sexually transmitted disease clinic patients","volume":"220","author":"Khosropour","year":"2019","journal-title":"J Infect Dis"},{"key":"2022101108551061000_98.6.427.3","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1093\/infdis\/jiz267","article-title":"Viable bacterial load is key to azithromycin treatment failure in rectally Chlamydia trachomatis infected women (FemCure)","volume":"220","author":"Dukers-Muijrers","year":"2019","journal-title":"J Infect Dis"},{"key":"2022101108551061000_98.6.427.4","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2017-053161"},{"key":"2022101108551061000_98.6.427.5","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2018-053950"},{"key":"2022101108551061000_98.6.427.6","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.rr7005a1"},{"key":"2022101108551061000_98.6.427.7","unstructured":"Australian Sexual Health Alliance (ASHA) . Australian STI management guidelines for use in primary care, 2019. Available: http:\/\/www.sti.guidelines.org.au\/sexually-transmissible-infections\/chlamydia#management"},{"key":"2022101108551061000_98.6.427.8","doi-asserted-by":"publisher","DOI":"10.1177\/0956462415618837"},{"key":"2022101108551061000_98.6.427.9","unstructured":"Britsh association for sexual health and HIV (BASHH) . Guidelines Chlamydia update, 2018. Available: https:\/\/www.bashh.org\/guidelines\/"},{"key":"2022101108551061000_98.6.427.10","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1502599"},{"key":"2022101108551061000_98.6.427.11","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2031631"},{"key":"2022101108551061000_98.6.427.12","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1093\/cid\/ciab153","article-title":"Doxycycline versus azithromycin for the treatment of rectal Chlamydia in men who have sex with men: a randomized controlled trial","volume":"73","author":"Dombrowski","year":"2021","journal-title":"Clin Infect Dis"},{"key":"2022101108551061000_98.6.427.13","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciz050"},{"key":"2022101108551061000_98.6.427.14","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cix243"},{"key":"2022101108551061000_98.6.427.15","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0000000000000754"},{"key":"2022101108551061000_98.6.427.16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2016\/5758387","article-title":"Extragenital infections caused by Chlamydia trachomatis and Neisseria gonorrhoeae: a review of the literature","volume":"2016","author":"Chan","year":"2016","journal-title":"Infect Dis Obstet Gynecol"},{"key":"2022101108551061000_98.6.427.17","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(16)30092-5"},{"key":"2022101108551061000_98.6.427.18","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2018-053778"},{"key":"2022101108551061000_98.6.427.19","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciz429"},{"key":"2022101108551061000_98.6.427.20","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-016-1721-x"},{"key":"2022101108551061000_98.6.427.21","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0230413"},{"key":"2022101108551061000_98.6.427.22","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0215606","article-title":"Chlamydia trachomatis bacterial load, estimated by CQ values, in urogenital samples from men and women visiting the general practice, hospital or STI clinic","volume":"14","author":"Wijers","year":"2019","journal-title":"PLoS One"},{"key":"2022101108551061000_98.6.427.23","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0165920"},{"key":"2022101108551061000_98.6.427.24","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1080\/14737159.2018.1498785","article-title":"Review of Chlamydia trachomatis viability methods: assessing the clinical diagnostic impact of NAAT positive results","volume":"18","author":"Janssen","year":"2018","journal-title":"Expert Rev Mol Diagn"},{"key":"2022101108551061000_98.6.427.25","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0053869"},{"key":"2022101108551061000_98.6.427.26","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0185295","article-title":"Monitoring therapy success of urogenital Chlamydia trachomatis infections in women: a prospective observational cohort study","volume":"12","author":"Versteeg","year":"2017","journal-title":"PLoS One"},{"key":"2022101108551061000_98.6.427.27","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1089\/jwh.2014.5018","article-title":"The use of biomarkers of semen exposure in sexual and reproductive health studies","volume":"23","author":"Snead","year":"2014","journal-title":"J Womens Health"},{"key":"2022101108551061000_98.6.427.28","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2016-052786"},{"key":"2022101108551061000_98.6.427.29","doi-asserted-by":"publisher","DOI":"10.1016\/j.jadohealth.2017.07.004"},{"key":"2022101108551061000_98.6.427.30","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2019-054267"}],"container-title":["Sexually Transmitted Infections"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/sextrans-2021-055032","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,11]],"date-time":"2022-10-11T15:58:34Z","timestamp":1665503914000},"score":1,"resource":{"primary":{"URL":"https:\/\/sti.bmj.com\/lookup\/doi\/10.1136\/sextrans-2021-055032"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,17]]},"references-count":30,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,8,22]]},"published-print":{"date-parts":[[2022,9]]}},"alternative-id":["10.1136\/sextrans-2021-055032"],"URL":"https:\/\/doi.org\/10.1136\/sextrans-2021-055032","relation":{},"ISSN":["1368-4973","1472-3263"],"issn-type":[{"value":"1368-4973","type":"print"},{"value":"1472-3263","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,17]]}}}