Day 1 - Testing for Rectal Chlamydia in Women: Is It Worth It? Dr Danae Kent

Monday 14/11/16 – Day 1: Jan Edwards Trainee Session

Dr Danae Kent, Senior Registrar at Adelaide’s Clinic 275: ‘Testing for Rectal Chlamydia in Women – Is It Worth It?’

In short the answer was yes…and no! 

Rectal chlamydia infections in women have the potential to result in significant morbidity and enhanced HIV transmission. 

Few other Australian studies have looked at this topic.  The estimated rectal CT positivity rate in women is 5-27% (variable depending on population eg. higher in sex workers and sexually adventurous females).  Awareness of site of CT infection is important as this has implications for choice of treatment (rectal CT treated with Doxycycline vs genital CT treated with Azithromycin).

Method:

This South Australian retrospective study looked at women who received anal CT testing if they reported anal sex and/or anal symptoms.

Results:

Overall CT positivity rate = 8.5%

Young women less likely to have anal CT testing done but more likely to have positive anal CT result (of those with a CT positive result, 16% of women <20yrs were positive for anal CT)

Isolated rectal infections:

70% were found to have urogenital AND anal CT

19% were found to have rectal CT only

11% were found to have urogenital CT only

Therefore urogenital testing alone would miss 1 in every 5 cases of chlamydia confirming the value of testing for anal CT where a women reports anal sex and/or anal symptoms.  These findings are not generalizable to settings outside the sexual health clinic. 

Interesting food for thought and also a timely reminder of the importance of a thorough sexual history for the female client including enquiry about anal sex practices.