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Rectal Chlamydia trachomatis and Neisseria gonorrhoeae Infections Among Women Reporting Anal Intercourse

Llata, Eloisa, MD, MPH; Braxton, Jim; Asbel, Lenore, MD; Chow, Joan, PhD; Jenkins, Lindsay; Murphy, Ryan, PhD; Pathela, Preeti, DrPh; Schumacher, Christina, PhD; Torrone, Elizabeth, PhD

doi: 10.1097/AOG.0000000000002804
Infectious Disease: Original Research: PDF Only

OBJECTIVE: To examine the prevalence and treatment of rectal Chlamydia trachomatis and Neisseria gonorrhoeae infections among women reporting receptive anal intercourse in a network of sexually transmitted disease or sexual health clinics and estimate the proportion of missed infections if women were tested at the genital site only.

METHODS: We conducted a cross-sectional analysis of C trachomatis and N gonorrhoeae test results from female patients reporting receptive anal intercourse in the preceding 3 months during visits to 24 sexually transmitted disease clinics from 2015 to 2016. Primary outcomes of interest were 1) anatomic site-specific C trachomatis and N gonorrhoeae testing and positivity among women attending selected U.S. sexually transmitted disease clinics who reported receptive anal intercourse and 2) the proportion of rectal infections that would have remained undetected if only genital sites were tested.

RESULTS: Overall, 7.4% (3,743/50,785) of women reported receptive anal intercourse during the 2 years. Of the 2,818 women tested at both the genital and rectal sites for C trachomatis, 292 women were positive (61 genital only, 60 rectal only, and 171 at both sites). Of the 2,829 women tested at both the genital and rectal sites for N gonorrhoeae, 128 women were positive (31 genital only, 23 rectal only, and 74 at both sites). Among women tested at both anatomic sites, the proportion of missed C trachomatis infections would have been 20.5% and for N gonorrhoeae infections, 18.0%.

CONCLUSION: Genital testing alone misses approximately one fifth of C trachomatis and N gonorrhoeae infections in women reporting receptive anal intercourse in our study population. Missed rectal infections may result in ongoing transmission to other sexual partners and reinfection.

Genital testing alone misses approximately one fifth of Chlamydia trachomatis and Neisseria gonorrhoeae rectal infections in women reporting receptive anal intercourse in our study population.

Centers for Disease Control and Prevention, Division of STD Prevention (NCCHSTP), Surveillance and Data Management Branch, Atlanta, Georgia; the Philadelphia Department of Public Health, Philadelphia, Pennsylvania; the California Department of Public Health–STD Control Branch, Richmond, California; the Multnomah County Health Department, Portland, Oregon; the Los Angeles County Department of Public Health, Los Angeles, California; the New York City Department of Health and Mental Hygiene, New York, New York; and the Johns Hopkins University School of Medicine and Baltimore City Health Department, Baltimore, Maryland.

Corresponding author: Eloisa Llata, MD, MPH, 1600 Clifton Road, MS E-02, Atlanta, GA 30329; email: gge3@cdc.gov.

This research was made possible through Centers for Disease Control and Prevention funding to state health departments to conduct the STD Surveillance Network (SSuN) under Funding Opportunity Announcement PS13-1306.

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented at the 2016 National STD Prevention Conference, September 20–23, 2016, Atlanta, Georgia.

The findings and conclusions in this paper are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

Each author has indicated that he or she has met the journal's requirements for authorship.

Received April 17, 2018

Received in revised form June 08, 2018

Accepted June 14, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.