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REVIEW

The prevalence of genital Chlamydia trachomatis in Australia 1997–2004: a systematic review

Claire M. Vajdic A D , Melanie Middleton A , Francis J. Bowden B , Christopher K. Fairley C and John M. Kaldor A
+ Author Affiliations
- Author Affiliations

A National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, NSW 2010, Australia.

B Australian National University and Canberra Sexual Health Centre, Woden, ACT 2606, Australia.

C Melbourne Sexual Health Centre, Carlton, VIC 3053, Australia.

D Corresponding author. Email: cvajdic@nchecr.unsw.edu.au

Sexual Health 2(3) 169-183 https://doi.org/10.1071/SH05018
Submitted: 30 March 2005  Accepted: 5 August 2005   Published: 20 September 2005

Abstract

Objectives: To determine by systematic review the prevalence of genital chlamydial infection in Australia between 1997 and 2004. Methods: Electronic literature databases, reference lists, and conference proceedings were searched and health agencies and jurisdictions were contacted for published and unpublished reports. Studies were eligible if they offered a diagnostic nucleic acid amplification test to consecutive individuals presenting during the study period. As a summary measure of the available data, mean prevalence rates, weighted by sample size and irrespective of participant age, were calculated for the population sub-groups. Results: 40 studies of 50 populations and 40587 individuals met the inclusion criteria, but only one of these was population-based. The use of non-systematic methodologies prevented an assessment of time trends and a statistical comparison of population sub-groups. The mean overall prevalence of genital chlamydial infection was 4.6% (95% CI 4.4–4.8%), reflecting over-sampling of high-risk groups. The mean community-based rates were 7.5% (95% CI 6.4–8.6%) and 8.7% (95% CI 7.9–9.7%) for Indigenous men and women, and 1.5% (95% CI 1.1–1.9%) and 1.4% (95% CI 0.9–2.0%) for non-Indigenous men and women. The overall mean estimates for other groups were 3.3% (95% CI 3.0–3.7%) for female attendees of sexual health and related clinics, 5.6% (95% CI 4.9–6.4%) for adolescents and young adults, 3.3% (95% CI 2.8–3.9%) for sex workers, and 1.6% (95% CI 1.2–2.0%) for urethral infection in men who have sex with men. Clinic-based estimates were generally, although not consistently, higher than community-based estimates. There is no serial population-based data for sexually active young men and women, but the available age-specific rates suggest under-ascertainment by the routine surveillance systems. Conclusions: The prevalence of genital chlamydial infection in Indigenous Australians and young adults is unacceptably high and quality epidemiological studies are urgently required to supplement the routinely collected national notification data.

Additional keywords: genital chlamydial infection, Indigenous, surveillance.


Acknowledgements

The authors acknowledge the support and advice from the STI Surveillance Subcommittee of the Intergovernmental Committee on HIV/AIDS, Hepatitis C and Related Diseases (IGCAHRD). The National Centre in HIV Epidemiology and Clinical Research is funded by the Australian Government Department of Health and Ageing, and is affiliated with the Faculty of Medicine, The University of New South Wales.


References


[1] Yohannes K,  Roche P,  Blumer C,  Spencer J,  Milton A,  Bunn C, et al. Australia’s notifiable disease status, 2002: annual report of the National Notifiable Diseases Surveillance System. Commun Dis Intell 2004; 28 6–68.
PubMed |

[2] National Centre in HIV Epidemiology and Clinical Research. HIV/AIDS, viral hepatits and sexually transmissible infections in Australia Annual Surveillance Report 2004. National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney; 2004.

[3] National Centre in HIV Epidemiology and Clinical Research. HIV/AIDS and related diseases in Australia Annual Surveillance Report 1997. National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney; 1997.

[4] Counahan ML,  Hocking JS,  Fairley CK. Enhanced chlamydia surveillance indicates more surveillance needed. Med J Aust 2003; 178(10): 523.


[5] Institute of Medicine. Committee on prevention and control of sexually transmitted diseases. In: Eng TR, Butler WT, editors. The hidden epidemic: confronting sexually transmitted diseases. Washington, DC: National Academy Press; 1997. pp. 28–68.

[6] Stamm WE. infections of the adult. Sexually transmitted diseases 3rd edn. New York: McGraw-Hill; 1999 p. 409–18.

[7] Hocking J,  Fairley CK,  Counahan M,  Crofts N. The pattern of notification and testing for genital Chlamydia trachomatis infection in Victoria, 1998–2000: an ecological analysis. Aust N Z J Public Health 2003; 27 405–8.
PubMed |

[8] Adams EJ,  Charlett A,  Edmunds WJ,  Hughes G. Chlamydia trachomatis in the United Kingdom: a systematic review and analysis of prevalence studies. Sex Transm Infect 2004; 80 354–62.
CrossRef | PubMed |

[9] Hocking, J, Willis, J, Tabrizi, S, Hellard, M, Jolley, D and  Garland, SM (2004) Chlamydia risk factor and prevalence survey of young women aged 18–35 living in Victoria. Adelaide, 31 March–3 April 2004

[10] Debattista J,  Marin P,  Jamieson J,  Crane K,  Donton I,  Russell-Hall S, et al. Detection of Chlamydia trachomatis in an Australian high school student population. Sex Transm Inf 2002; 78 194–7.
CrossRef |

[11] Estcourt CS,  Marks C,  Rohrsheim R,  Johnson AM,  Donovan B,  Mindel A. HIV, sexually transmitted infections, and risk behaviours in male commercial sex workers in Sydney. Sex Trans Inf 2000; 76 294–8.


[12] Coughlan E,  Mindel A,  Estcourt CS. Male clients of female commercial sex workers: HIV, STDs and risk behaviour. Int J STD AIDS 2001; 12 665–9.
CrossRef | PubMed |

[13] Fethers K,  Marks C,  Mindel A,  Estcourt CS. Sexually transmitted infections and risk behaviours in women who have sex with women. Sex Transm Inf 2000; 76 345–9.
CrossRef |

[14] Donovan B. Rising prevalence of genital Chlamydia trachomatis infection in heterosexual patients at the Sydney Sexual Health Centre, 1994 to 2000. Commun Dis Intell 2002; 26 51–5.
PubMed |

[15] Heal C,  Jones B,  Veitch C,  Lamb S,  Hodgens S,  Browning S, et al. Screening for chlamydia in general practice. Aust Family Physician 2002; 31 779–82.


[16] Morton AN,  Wakefield T,  Tabrizi SN,  Garland SM,  Fairley CK. An outreach programme for sexually transmitted infection in street sex workers using self-administered samples. Int J STD AIDS 1999; 10 741–3.
CrossRef | PubMed |

[17] Garland SM,  Tabrizi S,  Hallo J,  Chen S. Assessment of Chlamydia trachomatis prevalence by PCR and LCR in women presenting for termination of pregnancy. Sex Transm Inf 2000; 76 173–6.
CrossRef |

[18] Debattista J,  Lines D,  Patten J,  Latham S. Early detection of Chlamydia trachomatis in senior high school student populations: a pilot study. Venereol 1998; 11 19–23.


[19] Skov SJ,  Miller P,  Hateley W,  Bastian IB,  Davis J,  Tait PW. Urinary diagnosis of gonorrhoea and chlamydia in men in remote Aboriginal communities. Med J Aust 1997; 166 468–71.
PubMed |

[20] Miller PJ,  Torzillo PJ,  Hateley W. Impact of improved diagnosis and treatment on prevalence of gonorrhoea and chlamydial infection in remote Aboriginal communities on Anangu Pitjantjatjara Lands. Med J Aust 1999; 170 429–32.
PubMed |

[21] Fairley CK,  Bowden FJ,  Gay NJ,  Paterson BA,  Garland SM,  Tabrizi SN. Sexually transmitted diseases in disadvantaged Australian communities. JAMA 1997; 278 117–8.
CrossRef | PubMed |

[22] Miller GC,  McDermott R,  McCulloch B,  Fairley CK,  Muller R. Predictors of the prevalence of bacterial STI among young disadvantaged Indigenous people in north Queensland, Australia. Sex Transm Inf 2003; 79 332–5.
CrossRef |

[23] Jones S,  Barker S,  Athan E,  Graves S. The tip of the iceberg: opportunistic screening for Chlamydia trachomatis in asymptomatic patients attending a young people’s health clinic reveals a high prevalence – a pilot study. Sex Health 2004; 1 115–9.


[24] Debattista J,  Dwyer J,  Orth D,  Patten J,  Delandelles J. Community screening for Neisseria gonorhoeae and Chlamydia trachomatis among patrons of sex-on-premises venues. Venereol 1999; 12 27–30.


[25] Bowden, FJ, O’Keefe, EJ, Primrose, R and  Currie, MJ (2004) SHLiRP – a comprehensive STI and BBV screening in a senior high school population. (Australasian College of Sexual Health Physicians:  )

[26] Rodger A,  Hocking J,  Warren R,  Snow J,  Aboagye-Kwarteng T,  Croft N. Prevalence of genital Chlamydia trachomatis in male clients of female sex workers in Melbourne. Venereol 1999; 12 129–32.


[27] Debattista J,  Dwyer J,  Orth D,  Lister G,  Patten J. Community screening for Neisseria Gonorhoeae and Chlamydia trachomatis among patrons of sex-on-premises venues: two years later. Venereol 2000; 13 105–9.


[28] Debattista J,  Clementson C,  Mason D,  Dwyer J,  Argent S,  Woodward C, et al. Screening for Neisseria gonorhoeae and Chlamydia trachomatis at entertainment venues among men who have sex with men. Sex Transm Dis 2002; 29 216–21.
PubMed |

[29] Lister NA,  Smith A,  Tabrizi S,  Hayes P,  Medland NA,  Garland S, et al. Screening for Neisseria gonorrhoeae and Chlamydia trachomatis in men who have sex with men at male-only saunas. Sex Transm Dis 2003; 30 886–9.
PubMed |

[30] Hamlyn, E, McAllister, J, Winston, A, Sinclair, B, Carr, A and  Cooper, D (2004) Screening for sexually transmitted infections in individuals receiving non-occupational post exposure prophylaxis. (Australasian Society for HIV Medicine: Sydney)

[31] Jin F,  Prestage G,  Van de Ven P,  Mao L,  Kippax S,  Pell C, et al. Prevalence, incidence and risk factors for HIV, syphilis, gonorrhoea and chlamydia in an HIV negative cohort of homosexual men. Proceedings of the XV International AIDS Conference, Bangkok, Thailand 2004; 11–16 411.


[32] Butler T, Milner L. The 2001 New South Wales Inmate Health Survey. Corrections Health Service, Sydney; 2003.

[33] Rosenthal DA,  Fairley CK,  Garland SM,  Tabrizi SN,  Raynor K,  Edwards C, et al. Homeless young people: an important risk group for sexually transmitted infections. Med J Aust 2000; 172 244.
PubMed |

[34] Fenton KA,  Korovessis C,  Johnson AM,  McCadden A,  McManus S,  Wellings K, et al. Sexual behaviour in Britain: reported sexually transmitted infections and prevalenc genital Chlamydia trachomatis infection. Lancet 2001; 358 1851–4.
CrossRef | PubMed |

[35] Miller WC,  Ford CA,  Morris M,  Handcock MS,  Schmitz JL,  Hobbs MM, et al. Prevalence of chlamydial and gonococcal infections among young adults in the United States. JAMA 2004; 291 2229–36.
CrossRef | PubMed |

[36] Parish WL,  Laumann EO,  Cohen MS,  Pan S,  Zheng H,  Hoffman I, et al. Population-based study of chlamydial infection in China. JAMA 2003; 289 1265–73.
CrossRef | PubMed |

[37] Golden MR,  Schillinger JA,  Markowitz L,  St Louis ME. Duration of untreated genital infections with chlamydia trachomatis: a review of the literature. Sex Transm Dis 2000; 27 329–37.
PubMed |

[38] Shields SA,  Wong T,  Mann J,  Jolly AM,  Haase D,  Mahaffey S, et al. Prevalence and correlates of chlamydia infection in Canadian street youth. J Adolesc Health 2004; 34 384–90.
CrossRef | PubMed |

[39] Garland SM,  Gertig DM,  McInnes JA. Genital Chlamydia trachomatis infection in Australia. Med J Aust 1993; 15 90–6.


[40] Lyttle PH,  Thompson SC. Maintaining sexual health in commercial sex workers in Australia: condom effectiveness, screening, and management after acquiring sexually transmissible infections. Aust N Z J Public Health 2004; 28 351–9.
PubMed |

[41] Cook RL,  St George K,  Silvestre AJ,  Riddler SA,  Lassak M,  Rinaldo CR. Prevalence of chlamydia and gonorrhoea among a population of men who have sex with men. Sex Transm Inf 2002; 78 190–3.
CrossRef |

[42] Van der Snoek EM,  Gotz HM,  Mulder PGH,  Verkooyen RP,  van der Meijden WI. Prevalence of STD and HIV infections among attenders of the Erasmus MC STD clinic, Rotterdam, The Netherlands, during the years 1996 to 2000. Int J STD AIDS 2003; 14 119–24.
CrossRef | PubMed |

[43] Farley TA,  Cohen DA,  Elkins W. Asymptomatic sexually transmitted diseases: the case for screening. Prev Med 2003; 36 502–9.
CrossRef | PubMed |

[44] Götz H,  Lindbäck J,  Ripa T,  Arneborn M,  Ramstedt K,  Ekdahl K. Is the increase in notifications of Chlamydia trachomatis infections in Sweden the result of changes in prevalence, sampling frequency or diagnostic methods? Scand J Infect Dis 2002; 34 28–34.
CrossRef | PubMed |

[45] Lowndes CM,  Fenton KA. The European Surveillance of STIs Network. Surveillance systems for STIs in the European Union: facing a changing epidemiology. Sex Transm Infect 2004; 80 264–71.
CrossRef | PubMed |

[46] Tabrizi SN,  Paterson BA,  Fairley CK,  Bowden FJ,  Garland SM. Comparison of tampon and urine as self-administered methods of specimen collection in the detection of Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis in women. Int J STD AIDS 1998; 9 347–9.
CrossRef | PubMed |

[47] Knox J,  Tabrizi SN,  Miller P,  Petoumenos K,  Law M,  Chen S, et al. Evaluation of self-collected samples in contrast to practitioner collected samples for detection of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis by polymerase chain reaction among women living in remote areas. Sex Transm Dis 2002; 29 647–54.
PubMed |

[48] Watson EJ,  Templeton A,  Russell I,  Paavonen J,  Mardh PA,  Stary A, et al. The accuracy and efficiency of screening tests for Chlamydia trachomatis: a systematic review. J Med Microbiol 2002; 51 1021–31.
PubMed |

[49] Hocking J,  Fairley CK. Need for screening for genital Chlamydia trachomatis infection in Australia. Aust N Z J Public Health 2003; 27 80–1.
PubMed |

[50] Morton AN,  Tabrizi SN,  Garland SM,  Lee PJ. Will the legalisation of street sex work improve health? Sex Trans Infect 2002; 78 309.
CrossRef |

[51] Williams H,  Tabrizi SN,  Lee W,  Kovacs SN,  Garland S. Adolescence and other risk factors for Chlamydia trachomatis genitourinary infection in women in Melbourne, Australia. Sex Trans Inf 2003; 79 31–4.


[52] Bateson D. The Chlamydia Prevalence Pilot Study. Executive Summary April 2004. Sydney: Family Planning Association Health.

[53] Bateson D. FPA Health Chlamydia Prevalence Study, Draft Executive Summary January 2005. Sydney: Family Planning Association Health.

[54] Bowden FJ,  Paterson BA,  Mein J,  Savage J,  Fairley CK,  Garland SM, et al. Estimating the prevalence of Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae, and human papillomavirus infection in indigenous women in northern Australia. Sex Transm Inf 1999; 75 431–4.


[55] Garrow SC,  Smith DW,  Harnett GB. The diagnosis of chlamydia, gonorrhoea, trichomonas infections by self obtained low vaginal swabs, in remote nothern Australian clinical practice. Sex Transm Infect 2002; 78 278–81.
CrossRef | PubMed |

[56] Melbourne Sexual Health Centre (MSHC). Victorian Aboriginal Community Controlled Health Organisation (VACCHO). The Victorian Well Person’s Health Check Report – Sexual Health. Melbourne: VACCHO, Melbourne; 2003. p. 17.

[57] Mak DB,  Murray JC,  Bulsara MK. Antenatal Screening for sexually transmitted infections in remote Australia. Aust NZ J Obstet Gyn 2003; 43 457–63.
CrossRef |

[58] Latif A, Smith K. STI screening conducted in NT Department of Health and Community Services and Community Controlled Health Services in Central Australia in 2004. In: Krause V, editor. The Northern Territory Disease Control Bulletin 2004; 11: 18–20.

[59] Quinlivan JA,  Petersen RW,  Gurrin LC. High prevalence of chlamydia and pap-smear abnormalities in pregnant adolescants warrants routine screening. Aust N Z J Obstet Gynaecol 1998; 38 254–7.
PubMed |

[60] Quinlivan JA,  Evans SF. The impact of continuing illegal drug use on teenage pregnancy outcomes – a prospective cohort study. BJOG 2002; 109 1148–53.
PubMed |

[61] Debattista J,  Lines D,  James M,  Patten J. Early detection of Chlamydia trachomatis in university residential colleges. Venereol 1999; 12 35–6.



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