Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
Sex Transm Infect. 2019 Aug;95(5):361-367. doi: 10.1136/sextrans-2018-053950. Epub 2019 May 16.
There has been considerable discussion about anorectal (CT) in women, with some calling for anorectal CT screening, but little about anorectal (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.
Electronic databases were searched for English-language studies published to October 2018 using the following terms: ("Chlamydia" OR "") 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.
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=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=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=80.1%), PR=32.2 (95% CI 25.6 to 40.7; I=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=89.9%), PR=8.8 (95% CI 6.8 to 11.5; I=58.1%), respectively). Anal intercourse was associated with anorectal NG (PR=4.3; 95% CI 2.2 to 8.6; I=0.0%) but not with anorectal CT (PR=1.0; 95% CI 0.7 to 1.4; I=0.0%).
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.
CRD42df017080188.
针对女性肛门直肠衣原体（CT）的问题已经进行了大量讨论，有人呼吁对肛门直肠 CT 进行筛查，但很少涉及肛门直肠淋病奈瑟菌（NG）。鉴于泌尿生殖系 NG 与盆腔炎的关系更为密切，因此这是一个证据空白。本系统评价和荟萃分析调查了女性肛门直肠 CT 与其他部位（泌尿生殖系/口咽）CT 阳性和肛交之间的相关性，并在同一研究人群中比较了这些相关性与肛门直肠 NG 之间的相关性。
使用以下术语在英文数据库中搜索截至 2018 年 10 月发表的研究：（“衣原体”或“淋病奈瑟菌”）和（“肛门”或“直肠”或“肛门直肠”）或（“生殖”或“多部位”）。如果有肛门直肠 NG 数据，则纳入研究。使用随机效应荟萃分析计算汇总估计值；使用元回归调查异质性。
25 项研究符合条件。肛门直肠 CT 阳性率为 0%至 17.5%，综合估计值为 8.0%（95% CI 7.0 至 9.1；I=88.5%）。肛门直肠 NG 阳性率为 0%至 17.0%，综合估计值为 2.1%（95% CI 1.6 至 2.8；I=92.7%）。泌尿生殖系和肛门直肠阳性之间的相关性在 NG 中比 CT 更强（综合患病率比（PR）=89.3（95% CI 53.1 至 150.3；I=80.1%），PR=32.2（95% CI 25.6 至 40.7；I=70.3%）），而口咽和肛门直肠阳性之间的相关性在 NG 中比 CT 更强（PR=34.8（95% CI 10.2 至 118.2；I=89.9%），PR=8.8（95% CI 6.8 至 11.5；I=58.1%））。肛交与肛门直肠 NG 相关（PR=4.3；95%CI 2.2 至 8.6；I=0.0%），但与肛门直肠 CT 无关（PR=1.0；95%CI 0.7 至 1.4；I=0.0%）。
肛门直肠 CT 比肛门直肠 NG 更常见，但肛门直肠 NG 与肛交、泌尿生殖系和口咽 NG 的相关性更强，这表明对肛门直肠 CT 的持续讨论也应包括 NG。需要纵向数据来进一步了解肛门直肠性传播感染的病因，并评估女性是否需要进行肛门直肠筛查。
CRD42df017080188。
