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.

 

 

Hyde Street Practice: a service of SHINE SA

SHINE SA, September 2019

Hyde Street Practice is a service of SHINE SA. We offer affordable appointments with friendly and non-judgemental staff.

We are a safe and inclusive practice with general practitioners, specialist services, sexual health and relationship wellbeing services.

Services include:

  • General Practitioners

General GP services, including support for diabetes and cardiovascular health, Pre and post exposure HIV prevention (PEP and PrEP), HIV, hepatitis B and hepatitis C prescribing, STI testing and management

  • Sexual Health Services

SHINE SA sexual health services including contraception, STI testing and management, HIV, PEP & PrEP

  • Sexual Health Physician

A private specialist sexual health and HIV service available by referral

HIV, sexual health, PEP & PrEP, hepatitis C, transgender medicine, LGBTI health

  • Rapido – Rapid HIV Testing

Walk in and Wait service, peer led with results in 20 minutes

  • Psychologist and Counselling

General psychological services and sexual health counselling

  • Gender Wellbeing Service

Professional, peer support and information services for people who are questioning their gender or who identify as trans or gender diverse

  • SAMESH

Support services for gay men, MSM (men who have sex with men), trans men and people living with HIV and people at risk of HIV and STIs, health promotion and education

  • Bobby Goldsmith Foundation

Financial assistance for health related issues to people living with HIV on low incomes

Details:

57 Hyde Street, Adelaide
Call 7099 5320
Monday – Friday 9:00 am – 5:00 pm
Fees available on hydestreet.com.au
To make an appointment visit
www.hydestreet.com.au

or call 7099 5320

Rapido – Rapid HIV Testing
Mondays 3:00 – 6:00 pm
(except Public Holidays)

Sexual Health Service
Walk in and Wait
Fridays 1:00 – 4:00 pm

Clean Needle Program
Monday – Friday 9:00 am – 5:00 pm

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.

 

Increased screening for syphilis and HIV in SA – new advice for clinicians (video)

SHINE SA,  

SHINE SA have released a short video resource for health professionals providing advice on the current syphilis outbreak in South Australia.

Syphilis is a sexually transmitted infection (STI). It presents a serious public health issue as it causes harm to the developing foetus and increases the transmission and acquisition of HIV.

The 5 minute video SA Syphilis Outbreak – Advice for Clinicians urges health professionals to be aware that syphilis is increasing rapidly in SA and that there is a need to respond with increased screening.