High chlamydia positivity rates in Indigenous people attending Australian sexual health services

Catherine C O’Connor, Hammad Ali, Rebecca J Guy, David J Templeton, Christopher K Fairley, Marcus Y Chen, Bridget M Dickson, Lewis J Marshall, Andrew E Grulich, Margaret E Hellard, John M Kaldor, Basil Donovan and James S Ward
Med J Aust 2014; 200 (10): 595-598. || doi: 10.5694/mja13.10875


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.

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  • Catherine C O’Connor1,2
  • Hammad Ali2
  • Rebecca J Guy2
  • David J Templeton1,2
  • Christopher K Fairley3,4
  • Marcus Y Chen3
  • Bridget M Dickson5
  • Lewis J Marshall6,7
  • Andrew E Grulich2
  • Margaret E Hellard8
  • John M Kaldor2
  • Basil Donovan2,9
  • James S Ward10

  • 1 RPA Sexual Health, Sydney Local Health District, Sydney, NSW.
  • 2 Kirby Institute, University of New South Wales, Sydney, NSW.
  • 3 Melbourne Sexual Health Centre, Melbourne, VIC.
  • 4 Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC.
  • 5 CaraData Pty Ltd, Brisbane, QLD.
  • 6 Sexual Health Service, Fremantle Hospital, Perth, WA.
  • 7 University of Notre Dame Fremantle, Perth, WA.
  • 8 Centre for Population Health, Burnet Institute, Melbourne, VIC.
  • 9 Sydney Sexual Health Centre, Sydney, NSW.
  • 10 Baker IDI Heart and Diabetes Institute, Alice Springs, NT.


ACCESS is a collaboration between the Kirby Institute, the Burnet Institute, the National Serology Reference Laboratory, and the National Perinatal Epidemiology and Statistics Unit. The ACCESS project was funded by the Australian Government Department of Health and Ageing from 2007 to 2010. It is now funded by the health departments of NSW, Vic, NT and ACT. Margaret Hellard, Rebecca Guy and Bridget Dickson receive funding support from National Health and Medical Research Council fellowships. The Burnet Institute acknowledges the contribution to this work of the Victorian Operational Infrastructure Support Program. We thank all the sexual health services that provided data for ACCESS (Appendix 3). We thank Matthew Law, Professor and Program Head, and Handan Wand, Senior Lecturer, Biostatistics and Databases Program, Kirby Institute, University of New South Wales, who provided statistical advice.

Competing interests: No relevant disclosures.

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