Objective: To assess the impact of a long-term comprehensive control program for sexually transmitted infections (STIs) in remote Aboriginal communities in Central Australia, and to investigate a recent rise in gonorrhoea prevalence.
Design: STI prevalence was determined from annual, cross-sectional, population-wide, age-based screening, 1996–2006. During 2006, gonococcal isolates were obtained by on-site culture and tested for antimicrobial susceptibility.
Main outcome measures: Multivariable logistic regression models were used to compare prevalence of chlamydial infection, gonorrhoea and syphilis measured during each annual population-wide screen; antimicrobial susceptibility of gonococcal isolates obtained in 2006.
Results: Between 1996 and 2003, there was a significant reduction in prevalence of gonorrhoea and chlamydial infection, by 67% and 58%, respectively. Subsequently, chlamydia prevalence rate plateaued, but there was a rapid rise in prevalence of gonorrhoea. Syphilis prevalence decreased linearly over the study period (odds ratio, 0.81; P < 0.001). During the first 6 months of 2006, 89 gonococcal isolates were obtained, 39 through on-site culture during the 6-week screening period, and all were sensitive to penicillin (in the less-sensitive category).
Conclusions: The decrease in STI prevalence asssociated with the program was maintained until 2006 for chlamydial infection and syphilis, but not for gonorrhoea, which rose in prevalence after 2003. There was no change in antimicrobial resistance to explain this rise, and gonorrhoea transmission dynamics and travel of core transmitters to regions without STI control programs might be responsible.
- 1. Miller PJ, Torzillo PJ, Hateley W. Impact of improved diagnosis and treatment on prevalence of gonorrhoea and chlamydial infection in remote Aboriginal communities on Anangu Pitjantjatjara Lands. Med J Aust 1999; 170: 429-432.
- 2. Miller PJ, Torzillo P, Tizard J, Winslow B. Interventions to reduce the interval to treatment in syphilis: central case management and encrypted email. Venereology 1998; 11: 26-29.
- 3. Garrow SC, Smith DW, Harnett GB. The diagnosis of chlamydia, gonorrhoea, and trichomonas infections by self obtained low vaginal swabs, in remote northern Australian clinical practice. Sex Transm Infect 2002; 78: 278-281.
- 4. Knox J, Tabrizi SN, Miller P, et al. Evaluation of self-collected samples in contrast to practitioner-collected samples for detection of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis by polymerase chain reaction among women living in remote areas. Sex Transm Dis 2002; 29: 647-654.
- 5. National Centre in HIV Epidemiology and Clinical Research. Bloodborne viral and sexually transmitted infections in Aboriginal and Torres Strait Islander people: surveillance report 2007. Sydney: NCHECR, University of New South Wales, 2007.
- 6. Latif AS, Smith KS. Sexually transmitted infections in central Australia — time for concerted action. Public Health Bull S A 2006; 4: 32-33.
- 7. Latif AS, Smith KS. STI screening conducted in NT Department of Health and Community Services and Community Controlled Health Services in Central Australia in 2004. NT Disease Control Bull 2004; 11 (4): 18-20.
- 8. Sparling PF, Tsai J, Cornelissen CN. Gonococci are survivors. Scand J Infect Dis Suppl 1990; 69: 125-136.
- 9. Yorke JA, Hethcote HW, Nold A. Dynamics and control of the transmission of gonorrhoea. Sex Transm Dis 1978; 5: 51-56.
- 10. Warchivker I, Tapangati T, Wakerman J. The turmoil of Aboriginal enumeration: mobility and service population analysis in a central Australian community. Aust N Z J Public Health 2000; 24: 444-449.
- 11. Choudery B, Risley CL, Ghani AC, et al. Identification of individuals with gonorrhoea within sexual networks: a population-based study. Lancet 2006; 368: 139-146.
- 12. Sarafian SK, Knapp JS. Molecular epidemiology of gonorrhoea. Clin Microbiol Rev 1989; 2 Suppl: S49-S55.
- 13. Kolader M-E, Dukers NH, van der Bij AK, et al. Molecular epidemiology of Neisseria gonorrhoeae in Amsterdam, The Netherlands, shows distinct heterosexual and homosexual networks. J Clin Microbiol 2006; 44: 2689-2697.
- 14. Ward H, Ison CA, Sophie ED, et al. A prospective social and molecular investigation of gonococcal transmission. Lancet 2000; 356: 1812-1817.
- 15. Skov SJ, Miller P, Hateley W, et al. Urinary diagnosis of gonorrhoea and chlamydia in men in remote aboriginal communities. Med J Aust 1997; 166: 468-471. <MJA full text>
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.