title: Cross-sectional study of genital, rectal, and pharyngeal Chlamydia and gonorrhea in women in rural South Africa.
abstract: BACKGROUND
  Epidemiological data of genital chlamydia and gonorrhea, required to inform design and implementation of control programs, are limited for rural Africa. There are no data on the prevalence of rectal or pharyngeal infections among African women.
  
  
  METHODS
  A cross-sectional study of 604 adult women visiting 25 primary health care facilities in rural South Africa was conducted. Vaginal, anorectal, and oropharyngeal swabs were tested for Chlamydia trachomatis and Neisseria gonorrhoeae.
  
  
  RESULTS
  Prevalence of genital chlamydia was 16% and that of gonorrhea was 10%; rectal chlamydial infection was diagnosed in 7.1% and gonococcal in 2.5% of women. One woman had pharyngeal chlamydia. Most women with genital chlamydia (61%) and gonorrhea (57%) were asymptomatic. Independent risk factors for genital chlamydia were younger age (adjusted odds ratio [aOR], 0.96 per year; 95% confidence interval [CI], 0.93-0.98), hormonal contraceptive use (aOR, 2.2; 95% CI, 1.3-3.7), pregnancy (aOR, 2.4; 95% CI, 1.3-4.4), and intravaginal cleansing (aOR, 1.7; 95% CI, 1.04-2.8). Intravaginal cleansing was associated with genital gonorrhea (aOR, 1.9; 95% CI, 1.1-3.3).
  
  
  CONCLUSIONS
  Genital and rectal, but not pharyngeal, chlamydia and gonorrhea are highly prevalent and frequently asymptomatic in women in rural South Africa. Young women attending health care facilities for antenatal care or family planning should be prioritized in control efforts.
authors.affiliation: From the *Anova Health Institute, Johannesburg and Tzaneen, South Africa; †Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW (School for Oncology & Developmental Biology), Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, the Netherlands; ‡Laboratory of Immunogenetics, Department of Medical Microbiology & Infection Control, VU University Medical Centre, Amsterdam, the Netherlands; §Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa; ¶Faculty of Health Sciences, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa; ∥Division of Infectious Diseases & HIV Medicine, Department of Medicine, and **School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Remco P H
authors.initials: RP
authors.lastname: Peters
authors.forename: Jan Henk
authors.initials: JH
authors.lastname: Dubbink
authors.forename: Lisette
authors.initials: L
authors.lastname: van der Eem
authors.forename: Stephan P
authors.initials: SP
authors.lastname: Verweij
authors.forename: Myrte L A
authors.initials: ML
authors.lastname: Bos
authors.forename: Sander
authors.initials: S
authors.lastname: Ouburg
authors.forename: David A
authors.initials: DA
authors.lastname: Lewis
authors.forename: Helen
authors.initials: H
authors.lastname: Struthers
authors.forename: James A
authors.initials: JA
authors.lastname: McIntyre
authors.forename: Servaas A
authors.initials: SA
authors.lastname: Morré
mesh_terms: D000328:Adult; D002690:Chlamydia Infections / Q000453:epidemiology* / Q000473:pathology / Q000517:prevention & control; D002692:Chlamydia trachomatis / Q000302:isolation & purification; D017280:Condoms / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005193:Family Planning Services; D005260:Female; D005831:Genital Diseases, Female / Q000453:epidemiology* / Q000473:pathology / Q000517:prevention & control; D006069:Gonorrhea / Q000453:epidemiology* / Q000473:pathology / Q000517:prevention & control; D006801:Humans; D008403:Mass Screening; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification; D016017:Odds Ratio; D010608:Pharyngeal Diseases / Q000453:epidemiology* / Q000473:pathology / Q000517:prevention & control; D010614:Pharynx / Q000382:microbiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology* / Q000473:pathology / Q000517:prevention & control; D015995:Prevalence; D012002:Rectal Diseases / Q000453:epidemiology* / Q000473:pathology / Q000517:prevention & control; D012007:Rectum / Q000382:microbiology; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D014621:Vagina / Q000382:microbiology