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J Infect Dis. 2019 Mar 12. pii: jiz113. doi: 10.1093/infdis/jiz113. [Epub ahead of print]

Recurrent/intermittent vaginal and rectal chlamydial infection following treatment: a prospective cohort study among female STD clinic patients.

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Department of Epidemiology, University of Washington, Seattle, WA, USA.
Department of Medicine, University of Washington, Seattle, WA, USA.
Department of Global Health, University of Washington, Seattle, WA, USA.
Public Health - Seattle and King County HIV/STD Program, Seattle, WA, USA.



Rectal Chlamydia trachomatis (CT) is common among clinic-attending women, but little is known about clearance and health implications of rectal CT.


At the municipal STD clinic in Seattle, WA 2017-2018, we enrolled women at high risk for urogenital CT into an 8-week prospective study. Women received standard CT treatment at enrollment. Women self-collected daily rectal and vaginal specimens for nucleic acid amplification testing (NAAT) and completed weekly sexual exposure diaries. We performed CT culture on the enrollment rectal specimen.


We enrolled 50 women; 13 (26%) tested positive for vaginal (N=11) and/or rectal CT (N=11). Sixty-percent of women with rectal CT per NAAT were also culture-positive. Median time to CT clearance after azithromycin treatment was 8.0 days for vaginal CT and 7.0 days for rectal CT. Eight women with rectal CT at enrollment had at least one rectal CT-positive NAAT after clearance of the initial infection; none reported anal sex.


Most NAAT-positive rectal infections were culture-positive, suggesting active infection. Time to NAAT clearance of rectal and genital tract CT was similar, and intermittent rectal CT positivity was common in the absence of anal sexual exposure. The cause of recurrent/intermittent rectal CT and the clinical implications of these infections require further study.


azithromycin; chlamydia; doxycycline; sexually transmitted disease


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