Rectal bacterial STIs are increasingly recognized as common infections among clinic-attending women, with estimated prevalences of 5% for rectal Neisseria gonorrhoeae (GC) and 9% for rectal Chlamydia trachomatis (CT). Although these prevalences are similar to urogenital GC and CT among these same populations of women, we know very little about the health implications or epidemiology of rectal STIs among women. Rectal STIs are typically asymptomatic and the infections themselves may not be morbid conditions. However, some investigators have hypothesized that women could autoinoculate bacteria from the rectum to the vagina which may result in reproductive tract sequelae in the absence of vaginal sex. Even if there were strong evidence to suggest this does occur, it is unclear which populations of women should be targeted for rectal screening. Employing current screening guidelines for urogenital infections would assure treatment of women with concurrent rectal STI, but would miss women with isolated rectal STI. Further, the efficacy of azithromycin for CT may be lower in the rectum than the urogenital tract, suggesting that screening and treating women for urogenital CT without regard to the presence of rectal CT may result in a persistent rectal infection. Alternatively, rectal STI screening could be limited to women who report anal sex. However, the prevalence of rectal STIs is similar among women who do and do not report anal sex, suggesting that this screening strategy would miss a substantial proportion of cases. Finally, some have hypothesized that oral acquisition of CT may lead to rectal infection. If this route is possible, rectal screening for women who report penile-oral sex may be warranted. This session will review the epidemiologic and microbiologic evidence on these topics and will discuss what studies are needed to address the gaps in our understanding of these infections and define a way forward.

Disclosure No significant relationships.