Letters
Infectious diseases Sexual health
Volume 200 - Issue 1

Gonorrhoea infection, reinfection and co-infection in men in inner Sydney: a population-based analysis

Authors:  Kelly-Anne Ressler, Mark J Ferson and Elizabeth J Smedley

Med J Aust 2014; 200 (1): 26. || doi: 10.5694/mja13.10945
Published online: 20 January 2014
Data linking multiple disease notifications from the same individuals show patterns of infection in Sydney men
Download PDF (155 KB)
Share: Share on Blue Sky Share on Facebook Share on LinkedIn Share by email

To the Editor: From 2000 to 2009, national and New South Wales gonorrhoea notification rates were reasonably stable, but since 2010 have shown a marked rise.1 In a recent inner Sydney clinic-based study, most infections were in men who have sex with men (MSM), and chlamydia co-infection was common.2

In 2010, NSW Health introduced a new notifiable diseases database, which enables linking of multiple disease notifications from the same individual. We used the database to examine the pattern of notifications of gonorrhoea infection, reinfection and co-infection in residents of South Eastern Sydney Local Health District from 1 January 2010 to 31 December 2012. Ethics approval was not required as the Director of the Public Health Unit (M J F) is custodian of local notifiable diseases data and has authority to publish such data.

During the study period, 3132 cases of gonorrhoea were reported. We concentrated our analyses on men, who represented 2765 cases (88.3%). Of note was a fourfold increase in throat infections, from 87 in 2010 to 352 in 2012, and a 78.8% rise in anorectal infections, from 236 in 2010 to 422 in 2012 (Box 1). Almost one in 10 notifications (9.2%) were for two or more sites of infection.

The 2765 notifications were for 2430 men, of whom 272 (11.2%) had more than one episode of gonorrhoea infection in the 3-year period, or an 8.1% reinfection rate within 1 year. Thirteen men had notifications of infection at the same site within 10 weeks of the original notification; some of these may have represented treatment failure, an important concern in the context of increasing antibiotic resistance among isolates of Neisseria gonorrhoeae.3 The numbers of men with concurrent notifications of either primary or secondary syphilis or chlamydia are shown in Box 2. In addition, 841 men (34.6%) had notifications of two or more episodes of any sexually transmissible infection at any time during the 3-year period.

This population-based analysis allowed us to quantify the frequency of multiple notifiable sexually transmissible infections in men living in south-eastern Sydney, an area with Australia’s largest concentration of MSM,4 and in whom there has been a high rate of infectious syphilis.5 The rates of reinfection6 and co-infection with chlamydia2 were similar to those reported in sexual health clinic clients. As gonorrhoea is notifiable only by laboratories, demographic and risk factor information is not routinely provided. Work is currently proceeding in NSW on using enhanced surveillance to gain information on Indigenous status and risk factors for gonorrhoea infection.

1 Quarterly gonorrhoea notifications in men resident in south-eastern Sydney, 2010–2012, by infection site

2 Sexually transmissible co-infections in men with gonorrhoea notifications, 2010–2012

Co-infection

No. (%)

None

2029 (83.5%)

Chlamydia

384 (15.8%)

Infectious syphilis

11 (0.5%)

Chlamydia and infectious syphilis

6 (0.2%)

Total

2430 (100%)

Authors

  • Kelly-Anne Ressler1
  • Mark J Ferson1,2
  • Elizabeth J Smedley1
  • 1. Public Health Unit, South Eastern Sydney Local Health District, Sydney, NSW.
  • 2. School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW.

Correspondence: kelly-anne.ressler@sesiahs.health.nsw.gov.au

Competing interests

No relevant disclosures.

References

View this article on Wiley Online Library