Prevalence, risk factors, and comparative diagnostic performance of cryptic plasmid and MOMP-based real-time PCR assays for genital Chlamydia trachomatis infection among women of reproductive age in the West Region of Cameroon: a cross-sectional study

Chlamydia trachomatis ( C. trachomatis ) is a leading cause of sexually transmitted infections (STIs) in resource-limited settings. In low-income contexts such as Cameroon, the epidemiology of this bacterium remains poorly documented. This study aimed to determine the prevalence and risk factors of C. trachomatis infection among women of reproductive age in the West Region of Cameroon, and to assess the analytical performance and concordance of cryptic plasmid and major outer membrane protein (MOMP)-based real-time PCR (R-T PCR) assays. A cross-sectional study was conducted among 570 women of reproductive age presenting at four selected health facilities in the West Region of Cameroon. Endocervical swabs were collected and analyzed using R-T PCR targeting the MOMP and cryptic plasmid genes to detect C. trachomatis DNA. Socio-demographic, behavioral, and clinical data were recorded using a structured questionnaire. Statistical analyses were performed using SPSS version 24. Multivariable logistic regression was used to identify factors associated with C. trachomatis infection. Diagnostic performance of MOMP and cryptic plasmid R-T PCR was evaluated using Cohen’s kappa statistic and McNemar’s test, with ompA R-T PCR assay, used as the comparator. The prevalence of C. trachomatis infection was 12.98%. Infection was associated with secondary education level (aOR = 7.39, [95% CI]: 2.24–24.41), Bantu ethnicity (aOR = 6.52, [95% CI]: 2.35–18.11), being a secondary school student (aOR = 3.04, [95% CI]: 1.24–7.46), lack of knowledge of transmission routes (aOR = 5.91, [95% CI]: 2.16–16.12), postcoital pain (aOR = 14.86, [95% CI]: 4.12–55.10) and history of miscarriage (aOR = 2.40, [95% CI]: 0.94–6.08). Study shows that genital Chlamydia trachomatis infection was identified among women of reproductive age in the West Region of Cameroon and was associated with education level, ethnicity, occupation, limited knowledge of transmission routes, postcoital pain, and history of miscarriage. Cryptic plasmid–based R-T PCR showed acceptable diagnostic performance in this setting. These findings support strengthening sexual health education and considering the integration of C. trachomatis testing into reproductive health services in similar contexts.