title: High Proportion of Anorectal Chlamydia trachomatis and Neisseria gonorrhoeae After Routine Universal Urogenital and Anorectal Screening in Women Visiting the Sexually Transmitted Infection Clinic.
abstract: Testing on indication of self-reported anal sex or symptoms is used to manage anorectal Chlamydia trachomatis (chlamydia) and Neisseria gonorrhoeae (gonorrhea) infections in women. Little is known about the impact of another testing strategy, routine universal anorectal screening with respect to chlamydia and gonorrhea prevalence and risk factors.
  All women (n = 1012) aged ≥16 years attending our sexually transmitted infection clinic in 2015 were offered routine universal screening. In total, 19.5% (n = 185) of women had an indication (reported anal sex or symptoms), 72.5% (n = 689) did not have an indication, and 8.0% (n = 76) had missing information on indication. Logistic regression analyses were used to identify determinants associated with anorectal chlamydia and gonorrhea.
  Of all women who visited our clinic, 94% (n = 950) participated in the study. Overall anorectal chlamydia/gonorrhea positivity was 13.4% (n = 127)/1.3% (n = 12). Self-reported anal sex and anal symptoms were independently associated with anorectal gonorrhea (odds ratios [ORs], 3.3 [95% confidence interval {CI}, 1.01-10.7] and 14.5 [95% CI, 2.8-75.0], respectively), but not with anorectal chlamydia. Of all anorectal chlamydia/gonorrhea cases, 72% (n = 92)/33% (n = 4) were diagnosed in women without an indication, of which 19% (n = 19)/0% (n = 0) were anorectal only. For women with missing indication, this was 7% (n = 9)/8% (n = 1) and 44% (n = 4)/100% (n = 1).
  Anorectal screening in women without an indication is feasible and highly acceptable. Selective testing on indication could be an appropriate control strategy for anorectal gonorrhea, as few infections would be missed. In contrast, selective testing is a suboptimal control strategy for anorectal chlamydia, as we found a high prevalence in women both with and without indication for anorectal testing, along with a substantial amount of anorectal-only infections.
authors.affiliation: Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Geleen.|Department of Medical Microbiology, School of Public Health and Primary Care, Maastricht University Medical Centre ; and.
authors.forename: Geneviève A F S
authors.initials: GAFS
authors.lastname: van Liere
authors.affiliation: Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Geleen.|Department of Medical Microbiology, School of Public Health and Primary Care, Maastricht University Medical Centre ; and.
authors.forename: Nicole H T M
authors.initials: NHTM
authors.lastname: Dukers-Muijrers
authors.affiliation: Department of Infectious Disease Control, North Limburg Public Health Service, Venlo, The Netherlands.
authors.forename: Luuk
authors.initials: L
authors.lastname: Levels
authors.affiliation: Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Geleen.|Department of Medical Microbiology, School of Public Health and Primary Care, Maastricht University Medical Centre ; and.
authors.forename: Christian J P A
authors.initials: CJPA
authors.lastname: Hoebe
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D002690:Chlamydia Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D005260:Female; D006069:Gonorrhea / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D018451:Homosexuality, Male; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification*; D015995:Prevalence; D012002:Rectal Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology*; D012307:Risk Factors; D012725:Sexual Behavior; D055815:Young Adult
keywords: Chlamydia trachomatis; Neisseria gonorrhoeae; anorectal; test policy.; women