Women Who Report Rectal Intercourse Should Receive Rectal Screening for Chlamydia and Gonorrhea


Centers for Disease Control and Prevention researchers find that in women who have rectal intercourse, rectal sexually transmitted infections chlamydia and gonorrhea can be almost as common as urogenital infections.

Women who report having rectal intercourse should have rectal screening for chlamydia and gonorrhea, but often those tests are overlooked, according to study results presented at the Centers for Disease Control and Prevention (CDC) 2016 STD Prevention Conference in Atlanta, Georgia.

In their study, the researchers found that giving only a urogenital test to patients who had rectal-only chlamydia and/or gonorrhea infections led to 54 (30%) of the rectal infections being missed.

"While anal sex is commonly associated with MSM (men who have sex with men), in a recent round of the National Survey of Family Growth, heterosexual anal sex was reported in nearly 36% of women age 15 to 44 years over their lifetime, suggesting this type of sexual practice is not entirely uncommon," lead author Eloisa Llata, MD, said in her presentation.

"Using a large multisite dataset of routinely collected sexually transmitted disease (STD) clinic visits, we demonstrated a substantial rectal chlamydia and gonorrhea infection burden in the women reporting anal intercourse," said Dr. Llata, a medical epidemiologist in the Division of Sexually Transmitted Disease (STD) Prevention at the CDC in Atlanta.

Dr. Llata and her colleagues reviewed the electronic medical records of female patients attending any of 24 STD clinics in 5 US cities that participated in the STD Surveillance Network (SSuN) of STDs in 2015. The authors analyzed data from women reporting having rectal intercourse in the 3 months before their visit. The women ranged in age from 12 through 68 years and slightly more than two-thirds were 25 and above; almost half the women were African-American; 14 (0.6%) had documented HIV infection, and 172 (8%) reported having both male and female sex partners. Women reported anal intercourse in 2,307 visits (5.1%), made by 2,156 unique women, of 45,503 visits.

Rectal chlamydia and gonorrhea swabs were collected in 1822 (79%) of the 2307 visits where women reported anal intercourse. All screening was performed by nucleic acid amplification test (NAAT). A total of 135 (7.4%) tests were positive for rectal chlamydia only; 42 (2.3%) tests were positive for gonorrhea only; and 15 (0.8%) were infected with both, bringing the total to 192 patients who tested positive for rectal chlamydia or gonorrhea. The number of rectal infections detected overall increased by about 30%, from 128 to 192. Rectal infections (10.5%) were almost as common as urogenital infections (13.0%).

"Currently, chlamydia and gonorrhea screening is recommended for all sexually active women up to age 24 and for older women at increased risk for infection," Dr. Llata told Contagion®.

"In MSM who report receptive anal intercourse, routine anorectal screening is recommended. But, guidelines for women mainly involve genitourinary screening. We have no guidelines for rectal chlamydia and gonorrhea screening in women, even in women who report anal intercourse," she added.

Ina Park, MD, who moderated the session, but was not involved in the study, said in an interview, "This is an important study. Chlamydia and gonorrhea are very common and the organisms can migrate from the rectum to the vagina."

"Most infections in women don't have symptoms so they may not be treated on time or treated at all, possibly leading to pelvic inflammatory disease, chronic pelvic pain, or pregnancy complications," added Dr. Park, chief of the Office of Medical and Scientific Affairs of the California Department of Public Health Sexually Transmitted Disease Control Branch in Richmond, California.

Drs. Llata and Park recommended further studies to explore the clinical and public health impacts of detecting and treating these infections.

Lorraine L. Janeczko, MPH, is a medical science writer who creates news, continuing medical education and feature content in a wide range of specialties for clinicians, researchers and other readers. She has completed a Master of Public Health degree through the Department of Epidemiology of the Johns Hopkins Bloomberg School of Public Health and a Dana Postdoctoral Fellowship in Preventive Public Health Ophthalmology from the Wilmer Eye Institute, the Johns Hopkins University School of Medicine and the Bloomberg School.

DISCLOSURES: The authors of all three studies and Dr. Park did not report any conflicts of interest with the study.


  • Abstract 4A2 The Bottom Line: Possible Missed Infections Among Women Reporting Rectal Intercourse in STD Clinics, Sexually Transmitted Diseases Surveillance Network — United States, 2015: (https://cdc.confex.com/cdc/std2016/webprogram/Paper37519.html)
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