Both anorectal Chlamydia trachomatis (CT) and Neisseria
gonorrhoea (NG) can occur as a rectal-only infection or concurrently with
simultaneous urogenital infection with the same pathogen. Characterising the
target groups in which rectal-only infections occur may improve the efficacy of
screening practices.
We analysed data from two Dutch outpatient sexually
transmitted infection (STI) clinics between 2011 and 2012. We included all men
who have sex with men (MSM) (n = 9549) and women (n = 11113), ≥18 years, who
had been tested for anorectal and urogenital CT and/or NG (either as a result
of reporting anal sex/symptoms or via routine universal testing). Factors
associated with rectal-only CT and NG infections were assessed using
univariable and multivariable logistic regression.
In MSM, anorectal CT prevalence was 9.8% (693/7094),
anorectal NG prevalence was 4.2% (397/9534). In women this was 9.5% overall
(439/4597) and 0.9% (96/10972) respectively. Anorectal CT prevalence among
women who were routinely universally tested was 10.4% (20/192), for selective
testing this was 9.5% (419/4405) (p = 0.68). Anorectal NG infections were not
detected among women who were routinely universally tested (p = 0.19). Among CT
or NG positive MSM, rectal-only CT infections were found in 85.9% (595/693),
for NG this was 85.6% (340/397) respectively. In positive women these figures
were 22.1% (97/439)for CT and 20.8% (20/96) for NG, respectively.
In MSM,
independent factors associated with rectal-only CT were: being a sex worker, exclusively having sex with men, and
absence of urogenital symptoms. In women, these factors were:
older age and non-Western nationality. Factors associated with rectal-only NG in MSM were: having been warned for STIs
by an (ex) partner, oropharyngeal NG infection, and absence of urogenital symptoms,
while in women no significant factors were identified.
The prevalence of anorectal CT and NG was substantial in MSM
and prevalence of anorectal CT was also substantial in women. Anorectal
infections occurred mostly as rectal-only infections in MSM and mostly
concurrent with other infections in women. Given the lack of useful indicators
for rectal-only infections, selective screening based on a priori patient
characteristics will have low discriminatory power both in relation to MSM and
women.
Below: Anatomic site distribution of CT or NG positive MSM and women both tested at urogenital and anorectal sites
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- 1Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Geleen, The Netherlands; Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.
- 2Public Health Laboratory, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands; Department of Research, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands; STI Outpatient Clinic, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands.
- 3Department of Research, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands; STI Outpatient Clinic, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands.
- 4STI Outpatient Clinic, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands; Department of Dermatology, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands; Centre for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center (AMC), Amsterdam, The Netherlands.
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