{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T18:17:40Z","timestamp":1792174660614,"version":"4.4.0"},"reference-count":36,"publisher":"BMJ","issue":"5","funder":[{"name":"UKCRC Translational Infection Research"},{"name":"National Institute for Health Research (NIHR) i4i Programme"},{"DOI":"10.13039\/501100002141","name":"Public Health England","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002141","id-type":"DOI","asserted-by":"publisher"}]},{"name":"eSTI2 Consortium"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      <jats:italic>Chlamydia trachomatis<\/jats:italic>\n                      is the most commonly diagnosed bacterial STI. Lack of prevalence and risk factor data for rectal chlamydia in women has testing and treatment implications, as azithromycin (a first-line urogenital chlamydia treatment) may be less effective for rectal chlamydia. We conducted a systematic review of studies on women in high-income countries to estimate rectal chlamydia prevalence, concurrency with urogenital chlamydia and associations with reported anal intercourse (AI).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic review and four meta-analyses conducted using random-effects modelling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources<\/jats:title>\n                    <jats:p>Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and the Cochrane Database were searched for articles published between January 1997 and October 2017.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Eligibility criteria<\/jats:title>\n                    <jats:p>Studies reporting rectal chlamydia positivity in heterosexual women aged \u226515\u2009years old in high-income countries were included. Studies must have used nucleic acid amplification tests and reported both the total number of women tested for rectal chlamydia and the number of rectal chlamydia infections detected. Conference abstracts, case reports and studies with self-reported diagnoses were excluded. Data extracted included setting, rectal and urogenital chlamydia testing results, AI history, and demographics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Fourteen eligible studies were identified, all among diverse populations attending sexual health services. Among routine clinic-attending women, summary rectal chlamydia positivity was 6.0% (95% CI 3.2% to 8.9%); summary concurrent rectal chlamydia infection was 68.1% in those who tested positive for urogenital chlamydia (95%\u2009CI 56.6% to 79.6%); and of those who tested negative for urogenital chlamydia, 2.2% (95% CI 0% to 5.2%) were positive for rectal chlamydia. Reported AI was not associated with rectal chlamydia (summary risk ratio 0.90; 95%\u2009CI 0.75 to 1.10).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>High levels of rectal chlamydia infection have been shown in women with urogenital chlamydia infection. The absence of association between reported AI and rectal chlamydia suggests AI is not an adequate indicator for rectal testing. Further work is needed to determine policy and practice for routine rectal testing in women.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/sextrans-2017-053161","type":"journal-article","created":{"date-parts":[[2018,2,13]],"date-time":"2018-02-13T11:25:41Z","timestamp":1518521141000},"page":"320-326","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":77,"title":["Detection of\n                    <i>Chlamydia trachomatis<\/i>\n                    in rectal specimens in women and its association with anal intercourse: a systematic review and meta-analysis"],"prefix":"10.1136","volume":"94","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6259-230X","authenticated-orcid":false,"given":"Nastassya L","family":"Chandra","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Broad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Folkard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katy","family":"Town","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1432-8109","authenticated-orcid":false,"given":"Emma M","family":"Harding-Esch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah C","family":"Woodhall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9658-7798","authenticated-orcid":false,"given":"John M","family":"Saunders","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S Tariq","family":"Sadiq","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4562-5851","authenticated-orcid":false,"given":"J Kevin","family":"Dunbar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,2,3]]},"reference":[{"key":"2020050723332710000_94.5.320.1","unstructured":"Public Health England. Opportunistic chlamydia screening of young adults in England: an evidence summary. London, UK: Public Health England, 2014."},{"key":"2020050723332710000_94.5.320.2","doi-asserted-by":"publisher","DOI":"10.1177\/0956462415615443"},{"key":"2020050723332710000_94.5.320.3","doi-asserted-by":"publisher","DOI":"10.3310\/hta20220"},{"key":"2020050723332710000_94.5.320.4","doi-asserted-by":"publisher","DOI":"10.1258\/ijsa.2012.011378"},{"key":"2020050723332710000_94.5.320.5","doi-asserted-by":"crossref","first-page":"S5","DOI":"10.1016\/S0140-6736(98)90002-2","article-title":"Sexually transmitted diseases enhance HIV transmission: no longer a hypothesis","volume":"351(Suppl 3)","author":"Cohen","year":"1998","journal-title":"Lancet"},{"key":"2020050723332710000_94.5.320.6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2016\/5758387","article-title":"Extragenital infections caused by chlamydia trachomatis and Neisseria gonorrhoeae: a review of the Literature","volume":"2016","author":"Chan","year":"2016","journal-title":"Infect Dis Obstet Gynecol"},{"key":"2020050723332710000_94.5.320.7","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.02398-09"},{"key":"2020050723332710000_94.5.320.8","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1089\/jwh.2014.4948","article-title":"High prevalence of rectal gonorrhea and Chlamydia infection in women attending a sexually transmitted disease clinic","volume":"24","author":"Bazan","year":"2015","journal-title":"J Womens Health"},{"key":"2020050723332710000_94.5.320.9","doi-asserted-by":"crossref","unstructured":"Ding A , Challenor R . Rectal Chlamydia in heterosexual women: more questions than answers? International Journal of STD and AIDS 2013;24.","DOI":"10.1177\/0956462413515637"},{"key":"2020050723332710000_94.5.320.10","unstructured":"van Liere G , Dirks J , Hoebe C , et al . Genital and anorectal Chlamydia trachomatis load in women with a concurrent infection 30th IUSTI-Europe Congress. Budapest 2016."},{"key":"2020050723332710000_94.5.320.11","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-015-0939-3"},{"key":"2020050723332710000_94.5.320.12","doi-asserted-by":"publisher","DOI":"10.1128\/IAI.01244-13"},{"key":"2020050723332710000_94.5.320.13","unstructured":"Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2015. 2015. http:\/\/www.cdc.gov\/std\/tg2015\/default.htm (accessed 31 Oct 2016)."},{"key":"2020050723332710000_94.5.320.14","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciu220"},{"key":"2020050723332710000_94.5.320.15","unstructured":"World Health Organization. WHO guidelines for the treatment of Chlamydia trachomatis, 2016."},{"key":"2020050723332710000_94.5.320.16","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-14-274"},{"key":"2020050723332710000_94.5.320.17","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciu831"},{"key":"2020050723332710000_94.5.320.18","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0b013e31826ae9a2"},{"key":"2020050723332710000_94.5.320.19","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181d444f6"},{"key":"2020050723332710000_94.5.320.20","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)62035-8"},{"key":"2020050723332710000_94.5.320.21","unstructured":"European Centre for Disease Prevention and Control. Chlamydia control in Europe - a survey of Member States. 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Table 4: All STI diagnoses and services by gender and sexual risk. 2011 to 2016;2015."},{"key":"2020050723332710000_94.5.320.36","doi-asserted-by":"publisher","DOI":"10.1086\/597011"}],"container-title":["Sexually Transmitted Infections"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/sextrans-2017-053161","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,9,26]],"date-time":"2020-09-26T06:14:59Z","timestamp":1601100899000},"score":1,"resource":{"primary":{"URL":"https:\/\/sti.bmj.com\/lookup\/doi\/10.1136\/sextrans-2017-053161"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,2,3]]},"references-count":36,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2018,7,19]]},"published-print":{"date-parts":[[2018,8]]}},"alternative-id":["10.1136\/sextrans-2017-053161"],"URL":"https:\/\/doi.org\/10.1136\/sextrans-2017-053161","relation":{},"ISSN":["1368-4973","1472-3263"],"issn-type":[{"value":"1368-4973","type":"print"},{"value":"1472-3263","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,2,3]]}}}