(P94) Anorectal Neisseria gonorrhoeae infection in a large population of women tested at sexual health centres in the Netherlands

Background

Anorectal gonorrhoea infections among women are associated with anal sex, however anorectal infections are also seen among women without anal exposure. Reasons for this are unknown due to limited or small-sample studies on this topic. We aim to enhance our understanding of anorectal gonorrhoea infections in women, using data from three distinct groups of women tested at sexual health centres (SHCs).

Methods

We used surveillance data from Dutch SHCs from 2016 to 2021. We included cis-gender women who have sex with men and were tested for gonorrhoea both urogenital and anorectally. Due to differences in testing policy, we identified three distinct groups: 1) women without anal sex, 2) women with anal sex and 3) sex workers. For all three groups anorectal gonorrhoea prevalence was described and multivariable logistic regression was performed to identify determinants of anorectal gonorrhoea among all women and among gonorrhoea positive women only.

Results

A total of 117,693 consultations were included (43,757 women without anal sex, 51,728 women with anal sex and 22,208 sex workers), 2% was gonorrhoea positive. Consistent in all three groups, ≥70% of gonorrhoea positives had an anorectal infection (figure 1). In all three groups, urogenital gonorrhoea and anorectal chlamydia co-infections were the strongest predictors of anorectal gonorrhoea among all women. Significant other determinants were mainly general risk factors for gonorrhoea, including low education level, migration background and, among sex workers, no condom use and anal sex. In the second model among gonorrhoea positives only the only predictive determinant of anorectal infection among women without anal sex was anorectal chlamydia coinfection, and among women with anal sex it was migration background. Among sex workers no condom use, anal sex, and anorectal chlamydia coinfection were associated with anorectal gonorrhoea.

Conclusions

Anorectal gonorrhoea infection is common among women regardless of anal exposure, and urogenital gonorrhoea was consistently strongly associated with anorectal infection. Few other risk factors for anorectal gonorrhoea were determined. These findings are suggestive of a gonorrhoea autoinoculation process from the urogenital to the anorectal location. Further research into gonorrhoea autoinoculation as possible transmission route and the association with anorectal chlamydia coinfection is needed.