Screening for rectal chlamydia was not routinely offered in our department until we had a local outbreak of lymphogranuloma venereum (LGV) in men who have sex with men (MSM) in 2004/2005. We later decided to extend the screening to high-risk women (women who had receptive anal sex, contacts of gonorrhoea, women, with anorectal symptoms, women who had been sexually assaulted). A retrospective study of 152 women from whom 160 rectal chlamydia swabs were taken was carried out. Twenty (12.5%) swabs were positive, 19 of which were also positive at the cervix. All were non-LGV serovars. The groups at greatest risk were high-risk women aged less than 20 years and women with proven gonococcal infection where the prevalence was 22.6% and 30%, respectively. We conclude that rectal chlamydial infection in women may be common and further studies are needed to elucidate its importance.