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Hospitalisations for pelvic inflammatory disease in young Aboriginal women living in remote Australia: the role of chlamydia and gonorrhoea
  1. Louise Causer1,
  2. Bette Liu2,
  3. Caroline Watts1,
  4. Hamish McManus1,
  5. Basil Donovan1,3,
  6. James Ward4,
  7. Rebecca Guy1
  8. On behalf of the TTANGO2 Collaboration
    1. 1 Kirby Institute, UNSW, Sydney, New South Wales, Australia
    2. 2 School of Population Health, UNSW, Sydney, New South Wales, Australia
    3. 3 Sydney Sexual Health Centre, Sydney, New South Wales, Australia
    4. 4 Poche Centre for Indigenous Health, The University of Queensland—Saint Lucia Campus, Saint Lucia, Queensland, Australia
    1. Correspondence to Dr Louise Causer, Kirby Institute, University of New South Wales, Sydney, New South Wales, 2052, Australia; lcauser{at}


    Objective Aboriginal women living in remote Australia experience a high burden of both chlamydia and gonorrhoea infections and disproportionately high rates of pelvic inflammatory disease (PID). We estimated for the first time the fraction of PID attributable to these infections in young Aboriginal women living in these settings.

    Methods Using published data from two large Australian studies (2002–2013; 2010–2014), we calculated the fraction of emergency department presentations and hospitalisations for PID attributable to chlamydia and/or gonorrhoea infection in Aboriginal women aged 16–29 years living in remote Australia. We used a Monte Carlo simulation to estimate the mean and 95% CIs for the assumed prevalence and population attributable fractions for PID for infection stratifications (chlamydia only, gonorrhoea only and dual infection) as well as for any infection (chlamydia and/or gonorrhoea). Additional outputs were calculated for chlamydia infection with/without gonorrhoea coinfection, and vice versa.

    Results The prevalence of chlamydia only was 12.9% (95% CI: 11.6% to 14.2%), gonorrhoea only was 7.8% (95% CI: 6.6% to 8.9%) and dual infection was 6.5% (95% CI: 5.8% to 7.2%); rate ratios of PID were 1.9 (95% CI: 1.5 to 2.3), 5.2 (95% CI: 4.3 to 6.4) and 4.6 (95% CI: 3.8 to 5.5), respectively. The overall fraction of PID attributable to chlamydia and/or gonorrhoea was 40.2% (95% CI: 36.0% to 44.4%); any gonorrhoea was 33.4% (95% CI: 29.2% to 37.8%) and any chlamydia was 20.6% (95% CI: 16.9% to 24.6%).

    Conclusion Our study demonstrates the importance of calculating the fraction of PID related to chlamydia and gonorrhoea in the local context, demonstrating the major contribution gonorrhoea makes to PID hospitalisations among Australian Aboriginal women living in remote settings. To significantly and sustainably reduce the unacceptable rate of PID in this population, strategies are urgently needed to improve timely testing and treatment and recognition and management of PID in primary care.

    • gonorrhoea
    • pelvic inflammatory disease
    • chlamydia infections
    • Chalmydia trachomatis
    • Neisseria gonorrhoeae

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    • Handling editor Anna Maria Geretti

    • Collaborators TTANGO2 Collaboration: TTANGO2 is a collaboration between researchers named as coauthors and others from their institutions including Kirby Institute UNSW Sydney, Flinders University International Centre for Point-of-care Testing, Aboriginal Health Council of Western Australia, Western Australia Department of Health, West Australian Country Health Service, Aboriginal Health Council of South Australia, South Australia Health, Northern Territory Health, Aboriginal Medical Services Alliance of Northern Territory, Queensland Aboriginal and Islander Health Council, Queensland Health, Kimberley Aboriginal Medical Services Council, PathWest, Apunipima Cape York Health Council, Kimberley Aboriginal Medical Services, Ngaanyatjarra Health Service, Burnet Institute, Royal Women’s Hospital, Melbourne, University of Queensland, Monash University, National Reference Laboratory, Cepheid and Medical Communication Associates.

    • Contributors LC and RG conceived and planned the work. All coauthors assisted in acquisition and analysis of the data. All coauthors provided input to interpretation of data. LC and RG drafted the paper, with critical revisions provided by all coauthors. All approved the final version submitted and are accountable for all aspects of the work.

    • Funding TTANGO2 is funded by an NHMRC Partnership Project Grant (GNT1092503) and the Australian Government Department of Health, Western Australia Health and Queensland Health (no award number). LC (GTN1163929) and RG (GNT1124647) are supported by NHMRC fellowships and JW by a Sylvia and Charles Viertel Charitable Foundation fellowship (not applicable).

    • Competing interests None declared.

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