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Background: Sexually transmitted chlamydia (CT) and gonorrhea (GC) infections may occur at the cervix/vagina, urethra, or rectum. Though routine screening of the anorectal site in men who have sex with men reporting receptive rectal intercourse (RI) is recommended, screening guidelines have largely focused on genitourinary screening in women. We sought to examine the extent to which rectal GC and CT testing were performed, and quantify infections detected among women attending a network of US STD clinics.
Methods: We reviewed data on female patients reporting RI in the preceding 3 months during visits to 18 STD clinics participating in the STD surveillance Network between January-December 2015. Outcomes of interest were 1) GC and CT rectal test positivity among women attending facilities that screened ≥82% (based on median split) of women reporting RI (9 clinics), compared to facilities that screened <82% (9 clinics), and 2) proportion of rectal infections that would have remained undetected with urogenital screening alone.
Results: Overall, 71.5% (1587/2219) of the visits during which women reported RI included testing for rectal GC and CT. Rectal test positivity for either GC or CT was 10.3% (163/1587). Positivity was 9.5% (111/1171) in high screening facilities and 12.5% (52/416) in low screening facilities (p=0.08). Among 156 of the 163 visits of rectal CT or GC infected women who were also tested at the urogenital site, 23.1% (n=36) had rectal-only CT infections, and 6.4% (n=10) had rectal-only GC infections.
Conclusions: STD clinics with lower rectal CT/GC screening rates may be targeting women with higher risk for infection. However, similar and substantial rectal positivity in clinics with near-universal screening, and the fact that 29% of rectal CT/GC infections would have been missed if only urogenital testing were performed, underscores the importance of screening females reporting RI at the rectal site.