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Was an epidemic of gonorrhoea among heterosexuals attending an Adelaide sexual health services associated with variations in sex work policing policy?
  1. Bin Li1,2,
  2. Peng Bi1,
  3. Russell Waddell3,4,5,
  4. Eric PF Chow6,7,
  5. Basil Donovan8,9,
  6. Anna McNulty9,
  7. Glenda Fehler7,
  8. Bebe Loff10,
  9. Hana Shahkhan10,
  10. Christopher K Fairley6,7
  1. 1School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
  2. 2Adelaide Sexual Health Clinic (ASHC, known as Clinic 275), Infectious Disease Unit, Royal Adelaide Hospital, Adelaide, South Australia Australia
  3. 3Communicable Disease Control Branch, SA Health, Adelaide, South Australia, Australia
  4. 4Infectious Diseases Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
  5. 5Microbiology and infectious Diseases, Flinders Medical Centre, Adelaide, South Australia, Australia
  6. 6Central Clinical School, Monash University, Melbourne, Victoria, Australia
  7. 7Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
  8. 8The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
  9. 9Sydney Sexual Health Centre, Sydney Hospital, New South Wales, Australia
  10. 10School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  1. Correspondence to Professor Christopher K Fairley, Monash University, 580 Swanston Street, Carlton, Melbourne, VIC 3053; Australia; cfairley{at}


Background A review of historical trends in gonococcal diagnoses made at the Adelaide Sexual Health Clinic (ASHC), South Australia, identified a substantial rise in diagnoses among heterosexuals between 2006 and 2010. Sex work is illegal in South Australia, regulated in Victoria and legal in New South Wales. This and other factors that could have influenced the epidemic were explored in this analysis.

Methods Retrospective analyses of gonorrhoea diagnoses made by sexual health services between 1990 and 2012 in three Australian state capitals, Melbourne (Victoria) and Sydney (New South Wales) were undertaken.

Results At the ASHC the proportion of gonorrhoea diagnoses was higher between 2006 and 2010 among heterosexual men (5.34% vs 0.84%, p<0.001), non-sex worker women (0.64% vs 0.28%, p<0.001) and female sex workers (FSWs) (1.75% vs 0.24%, p<0.001) compared with other years. This relationship was not seen at the Melbourne Sexual Health Clinic and corresponding data from the Sydney Sexual Health Centre showed that FSWs were less likely to have gonorrhoea between 2006 and 2010 than the other groups (p=0.746, p=0.522, p=0.024, respectively). At ASHC FSWs were significantly more likely to be diagnosed between 2006 and 2010 (OR 2.8, 95% CI 1.48 to 5.27, p=0.002). Charges against sex workers peaked in 2007/2008.

Conclusions A substantial, self-limiting rise in diagnoses of heterosexual gonorrhoea was seen in Adelaide FSWs between 2006 and 2010. Removing barriers to condom use is vital to the prevention of HIV and STI transmission.


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