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Prevalence and Correlates of Rectal Chlamydia and Gonorrhea Among Female Clients at Sexually Transmitted Disease Clinics

Javanbakht, Marjan PhD*; Gorbach, Pamina DrPH*; Stirland, Ali MBChB; Chien, Michael MPH; Kerndt, Peter MD; Guerry, Sarah MD

doi: 10.1097/OLQ.0b013e31826ae9a2
Original Study

Background The prevalence and correlates of rectal sexually transmitted infections are well described among men who report receptive anal intercourse (AI); however, little is known about the epidemiology of rectal sexually transmitted infections among women.

Methods We conducted a cross-sectional study of women attending public sexually transmitted disease clinics in Los Angeles County, California. Women were eligible for inclusion in this study if they reported AI in the previous 90 days, were tested for rectal chlamydia and gonorrhea, and were seen between January 2008 and December 2010.

Results Among the 2084 clinic visits by women in this analysis, chlamydia and gonorrhea percent positivity by anatomic site was 12% (n = 144) for urogenital chlamydia, 14.6% (n = 171) for rectal chlamydia, 3.3% (n = 66) for urogenital gonorrhea, and 3.0% (n = 60) for rectal gonorrhea, with 25% of chlamydia cases and 19% of gonorrhea cases having rectal-only infections. Among women 25 years or younger, rectal infections were higher in visits in which women reported sex with an injection drug user (46.5% vs. 15.5%; P < 0.01) or sex with a HIV–positive partner (66.7% vs. 15.8%; P = 0.02). Among women older than 25 years, rectal infections were higher in visits where women reported substance use (10.6% vs. 5.8%; P ≤ 0.01). In multivariable models controlling for age and the presence of a urogenital infection, these associations remained.

Conclusions Chlamydia and gonorrhea positivity was high among women reporting AI, and a large proportion of these cases would be missed in the absence of rectal testing. The high-risk behaviors of women with rectal infections highlight the need for rectal screening recommendations.

A study of women reporting anal intercourse showed high positivity for chlamydia and gonorrhea, of which a large proportion would be missed in the absence of rectal testing.

From the *Department of Epidemiology, University of California, Los Angeles; and †Division of HIV and Sexually Transmitted Disease Programs, Los Angeles County Department of Public Health, Los Angeles, CA

Supported by funds from the California HIV/AIDS Research Grants Program Office of the University of California, grant number ID09-LA-012.

The authors have no conflicts of interest to declare.

Correspondence: Marjan Javanbakht, PhD, Department of Epidemiology, University of California, Los Angeles, Box 951772, Los Angeles, CA 90095-1772. E-mail:

Received for publication February 27, 2012, and accepted July 20, 2012.

© Copyright 2012 American Sexually Transmitted Diseases Association