High chlamydia and gonorrhoea repeat positivity in remote Aboriginal communities 2009–2011: longitudinal analysis of testing for re-infection at 3 months suggests the need for more frequent screening
Linda Garton A B H , Amalie Dyda B , Rebecca Guy B , Bronwyn Silver C , Skye McGregor B , Belinda Hengel B D , Alice Rumbold C E , Debbie Taylor-Thomson C , Janet Knox F , Lisa Maher B , John Kaldor B , James Ward G and on behalf of the STRIVE Investigators
+ Author Affiliations
- Author Affiliations
A Centre for Disease Control, Department of Health, PO Box 40596, Casuarina, NT 0811, Australia.
B Kirby Institute, University of New South Wales (UNSW), Sydney, NSW 2052, Australia.
C Menzies School of Health Research, PO Box 41096, Casuarina, Darwin, NT 0811, Australia.
D Apunipima Cape York Health Council, Cairns, PO Box 12045, Earlville, Qld 4870, Australia.
E Robinson Research Institute, The University of Adelaide, Adelaide, SA 5005, Australia.
F Lismore Sexual Health Service, New South Wales Health, Sydney, NSW 2480, Australia.
G South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, SA 5001, Australia.
H Corresponding author. Email: linda.garton@nt.gov.au
Sexual Health 13(6) 568-574 https://doi.org/10.1071/SH16025
Submitted: 4 February 2016 Accepted: 15 August 2016 Published: 21 October 2016
Abstract
Background: Extremely high rates of diagnosis of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) have been recorded in remote communities across northern and central Australia. Re-testing at 3 months, after treatment administered, of CT or NG is recommended to detect repeat infections and prevent morbidity and ongoing transmission. Methods: Baseline CT and NG laboratory data (2009–2010) from 65 remote health services participating in a cluster randomised trial was used to calculate the proportion of individuals re-tested after an initial CT or NG diagnosis at <2 months (not recommended), 2–4 months (recommended) and 5–12 months and the proportion with repeat positivity on re-test. To assess if there were difference in re-testing and repeat positivity by age group and sex, t-tests were used. Results: There was a total of 2054 people diagnosed with CT and/or NG in the study period; 14.9% were re-tested at 2–4 months, 26.9% at 5–12 months, a total of 41.8% overall. Re-testing was higher in females than in males in both the 2–4-month (16.9% v. 11.5%, P < 0.01) and 5–12-month (28.9% v. 23.5%, P = 0.01) periods. Women aged 25–29 years had a significantly higher level of re-testing 5–12 months post-diagnosis than females aged 16–19 years (39.8% v. 25.4%, P < 0.01). There was a total of 858 people re-tested at 2–12 months and repeat positivity was 26.7%. There was higher repeat NG positivity than repeat CT positivity (28.8% v. 18.1%, P < 0.01). Conclusions: Just under half the individuals diagnosed with CT or NG were re-tested at 2–12 months post-diagnosis; however, only 15% were re-tested in the recommended time period of 2–4 months. The higher NG repeat positivity compared with CT is important, as repeat NG infections have been associated with higher risk of pelvic inflammatory disease-related hospitalisation. Findings have implications for clinical practice in remote community settings and will inform ongoing sexual health quality improvement programs in remote community clinics.
Additional keywords: Indigenous, STI re-testing, test for re-infection.
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