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.