Gonorrhoea gone wild: rising incidence of gonorrhoea and associated risk factors among gay and bisexual men attending Australian sexual health clinics
Denton Callander A K , Rebecca Guy A , Christopher K. Fairley B C , Hamish McManus A , Garrett Prestage A , Eric P. F. Chow B C , Marcus Chen B D , Catherine C. O Connor A E F , Andrew E. Grulich A , Christopher Bourne A G , Margaret Hellard H , Mark Stoové H I , Basil Donovan A J and on behalf of the ACCESS CollaborationA The Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia.
B Melbourne Sexual Health Centre, 580 Swanston Street, Melbourne, Vic. 3000, Australia.
C Central Clinical School, Monash University, Melbourne, Vic. 3800, Australia.
D Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Vic. 3000, Australia.
E RPA Sexual Health Clinic, Sydney Local Health District, 16 Marsden Road, Sydney, NSW 2050, Australia.
F Central Clinical School, University of Sydney, Sydney, NSW 2006, Australia.
G STI Programs Unit, NSW Ministry of Health, 150 Albion Street, Sydney, NSW 2060, Australia.
H Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3000, Australia.
I School of Public Health and Preventative Medicine, Monash University, Melbourne, Vic. 3800, Australia.
J Sydney Sexual Health Centre, Sydney Hospital, 8 Macquarie Street, Sydney, NSW 2000, Australia.
K Corresponding author. Email: d.callander@unsw.edu.au
Sexual Health 16(5) 457-463 https://doi.org/10.1071/SH18097
Submitted: 14 May 2018 Accepted: 17 July 2018 Published: 9 November 2018
Journal Compilation © CSIRO 2019 Open Access CC BY-NC-ND
Abstract
Background: Gonorrhoea notifications continue to rise among gay and bisexual men in Australia and around the world. More information is needed on infection trends, accounting for testing and complimented by demographics and risk practices. Methods: A retrospective cohort analysis was undertaken using repeat gonorrhoea testing data among gay and bisexual men from 2010 to 2017, which was extracted from a network of 47 sexual health clinics across Australia. Poisson and Cox regression analyses were used to determine temporal trends in gonorrhoea incidence rates, as well as associated demographic and behavioural factors. Results: The present analysis included 46 904 gay and bisexual men. Gonorrhoea incidence at any anatomical site increased from 14.1/100 person years (PY) in 2010 to 24.6/100 PY in 2017 (P < 0.001), with the greatest increase in infections of the pharynx (5.6-15.9/100 PY, P < 0.001) and rectum (6.6–14.8/100 PY, P < 0.001). After adjusting for symptomatic and contact-driven presentations, the strongest predictors of infection were having more than 20 sexual partners in a year (hazard ratio (HR) = 1.9, 95% confidence interval (CI): 1.7–2.2), using injecting drugs (HR = 1.7, 95%CI: 1.4–2.0), being HIV positive (HR = 1.4, 95%CI: 1.2–1.6) and being aged less than 30 years old (HR = 1.4, 95%CI: 1.2–1.6). Conclusions: Gonorrhoea has increased dramatically among gay and bisexual men in Australia. Enhanced prevention efforts, as well as more detailed, network-driven research are required to combat gonorrhoea among young men, those with HIV and those who use injecting drugs.
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