{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T01:04:25Z","timestamp":1785546265024,"version":"3.56.0"},"reference-count":60,"publisher":"BMJ","issue":"5","funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["1133144"],"award-info":[{"award-number":["1133144"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["1136117"],"award-info":[{"award-number":["1136117"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"accepted":{"date-parts":[[2019,4,18]]},"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>There has been considerable discussion about anorectal<jats:italic>Chlamydia trachomatis<\/jats:italic>(CT) in women, with some calling for anorectal CT screening, but little about anorectal<jats:italic>Neisseria gonorrhoeae<\/jats:italic>(NG). Given that urogenital NG is more strongly associated with pelvic inflammatory disease, this is an evidence gap. This systematic review and meta-analysis investigates the associations between anorectal CT in women and CT positivity at other sites (urogenital\/oropharyngeal) and with anal intercourse, and compares these with anorectal NG within the same study populations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Electronic databases were searched for English-language studies published to October 2018 using the following terms: (\u201cChlamydia\u201d OR \u201c<jats:italic>Chlamydia trachomatis<\/jats:italic>\u201d) AND ((\u201canal\u201d OR \u201crect*\u201d OR \u201canorect*\u201d) OR (\u201cextra?genital\u201d OR \u201cmulti?site\u201d)). Studies were included if anorectal NG data were available. Random-effects meta-analyses calculated pooled estimates; heterogeneity was investigated using meta-regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>25 studies were eligible. Anorectal CT positivity ranged from 0% to 17.5%, with a summary estimate of 8.0% (95% CI 7.0 to 9.1; I<jats:sup>2<\/jats:sup>=88.5%). Anorectal NG positivity ranged from 0% to 17.0%, with a summary estimate of 2.1% (95% CI 1.6 to 2.8; I<jats:sup>2<\/jats:sup>=92.7%). The association between urogenital and anorectal positivity was stronger for NG than CT (summary prevalence ratio (PR)=89.3 (95% CI 53.1 to 150.3; I<jats:sup>2<\/jats:sup>=80.1%), PR=32.2 (95% CI 25.6 to 40.7; I<jats:sup>2<\/jats:sup>=70.3%), respectively), and between oropharyngeal and anorectal positivity it was stronger for NG than CT (PR=34.8 (95% CI 10.2 to 118.2; I<jats:sup>2<\/jats:sup>=89.9%), PR=8.8 (95% CI 6.8 to 11.5; I<jats:sup>2<\/jats:sup>=58.1%), respectively). Anal intercourse was associated with anorectal NG (PR=4.3; 95%\u2009CI 2.2 to 8.6; I<jats:sup>2<\/jats:sup>=0.0%) but not with anorectal CT (PR=1.0; 95%\u2009CI 0.7 to 1.4; I<jats:sup>2<\/jats:sup>=0.0%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Anorectal CT is more common than anorectal NG, but anorectal NG is more strongly associated with anal intercourse, urogenital and oropharyngeal NG, suggesting that ongoing discussion about anorectal CT should also include NG. Longitudinal data are required to further understanding of the aetiology of anorectal STIs and assess whether anorectal screening is needed in women.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration number<\/jats:title><jats:p>CRD42df017080188.<\/jats:p><\/jats:sec>","DOI":"10.1136\/sextrans-2018-053950","type":"journal-article","created":{"date-parts":[[2019,5,16]],"date-time":"2019-05-16T21:16:00Z","timestamp":1558041360000},"page":"361-367","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":26,"title":["Factors associated with anorectal<i>Chlamydia trachomatis<\/i>or<i>Neisseria gonorrhoeae<\/i>test positivity in women: a systematic review and meta-analysis"],"prefix":"10.1136","volume":"95","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5240-8468","authenticated-orcid":false,"given":"Andrew","family":"Lau","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian Yuh Shiong","family":"Kong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Willa","family":"Huston","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1766-0657","authenticated-orcid":false,"given":"Eric P F","family":"Chow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher K","family":"Fairley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane S","family":"Hocking","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,5,16]]},"reference":[{"key":"2024092304402304000_95.5.361.1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0143304","article-title":"Global estimates of the prevalence and incidence of four curable sexually transmitted infections in 2012 based on Systematic review and global reporting","volume":"10","author":"Newman","year":"2015","journal-title":"Plos One"},{"key":"2024092304402304000_95.5.361.2","unstructured":"Public Health England . 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