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Incidence of curable sexually transmissible infections among adolescents and young adults in remote Australian Aboriginal communities: analysis of longitudinal clinical service data
  1. Bronwyn J Silver1,2,
  2. Rebecca J Guy2,
  3. Handan Wand2,
  4. James Ward3,
  5. Alice R Rumbold1,4,
  6. Christopher K Fairley5,6,
  7. Basil Donovan2,7,
  8. Lisa Maher2,
  9. Amalie Dyda2,
  10. Linda Garton2,8,
  11. Belinda Hengel9,
  12. Janet Knox10,
  13. Skye McGregor2,
  14. Debbie Taylor-Thomson1,
  15. John M Kaldor2,
  16. on behalf of the STRIVE investigators
  1. 1Epidemiology and Health Systems Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
  2. 2The Kirby Institute, UNSW Australia (University of New South Wales), Sydney, New South Wales, Australia
  3. 3Baker IDI Central Australia, Alice Springs, Northern Territory, Australia
  4. 4Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
  5. 5Central Clinical School, Monash University, Melbourne, Victoria, Australia
  6. 6Melbourne Sexual Health Centre, Carlton, Victoria, Australia
  7. 7Sydney Sexual Health Centre, Sydney Hospital, Sydney, New South Wales, Australia
  8. 8NT Department of Health, Sexual Health & Blood Borne Virus Unit, Darwin, Australia
  9. 9Apunipima Cape York Health Council, Cairns, Queensland, Australia
  10. 10Lismore sexual health service NSW Health, Sydney, New South Wales, Australia
  1. Correspondence to Bronwyn J Silver, Menzies School of Health Research, PO Box 4066 Alice Springs, NT 0870, Australia; bronwyn.silver{at}menzies.edu.au

Abstract

Objectives To undertake the first comprehensive analysis of the incidence of three curable sexually transmissible infections (STIs) within remote Australian Aboriginal populations and provide a basis for developing new control initiatives.

Methods We obtained all results for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) testing conducted during 2009–2011 in individuals aged ≥16 years attending 65 primary health services across central and northern Australia. Baseline prevalence and incidence of all three infections was calculated by sex and age group.

Results A total of 17 849 individuals were tested over 35 months. Baseline prevalence was 11.1%, 9.5% and 17.6% for CT, NG and TV, respectively. During the study period, 7171, 7439 and 4946 initially negative individuals had a repeat test for CT, NG and TV, respectively; these were followed for 6852, 6981 and 6621 person-years and 651 CT, 609 NG and 486 TV incident cases were detected. Incidence of all three STIs was highest in 16-year-olds to 19-year-olds compared with 35+ year olds (incident rate ratio: CT 10.9; NG 11.9; TV 2.5). In the youngest age group there were 23.4 new CT infections per 100 person-years for men and 29.2 for women; and 26.1 and 23.4 new NG infections per 100 person-years in men and women, respectively. TV incidence in this age group for women was also high, at 19.8 per 100 person-years but was much lower in men at 3.6 per 100 person-years.

Conclusions This study, the largest ever reported on the age and sex specific incidence of any one of these three curable infections, has identified extremely high rates of new infection in young people. Sexual health is a priority for remote communities, but will clearly need new approaches, at least intensification of existing approaches, if a reduction in rates is to be achieved.

  • CHLAMYDIA TRACHOMATIS
  • NEISSERIA GONORRHOEA
  • TRICHOMONAS
  • EPIDEMIOLOGY (CLINICAL)

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