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Background  Trachoma, caused by ocular  Chlamydia trachomatis  infection, is the leading infectious cause of blindess, but its prevalence is now falling in many countries. As the prevalence falls, an increasing proportion of individuals with clinical signs of follicular trachoma (TF) is not infected with  C. trachomatis . A recent study in Tanzania suggested that other bacteria may play a role in the persistence of these clinical signs.    Methodology/Principal Findings  We examined associations between clinical signs of TF and ocular colonization with four pathogens commonly found in the nasopharnyx, three years after the initiation of mass azithromycin distribution. Children aged 0 to 5 years were randomly selected from 16 Gambian communitites. Both eyes of each child were examined and graded for trachoma according to the World Health Organization (WHO) simplified system. Two swabs were taken from the right eye: one swab was processed for polymerase chain reaction (PCR) using the Amplicor test for detection of  C. trachomatis  DNA and the second swab was processed by routine bacteriology to assay for the presence of viable  Streptococcus pneumoniae ,  Haemophilus influenzae ,  Staphylococcus aureus  and  Moraxella catarrhalis . Prevalence of TF was 6.2% (96/1538) while prevalence of ocular  C. trachomatis  infection was 1.0% (16/1538). After adjustment, increased odds of TF were observed in the presence of  C. trachomatis  (OR = 10.4, 95%CI 1.32–81.2, p = 0.03),  S. pneumoniae  (OR = 2.14, 95%CI 1.03–4.44, p = 0.04) and  H. influenzae  (OR = 4.72, 95% CI 1.53–14.5, p = 0.01).    Conclusions/Significance  Clinical signs of TF can persist in communities even when ocular  C. trachomatis  infection has been controlled through mass azithromycin distribution. In these settings, TF may be associated with ocular colonization with bacteria commonly carried in the nasopharnyx. This may affect the interpretation of impact surveys and the determinations of thresholds for discontinuing mass drug administration.

Association between Ocular Bacterial Carriage and Follicular Trachoma Following Mass Azithromycin Distribution in The Gambia