Background There has been considerable discussion about anorectal Chlamydia trachomatis (CT) in women, but little about anorectal Neisseria gonorrheae (NG). This systematic review and meta-analysis investigates whether anorectal CT in women is associated with detection at other sites (urogenital, oropharyngeal) or anal intercourse and compares this with anorectal NG in the same populations.
Methods Electronic databases EMBASE, MEDLINE and PUBMED were searched for English-language studies published to October 2018 using the search terms: (“Chlamydia” OR “Chlamydia trachomatis”) AND ((“anal” OR “rect*” OR “anorect*”) OR (“extra-genital” OR “multi-site”)). Studies were included if anorectal NG data were available. The primary outcomes, CT and NG positivity, were measured as the proportion of those tested who were test positive. Prevalence ratios (PR) were calculated for the association of anorectal CT or NG with detection at other sites or anal intercourse. Random effects meta-analyses were used to calculate summary estimates; heterogeneity was investigated using meta-regression.
Results 25 studies were eligible. Anorectal CT positivity ranged from 0% to 17.5% with a summary estimate of 8.2% (95% CI: 7.2, 9.2; I2=86.4%). Anorectal NG positivity ranged from 0% to 17.0% with a summary estimate of 2.2% (95% CI: 1.6, 2.8; I2=92.6%). The association between urogenital and anorectal positivity was stronger for NG than CT (PR=82.2 [95% CI: 50.0, 140.9; I2=80.4%], PR=29.7 [95% CI 23.8, 37.1; I2=64.6%], respectively). Anal intercourse was associated with anorectal NG (PR=4.3; 95% CI: 2.18, 8.55; I2=0.0%) but not anorectal CT (PR=1.0; 95% CI: 0.71, 1.4; I2=0.0%).
Conclusion Discussion in the literature has focused on anorectal CT in women. This review found that although anorectal CT is more common, anorectal NG is more strongly associated with anal intercourse, urogenital, and oropharyngeal detection. Longitudinal data are required to further understanding of the etiology of anorectal STIs and to inform whether anorectal screening is needed in women.
Disclosure No significant relationships.
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