title: Female users of internet-based screening for rectal STIs: descriptive statistics and correlates of positivity.
abstract: BACKGROUND
  Internet-based screening for vaginal sexually transmitted infections (STI) has been shown to reach high-risk populations. Published studies of internet-based screening for rectal STIs in women are needed. Our objectives were to describe the female users of a rectal internet-based screening intervention and assess what factors correlated with rectal positivity for STIs.
  
  
  METHODS
  The website http://www.iwantthekit.org offers free STI testing via home self-sampling kits. Women could order vaginal and rectal kits, both containing questionnaires. Rectal and vaginal swabs were tested for Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis using nucleic acid amplification tests. Data were analysed from 205 rectal kits from January 2009 through February 2011. Self-reported characteristics of participants were examined, and correlates of rectal STI positivity were analysed.
  
  
  RESULTS
  Of the 205 rectal samples returned and eligible for testing, 38 (18.5%) were positive for at least one STI. The women were young (mean age 25.8 years), mostly African-American (50.0%), and only 14.0% always used condoms. After adjusting for age and race, Black race (AOR=3.06) and vaginal STI positivity (AOR=40.6) were significantly correlated with rectal STI positivity. Of women testing positive for rectal STIs who also submitted vaginal swabs, 29.4% were negative in the vaginal sample.
  
  
  CONCLUSIONS
  Internet-based rectal screening can reach populations that appear to be at high risk for rectal STIs (18.5% prevalence) and led to the diagnosis of STIs in women who would not have been diagnosed vaginally. Black race and vaginal STI positivity were highly correlated with rectal STI positivity.
authors.affiliation: Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Ladd
authors.affiliation: Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Yu-Hsiang
authors.initials: YH
authors.lastname: Hsieh
authors.affiliation: Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Mathilda
authors.initials: M
authors.lastname: Barnes
authors.affiliation: Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Quinn
authors.affiliation: Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Jett-Goheen
authors.affiliation: Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Charlotte A
authors.initials: CA
authors.lastname: Gaydos
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000453:epidemiology; D017280:Condoms / Q000706:statistics & numerical data*; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D020407:Internet; D008403:Mass Screening; D012002:Rectal Diseases / Q000175:diagnosis* / Q000453:epidemiology; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000175:diagnosis / Q000453:epidemiology; D014245:Trichomonas Infections / Q000175:diagnosis* / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
keywords: ANOGENITAL CONDITIONS; CHLAMYDIA TRACHOMATIS; NEISSERIA GONORRHOEA; SCREENING; TRICHOMONAS