Objective: To assess the clinical epidemiology of chlamydia among Aboriginal and Torres Strait Islander (Indigenous) people attending sexual health services around Australia.
Design: Retrospective analysis of routine demographic, behavioural and clinical data, between 1 January 2006 and 31 December 2011.
Setting: 18 sexual health services in major cities and regional centres in five jurisdictions.
Main outcome measures: Attendance, chlamydia testing and positivity rates in patients visiting for the first time, and factors associated with chlamydia positivity.
Results: Of 168 729 new patients, 7103 (4.2%) identified as Indigenous, of whom 74.3% were tested for chlamydia. Chlamydia positivity was 17.0% in Indigenous women (23.3% in 15–19-year-olds and 18.9% in 20–24-year-olds) and 17.3% in Indigenous men (20.2% in 15–19-year-olds and 24.2% in 20–24-year-olds). There was an increasing trend in chlamydia positivity in Indigenous women from 2006 to 2011 (P for trend = 0.001), but not in Indigenous men. In Indigenous women, factors independently associated with positivity were: younger age, being heterosexual, living in Queensland and attending the service in 2010. In Indigenous men, independent factors associated with chlamydia positivity were younger age, being heterosexual, having sex only in Australia and living in a regional area.
Conclusion: The high and increasing chlamydia positivity rates highlight the need for enhanced prevention and screening programs for Indigenous people.
- 1. Australian Government Department of Health. Introduction to the National Notifiable Diseases Surveillance System. Canberra; 2011. http://www.health.gov.au/internet/main/publishing.nsf/content/cda-surveil-nndss-nndssintro.htm (accessed Apr 2014).
- 2. Graham S, Guy RJ, Donovan B, et al. Epidemiology of chlamydia and gonorrhoea among Indigenous and non-Indigenous Australians, 2000-2009. Med J Aust 2012; 197: 642-646. <MJA full text>
- 3. The Kirby Institute. Bloodborne viral and sexually transmitted infections in Aboriginal and Torres Strait Islander people: surveillance and evaluation report 2012. Sydney: The Kirby Institute, University of New South Wales. http://www.kirby.unsw.edu.au/surveillance/2012-aboriginal-surveillance-report-hiv-viral-hepatitis-stis (accessed May 2013).
- 4. Jin F, Prestage GP, Mao L, et al. Incidence and risk factors for urethral and anal gonorrhoea and chlamydia in a cohort of HIV-negative homosexual men: the Health in Men Study. Sex Transm Infect 2007; 83: 113-119.
- 5. Lister NA, Smith A, Tabrizi S, et al. Screening for Neisseria gonorrhoeae and Chlamydia trachomatis in men who have sex with men at male-only saunas. Sex Transm Dis 2003; 30: 886-889.
- 6. Australian Bureau of Statistics. 2011 Census QuickStats. http://www.censusdata.abs.gov.au/census_services/getproduct/census/2011/quickstat/0 (accessed Sep 2013).
- 7. Australian Department of Health. Second National Sexually Transmissible Infections Strategy 2010−2013. https://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-national-strategies-2010-sti (accessed May 2013).
- 8. Guy R, Ward JS, Smith KS, et al. The impact of sexually transmissible infection programs in remote Aboriginal communities in Australia: a systematic review. Sex Health 2012; 9: 205-212.
- 9. Ali H, Guy RJ, Fairley CK, et al. Understanding trends in genital Chlamydia trachomatis can benefit from enhanced surveillance: findings from Australia. Sex Transm Infect 2012; 88: 552-557.
- 10. Guy RJ, Kong F, Goller J, et al. A new national chlamydia sentinel surveillance system in Australia: evaluation of the first stage of implementation. Commun Dis Intell Q Rep 2010; 34: 319-328.
- 11. Australian Bureau of Statistics. Australian Statistical Geography Standard (ASGS). Remoteness structure. http://www.abs.gov.au/websitedbs/D3310114.nsf/home/Australian+Statistical+Geography+Standard+(ASGS) (accessed May 2013).
- 12. Australian Bureau of Statistics. National regional profile 2007-2011. http://www.ausstats.abs.gov.au/ausstats/nrpmaps.nsf/NEW+GmapPages/national+regional+profile?opendocument (accessed Dec 2013).
- 13. Walker J, Fairley CK, Bradshaw CS, et al. The difference in determinants of Chlamydia trachomatis and Mycoplasma genitalium in a sample of young Australian women. BMC Infect Dis 2011; 11: 35.
- 14. 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.
- 15. Lenton JA, Freedman E, Hoskin K, et al. Chlamydia trachomatis infection among antenatal women in remote far west New South Wales, Australia. Sex Health 2007; 4: 139-140.
- 16. 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.
- 17. 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.
- 18. Templeton DJ, Tyson BA, Meharg JP, et al. Aboriginal health worker screening for sexually transmissible infections and blood-borne viruses in a rural Australian juvenile correctional facility. Sex Health 2010; 7: 44-48.
- 19. Chen MY, Donovan B. Genital Chlamydia trachomatis infection in Australia: epidemiology and clinical implications. Sex Health 2004; 1: 189-196.
- 20. Lewis D, Newton DC, Guy RJ, et al. The prevalence of Chlamydia trachomatis infection in Australia: a systematic review and meta-analysis. BMC Infect Dis 2012; 12: 113.
- 21. Lee V, Tobin JM, Foley E. Relationship of cervical ectopy to chlamydia infection in young women. J Fam Plann Reprod Health Care 2006; 32: 104-106.
- 22. Grulich AE, de Visser RO, Smith AM, et al. Sex in Australia: knowledge about sexually transmissible infections and blood-borne viruses in a representative sample of adults. Aust N Z J Public Health 2003; 27: 230-233.
- 23. Fairley CK, Vodstrcil LA, Read T. The importance of striving for greater efficiency. Sex Health 2011; 8: 3-4.
- 24. Guy R, Ward JS, Smith KS, et al. The impact of sexually transmissible infection programs in remote Aboriginal communities in Australia: a systematic review. Sex Health 9: 205-212.
- 25. Ward J, Guy R, Huang RL, et al. Rapid point-of-care tests for HIV and sexually transmissible infection control in remote Australia: can they improve Aboriginal people's and Torres Strait Islanders' health. Sex Health 9: 109-112.
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.