title: High prevalence of rectal gonorrhea and Chlamydia infection in women attending a sexually transmitted disease clinic.
abstract: BACKGROUND
  Testing women for urogenital Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) is common in sexually transmitted disease (STD) clinics. However, women may not be routinely tested for rectal GC/CT. This may lead to missed infections in women reporting anal intercourse (AI).
  
  
  METHODS
  This was a retrospective review of all women who underwent rectal GC/CT testing from August 2012 to June 2013 at an STD clinic in Columbus, Ohio. All women who reported AI in the last year had a rectal swab collected for GC/CT nucleic acid amplification testing (n=331). Using log-binomial regression models, we computed unadjusted and adjusted associations for demographic and behavioral factors associated with rectal GC/CT infection.
  
  
  RESULTS
  Participants (n=331) were 47% African-American, with median age of 29 years. Prevalence of rectal GC was 6%, rectal CT was 13%, and either rectal infection was 19%. Prevalence of urogenital GC and CT was 7% and 13% respectively. Among women with rectal GC, 14% tested negative for urogenital GC. Similarly, 14% of women with rectal CT tested negative for urogenital CT. In unadjusted analyses, there was increased rectal GC prevalence among women reporting sex in the last year with an injection drug user, with a person exchanging sex for drugs or money, with anonymous partners, and while intoxicated/high on alcohol or illicit drugs. After multivariable adjustment, no significant associations persisted, but a trend of increased rectal GC prevalence was observed for women <26 years of age (p=0.06) and those reporting sex while intoxicated/high on alcohol or drugs (p=0.05). For rectal CT, only age <26 years was associated with prevalent infection in unadjusted models; this association strengthened after multivariable adjustment (prevalence ratio: 6.03; 95% confidence interval: 2.29-15.90).
  
  
  CONCLUSIONS
  Nearly one in five women who reported AI in the last year had rectal GC or CT infection. Urogenital testing alone would have missed 14% of rectal infections. Standardized guidelines would increase rectal GC/CT testing in women and help detect missed infections.
authors.affiliation: 1 Colleges of Medicine, The Ohio State University , Columbus, Ohio.
authors.forename: Jose A
authors.initials: JA
authors.lastname: Bazan
authors.forename: Patricia
authors.initials: P
authors.lastname: Carr Reese
authors.forename: Allahna
authors.initials: A
authors.lastname: Esber
authors.forename: Samantha
authors.initials: S
authors.lastname: Lahey
authors.forename: Melissa
authors.initials: M
authors.lastname: Ervin
authors.forename: John A
authors.initials: JA
authors.lastname: Davis
authors.forename: Karen
authors.initials: K
authors.lastname: Fields
authors.forename: Abigail Norris
authors.initials: AN
authors.lastname: Turner
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D002690:Chlamydia Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D002692:Chlamydia trachomatis / Q000235:genetics / Q000302:isolation & purification*; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D008403:Mass Screening; D009344:Neisseria gonorrhoeae / Q000235:genetics / Q000302:isolation & purification*; D021141:Nucleic Acid Amplification Techniques; D009820:Ohio / Q000453:epidemiology; D015995:Prevalence; D012002:Rectal Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D012189:Retrospective Studies; D012725:Sexual Behavior; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D014505:Urban Population; D055815:Young Adult