Factors associated with anorectal Chlamydia trachomatis or Neisseria gonorrhoeae test positivity in women: a systematic review and meta-analysis

Andrew Lau, Fabian Yuh Shiong Kong, Willa Huston, Eric P.F. Chow, Christopher K. Fairley, Jane S. Hocking

Research output: Contribution to journalReview ArticleResearchpeer-review

Abstract

Objectives: There has been considerable discussion about anorectal Chlamydia trachomatis (CT) in women, with some calling for anorectal CT screening, but little about anorectal Neisseria gonorrhoeae (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. Methods: Electronic databases were searched for English-language studies published to October 2018 using the following terms: ("Chlamydia" OR "Chlamydia trachomatis") AND (("anal" OR "rect∗" OR "anorect∗") OR ("extra?genital" OR "multi?site")). Studies were included if anorectal NG data were available. Random-effects meta-analyses calculated pooled estimates; heterogeneity was investigated using meta-regression. Results: 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 2 =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 2 =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 2 =80.1%), PR=32.2 (95% CI 25.6 to 40.7; I 2 =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 2 =89.9%), PR=8.8 (95% CI 6.8 to 11.5; I 2 =58.1%), respectively). Anal intercourse was associated with anorectal NG (PR=4.3; 95% CI 2.2 to 8.6; I 2 =0.0%) but not with anorectal CT (PR=1.0; 95% CI 0.7 to 1.4; I 2 =0.0%). Conclusions: 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. Trial registration number: CRD42df017080188.

Original languageEnglish
Number of pages7
JournalSexually Transmitted Infections
DOIs
Publication statusAccepted/In press - 16 May 2019

Keywords

  • chlamydia trachomatis
  • neisseria gonorrhoeae
  • systematic review, meta-analysis
  • women

Cite this

@article{2395342947d449a1a68196770e0bd29d,
title = "Factors associated with anorectal Chlamydia trachomatis or Neisseria gonorrhoeae test positivity in women: a systematic review and meta-analysis",
abstract = "Objectives: There has been considerable discussion about anorectal Chlamydia trachomatis (CT) in women, with some calling for anorectal CT screening, but little about anorectal Neisseria gonorrhoeae (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. Methods: Electronic databases were searched for English-language studies published to October 2018 using the following terms: ({"}Chlamydia{"} OR {"}Chlamydia trachomatis{"}) AND (({"}anal{"} OR {"}rect∗{"} OR {"}anorect∗{"}) OR ({"}extra?genital{"} OR {"}multi?site{"})). Studies were included if anorectal NG data were available. Random-effects meta-analyses calculated pooled estimates; heterogeneity was investigated using meta-regression. Results: 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 2 =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 2 =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 2 =80.1{\%}), PR=32.2 (95{\%} CI 25.6 to 40.7; I 2 =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 2 =89.9{\%}), PR=8.8 (95{\%} CI 6.8 to 11.5; I 2 =58.1{\%}), respectively). Anal intercourse was associated with anorectal NG (PR=4.3; 95{\%} CI 2.2 to 8.6; I 2 =0.0{\%}) but not with anorectal CT (PR=1.0; 95{\%} CI 0.7 to 1.4; I 2 =0.0{\%}). Conclusions: 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. Trial registration number: CRD42df017080188.",
keywords = "chlamydia trachomatis, neisseria gonorrhoeae, systematic review, meta-analysis, women",
author = "Andrew Lau and Kong, {Fabian Yuh Shiong} and Willa Huston and Chow, {Eric P.F.} and Fairley, {Christopher K.} and Hocking, {Jane S.}",
year = "2019",
month = "5",
day = "16",
doi = "10.1136/sextrans-2018-053950",
language = "English",
journal = "Sexually Transmitted Infections",
issn = "1368-4973",
publisher = "BMJ Group",

}

Factors associated with anorectal Chlamydia trachomatis or Neisseria gonorrhoeae test positivity in women: a systematic review and meta-analysis. / Lau, Andrew; Kong, Fabian Yuh Shiong; Huston, Willa; Chow, Eric P.F.; Fairley, Christopher K.; Hocking, Jane S.

In: Sexually Transmitted Infections, 16.05.2019.

Research output: Contribution to journalReview ArticleResearchpeer-review

TY - JOUR

T1 - Factors associated with anorectal Chlamydia trachomatis or Neisseria gonorrhoeae test positivity in women: a systematic review and meta-analysis

AU - Lau, Andrew

AU - Kong, Fabian Yuh Shiong

AU - Huston, Willa

AU - Chow, Eric P.F.

AU - Fairley, Christopher K.

AU - Hocking, Jane S.

PY - 2019/5/16

Y1 - 2019/5/16

N2 - Objectives: There has been considerable discussion about anorectal Chlamydia trachomatis (CT) in women, with some calling for anorectal CT screening, but little about anorectal Neisseria gonorrhoeae (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. Methods: Electronic databases were searched for English-language studies published to October 2018 using the following terms: ("Chlamydia" OR "Chlamydia trachomatis") AND (("anal" OR "rect∗" OR "anorect∗") OR ("extra?genital" OR "multi?site")). Studies were included if anorectal NG data were available. Random-effects meta-analyses calculated pooled estimates; heterogeneity was investigated using meta-regression. Results: 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 2 =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 2 =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 2 =80.1%), PR=32.2 (95% CI 25.6 to 40.7; I 2 =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 2 =89.9%), PR=8.8 (95% CI 6.8 to 11.5; I 2 =58.1%), respectively). Anal intercourse was associated with anorectal NG (PR=4.3; 95% CI 2.2 to 8.6; I 2 =0.0%) but not with anorectal CT (PR=1.0; 95% CI 0.7 to 1.4; I 2 =0.0%). Conclusions: 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. Trial registration number: CRD42df017080188.

AB - Objectives: There has been considerable discussion about anorectal Chlamydia trachomatis (CT) in women, with some calling for anorectal CT screening, but little about anorectal Neisseria gonorrhoeae (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. Methods: Electronic databases were searched for English-language studies published to October 2018 using the following terms: ("Chlamydia" OR "Chlamydia trachomatis") AND (("anal" OR "rect∗" OR "anorect∗") OR ("extra?genital" OR "multi?site")). Studies were included if anorectal NG data were available. Random-effects meta-analyses calculated pooled estimates; heterogeneity was investigated using meta-regression. Results: 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 2 =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 2 =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 2 =80.1%), PR=32.2 (95% CI 25.6 to 40.7; I 2 =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 2 =89.9%), PR=8.8 (95% CI 6.8 to 11.5; I 2 =58.1%), respectively). Anal intercourse was associated with anorectal NG (PR=4.3; 95% CI 2.2 to 8.6; I 2 =0.0%) but not with anorectal CT (PR=1.0; 95% CI 0.7 to 1.4; I 2 =0.0%). Conclusions: 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. Trial registration number: CRD42df017080188.

KW - chlamydia trachomatis

KW - neisseria gonorrhoeae

KW - systematic review, meta-analysis

KW - women

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U2 - 10.1136/sextrans-2018-053950

DO - 10.1136/sextrans-2018-053950

M3 - Review Article

JO - Sexually Transmitted Infections

JF - Sexually Transmitted Infections

SN - 1368-4973

ER -