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RESEARCH ARTICLE
Contents Vol 6(3)

Neisseria gonorrhoeae infection in urban Sydney women: prevalence and predictors

Paula McDonagh A , Nathan Ryder A B C , Anna M. McNulty A B and Eleanor Freedman A
+ Author Affiliations
- Author Affiliations

A Sydney Sexual Health Centre, Sydney Hospital, GPO Box 1614, Sydney, NSW 2001, Australia.

B School of Public Health and Community Medicine, University of New South Wales, Kensington, NSW 2052, Australia.

C Corresponding author. Email: nathan.ryder@sesiahs.health.nsw.gov.au

Sexual Health 6(3) 241-244 https://doi.org/10.1071/SH09025
Submitted: 4 March 2009  Accepted: 30 April 2009   Published: 3 August 2009

Abstract

Background: The notification rate of female gonorrhoea in urban Sydney is very low. With the increasing use of nucleic acid amplification tests (NAAT), demonstrating a low prevalence of gonorrhoea in women would have important implications for the reliability of positive results. We determined the prevalence of female cervical gonorrhoea in our urban sexual health clinic and identified associated clinical, behavioural and demographic variables that may allow more targeted screening practices. Methods: The Sydney Sexual Health Centre database was used to identify women tested for cervical gonorrhoea between 1997 and 2007. Diagnostic, demographic and behavioural information were extracted to ascertain the prevalence of gonorrhoea and describe variables associated with infection. Additionally, a case control study was conducted of cervical gonorrhoea cases from January 2000 to December 2005, with two gonorrhoea negative women selected for each case as controls. A blinded researcher examined each medical record to determine genital symptoms, being a contact of gonorrhoea, sex work, sex outside of Australia, injecting drug use. Results: Between 1997 and 2007, 77 women were diagnosed with cervical gonorrhoea, a prevalence of 0.37%. Results of the case control study reveal that women with gonorrhoea were more likely to be symptomatic [odds ratio (OR) 3.7, 95% confidence interval (CI) 1.7–8.4], be a known contact of gonorrhoea (OR 264, 95% CI 149–470), or have had recent sex overseas, or with a partner from overseas (OR 1.75, 95% CI 1.11–2.75). Conclusion: Cervical gonorrhoea infection is rare in our urban sexual health clinic, and even more unlikely in asymptomatic women without risk factors. This low prevalence of gonorrhoea, particularly in asymptomatic women, decreases the reliability of positive NAAT test results. This has important implications for the screening of asymptomatic women presenting to urban sexual health clinics in Australia.

Additional keywords: Australia, epidemiology, sexually transmissible infection.


Acknowledgements

The authors would like to acknowledge the contribution of Heng Lu, SSHC data manager for performing the data extraction and our reception staff for assisting with the medical records.


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