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Chlamydia prevalence in young attenders of rural and regional primary care services in Australia: a cross-sectional survey

Med J Aust 2014; 200 (3): 170-175. || doi: 10.5694/mja13.10729

Summary

Objective: To estimate chlamydia prevalence among 16–29-year-olds attending general practice clinics in Australia.

Design, participants and setting: A cross-sectional survey was conducted from May 2010 to December 2012. Sexually experienced 16–29-year-olds were recruited from 134 general practice clinics in 54 rural and regional towns in four states and in nine metropolitan clinics (consecutive patients were invited to participate). Participants completed a questionnaire and were tested for chlamydia.

Main outcome measure: Chlamydia prevalence.

Results: Of 4284 participants, 197 tested positive for chlamydia (4.6%; 95% CI, 3.9%–5.3%). Prevalence was similar in men (5.2% [65/1257]; 95% CI, 3.9%–6.4%) and women (4.4% [132/3027]; 95% CI, 3.5%–5.2%) (P = 0.25) and high in those reporting genital symptoms or a partner with a sexually transmissible infection (STI) — 17.0% in men (8/47; 95% CI, 2.8%–31.2%); 9.5% in women (16/169; 95% CI, 5.1%–13.8%). Nearly three-quarters of cases (73.4% [130/177]) were diagnosed in asymptomatic patients attending for non-sexual health reasons, and 83.8% of all participants (3258/3890) had attended for non-sexual health reasons. Prevalence was slightly higher in participants from rural and regional areas (4.8% [179/3724]; 95% CI, 4.0%–5.6%) than those from metropolitan areas (3.1% [17/548]; 95% CI, 1.5%–4.7%) (P = 0.08). In multivariable analysis, increasing partner numbers in previous 12 months (adjusted odds ratio [AOR] for three or more partners, 5.11 [95% CI, 2.35–11.08]), chlamydia diagnosis in previous 12 months (AOR, 4.35 [95% CI, 1.52–12.41]) and inconsistent condom use with most recent partner (AOR, 2.90 [95% CI, 1.31–6.40]) were significantly associated with chlamydia in men. In women, increasing partner numbers in previous 12 months (AOR for two partners, 2.59 [95% CI, 1.59–4.23]; AOR for three or more partners, 3.58 [95% CI, 2.26–5.68]), chlamydia diagnosis in previous 12 months (AOR, 3.13 [95% CI, 1.62–6.06]) and age (AOR for 25–29-year-olds, 0.23 [95% CI, 0.12–0.44]) were associated with chlamydia.

Conclusions: Chlamydia prevalence is similar in young men and women attending general practice. Testing only those with genital symptoms or a partner with an STI would have missed three-quarters of cases. Most men and women are amenable to being tested in general practice, even in rural and regional areas.

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  • Anna H Yeung1
  • Meredith Temple-Smith2
  • Christopher K Fairley1,3
  • Alaina M Vaisey1
  • Rebecca Guy4
  • Matthew G Law4
  • Nicola Low5
  • Amie L Bingham1
  • Jane Gunn2
  • John Kaldor4
  • Basil Donovan4,6
  • Jane S Hocking1

  • 1 Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC.
  • 2 General Practice and Primary Health Care Academic Centre, University of Melbourne, Melbourne, VIC.
  • 3 Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC.
  • 4 Kirby Institute, University of New South Wales, Sydney, NSW.
  • 5 Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
  • 6 Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW.

Correspondence: ayeung@unimelb.edu.au

Acknowledgements: 

This survey was conducted as part of the Department of Health and Ageing-funded Australian Chlamydia Control Effectiveness Pilot. We thank: Jane Tomnay, from the Centre for Excellence in Rural Sexual Health, University of Melbourne, for providing resources, support and advice on conducting this study in rural Victoria; Carolyn Murray and Chris Bourne, from the Sexually Transmissible Infections Program Unit, NSW Health, for providing advice and resources; the ACCEPt research team of Simone Spark, Alaina Vaisey, Anna Wood, Rebecca Lorch, Belinda Ford, Jennifer Walker, Michelle King, Dyani Lewis, Eris Smyth, Lisa Edward, Chantal Maloney and Anne Shaw for recruiting the participating clinics; and the 80 research assistants employed by the University of Melbourne for recruiting patients.

We acknowledge input from the ACCEPt Consortium of investigators: Jane Hocking, Christopher Fairley, Jane Gunn, Marcus Chen, Marie Pirotta, Meredith Temple-Smith and Lena Sanci, from the University of Melbourne; Rebecca Guy, Matthew Law, John Kaldor, Basil Donovan, David Wilson and David Regan, from the University of New South Wales; Sepehr Tabrizi, from the Royal Women’s Hospital; James Ward, from Baker IDI and the University of New South Wales; Marian Pitts and Anne Mitchell, from La Trobe University; Rob Carter, from Deakin University; Marion Saville and Dorota Gertig, from the Victorian Cytology Service; Margaret Hellard, from the Burnet Institute; Nicola Low, from the University of Bern; and John Imrie, from the University of KwaZulu-Natal.

Competing interests:

No relevant disclosures.

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