Changing Epidemiology of Gonorrhea in Adelaide, South Australia

Ellis SL, Tsourtos G, Waddell R, Woodman R, Miller ER.

Changing Epidemiology of Gonorrhea in Adelaide, South Australia.

Sex Transm Dis. 2020 Jun;47(6):402-408. doi: 10.1097/OLQ.0000000000001162.

Abstract

Background: Gonorrhea is a significant public health concern. The changing epidemiology of gonorrhea in Australia has highlighted the need for detailed examination of surveillance data to determine population groups at greatest risk for infection.

Methods: We analyzed deidentified gonorrhea notification data for the years 2012 to 2017, in Adelaide (N = 3680), calculating age-adjusted notification and antibiotic resistance rates. Age, gender, year, sexual orientation, and socioeconomic status were assessed for associations with gonorrhea notifications using negative binomial, log binomial and spatial autoregressive models. Maps were generated to examine spatial localization of gonorrhea rates in Adelaide.

Results: Gonorrhea notification rates in Adelaide increased annually, with a 153% adjusted increase in rates from 2012 to 2017, localized to specific areas and inversely associated with income levels. The increase in rates in 2016 and 2017 was associated with young heterosexuals from low income areas. Azithromycin-resistant notifications increased significantly in 2016 in young heterosexuals. Reinfections were significantly more likely in men who have sex with men than other population groups.

Conclusions: This study demonstrates the changing epidemiology of gonorrhea in Adelaide from a largely men who have sex with men profile toward an increase in young heterosexual gonorrhea. This could be seen as a harbinger for future increases in heterosexually transmitted HIV and other sexually transmitted infections in Australia.

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Diagnosis and Management of Syphilis in Patients With HIV Co-infection

Khaw, C., Malden, C., Ratnayake, M. et al. Diagnosis and Management of Syphilis in Patients With HIV Co-infectionCurr Treat Options Infect Dis (2020). https://doi.org/10.1007/s40506-020-00225-6

Published

Purpose of review

Syphilis cases are on the increase especially in men who have sex with men (MSM) in urban areas of high-income countries.

There is a strong association between syphilis and HIV infections.

We review the more recent literature regarding the epidemiology, clinical manifestations, diagnostic investigations, treatment and follow-up of syphilis in HIV infection.

  • Read abstract here (For full text access you can purchase from the publisher or see your librarian)

New ‘Syphilis Is Still Out There’ Campaign for Health Professionals

The Aboriginal Health Council of South Australia (AHCSA) & SHINE SA, May 2020

The Aboriginal Health Council of South Australia (AHCSA) and SHINE SA have released a new social media campaign for health professionals.

The campaign aims to raise awareness of syphilis screening and treatment during COVID-19.

  • Syphilis Is Still Out There Campaign for Health Professionals

While we deal with the COVID-19 pandemic, the syphilis outbreak in South Australia continues. It’s essential that we continue to test, treat, cure and notify partners during this time.

To learn more visit www.shinesa.org.au/syphilisoutbreak

  • Social Media Tiles and Posters

To help support this campaign and reinforce key messages around syphilis prevention and treatment, we have a range of social media tiles and posters to download.

Help us share this campaign by downloading our social media tiles to share on Facebook, Instagram, Twitter and LinkedIn. Use the hashtag #SyphilisIsStillOutThere

Download the files here as a zipped folder: Syphilis Is Still Out There Campaign

Key Messages of this Campaign 

  • Syphilis is still out there #SyphilisIsStillOutThere
  • Syphilis outbreak minimised in 4 steps: test, treat, cure and notify partners
  • Syphilis is still threatening unborn children. Know when to test before, during and after pregnancy

  • For the Community

Stay tuned: whilst this campaign is aimed at health professionals, AHCSA are currently producing resources to share on social media targeted towards community members.

To stay up-to-date follow AHCSA on Facebook.

 

Chlamydia trachomatis and the Risk of Pelvic Inflammatory Disease, Ectopic Pregnancy, and Female Infertility

Clinical Infectious Diseases, ciz429, https://doi.org/10.1093/cid/ciz429
Published: 24 August 2019

Abstract

Background

We evaluated the risk of pelvic inflammatory disease (PID), ectopic pregnancy, and infertility in women with a previous Chlamydia trachomatis (CT) diagnosis compared with women who tested negative for CT and CT untested women, considering both targeted and incidental (ie, prescribed for another indication) use of CT-effective antibiotics.

Methods

This was a retrospective study of women aged 12–25 years at start of follow-up within the Clinical Practice Research Datalink GOLD database linked to index of multiple deprivation quintiles, 2000–2013. CT test status and antibiotic use were determined in a time-dependent manner. Risk of PID, ectopic pregnancy, or female infertility were evaluated using of Cox proportional hazard models.

Results

We studied 857 324 women, contributing 6 457 060 person-years. Compared with women who tested CT-negative, women who tested CT-positive had an increased risk of PID (adjusted hazard ratio [aHR], 2.36; 95% confidence interval [CI], 2.01–2.79), ectopic pregnancy (aHR, 1.87; 95% CI, 1.38–2.54), and infertility (aHR, 1.85; 95% CI, 1.27–2.68). The PID risk was higher for women with 2 or more positive CT tests than those with 1 positive test. PID risk increased with the number of previous antibiotic prescriptions, regardless of CT test status.

Conclusions

We showed an association between CT-positive tests and 3 adverse reproductive health outcomes. Moreover, this risk increased with repeat CT infections. CT-effective antibiotic use showed no decreased risks of subsequent PID regardless of CT history. Our results confirm the reproductive health burden of CT, which requires adequate public health interventions.

New Bacterial Vaginosis Fact Sheet

SHINE SA, May 2019

SHINE SA has recently produced a bacterial vaginosis fact sheet. 

Bacterial vaginosis (BV) is a condition where there are too many of a certain type of bacteria in the vagina. Bacteria which are normally present in small numbers can sometimes overgrow, causing bacterial vaginosis.

Bacterial vaginosis is not a sexually transmitted infection. Bacterial vaginosis can occur when conditions in the vagina change and upset the normal balance of bacteria. It can be associated with new or increased sexual activity or with other changes such as menstruation or sexually transmitted infections.

Update on multi-drug resistant shigella

SHINE SA, 7/3/2019

The shigella outbreak is continuing in South Australia. This is to advise clinicians to be on alert for a potential increase in shigella cases, and to highlight updated recommendations on treatment as released by the Communicable Disease Control Branch (CDCB).

The outbreak is predominantly in men who have sex with men (MSM) and there is a potential for further increase in numbers related to a larger outbreak in Victoria and NSW. We encourage you to be alert for clients who have recently traveled interstate.The CDCB is now recommending that patients with confirmed multi-drug resistant (MDR) shigella (or at risk of MDR shigella while awaiting sensitivities) be treated with five days of Ceftrixaone 1g IV, rather than 1 day (as recommended in the Public Health Alert issued in December 2018).