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RESEARCH ARTICLE

Epidemiology of gonorrhoea notifications in Australia, 2007–12

April Roberts-Witteveen A H , Kate Pennington B , Nasra Higgins C , Carolyn Lang D , Monica Lahra E , Russell Waddell F and John Kaldor G
+ Author Affiliations
- Author Affiliations

A ACT Health, Population Health, Locked Bag 5005, Weston Creek, ACT 2611, Australia.

B Department of Health, Office of Health Protection, GPO Box 9848, ACT 2601, Australia.

C Victorian Government, Department of Health, 50 Lonsdale Street, Melbourne, Vic. 3000, Australia.

D Department of Health, Queensland, PO Box 48, Brisbane, Qld 4000, Australia.

E South Eastern Area Laboratory Services, The Prince of Wales Hospital, WHO Collaborating Centre for STD and Neisseria Reference Laboratory, High Street, Randwick, NSW 2031, Australia.

F SA Health, Communicable Disease Control Branch, PO Box 6, Rundle Mall, Adelaide, SA 5000, Australia.

G Kirby Institute, Wallace Wurth Building, UNSW Australia, Sydney, NSW 2052, Australia.

H Corresponding author. Email: april.witteveen@act.gov.au

Sexual Health 11(4) 324-331 https://doi.org/10.1071/SH13205
Submitted: 30 January 2014  Accepted: 12 June 2104   Published: 21 August 2014

Abstract

Background: An increase in the notification rate of gonorrhoea was observed in the national surveillance system. In Australia, gonorrhoea is relatively rare, apart from among some populations of Aboriginal people and men who have sex with men. Methods: Data about gonorrhoea cases reported between 2007 and 2012 from all Australian jurisdictions were extracted from the National Notifiable Diseases Surveillance System. Analyses were undertaken of the time trends in counts and rates, according to jurisdiction, gender, Aboriginal and Torres Strait Islander status, diagnosis method and sexual orientation. Results: The largest increase in notifications between 2007 and 2012 was observed in both men and women in New South Wales (2.9- and 3.7-fold greater in 2012 than 2007, respectively) and Victoria (2.4- and 2.7-fold greater in 2012 than 2007, respectively), men in the Australian Capital Territory and women in Queensland. The highest notification rates remained in Indigenous people in the Northern Territory and Western Australia, and particularly in women, although rates may have decreased over the study period. Changes in age and sex distribution, antimicrobial resistance and patterns of exposure and acquisition were negligible. Conclusions: There is an ongoing gonorrhoea epidemic affecting Aboriginal and Torres Strait Islander people in Australia, but the increases in notifications have occurred primarily in non-Aboriginal populations in the larger jurisdictions. Interpretation of these surveillance data, especially in relation to changes in population subgroups, would be enhanced by laboratory testing data. Further efforts are needed to decrease infection rates in populations at highest risk.

Additional keywords: Aboriginal, incidence, Indigenous, men who have sex with men, Neisseria gonorrhoeae, prevalence.


References

[1]  The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia. Annual surveillance report 2013. Sydney: The Kirby Institute, University of New South Wales; 2013.

[2]  The Kirby Institute. Bloodborne viral and sexually transmitted infections in Aboriginal and Torres Strait Islander People: surveillance and evaluation report 2013. Sydney: The Kirby Institute, University of New South Wales; 2013.

[3]  Graham S, Guy R, Donovan B, McManus H, Jiunn-Yu S, El-Hayek C, et al Epidemiology of chlamydia and gonorrhoea among Indigenous and non-Indigenous Australians, 2000–2009. Med J Aust 2012; 197 642–6.
Epidemiology of chlamydia and gonorrhoea among Indigenous and non-Indigenous Australians, 2000–2009.Crossref | GoogleScholarGoogle Scholar | 23230936PubMed |

[4]  Guy RJ, Kong F, Goller J, Franklin N, Bergeri I, Dimech W, et al A new national chlamydia sentinel surveillance system in Australia: evaluation of the first stage of implementation. Commun Dis Intell Q Rep 2010; 34 319–28.
| 21090187PubMed |

[5]  Ryder N, Bourne C, Donovan B. Different trends for different sexually transmissible infections despite increased testing of men who have sex with men. Int J STD AIDS 2011; 22 335–7.
Different trends for different sexually transmissible infections despite increased testing of men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3MnhtlOitw%3D%3D&md5=421e995afe02ec53612bc6d086d2844fCAS | 21680670PubMed |

[6]  Yeung AH, Temple-Smith M, Fairley CK, Vaisey AM, Guy RJ, Law MG, et al Chlamydia prevalence in young attenders of rural and regional primary care services in Australia: a cross-sectional survey. Med J Aust 2014; 200 170–5.
Chlamydia prevalence in young attenders of rural and regional primary care services in Australia: a cross-sectional survey.Crossref | GoogleScholarGoogle Scholar | 24528434PubMed |

[7]  Guy R, Ward JS, Smith KS, Su JY, Huang RL, Tangey A, et al The impact of sexually transmissible infection programs in remote Aboriginal communities in Australia: a systematic review. Sex Health 2012; 9 205–12.
The impact of sexually transmissible infection programs in remote Aboriginal communities in Australia: a systematic review.Crossref | GoogleScholarGoogle Scholar | 22697136PubMed |

[8]  Vodstrcil LA, Fairley CK, Fehler G, Leslie D, Walker J, Bradshaw CS, et al Trends in chlamydia and gonorrhea positivity among heterosexual men and men who have sex with men attending a large urban sexual health service in Australia, 2002–2009. BMC Infect Dis 2011; 11 158
Trends in chlamydia and gonorrhea positivity among heterosexual men and men who have sex with men attending a large urban sexual health service in Australia, 2002–2009.Crossref | GoogleScholarGoogle Scholar | 21639943PubMed |

[9]  Lim MSC, El-Hayek C, Goller JL, Fairley CK, Nguyen PLT, Hamilton RA,, et al Trends in chlamydia positivity among heterosexual patients from the Victorian Primary Care Network for Sentinel Surveillance, 2007–2011. Med J Aust 2014; 200 166–9.
Trends in chlamydia positivity among heterosexual patients from the Victorian Primary Care Network for Sentinel Surveillance, 2007–2011.Crossref | GoogleScholarGoogle Scholar |

[10]  Currie MJ, Martin SJ, Soo TM, Bowden FJ. Screening for chlamydia and gonorrhoea in men who have sex with men in clinical and non-clinical settings. Sex Health 2006; 3 123–6.
Screening for chlamydia and gonorrhoea in men who have sex with men in clinical and non-clinical settings.Crossref | GoogleScholarGoogle Scholar | 16800399PubMed |

[11]  Jin F, Prestage GP, Mao L, Kippax SC, Pell CM, Donovan B, et al Incidence and risk factors for urethral and anal gonorrhoea and chlamydia in a cohort of HIV-negative homosexual men: the Health in Men Study. Sex Transm Infect 2007; 83 113–9.
Incidence and risk factors for urethral and anal gonorrhoea and chlamydia in a cohort of HIV-negative homosexual men: the Health in Men Study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2s3it12ltQ%3D%3D&md5=c30f0c0de795622416e469a959f27e8cCAS | 17005541PubMed |

[12]  Templeton DJ, Jin F, McNally LP, Imrie JC, Prestage GP, Donovan B, et al Prevalence, incidence and risk factors for pharyngeal gonorrhoea in a community-based HIV-negative cohort of homosexual men in Sydney, Australia. Sex Transm Infect 2010; 86 90–6.
Prevalence, incidence and risk factors for pharyngeal gonorrhoea in a community-based HIV-negative cohort of homosexual men in Sydney, Australia.Crossref | GoogleScholarGoogle Scholar | 19841003PubMed |

[13]  Jin F, Prestage GP, Grulich AE, Kaldor JM, Kippax SC, Pell CM, et al Epidemic syphilis among homosexually active men in Sydney. Med J Aust 2005; 183 179–83.
| 16097913PubMed |

[14]  Guy RJ, Leslie DE, Simpson K, Hatch B, Leydon J, Hellard ME, et al Sustained increase in infectious syphilis notifications in Victoria. Med J Aust 2005; 183 218
| 16097926PubMed |

[15]  Ward JS, Guy RJ, Akre SP, Middleton MG, Giele CM, Su JS, et al Epidemiology of syphilis in Australia: moving toward elimination of infectious syphilis from remote Aboriginal and Torres Strait Islander communities? Med J Aust 2011; 194 525–9.
| 21644900PubMed |

[16]  Huang RL, Torzilla PJ, Hammond VA, Coulter ST, Kirby AC. Epidemiology of sexually transmitted infections on the Anangu Pitjantjatjara Yankunytjatjara lands: results of a comprehensive control program. Med J Aust 2008; 189 442–5.
| 18928437PubMed |

[17]  Bowden FJ, Fethers K. ‘Let’s not talk about sex’: reconsidering the public health approach to sexually transmissible infections in remote Indigenous populations in Australia. Med J Aust 2008; 188 182–4.
| 18241182PubMed |

[18]  Wright MR, Giele CM, Dance PR, Thompson SC. Fulfilling prophecy? Sexually transmitted infections and HIV in Indigenous people in Western Australia. Med J Aust 2005; 183 124–8.
| 16053413PubMed |

[19]  Heymann DL, ed. Control of communicable diseases manual. 19th edn. Washington, DC: American Public Health Association; 2008.

[20]  Liu B, Roberts CL, Clarke M, Jorm L, Hunt J, Ward J. Chlamydia and gonorrhoea infections and the risk of adverse obstetric outcomes: a retrospective cohort study. Sex Transm Infect 2013; 89 672–8.
Chlamydia and gonorrhoea infections and the risk of adverse obstetric outcomes: a retrospective cohort study.Crossref | GoogleScholarGoogle Scholar | 24005255PubMed |

[21]  Sherris JC, Champoux JJ, Corey L, Neidhardt FC, Plorde JJ, Ray CG, et al., eds. Medical microbiology: an introduction to infectious diseases. 2nd ed. New York: Elsevier Science Publishing Company; 1990.

[22]  Cecil JA, Howell MR, Tawes JJ, Gaydos JC, McKee KTJ, Quinn TC, et al Features of Chlamydia trachomatis and Neisseria gonorrhoeae infection in male army recruits. J Infect Dis 2001; 184 1216–19.
Features of Chlamydia trachomatis and Neisseria gonorrhoeae infection in male army recruits.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MrltFKjsw%3D%3D&md5=641dc7f1e676d02d863922442f757863CAS | 11598849PubMed |

[23]  Sturgiss EA, Jin F, Martin SJ, Grulich AE, Bowden FJ. Prevalence of other sexually transmissible infections in patients with newly diagnosed anogenital warts in a sexual health clinic. Sex Health 2010; 7 55–9.
Prevalence of other sexually transmissible infections in patients with newly diagnosed anogenital warts in a sexual health clinic.Crossref | GoogleScholarGoogle Scholar | 20152097PubMed |

[24]  Lahra MM, for the Australian Gonococcal Surveillance Programme Annual report of the Australian Gonococcal Surveillance Programme, 2011. Commun Dis Intell Q Rep 2012; 36 E166–73.
| 23186215PubMed |

[25]  Whiley DM, Goire N, Lahra MM, Donovan B, Limnios AE, Nissen MD, et al The ticking time bomb: escalating antibiotic resistance in Neisseria gonorrhoeae is a public health disaster in waiting. J Antimicrob Chemother 2012; 67 2059–61.
The ticking time bomb: escalating antibiotic resistance in Neisseria gonorrhoeae is a public health disaster in waiting.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC38Xht1egt73L&md5=ab5943861036af40d6ec03bae5e06e27CAS | 22604449PubMed |

[26]  Barbee LA. Preparing for an era of untreatable gonorrhea. Curr Opin Infect Dis 2014; 27 282–7.
Preparing for an era of untreatable gonorrhea.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC2cXnsVSlt70%3D&md5=7a18fc4abbadc914ca1ff9dc182160a3CAS | 24685549PubMed |

[27]  Department of Health and Ageing Surveillance systems reported in CDI, 2012. Commun Dis Intell 2012; 36 120–4.

[28]  Hargreaves J, Longbottom H, Myint H, Herceg A, Oliver G, Curran M, et al Annual report of the national notifiable diseases surveillance system, 1994. Commun Dis Intell 1995; 19 542–74.

[29]  Communicable Diseases Network Australia (CDNA). Australian national notifiable diseases and case definitions 2004. Canberra: CDNA; 2013. Available online at: www.health.gov.au/internet/main/publishing.nsf/Content/cdna-casedefinitions.htm#e [verified 8 September 2013].

[30]  Australian Bureau of Statistics (ABS). Australian demographic statistics, Sep 2011. Catalogue no. 3101.0. Canberra: ABS; 2012.

[31]  Australian Bureau of Statistics (ABS). Experimental estimates and projections, Aboriginal and Torres Strait Islander Australians, 1991 to 2021. Catalogue no. 3238.0. Canberra: ABS; 2009.

[32]  Australian Bureau of Statistics (ABS). ASGC remoteness classification: purpose and use. Census paper no. 03/01. Canberra: ABS; 2003.

[33]  Australian Government ComLaw. National Health Security Act 2007. Canberra: Australian Government; 2013. Available online at: http://www.comlaw.gov.au/Details/C2013C00147 [verified 14 July 2014].

[34]  European Centre for Disease Prevention and Control (ECDPC). Sexually transmitted infections in Europe 2011. Stockholm: ECDPC; 2013.

[35]  The Institute of Environmental Science and Research (IESR). Sexually transmitted infections in New Zealand: annual surveillance report 2012. Porirua, New Zealand: IESR; 2013.

[36]  Burnet Institute. Victorian primary care network for sentinel surveillance on blood borne viruses and sexually transmitted infections: 2011 annual report. Melbourne: Centre for Population Health Burnet Institute; 2011. Available online at: http://www.burnet.edu.au/system/asset/file/1120/Sentinel_Surveillance_Annual_Report_2011-digital_version-edited.pdf [verified 8 September 2013].

[37]  Department of Health Western Australia (DoHWA). Report on testing data for notifiable sexually transmissible infections and blood-borne viruses in Western Australia Period covered: 1 January 2009 to 31 December 2011. Perth: DoHWA; 2012. Available online at: http://www.public.health.wa.gov.au/cproot/4674/2/report_on_testing_data_for_notifiable_sti_and_bbv_in_wa%20_3_.pdf [verified 8 September 2013].

[38]  Su JY, Condon JR. Trends in testing and notification for genital gonorrhoea in a northern Australian district, 2004–2008. Sex Health 2012; 9 384–8.
Trends in testing and notification for genital gonorrhoea in a northern Australian district, 2004–2008.Crossref | GoogleScholarGoogle Scholar | 22877599PubMed |

[39]  Bromhead C, Miller A, Jones M, Whiley D. Comparison of the cobas 4800 CT/NG test with culture for detecting Neisseria gonorrhoeae in genital and nongenital specimens in a low-prevalence population in New Zealand. J Clin Microbiol 2013; 51 1505–9.
Comparison of the cobas 4800 CT/NG test with culture for detecting Neisseria gonorrhoeae in genital and nongenital specimens in a low-prevalence population in New Zealand.Crossref | GoogleScholarGoogle Scholar | 23467604PubMed |

[40]  Hjelmevoll SO, Olsen ME, Sollid JU, Haaheim H, Melby KK, Moi H, et al Clinical validation of a real-time polymerase chain reaction detection of Neisseria gonorrheae porA pseudogene versus culture techniques. Sex Transm Dis 2008; 35 517–20.
Clinical validation of a real-time polymerase chain reaction detection of Neisseria gonorrheae porA pseudogene versus culture techniques.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD1cXlt1agt7k%3D&md5=f908e784cde6aad1f5ee6a63e801ad96CAS | 18434945PubMed |

[41]  Lahra M, Australian Gonococcal Surveillance Programme Annual report of the Australian Gonococcal Surveillance Programme, 2012. Commun Dis Intell 2013; 37 E233–9.

[42]  Watkins RE, Mak DB, Giele CM, Clews S. Aboriginal and non-Aboriginal sexually transmitted infections and blood borne virus notification rates in Western Australia: using linked data to improve estimates. BMC Public Health 2013; 13 404
Aboriginal and non-Aboriginal sexually transmitted infections and blood borne virus notification rates in Western Australia: using linked data to improve estimates.Crossref | GoogleScholarGoogle Scholar | 23621957PubMed |