title: Prevalence and correlates of rectal Chlamydia and gonorrhea among female clients at sexually transmitted disease clinics.
abstract: 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.
authors.affiliation: Department of Epidemiology, University of California, Los Angeles 90095, CA. javan@ucla.edu
authors.forename: Marjan
authors.initials: M
authors.lastname: Javanbakht
authors.forename: Pamina
authors.initials: P
authors.lastname: Gorbach
authors.forename: Ali
authors.initials: A
authors.lastname: Stirland
authors.forename: Michael
authors.initials: M
authors.lastname: Chien
authors.forename: Peter
authors.initials: P
authors.lastname: Kerndt
authors.forename: Sarah
authors.initials: S
authors.lastname: Guerry
mesh_terms: D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D003376:Counseling; D003430:Cross-Sectional Studies; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D015141:Los Angeles / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D012002:Rectal Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D012189:Retrospective Studies; D012725:Sexual Behavior; D012747:Sexual Partners