Are at-risk women commonly tested for rectal gonorrhea, chlamydia?
According to a study published in Clinical Infectious Diseases, fewer than 0.1% of women who undergo genital testing for gonorrhea and chlamydia undergo rectal testing for these disorders. While the Centers for Disease Control and Prevention (CDC) guidelines do not currently recommend rectal screening for gonorrhea and chlamydia in women who engage in anal intercourse, the authors note that those sexual transmitted infection (STIs)s often are missed due to infrequent testing and follow-ups, which suggests a need for increased testing and education.
The study’s authors used data from a large US commercial laboratory of women aged 15-60 years who were screened for chlamydia and gonorrhea between November 2012 and September 2015. Of 5499 women who were given rectal chlamydia and gonorrhea tests, positive results were found 10.8% of the time. Approximately 80% of the patients who received the rectal test were also given genital chlamydia and gonorrhea tests the same day. The authors found that rectal chlamydia or gonorrhea infection was associated with genital chlamydia or gonorrhea, but 46.5% of such STIs would not have been identified with genital testing alone. Among women with rectal chlamydia or gonorrhea infection, only 20.0% had a recommended repeat rectal test, and of those who had the repeat test, 17.7% were positive.
While testing women for rectal chlamydia and gonorrhea was infrequent, positive rectal tests were often found in women who had negative genital tests. The authors recommend that extragenital chlamydia and gonorrhea testing in at-risk women be increased. They also recommend educating women and healthcare providers about the risks of anal sex and developing a reminder system to prompt physicians to perform follow-up testing at all anatomic sites in women who had a positive genital test.