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High chlamydia incidence among clients attending a large urban STI clinic

High chlamydia incidence among clients attending a large urban STI clinic School of Population Health, University of Melbourne, Victoria, and Macfarlane Burnet Institute for Medical Research and Public Health, Victoria Christopher K. Fairley Melbourne Sexual Health Centre, Victoria, and Sexual Health Unit, School of Population Health, University of Melbourne, Victoria Genital chlamydia infection is a significant public health problem in Australia, with notification rates having increased dramatically in recent years from 35.2 per 100,000 persons in 1994 to 160.7 per 100,000 persons in 2003.1 We do not know 2005 VOL. 29 NO. 4 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 389 Gender Women Group Sex workers Non-sex worker Total Male to male sexual contact Heterosexual contact only Total Number Incidence per 100 person years (95%CI) 8.1 (4.6-13.2) 9.3 (4.4-17.0) 8.5 (5.6-12.5) 28.5 (18.3-42.5) 18.9 (11.4-29.7) 23.3 (16.8-31.3) Men are tested two or more times and who reflect a higher-risk group than all attendees at the centre. It excludes any chlamydia testing outside the clinic, does not consider treatment failure and ignores potential undiagnosed infections. However, the results do indicate that repeat attendees at the MSHC have a high rate of incident infection and should be tested two or more times per year. Clinics with a high case load of clients seeking sexual health advice should also consider testing its clients two or more times per year. Acknowledgements Jane Hocking was supported by the Victorian Health Promotion Foundation (VicHealth). The authors would like to thank Tim Kuo from the Melbourne Sexual Health Centre for extracting the data. whether the rising notification numbers represent a true increase in the incidence of chlamydia or are simply due to the increased use of more sensitive diagnostic tests. We undertook an analysis of the computerised client records to estimate the incidence of chlamydia infection among Melbourne Sexual Health Centre (MSHC) clients attending the clinic two or more times between July 2002 and June 2003. Person time at risk was calculated as the cumulative time between consultations. An individual was classified as having an incident infection if a positive test with either a prior negative test or a prior positive at least 30 days earlier had been documented within the study period.2 All cases identified as positive received treatment. A positive result at the first visit was not considered an incident case. During this time period, 4,382 men and 3,459 women had chlamydia tests, of whom 553 men and 719 women were tested during two or more consultations. The incidence of chlamydia among women reporting sex work was similar to that among those reporting no sex work (8.1 per 100 person years vs. 9.3 per 100 person years). The incidence of chlamydia was higher among men at 28.5 per 100 person years for men reporting male-to-male sexual contact (MSM) and 18.9 per 100 person years for men reporting heterosexual contact only (non-MSM) (see Table 1). MSM tested two or more times were more likely to report three or more male sexual partners in the last three months (RR=3.2, 95% CI 2.44.3) and non-MSM were more likely to report three or more female sexual partners (RR=3.4, 95% CI 2.8-4.3). Among women, nonsex workers who tested two or more times were more likely to report three or more sexual partners in the last three months (RR=2.8, 95% CI 2.2-3.6) whereas the association was less pronounced for sex workers (RR=1.2, 95% CI 1.0-1.4). These are high incidence rates for men, particularly as they are in regular contact with sexual health services and should be informed about the risk of infection and methods of prevention. Nevertheless, these findings of a high incidence among men who have sex with men are consistent with the data reported by Lister et al., who found that participants attending a male-only sauna in Melbourne had a higher risk of infection if they had recently sought sexual health advice.3 While the incidence rates are much lower for women, they indicate a level of unprotected sexual activity. This analysis can be repeated in subsequent years to monitor incidence over time. There are limitations in this analysis. It is based on clients who http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Australian and New Zealand Journal of Public Health Wiley

High chlamydia incidence among clients attending a large urban STI clinic

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References (3)

Publisher
Wiley
Copyright
Copyright © 2005 Wiley Subscription Services, Inc., A Wiley Company
ISSN
1326-0200
eISSN
1753-6405
DOI
10.1111/j.1467-842X.2005.tb00214.x
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Abstract

School of Population Health, University of Melbourne, Victoria, and Macfarlane Burnet Institute for Medical Research and Public Health, Victoria Christopher K. Fairley Melbourne Sexual Health Centre, Victoria, and Sexual Health Unit, School of Population Health, University of Melbourne, Victoria Genital chlamydia infection is a significant public health problem in Australia, with notification rates having increased dramatically in recent years from 35.2 per 100,000 persons in 1994 to 160.7 per 100,000 persons in 2003.1 We do not know 2005 VOL. 29 NO. 4 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 389 Gender Women Group Sex workers Non-sex worker Total Male to male sexual contact Heterosexual contact only Total Number Incidence per 100 person years (95%CI) 8.1 (4.6-13.2) 9.3 (4.4-17.0) 8.5 (5.6-12.5) 28.5 (18.3-42.5) 18.9 (11.4-29.7) 23.3 (16.8-31.3) Men are tested two or more times and who reflect a higher-risk group than all attendees at the centre. It excludes any chlamydia testing outside the clinic, does not consider treatment failure and ignores potential undiagnosed infections. However, the results do indicate that repeat attendees at the MSHC have a high rate of incident infection and should be tested two or more times per year. Clinics with a high case load of clients seeking sexual health advice should also consider testing its clients two or more times per year. Acknowledgements Jane Hocking was supported by the Victorian Health Promotion Foundation (VicHealth). The authors would like to thank Tim Kuo from the Melbourne Sexual Health Centre for extracting the data. whether the rising notification numbers represent a true increase in the incidence of chlamydia or are simply due to the increased use of more sensitive diagnostic tests. We undertook an analysis of the computerised client records to estimate the incidence of chlamydia infection among Melbourne Sexual Health Centre (MSHC) clients attending the clinic two or more times between July 2002 and June 2003. Person time at risk was calculated as the cumulative time between consultations. An individual was classified as having an incident infection if a positive test with either a prior negative test or a prior positive at least 30 days earlier had been documented within the study period.2 All cases identified as positive received treatment. A positive result at the first visit was not considered an incident case. During this time period, 4,382 men and 3,459 women had chlamydia tests, of whom 553 men and 719 women were tested during two or more consultations. The incidence of chlamydia among women reporting sex work was similar to that among those reporting no sex work (8.1 per 100 person years vs. 9.3 per 100 person years). The incidence of chlamydia was higher among men at 28.5 per 100 person years for men reporting male-to-male sexual contact (MSM) and 18.9 per 100 person years for men reporting heterosexual contact only (non-MSM) (see Table 1). MSM tested two or more times were more likely to report three or more male sexual partners in the last three months (RR=3.2, 95% CI 2.44.3) and non-MSM were more likely to report three or more female sexual partners (RR=3.4, 95% CI 2.8-4.3). Among women, nonsex workers who tested two or more times were more likely to report three or more sexual partners in the last three months (RR=2.8, 95% CI 2.2-3.6) whereas the association was less pronounced for sex workers (RR=1.2, 95% CI 1.0-1.4). These are high incidence rates for men, particularly as they are in regular contact with sexual health services and should be informed about the risk of infection and methods of prevention. Nevertheless, these findings of a high incidence among men who have sex with men are consistent with the data reported by Lister et al., who found that participants attending a male-only sauna in Melbourne had a higher risk of infection if they had recently sought sexual health advice.3 While the incidence rates are much lower for women, they indicate a level of unprotected sexual activity. This analysis can be repeated in subsequent years to monitor incidence over time. There are limitations in this analysis. It is based on clients who

Journal

Australian and New Zealand Journal of Public Health – Wiley

Published: Aug 1, 2005

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