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

Elisabeth Ab; Dirk Luijt; Alewijn Ott; Janny H Dekker

doi:10.3399/BJGPO.2021.0223

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

BJGP Open. 2022 Sep 28;6(3):BJGPO.2021.0223. doi: 10.3399/BJGPO.2021.0223. Print 2022 Sep.

Authors

Elisabeth Ab¹, Dirk Luijt², Alewijn Ott, Janny H Dekker³

Affiliations

¹ Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, The Netherlands e.ab@umcg.nl.
² Department of Medical Microbiology, University Medical Centre Groningen, Groningen, The Netherlands.
³ Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, The Netherlands.

Abstract

Background: Genital and anorectal Chlamydia trachomatis (CT) frequently present together in sexually transmitted infection (STI) clinics.

Aim: To investigate the prevalence of co-occurrent genital and anorectal chlamydia infection, and to study whether sexual behaviour 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 versus experimental (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 women included. Overall, 17.8% (n = 87/490) were positive for CT; of these, 72.4% (n = 63/87) had co-occurrent genital and anorectal infection, 13.8% (n = 12/87) had genital infection only, and 12.6% (n = 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.

Conclusion: The prevalence of anorectal disease is high among women who visit their GP with an indication for genital CT 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 CT testing is, therefore, recommended.

Keywords: Chlamydia trachomatis; general practice; primary healthcare; sexual behaviour; sexually transmitted diseases; women.