Rectal chlamydia – should screening be recommended in women?

Abstract

Chlamydia trachomatis is the most common bacterial sexually transmitted infection in Europe and has large impacts on patients' physical and emotional health. Unidentified asymptomatic rectal Chlamydia trachomatis could be a partial explanation for the high Chlamydia trachomatis prevalence. In this study, we evaluated rectal Chlamydia trachomatis testing in relation to symptoms and sexual habits in women and men who have sex with men. Rectal Chlamydia trachomatis prevalence was 9.1% in women and 0.9% in men who have sex with men. None of the patients reported any rectal symptoms; 59.0% of the women with a rectal Chlamydia trachomatis infection denied anal intercourse and 18.8% did not have a urogenital infection; 9.4% did neither have a urogenital infection nor reported anal sex. We suggest that rectal sampling should be considered in women visiting sexually transmitted infection clinics regardless of rectal symptoms and irrespective of anal intercourse, since our data suggest that several cases of rectal Chlamydia trachomatis otherwise would be missed, thus enabling further disease transmission.

Genital Chlamydia trachomatis Infections Clear More Slowly in Men Than Women, but Are Less Likely to Become Established

“…Linkage of patient records would allow studies examining whether the association between faster natural clearance of infection and lower rates of reinfection, reported by Geisler et al [ 42 ] for mostly African American women in a sexually transmitted disease clinic setting, occurs in other populations. Additionally, as the gastrointestinal tract may be an important reservoir for chlamydia infection in women because of the possibility of autoinfection [ 43 , 44 ], rectal testing could be used to obtain estimates of the duration of rectal infection. A strength of the Bayesian approach that we have used is that different types of information can be incorporated as they become available to improve estimates in the future.…”

Whole-Genome Enrichment and Sequencing ofChlamydia trachomatisDirectly from Patient Clinical Vaginal and Rectal Swabs

“…Several studies have reported that the prevalence of these genotypes differ by anatomical site and sexual network. Genotypes D and G are more commonly detected in the anorectal tract and, along with genotype J, are prevalent in women and men who have sex with men (MSM) [8][9][10][11][12][13][14][15] . Genotypes D, E, and F are found in the majority of urogenital infections and are common among heterosexuals 8,16 .…”

Pathogenic Interplay Between Chlamydia trachomatis and Neisseria gonorrhoeae that Influences Management and Control Efforts—More Questions than Answers?

“…Management and control of CT infection remain continuously challenging [4,19]. Reasons are likely manifold, but there is prominent discussion about the potential importance of rectal CT infection in women in particular [20,21]. Asymptomatic rectal CT has been hypothesized to be a reservoir of untreated infection, hindering chlamydia control [22].…”