Background The website http://www.iwantthekit.org/ (IWTK) began offering self-administered rectal swab kits in addition to vaginal swab kits in January 2009 to test for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis.

Methods Swab samples were collected at home by participants and sent by US mail and tested by NAAT (Gen-Probe) assays. Participants submitted separate questionnaires for the vaginal and rectal kits. Data were analysed by STATA, version 11.

Results In 1084 questionnaires from women submitting vaginal swabs to the IWTK program since 2009, 194 (17.9%) reported anal intercourse (AI) in the last 90 days. Of these women, only 113 (58.2%) also ordered and returned rectal kits for testing. An additional 95 kits were ordered and returned by women who did not report recent AI (82), did not return a vaginal swab (5), or did not answer the AI question on the vaginal questionnaire (8). From a total of 406 rectal kits ordered by women overall, 208 (51.2%) were returned; three had no consent form; thus, 205 were tested. Of those tested, 26 (12.7%) were positive for chlamydia, 5 (2.4%) were positive for gonorrhoea, and 13 (6.3%) were positive for trichomoniasis. Two of these samples were positive for both Chlamydia and gonorrhoea, two for both chlamydia and trichomonas, and one for all three STIs. The total number of women testing positive for any rectal STI was 38 (18.5%), and 35 of these women also received and returned vaginal swabs, 34 of which were tested. Of those tested, 24 (70.5%) were positive for at least one of the three STIs vaginally, indicating that women who tested positive for rectal STIs were at very high risk for vaginal STIs. Of the 38 women with rectal STIs, the median age was 22 yr. and the median age of first rectal sex was 20 yr. Questionnaires demonstrated 93.6% were single, 62.5% were Black, and 21.9% were White. Of the women with rectal STIs, 67.7% reported no symptoms, 12.0% reported no rectal partners in previous yr, 56.0% reported one partner, and 32% reported 2–4 partners. Only 16.0% reported having a new rectal partner in the last 3 months. Half (50.0%) reported never using condoms, 15.4% reported they always used condoms, 15.4% reported using condoms most of the time, and 19.2% reported using condoms some of the time.

Conclusions Public health officials should be aware that AI and rectal STIs are not uncommon among sexually active women. Future STI screening programs should consider rectal infections.