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Original research
Evidence supporting the standardisation of extragenital gonorrhoea and chlamydia screenings for women
  1. Jamieson Trevor Jann1,
  2. Nicole J Cunningham1,
  3. Ryan D Assaf1,2,
  4. Robert K Bolan1
  1. 1Health Services, Los Angeles LGBT Center, Los Angeles, California, USA
  2. 2Department of Epidemiology, University of California Los Angeles Jonathan and Karin Fielding School of Public Health, Los Angeles, California, USA
  1. Correspondence to Jamieson Trevor Jann, Los Angeles LGBT Center, Los Angeles, CA 90028-6213, USA; tjann{at}


Objective Current guidelines for women do not include extragenital screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) and do not mention anal sex behaviour. The objective of this cross-sectional study was to determine the number of potentially missed CT and NG cases by relying on urogenital screening and self-reported anal sex behaviour among women.

Methods Demographic and clinical data of 4658 women attending a community health centre in Los Angeles, California, USA from 2015 to 2018 were examined. CT and NG were detected using nucleic acid amplification test (APTIMA Combo 2, Hologic Gen-Probe, San Diego, California). Demographic and behavioural factors were also examined to assess potentially missed NG/CT cases. Multivariable regression analyses were used to determine whether reported anal sex behaviour predicts NG/CT rectal infection.

Results A total of 193 NG cases and 552 CT cases were identified; however, 53.9% of NG cases and 25.5% of CT cases were identified exclusively through extragenital screening. Of all positive cases of rectal CT, 87.0% did not report anal sex without a condom and 91.3% did not report any anal sex with their last sexual partner. Of all positive cases of rectal NG, 78.9% did not report anal sex without a condom and 76.3% did not report any anal sex with their last sexual partner. Anal sex with last partner was not predictive of NG/CT rectal infection.

Conclusions Relying solely on urogenital screening and reported behaviour misses NG/CT cases. Extragenital NG/CT screening should be conducted in all women regardless of reported anal sex behaviour.

  • sexual behaviour
  • sexual health
  • anogenital conditions
  • women

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  • Handling editor Federico Garcia

  • Contributors JTJ: analysis and interpretation of data, drafting, critical revision of the manuscript and final approval. NJC: conception, design, interpretation of data and critical revision of the manuscript. RDA: design, interpretation of data and critical revision of the manuscript. RB: revision of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval This study was reviewed and approved by the Los Angeles County Department of Public Health Institutional Review Board (#2019-12-858).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. The study used existing patient data from the LA LGBT Center’s electronic medical records.

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