Feasibility of anorectal chlamydia testing in women: a cross-sectional survey among general practitioners. (26th June 2021)

• Record Type: Journal Article
• Authors: Derckx, Raissa T; Rinsma, Sygriet; Dukers-Muijrers, Nicole H T M; AB, Elisabeth; van Bergen, Jan; de Bont, Eefje; Hoebe, Christian J P A; Cals, Jochen W L
• Is Part Of: Family practice. Volume 38:Number 6(2021)
• Page Start: 724
• Page End: 730
• Publication Date: 2021-06-26
• Subjects: Chlamydia trachomatis -- diagnostic techniques and procedures -- general practice -- medical history taking -- sexually transmitted diseases -- women; Primary care (Medicine) -- Periodicals; Clinical medicine -- Periodicals; 616.005
• DOI: 10.1093/fampra/cmab036
• Languages: English
• ISSNs: 0263-2136

Abstract

Abstract: Background: Anorectal Chlamydia trachomatis (CT) may be clinically relevant for women in general practice. Although anorectal CT testing in this setting may prevent underdiagnosis and undertreatment, its feasibility is questioned as GPs currently rarely order anorectal CT tests, for yet unknown reasons. Objective: To explore the feasibility of anorectal CT testing in women in general practice. Methods: GPs across the Netherlands were invited directly ( n = 1481) and by snowball sampling ( n = 330) to join an online cross-sectional survey that asked about the acceptability of and barriers for (standard) anorectal testing in women during CT-related consultations. Data were analysed with univariable and multivariable logistic regression models. Results: The questionnaire was opened by 514 respondents (28%, 514/1811) and 394 fully completed it. GPs' acceptability of anorectal testing by either self-sampling or provider-sampling was high (86%). Twenty-eight percent of GPs felt neutral, and 43% felt accepting towards standard anorectal testing. Nevertheless, 40% of GPs had never tested for anorectal CT in women, which was associated with a reported difficulty in asking about anal sex (odds ratio [OR]: 3.07, 95% confidence interval [CI]: 1.21–7.80), infrequency of anal sexual history taking (OR: 11.50, 95% CI: 6.39–20.72), low frequency of urogenital CT testing (OR 3.44, 95%-CI: 1.86–6.38) and with practicing in a non-urban area (OR: 2.27, 95% CI: 1.48–3.48). Acceptability of anorectal testing was not associated with the studied factors. Conclusion: This quantitative survey shows that anorectal CT testing is feasible based on its acceptability, but is likely hindered by a lower awareness of (anorectal) CT in GPs. Lay Summary: Background: Chlamydia trachomatis (CT) is a sexually transmitted disease that occurs both vaginally and anorectally (anally) in women. Testing for anorectal CT may improve treatment outcomes, but GPs currently rarely order anorectal CT tests. It is therefore uncertain whether anorectal CT testing is feasible. Objective: To find out whether anorectal CT testing in women by GPs is feasible. Methods: We sent an online survey to GPs across the Netherlands and asked about (1) the acceptability of and (2) barriers for anorectal CT testing in women. Results: GPs thought anorectal CT testing, either when the patient self-sampled or when the GP sampled, was acceptable (86%). Twenty-eight percent of GPs felt neutral, and 43% felt accepting towards standard anorectal testing. Nevertheless, 40% of GPs had never tested for anorectal CT in women. These GPs were more likely to find it difficult to ask women about anal sex, to do so less frequently, to less frequently offer CT tests all together and to work in a non-urban area. These factors imply a lower awareness of (anorectal) CT. Conclusion: This study shows that anorectal CT testing is feasible based on its acceptability, but is likely hindered by a lower awareness of (anorectal) CT.