Participation, retention, and associated factors of women in a prospective multicenter study on Chlamydia trachomatis infections (FemCure)

Dukers-Muijrers, Nicole H. T. M.; Heijman, Titia; Götz, Hannelore M; Zaandam, Patricia; Wijers, Juliën; Leenen, Jeanine; Liere, Geneviève Van; Heil, Jeanne; Brinkhues, Stephanie; Wielemaker, Astrid; Loeff, Maarten F. Schim van der; Wolffs, Petra; Bruisten, Sylvia M.; Steenbakkers, Mieke; Hogewoning, Arjan; Vries, Henry J C de; Hoebe, Christian J. P. A.

doi:10.1371/journal.pone.0230413

Cited by 6 publications

(14 citation statements)

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“…Findings in mice, in which pharyngeal CT may pass the gastrointestinal tract to the rectal site, are not evidenced by human data. Prospective epidemiological studies in women and MSM did not show an independent association between pharyngeal CT and a subsequent rectal CT [25,32,[114][115][116][117].…”

Section: Impact Of Missed Ct Estimates On Sti Clinical Populations In...mentioning

confidence: 82%

Controversies and evidence on Chlamydia testing and treatment in asymptomatic women and men who have sex with men: a narrative review

et al. 2022

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Background Chlamydia trachomatis (CT) is the most common bacterial sexually transmitted infection (STI) worldwide. CT is mainly asymptomatic. Test-and-treat strategies are widely implemented to prevent transmission and complications. Strategies are not without controversy in asymptomatic women and men who have sex with men (MSM). Concerns are emerging to test and treat asymptomatic persons for urogenital CT (‘Controversy 1’) and pharyngeal or rectal CT (‘Controversy 2’), whereby testing symptomatic persons is not under debate. Opposed views in CT treatment involve using azithromycin versus doxycycline (‘Controversy 3’). The objective of this review is to provide coverage of these public health and clinical controversies by reviewing the current scientific evidence. Methods A literature search was performed using PubMed for relevant publications between 2018 and September 2021, and iterative retrieval of additional relevant publications. Results Controversy 1. In women, the majority of asymptomatic CT are at the urogenital site, and detections mostly include viable CT. CT easily transmits to a partner and potentially also between the vaginal and rectal areas; the clinical impact of urogenital CT is established, although risks for adverse outcomes are uncertain. Wide-scale testing in asymptomatic women has not resulted in reduced prevalence. In MSM, evidence for the clinical impact of asymptomatic urogenital CT is lacking. Controversy 2. Rectal CT is common in women diagnosed with urogenital CT, but the clinical impact of asymptomatic rectal CT is uncertain. In MSM, rectal CT is common, and most CT infections are at the rectal site, yet the risk of longer term complications is unknown. In both sexes, pharyngeal CT is uncommon and has no documented clinical impact. Controversy 3. In the treatment of rectal CT, doxycycline has superior effectiveness to azithromycin. Evidence has also accumulated on the harms of test-and-treat strategies. Conclusions Current practices vary widely, from widescale test-and-treat approaches to more individual patient- and partner-level case management. Choosing which asymptomatic people to test at what anatomic site, and whether to test or not, requires an urgent (re-)definition of the goals of testing and treating asymptomatic persons. Treatment guidelines are shifting toward universal doxycycline use, and clinical practice now faces the challenge of implementation.

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Section: Impact Of Missed Ct Estimates On Sti Clinical Populations In...mentioning

confidence: 82%

Controversies and evidence on Chlamydia testing and treatment in asymptomatic women and men who have sex with men: a narrative review

et al. 2022

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“…Finally, participants originated from STI clinic practice and likely are not fully representative for the general population 20. Compared with all CT diagnosed STI clinic women, in FemCure, women with either high or low educational level (compare to middle), women without a history of STI and non-Western migrant women were under-represented 21…”

Section: Discussionmentioning

confidence: 99%

“…A prospective multicentre cohort study, FemCure 20 21. We analysed data collected between week 4 and 12 after treatment (figure 1).…”

Section: Methodsmentioning

confidence: 99%

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Incident urogenital and anorectal Chlamydia trachomatis in women: the role of sexual exposure and autoinoculation: a multicentre observational study (FemCure)

et al. 2022

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BackgroundAnorectal 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.MethodsProspective 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.ResultsWe 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).ConclusionsAfter 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.

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“…In the FemCure study, women with high education, women without a history of STI and non-Western migrant women were under-represented compared with all STI clinic women with CT infection. 26 Also, STI clinic populations may not represent the general population.…”

Section: Epidemiologymentioning

confidence: 99%

Oropharyngeal Chlamydia trachomatis in women; spontaneous clearance and cure after treatment (FemCure)

et al. 2020

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ObjectivesWomen attending STI clinics are not routinely tested for oropharyngeal Chlamydia trachomatis (CT) infections. We aimed to assess spontaneous clearance of oropharyngeal CT and cure after antibiotic treatment in women.MethodsWomen with vaginal or rectal CT (n=560) were recruited at STI clinics in 2016–2017, as part of the FemCure study (prospective cohort study). We included participants’ data from week −1, that is, the diagnosis at initial visit, when clinics applied selective oropharyngeal testing. At week −1, a total of 241 women were oropharyngeally tested (30 positive) and 319 were untested. All FemCure participants provided nurse-collected oropharyngeal samples at study enrolment, that is, week 0, just prior to treatment (n=560), and after treatment at weeks 4 (n=449), 8 (n=433) and 12 (n=427). Samples were tested by nucleic acid amplification test, and at week 0 also by viability testing by viability PCR. Proportions of oropharyngeal CT test results were presented to represent spontaneous clearance and cure.ResultsOf 30 women diagnosed with oropharyngeal CT at week −1, fifteen (50%) were negative at week 0 after a median of 9 days, that is, ‘spontaneous clearance’. At week 0, a total of 560 participants were tested, and 46 (8.8%) were oropharyngeal CT positive; 12 of them (26.1%) had viable CT. Of the 46 positive, 36 women had an oropharyngeal test after treatment; 97.2% (35/36) were negative at week 4, that is, ‘cure’. Of all women with follow-up visits, the proportion of oropharyngeal CT positive was between 0.5% and 1.6% between weeks 4 and 12. Of those not tested at week −1 (n=319), 8.5% (n=27) were oropharyngeal positive at week 0.ConclusionsThe clinical importance of oropharyngeal CT in women is debated. We demonstrated that spontaneous clearance of oropharyngeal CT among women is common; of those who did not clear for CT, three-quarters had non-viable CT. After regular treatment with azithromycin or doxycycline, cure rate (97%) of oropharyngeal CT is excellent.Trial registration numberNCT02694497.

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Participation, retention, and associated factors of women in a prospective multicenter study on Chlamydia trachomatis infections (FemCure)

Cited by 6 publications

References 34 publications

Controversies and evidence on Chlamydia testing and treatment in asymptomatic women and men who have sex with men: a narrative review

Controversies and evidence on Chlamydia testing and treatment in asymptomatic women and men who have sex with men: a narrative review

Incident urogenital and anorectal Chlamydia trachomatis in women: the role of sexual exposure and autoinoculation: a multicentre observational study (FemCure)

Oropharyngeal Chlamydia trachomatis in women; spontaneous clearance and cure after treatment (FemCure)

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