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Understanding trends in genital Chlamydia trachomatis can benefit from enhanced surveillance: findings from Australia
  1. Hammad Ali1,
  2. Rebecca J Guy1,
  3. Christopher K Fairley2,3,
  4. Handan Wand1,
  5. Marcus Y Chen2,3,
  6. Bridget Dickson4,
  7. Catherine C O'Connor5,6,
  8. Lewis Marshall7,
  9. Andrew E Grulich1,
  10. John M Kaldor1,
  11. Margaret E Hellard8,
  12. Basil Donovan1,9,
  13. on behalf of the ACCESS Collaboration*
  1. 1The Kirby Institute, The University of New South Wales, Sydney, New South Wales, Australia
  2. 2Melbourne Sexual Health Centre, Melbourne, Victoria, Australia
  3. 3School of Population Health, University of Melbourne, Melbourne, Victoria, Australia
  4. 4CaraData Pty Ltd, Parkwood, Queensland, Australia
  5. 5Royal Prince Alfred Sexual Health Service, Royal Prince Alfred Hospital, Camperdown, Sydney, New South Wales, Australia
  6. 6South Western Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
  7. 7Fremantle Sexual Health Clinic, Fremantle Hospital, Fremantle, Western Australia, Australia
  8. 8Centre for Population Health, Burnett Institute, Melbourne, Victoria, Australia
  9. 9Sydney Sexual Health Centre, Sydney Hospital, Sydney, New South Wales, Australia
  1. Correspondence to Professor Basil Donovan, The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia; bdonovan{at}


Objectives To determine trends and correlates of chlamydia positivity among young heterosexuals attending Australian sexual health services and to compare these with population-based notification data.

Methods Data from 18 sexual health services and the national notification scheme were analysed. A χ2 test assessed trends in chlamydia positivity among young heterosexuals tested from 2006 to 2010, and logistic regression was used to determine correlates of positivity. Nucleic acid amplification tests were used throughout the study period.

Results During 2006–2010, 64 588 heterosexuals aged 15–29 years attended the sexual health services for the first time and the annual chlamydia testing rate was consistently >80%. Overall, chlamydia positivity increased by 12%, by 8.3% in heterosexual men (from 13.2% in 2006 to 14.3% in 2010; p-trend=0.04) and by 15.9% in women (from 11.3% in 2006 to 13.1% in 2010; p-trend<0.01). Independent correlates of chlamydia positivity in sexual health service patients were being aged 15–24 years, residing in a regional/rural area, being Aboriginal and/or Torres Strait Islander, being a non-Australian resident and attending in 2010 compared with 2006. Over the same period, the population-based notification rate increased by 43% against a background of a >100% increase in testing.

Conclusions The sexual health service network suggests a moderate increase in chlamydia prevalence in young heterosexuals tested at sexual health services, in contrast to the steep increase shown by notifications. This highlights the caution needed in interpreting chlamydia trends without a corresponding testing denominator.

  • Testing denominators
  • young people
  • notifications
  • chlamydia infection
  • Chlamydia trachomatis
  • sexual health
  • epidemiology (clinical)
  • epidemiology (general)
  • bacterial infection
  • prevention
  • primary care
  • chlamydia
  • anogenital cancer
  • AIDS
  • bacterial vaginosis
  • behavioural science
  • biostatistics
  • HIV
  • syphilis
  • partner notification
  • contact tracing
  • gay men
  • HIV clinical care
  • commercial sex
  • herpes
  • AIN
  • kaposis sarcoma

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  • * See acknowledgements and web appendix 1.

  • Funding The ‘ACCESS project’ was funded by the Australian Government Department of Health and Ageing from 2007 to 2010, as part of the National Chlamydia Pilot Program. The views expressed in this paper are not necessarily the views of the department.

  • Competing interests None.

  • Patient consent Individual patient data are not shared as part of the study; only deidentified data are shared. Thus, getting individual patient consent was not a requirement for this study.

  • Ethics approval Ethics approval was provided by Human Research Ethics Committees of St Vincent's Hospital and the University of New South Wales and the 25 ethics committees overlooking each sexual health service.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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