Should we screen women for rectal chlamydia? — ASN Events
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  3. Should we screen women for rectal chlamydia?

Should we screen women for rectal chlamydia? (#229)

Miranda Sherley 1 , Kate Musil 2 , Marian Currie 3 , Sarah J Martin 1
  1. Canberra Sexual Health Centre, Woden, ACT, Australia
  2. Medical School, Australian National University, Canberra, ACT, Australia
  3. University of Canberra, Canberra, ACT, Australia

Chlamydia is the most common notifiable Sexually Transmissible Infection (STI) in Australia1. Public health control measures rely on screening and treatment of affected individuals and their sexual contacts. The management of rectal chlamydia differs substantially from that of urethral/cervical chlamydia2, making the diagnosis and treatment of rectal chlamydia in at-risk groups a priority. Current screening guidelines recommend rectal-screening for men who have sex with men (MSM), and women with rectal symptoms or reporting anal intercourse, but not for women in general2. International studies have reported a prevalence of rectal Chlamydia in women of up to 21% but little data have previously been collected for Australian women3-12. In this study we offered rectal chlamydia Nucleic Acid Amplification Testing (NAAT) to all women attending Canberra Sexual Health Centre (CSHC) from Nov 2013- June 2014 who fell into any of the following three groups: (1) Having symptoms of chlamydia or PID. (2) Presenting as a contact of chlamydia. (3) Attending for followup after a positive urine chlamydia screen. Fifty-seven percent (32/56) tested positive from their rectal sample13. There was no association with anal sex, use of sex toys, or rectal symptoms13. There was a strong association (p<0.000) with urethral/cervical chlamydia, with 97% (31/32) of women with a positive rectal chlamydia test also having a positive urogenital test13. A lack of routine rectal screening in Australia may be resulting in the underdiagnosis and undertreatment of rectal chlamydia, and resultant persistent infection, reproductive tract re-infection, transmission and complications. The high prevalence of rectal chlamydia found in this study raises three important questions: Should we be screening women for rectal chlamydia? Should we routinely offer women diagnosed with chlamydia treatment that will effectively treat rectal infection? What is the most effective treatment for rectal chlamydia in women?

  1. The Kirby Institute. HIV, viral Hepatitis and sexually transmissible infections in Australia, annual surveillance report, 2014. Sydney: University of New South Wales, 2014
  2. Australian STI Management Guidelines, https://www.sti.guidelines.org.au
  3. Barry PM, Kent CK, Philip SS et al. Results of a program to test women for rectal chlamydia and gonorrhoea. Obstet gynecol 2010; 115: 753-759.
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  5. van Liere GA, Hoebe CJ, Wolffs PF et al. High co-occurrence of anorectal chlamydia with urogenital chlamydia in women visiting an STI clinic revealed by routine universal testing in an observational study; a recommendation towards a better anorectal chlamydia control in women. BMC Infect Dis 2014; 14:274-280
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  8. Peters RP, Nijsten N, Mutsaers J et al. Screening of oropharynx and anorectum increases prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infection in female STD clinic visitors. Sex Transm Dis 2011; 38: 783-787.
  9. Javanbakht M, Gorbach P, Stirland A et al. Prevalence and correlates of rectal chlamydia and gonorrhoea among femate clients at sexually transmitted disease clinics. Sex Transm Dis 2012; 39: 917-922.
  10. Sethupathi M, Blackwell A and Davies H. Rectal Chlamydia trachomatis infection in women is it over looked? Int J STD AIDS 2010; 21: 93-95.
  11. Koedijk FD, ven Bergen JE, Dukers- Muijrers NH et al. The value of testing multiple anatomic sites for gonorrhoea and chlamydia in sexually transmitted infection centres in the Netherlands, 2006-2010. Int J STD AIDS 2012; 23: 626-631.
  12. van Liere GA, Hoebe CJ, Niekamp A, et al. Standard symptom and sexual history based testing misses anorectal chlamydia trachomatis and Neisseria gonorrhoeae infections in swingers and men who have sex with men. Sex Transm Dis 2013; 40: 285-289.
  13. Musil K, Currie M, Sherley M and Martin S. Rectal chlamydia infection in women at high riskof chlamydia attending Canberra Sexual Health Centre. Int J STD AIDS in press.
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