High rates of anorectal chlamydia in women: Cross-sectional study in general practice

Background Genital and anorectal Chlamydia trachomatis frequently present together in sexually transmitted infection clinics.

Aim This study aimed to investigate the prevalence of co-occurrent genital and anorectal chlamydia infection, and to study whether sexual behavior is associated with anorectal infection.

Design & setting A cross-sectional study in general practices in the north of the Netherlands.

Method Women attending general practice with an indication for genital chlamydia testing were included and asked to complete a structured questionnaire on sexual behaviour. Anorectal infection prevalence was compared according to testing indications: standard vs experimental (ie, based on questionnaire answers). Variables associated with anorectal chlamydia were analysed by univariate and multivariate logistic regression analyses.

Results Data could be analysed for 497 of 515 included women. Overall, 17.8% (87/490) were positive for C. trachomatis; of these, 72.4% (63/87) had co-occurrent genital and anorectal infection, 13.8% (12/87) had genital infection only, and 12.6% (11/87) had anorectal infection only. Rectal infection was missed in 69.3% of cases using the standard indication alone, while adding the sexual history still missed 20.0%. Age was the only variable significantly associated with anorectal infection.

Conclusions The prevalence of anorectal disease is high among women who visit their general practitioner with an indication for genital C. trachomatis testing. Many anorectal infections are missed despite taking comprehensive sexual histories, meaning that standard treatment of genital infection with azithromycin may result in rectal persistence. Performing anorectal testing in all women with an indication for genital C. trachomatis testing is therefore recommended.