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Epidemiology of sexually transmitted infections on the Anangu Pitjantjatjara Yankunytjatjara Lands: results of a comprehensive control program

Rae-Lin Huang, Paul J Torzillo, Vivien A Hammond, Stephanie T Coulter and Adrienne C Kirby
Med J Aust 2008; 189 (8): 442-445.

Summary

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.

Setting: Six remote clinics on the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands, South Australia, which are served by Nganampa Health Council, an Aboriginal community-controlled health service.

Participants: All resident Aboriginal people aged 14–40 years at the commencement date of each annual population-wide screen.

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.

  • Rae-Lin Huang1
  • Paul J Torzillo1,2
  • Vivien A Hammond1
  • Stephanie T Coulter3
  • Adrienne C Kirby4

  • 1 Nganampa Health Council, Alice Springs, NT.
  • 2 Royal Prince Alfred Hospital, Sydney, NSW.
  • 3 Infectious Diseases Laboratory, Institute of Medical and Veterinary Science, Adelaide, SA.
  • 4 NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW.

Correspondence: raelin.huang@palya.org.au

Acknowledgements: 

This article is published with permission of the NHC Aboriginal board of management. We thank NHC clinic staff for their contribution, in particular Dr Kerrie Gell for her significant ongoing contribution to STI data management and clinical care. Thanks to Professor Anthony Keech (NHMRC Clinical Trials Centre, Sydney, NSW) for his assistance with statistical analysis. The NHC STI Control and HIV Prevention Program is funded by the Office for Aboriginal and Torres Strait Islander Health, Commonwealth Department of Health and Ageing.

Competing interests:

None identified.

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