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.

STI/BBV testing tool for asymptomatic people

NSW STI Programs Unit, ASHM & Qld. Govt.,  2019

This resource has charts and information about how routine STI/BBV testing can be offered, who to, and how to follow up.

Developed by NSW STI Programs Unit, NSW Australia, and reproduced with permission by the Sunshine Coast Hospital and Health Service, ASHM and Communicable Diseases Branch.

 

 

STIs among transgender men and women attending Australian sexual health clinics

Med J Aust. 2019 Aug 29. doi: 10.5694/mja2.50322. [Epub ahead of print]

Abstract

Objectives

To estimate rates of HIV infection, chlamydia, gonorrhoea, and infectious syphilis in transgender men and women in Australia; to compare these rates with those for cisgender people.

Design

Cross‐sectional, comparative analysis of de‐identified health data.

Setting, participants

We analysed data for 1260 transgender people (404 men, 492 women, 364 unrecorded gender), 78 108 cisgender gay and bisexual men, and 309 740 cisgender heterosexual people who attended 46 sexual health clinics across Australia during 2010–2017.

Main outcome measures

First‐visit test positivity for sexually transmitted infections (STIs), stratified by patient group and year; demographic and behavioural factors associated with having STIs.

Results

14 of 233 transgender men (6.0%) and 34 of 326 transgender women (10%) tested during first clinic visits were chlamydia‐positive; nine transgender men (4%) and 28 transgender women (8.6%) were gonorrhoea‐positive. One of 210 tested transgender men (0.5%) and ten of 324 tested transgender women (3.1%) were diagnosed with infectious syphilis; 14 transgender men (3.5%) and 28 transgender women (5.7%) were HIV‐positive at their first visit. The only significant change in prevalence of an STI among transgender patients during the study period was the increased rate of gonorrhoea among transgender women (from 3.1% to 9.8%). Compared with cisgender gay and bisexual men, transgender men were less likely (adjusted odds ratio [aOR], 0.46; 95% CI, 0.29–0.71; P = 0.001) and transgender women as likely (aOR, 0.98; 95% CI, 0.73–1.32; P = 0.92) to be diagnosed with a bacterial STI; compared with heterosexual patients, transgender men were as likely (aOR, 0.72; 95% CI, 0.46–1.13; P = 0.16) and transgender women more likely (aOR, 1.56; 95% CI, 1.16–2.10; P = 0.003) to receive a first‐visit bacterial STI diagnosis.

Conclusions

The epidemiology of STIs in transgender people attending Australian sexual health clinics differs from that of cisgender patients. Gender details must be captured by health data systems to facilitate appropriate delivery of sexual health care.

New report: Surveillance of STIs and Blood-Borne Viruses in South Australia, 2018

Communicable Disease Control Branch, SA Health, July 2019

In 2018, there were 8,556 new notifications of STI and BBV in South Australia. This represents a 3% increase in the number of new notifications compared to notifications received in 2017.

In 2018, there were 6,256 notifications of Chlamydia trachomatis (chlamydia) making this the most commonly notified STI in South Australia. The demographics of people diagnosed with chlamydia have remained relatively stable over the past five
years.

There were no notifications of donovanosis in 2018.

There were 1,288 notifications of gonorrhoea in 2018. The notification rate of gonorrhoea increased from 45 per 100,000 population in 2014 to 74 per 100,000 population in 2017 and 2018. The rate in the Aboriginal population was 813 per 100,000 population in 2018 compared to 55 per 100,000 population in the non-Indigenous population.

There were 203 notifications of infectious syphilis in 2018, the highest number of annual notifications in the past 10 years. The notification rate of infectious syphilis in 2018 was 11.7 per 100,000 population, more than double the rate in 2016 of 5.2 per 100,000 population. In 2018, 88% of notifications were in males, the majority being among men who have sex with men (MSM) (75%). Infectious syphilis remains high in the Aboriginal population. There were no notifications of congenital syphilis in 2018.

There were 39 new diagnoses of human immunodeficiency virus (HIV) infection in 2018. Thirty-two of the 39 notifications were in males (82%). In 2018, 63% of male cases reported male-to-male sex. Six females acquired their infection overseas and one in South Australia.

There were four notifications of newly acquired hepatitis B infection in 2018, below the five year average (2013-2017) of eight cases per year. There were no notifications in the Aboriginal population. There were 254 notifications of unspecified hepatitis B infection reported in 2018, a decrease compared to the five year average (2013-2017) of 325 cases per year. The notification rate has declined in the Aboriginal population over the past five years.

There were 41 notifications of newly acquired hepatitis C in 2018. Sixty-one per cent of cases were males, and 66% were aged 30 years and over. The notification rate of unspecified hepatitis C infection was 22.2 per 100,000 population in 2018, with a
total of 385 notifications in 2018 compared to 465 in 2017.

There were five new diagnoses of hepatitis D infection in 2018, below the five year average (2013-2017) of 9.8 cases per year.

 

STI’S on the rise in SA – free campaign resources (SHINE SA media release)

SHINE SA, April 2, 2019

Sexually transmitted infection (STI) rates are on the rise in South Australia, with around 1 in 20 young people infected with chlamydia¹. Left untreated chlamydia can lead to infection of the reproductive systems and long term consequences. Having one STI also increases the risk of being infected with another. As such it’s important that young people in SA are encouraged to practise safer sex as well as getting a sexual health check.

In response to this rise in STIs, SHINE SA is excited to announce the launch of their Sexual Health Check campaign and related resources for use across South Australia. These resources can be used by organisations including universities, secondary schools, youth services, general practice and community health services.

The Sexual Health Check campaign aims to raise awareness of STIs as well as highlight how easy it is to get a sexual health check.
According to the most recent epidemiological report released by SA Health in 2017, STI and blood borne viruses (BBVs) have jumped 14% compared to the previous five years.

In 2017:

  • there were 8,181 new infections of STIs and BBVs, this is a 7% increase compared to 2016
  • 77% of infections were in people aged 15 to 29 years.

SHINE SA encourages young people to receive a sexual health check at a SHINE SA clinic, their local doctor or Aboriginal Health service. SHINE SA offers FREE sexual health checks as well as counselling to South Australians under the age of 30 with a Medicare Card.

Dr Amy Moten, SHINE SA’s Coordinator of Medical Education said:
“STIs are on the rise, so practicing safer sex and having regular testing is vital. Left untreated, serious infection may occur and lead to complications such as infertility, chronic pelvic pain and ectopic pregnancy. As most people don’t have any symptoms, lack of testing contributes to the continued spread of the disease”.

SHINE SA hopes other health and education organisations and media outlets can assist by promoting and sharing the Sexual Health Check campaign. By doing so we can help raise awareness of STIs in the community and encourage young people to access sexual heath checks.

  • The free campaign resources including a Sexual Health + STIs FAQ booklet, posters and social media tiles can be downloaded here
  • For further information contact Tracey Hutt, Director Workforce Education and Development, by email here 
  • Download this media release

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¹ http://www.sti.guidelines.org.au/populations-and-situations/young-people

 

 

STIs in remote Australia

ABC Health Report, Monday 18 March 2019 5:45 PM

Leading Aboriginal researcher Associate Professor James Ward* is calling for action in remote Australia to deal with a preventable epidemic of sexually transmissible infections — including syphilis — in a population that’s no more sexually active than non-Indigenous people of the same age.  

He joined Dr Norman Swan’s Health Report on ABC RN.

Later this month James will present to the National Rural Health Conference about addressing sexually transmitted infections in remote Australia.

*James Ward is Associate Professor, Flinders University; & Head of Infectious Diseases Research, Aboriginal Health, South Australian Health and Medical Research Institute.