B7f Prevalence of Rectal Chlamydia and Gonorrhea Among High-Risk Female Youths: An Evaluation of Multi-Site Testing at Juvenile Detention Facilities in Los Angeles

Tuesday, March 9, 2010: 4:30 PM
International Ballroom A/B/C/D (M2) (Omni Hotel)
Binh Goldstein, PhD, Sarah Guerry, MD, Melina Boudov, MA, Ali Stirland, MBChB, MSc, Getahun Aynalem, MD, MPH, Peter Kerndt, MD, MPH and Harlan Rotblatt, BA, Sexually Transmitted Disease Program, Los Angeles County Department of Public Health, Los Angeles, CA

Background: Routine urogenital chlamydia (CT) and gonorrhea (GC) screening is recommended for all sexually active young women. The availability of nucleic acid amplification tests (NAATs) for rectal CT/GC and recommendations for rectal screening in men who have sex with men raise the question of whether women should also be screened.

Objectives: This study evaluates CT/GC multi-site screening in young women admitted to juvenile detention facilities. Our goal is to (1) compare the prevalence of CT/GC in rectal, cervical, and urine specimens, and (2) determine the proportion of rectal-only positive CT/GC specimens.

Methods: Females were screened with CT/GC NAATs on urine at intake and rectal and cervical swabs at screening physicals. Testing data from 2008 (January-December) were examined. Females with rectal and cervical specimens collected within fourteen days of the urine specimen were included in the analysis. Cases treated between urine and rectal/cervical specimen collection were excluded.

Results: Of the 1,294 eligible females with urine, cervical, and rectal CT tests, the overall prevalence was 19.8% (n=256). The prevalence of rectal CT was 16.9%, cervical CT was 16.1%, and urine CT was 15.5%. Thirteen percent (33/256) of CT positives were rectal-only. Of the 1,323 eligible females with urine, cervical, and rectal GC tests, the overall prevalence was 5.2% (n=69). The prevalence of rectal GC was 3.8%, cervical GC was 4.1%, and urine GC was 4.2%. Ten percent (7/69) of GC positives were rectal-only.

Conclusions: While the majority of females with rectal positive specimens had concomitant results with urogenital sites, over 10% of CT/GC positives would have been missed in the absence of rectal screening.

Implications for Programs, Policy, and/or Research: Further research is needed to determine the risk factors for rectal CT/GC. More importantly, a better understanding of the clinical and public health significance of rectal-only positive specimens in women is needed.

See more of: STIs in Non-Genital Sites
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