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Background  Performing a test of cure (TOC) could demonstrate success or failure of antimicrobial treatment of  Chlamydia trachomatis  infection, but recommendations for the timing of a TOC using nucleic acid amplification tests (NAATs) are inconsistent. We assessed time to clearance of  C. trachomatis  after treatment, using modern RNA- and DNA-based NAATs.    Methods  We analysed data from patients with a  C. trachomatis  and  Neisseria gonorrhoeae  coinfection who visited the STI Clinic Amsterdam, The Netherlands, from March through October 2014. After treatment with ceftriaxone plus either azithromycin or doxycycline, patients self-collected anal, vaginal or urine samples during 28 consecutive days. Samples were analysed using an RNA-based NAAT (Aptima Combo 2) and a DNA-based NAAT (Cobas 4800 CT/NG). We defined clearance as three consecutive negative results, and defined “blips” as isolated positive results following clearance.    Results  We included 23 patients with  C. trachomatis  and  N. gonorrhoeae  coinfection. All patients cleared  C. trachomatis  during follow-up, and we observed no reinfections. The median time to clearance (range) was 7 days (1–13) for RNA, and 6 days (1–15) for DNA. Ninety-five per cent of patients cleared RNA at day 13, and DNA at day 14. The risk of a blip after clearance was 4.4 % (RNA) and 1.7 % (DNA).    Conclusions  If a TOC for anogenital chlamydia is indicated, we recommend performing it at least 14 days after initiation of treatment, when using modern RNA- and DNA-based assays. A positive result shortly after 14 days probably indicates a blip, rather than a treatment failure or a reinfection.

Time to clearance of Chlamydia trachomatis RNA and DNA after treatment in patients coinfected with Neisseria gonorrhoeae – a prospective cohort study