Prevalence and Correlates of Rectal Chlamydia and Gonorrhea Among Female Clients at Sexually Transmitted Disease Clinics

Javanbakht, Marjan; Gorbach, Pamina M.; Stirland, Ali; Chien, Michael; Kerndt, Peter R.; Guerry, Sarah

doi:10.1097/olq.0b013e31826ae9a2

Cited by 64 publications

(60 citation statements)

References 30 publications

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“…5,6 Consequently, rectal GC/CT infections do not garner the same public health attention in women as they do in MSM. 5,10,12 Yet, among women reporting any AI in the previous 12 months, we report a high prevalence of rectal GC (6%), rectal CT (13%), and either rectal GC or CT (19%) infections; these estimates are similar to a growing number of published studies. 4,[7][8][9][10][13][14][15][16][17][18][19][20] The vast majority of the women who were infected with either rectal GC (91%) or rectal CT (98%) reported no symptoms of rectal infection.…”

Section: Discussionsupporting

confidence: 75%

“…For example, in three earlier studies, urogenital testing alone using NAAT would have missed 35%, 19%, and 16% of rectal GC and 6%, 25%, and 23% of rectal CT infections in women, respectively. 8,10,15 In our study, urogenital testing alone would have missed 14% of rectal GC and 14% of rectal CT infections. Missed and untreated rectal infections in women who practice AI could not only lead to ongoing transmission to male sex partners, but could potentially increase the risk of subsequent urogenital reinfection in the woman and associated long-term reproductive tract complications.…”

Section: Discussionmentioning

confidence: 99%

“…12 Reported prevalence estimates range from 0.64% to 19.2% for rectal GC and 2% to 54.3% for rectal CT. 4,[7][8][9][10][13][14][15][16][17][18][19][20] While concordance between the results of urogenital and rectal GC/CT testing in women is generally strong, a growing number of studies demonstrate that some women who test positive for rectal infections are simultaneously negative at urogenital sites. 4,8,10,15,[18][19][20] These findings raise the concern that failure to screen women for rectal GC/CT could result in missed and untreated infections. Untreated rectal infections could then be transmitted to male partners, who could subsequently transmit a urogenital infection to the female partner, leaving her susceptible to the long-term reproductive tract complications.…”

Section: Introductionmentioning

confidence: 99%

“…5,6 However, there are currently no standardized guidelines for rectal GC/CT testing in women, including among those who routinely engage in AI. 5,[7][8][9][10] A 2009 study found that up 23% of women attending public STD clinics reported AI with their most recent sex partner, and only 26% reported using a condom during that experience. 11 Contrary to MSM, data on the prevalence and factors associated with rectal GC/CT infection in women is not as robust.…”

Section: Introductionmentioning

confidence: 99%

“…Untreated rectal infections could then be transmitted to male partners, who could subsequently transmit a urogenital infection to the female partner, leaving her susceptible to the long-term reproductive tract complications. 2,3,9,10,20 Furthermore, prevalent rectal GC/CT infections may also increase the risk of human immunodeficiency virus (HIV) acquisition through AI. 21 The goals of the present study were to determine the prevalence of rectal GC and rectal CT infection among female patients seen at a large, urban STD clinic and who reported any AI in the previous 12 months.…”

Section: Introductionmentioning

confidence: 99%

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High Prevalence of Rectal Gonorrhea and Chlamydia Infection in Women Attending a Sexually Transmitted Disease Clinic

Bazan

Reese

Esber

et al. 2015

Journal of Women's Health

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Background: Testing women for urogenital Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) is common in sexually transmitted disease (STD) clinics. However, women may not be routinely tested for rectal GC/CT. This may lead to missed infections in women reporting anal intercourse (AI). Methods: This was a retrospective review of all women who underwent rectal GC/CT testing from August 2012 to June 2013 at an STD clinic in Columbus, Ohio. All women who reported AI in the last year had a rectal swab collected for GC/CT nucleic acid amplification testing (n = 331). Using log-binomial regression models, we computed unadjusted and adjusted associations for demographic and behavioral factors associated with rectal GC/CT infection. Results: Participants (n = 331) were 47% African-American, with median age of 29 years. Prevalence of rectal GC was 6%, rectal CT was 13%, and either rectal infection was 19%. Prevalence of urogenital GC and CT was 7% and 13% respectively. Among women with rectal GC, 14% tested negative for urogenital GC. Similarly, 14% of women with rectal CT tested negative for urogenital CT. In unadjusted analyses, there was increased rectal GC prevalence among women reporting sex in the last year with an injection drug user, with a person exchanging sex for drugs or money, with anonymous partners, and while intoxicated/high on alcohol or illicit drugs. After multivariable adjustment, no significant associations persisted, but a trend of increased rectal GC prevalence was observed for women < 26 years of age ( p = 0.06) and those reporting sex while intoxicated/high on alcohol or drugs ( p = 0.05). For rectal CT, only age < 26 years was associated with prevalent infection in unadjusted models; this association strengthened after multivariable adjustment (prevalence ratio: 6.03; 95% confidence interval: 2.29-15.90). Conclusion: Nearly one in five women who reported AI in the last year had rectal GC or CT infection. Urogenital testing alone would have missed 14% of rectal infections. Standardized guidelines would increase rectal GC/CT testing in women and help detect missed infections.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

High Prevalence of Rectal Gonorrhea and Chlamydia Infection in Women Attending a Sexually Transmitted Disease Clinic

Bazan

Reese

Esber

et al. 2015

Journal of Women's Health

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Chlamydia Trachomatis Urogenital Infections

Armitage

Carey

Hickey

et al. 2018

Diagnostics to Pathogenomics of Sexually Transmitted Infections

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Quantitative evaluation of the cells involved in the immune system, such as lymphocytes, plasma cells, macrophages, dendritic cells, and epithelial cells, together with their products, including antibodies, cytokines, and humoral factors of innate immunity, convincingly revealed that the immune system associated with the mucosae is greater than its systemic counterpart (Russell et al. 2015a). This fact should not be surprising, as the development of the entire immune system during evolution and continuously in everyday life is driven by stimulation with commensal microbiota, antigens present in food and inhaled air, as well as pathogens throughout the enormous surface area of mucosal sites, which far exceeds the skin surface. The mucosal immune system comprises anatomically remote and physiologically distinct compartments that provide protection at various mucosal sites. Although the genital tract shares some common features with other mucosae, including the presence of humoral factors and cells of innate immunity, and the origin of cells involved in antibody production and T cell-mediated immunity, there are also many distinct features characteristic of the genital tract (Russell and Mestecky 2002, 2010; Mestecky et al. 2005). The spectrum of antigens including commensal or pathogenic microorganisms, and sperm is different from those at other mucosal sites. Furthermore, the primary physiological role of the genital tract is reproduction, which involves the acceptance of allogeneic sperm and semi-allogeneic offspring. This distinct physiological role influences the immune system of the genital tract with respect to the induction or suppression of immune responses, which must be considered in the development and application of vaccines against infectious agents of sexually transmitted diseases.

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Transitions in Latent Classes of Sexual Risk Behavior Among Young Injection Drug Users Following HIV Prevention Intervention

et al. 2013

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We analyzed data from a large randomized HIV/HCV prevention intervention trial with young injection drug users (IDUs). Using categorical latent variable analysis, we identified distinct classes of sexual behavior for men and women. We conducted a latent transition analysis to test the effect of the intervention on transitions from higher to lower risk classes. Men who were in a high-risk class at baseline who received the intervention were 86% more likely to be in a low-risk class at follow-up compared to those in the control group (p = .025). High-risk intervention participants were significantly more likely to transition to the class characterized by unprotected sex with a main partner only, while low-risk intervention participants were significantly less likely to transition to that class. No intervention effect was detected on the sexual risk behavior of women, or of men who at baseline were having unprotected sex with a main partner only.

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Prevalence and Correlates of Rectal Chlamydia and Gonorrhea Among Female Clients at Sexually Transmitted Disease Clinics

Abstract: Chlamydia and gonorrhea positivity was high among women reporting AI, and a large proportion of these cases would be missed in the absence of rectal testing. The high-risk behaviors of women with rectal infections highlight the need for rectal screening recommendations.

Cited by 64 publications

References 30 publications

High Prevalence of Rectal Gonorrhea and Chlamydia Infection in Women Attending a Sexually Transmitted Disease Clinic

High Prevalence of Rectal Gonorrhea and Chlamydia Infection in Women Attending a Sexually Transmitted Disease Clinic

Chlamydia Trachomatis Urogenital Infections

Transitions in Latent Classes of Sexual Risk Behavior Among Young Injection Drug Users Following HIV Prevention Intervention

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