In most Australian settings, chlamydia notifications do not contain information on the gender of sexual partners. We assessed trends and predictors of chlamydia testing and positivity among men who have sex with men (MSM), attending sexual health services in Australia.
The Australian Collaboration for Chlamydia Enhanced Sentinel Surveillance (ACCESS) program was established in 2008 to collate demographic and chlamydia testing information from 25 sexual health services. We calculated the proportion tested and chlamydia positivity among MSM and assessed trends from 2004 to 2008 using a χ2 test and predictors using logistic regression.
In the 5-year period, 11,777 MSM attended as new patients (first visit ever to the service) and the proportion tested for chlamydia increased significantly from 71% in 2004 to 79% in 2008 (P < 0.01). Independent predictors of chlamydia testing were younger age, residing in a metropolitan area (adjusted prevalence ratio [APR] = 1.23; 95% confidence interval [CI]: 1.19, 1.27), being Australian-born (APR = 1.03; 95% CI: 1.01, 1.06), being a traveler or migrant (APR = 1.09; 95% CI: 1.06, 1.12), and sex overseas in the past year (APR = 1.05; 95% CI: 1.03, 1.07). Overall chlamydia positivity was 8.6% (95% CI: 8.0%–9.2%). There was no significant trend in chlamydia positivity between 2004 and 2008. Independent predictors of chlamydia positivity were younger age, being a traveler or migrant (APR = 1.52; 95% CI: 1.26–1.84), and exclusive same-sex contact (APR = 1.28; 95% CI: 1.05–1.55).
This new national surveillance program demonstrates that the majority of MSM attending sexual health services was offered chlamydia testing and testing has increased over time. The MSM at highest risk of chlamydia were more likely to be tested. Chlamydia transmission was frequent but stable among MSM accessing clinical services.
From the *National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales Sydney, New South Wales, Australia; †Melbourne Sexual Health Centre, Carlton, Victoria, Australia; ‡School of Population Health University of Melbourne, Melbourne, Victoria, Australia; §RPA Sexual Health Clinic, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; South Western Clinical School, Liverpool, University of New South Wales, New South Wales, Australia; ¶Fremantle Hospital, Western Australia, Australia; ∥Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia; and **Sydney Sexual Health Centre, Sydney Hospital, Sydney, New South Wales, Australia
The authors thank all sentinel sites which provided data for ACCESS. ACCESS coordinating committee: Prof Basil Donovan, Dr Rebecca Guy, Prof John Kaldor, Neil Franklin, James Ward- the National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, NSW; A/Prof Margaret Hellard, Jane Goller, Fabian Kong, Dr Isabel Bergeri- Burnet Institute, Melbourne, VIC; A/Prof Elizabeth Sullivan- Perinatal and Reproductive Epidemiology Research Unit, University of New South Wales, Sydney, NSW; Wayne Dimech- National Serology Reference Laboratory, Fitzroy, VIC.
Representatives from participating sexual health services: Mairead Hetherington - Alice Springs Clinic 34, Alice Springs, NT; Professor Frank Bowden, Dr Sarah Martin, Deborah Miller - Canberra Sexual Health Centre, Canberra, ACT; Dr Phillip Read, Heng Lu - Sydney Sexual Health Centre, Sydney, NSW; Dr Brian Mulhall, Amanda Rickett, Jenny Heslop - Coffs Harbour Sexual Health, Coffs Harbour, NSW; Dr Nathan Ryder, Peter Knibbs - Darwin Clinic 34, Darwin, NT; A/Prof Darren Russell, Sandra Downing - Dolls House Sexual Health Clinic, Cairns, QLD; Dr Lewis Marshall - Fremantle Hospital, Fremantle, WA; Dr John Chuah, May Ngieng - Gold Coast Sexual Health, Gold Coast, QLD; Michael Bolton, Alison Kincaid - Greater Southern Area Health Service, NSW; Dr Maree O'Sullivan - Hobart Sexual Health Service, Hobart, Tas; Dr Debbie Allen - Holden St Sexual Health Centre, Gosford, NSW; Dr Catriona Ooi, Martin O'Connor - Hunter New England Sexual Health Service, Newcastle, NSW; Dr Ingrid Van Beek, Dr Craig Rogers - Kirketon Road Centre, Sydney, NSW; Dr David J Smith, Cecily Gray - Lismore/Tweed Heads Sexual Health Service, Lismore, NSW; Prof Christopher Fairley, Dr Marcus Chen, Afrizal Afrizal - Melbourne Sexual Health Centre, Melbourne, VIC; Tim lynch, Fiona D'Aquino - Orange Sexual Health Centre, Orange, NSW; Dr David Jardine, Dee Archbold - Princess Alexandra Sexual Health, South Brisbane, QLD; A/Prof Catherine O'Connor, Chloe Dijanosic - RPA Sexual Health Clinic, Camperdown, NSW; Dr Stephen Davies, Amanda Rickett - Royal North Shore Hospital Sexual Health, North Sydney, NSW; Dr Deborah Couldwell, Sangeetha Eswarappa - SWAHS: Eastern Division, NSW; Dr Eva Jackson, Jane Shakeshaft - SWAHS: Western Division, NSW; A/Prof Katherine Brown, Victoria McGrath - Sydney South Illawarra Health Service, Wollongong, NSW; Dr Pam Konecny - St George Short St Sexual Health Centre, Kogarah, NSW; Dr Yoges Paramsothy - Bigge Park Centre, Liverpool, NSW; Dr Arun Menon, Angela Cooper - Townsville Sexual Health Service, Townsville, QLD.
ACCESS is funded by the Australian Government Department of Health and Ageing (DoHA) through the Chlamydia Targeted Grants Program. The opinions expressed here are not necessarily those of the Department of Health and Ageing.
Correspondence: Rebecca Jane Guy, BAppSc, MAppEpid, PhD, National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Cliffbrook Campus, 45 Beach St, Coogee, New South Wales 2031, Australia. E-mail: email@example.com.
Received for publication June 24, 2010, and accepted September 8, 2010.