Re-testing for chlamydia at sexual health services in Australia, 2004–08Rebecca Guy A I , Handan Wand A , Neil Franklin A , Christopher K. Fairley B C , Marcus Y. Chen B , Catherine C. O’Connor D , Lewis Marshall E , Andrew E. Grulich A , John M. Kaldor A , Margaret Hellard F , Basil Donovan A G and on behalf of the ACCESS Collaboration H
A National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney, NSW 2034, Australia.
B Melbourne Sexual Health Centre, Carlton, Vic. 3053, Melbourne, Australia.
C School of Population Health University of Melbourne, Melbourne, Vic. 3053, Australia.
D Sexual Health Service, Community Health, Royal Prince Alfred Hospital, Sydney South West Area Health Service, Camperdown, NSW 2050, Australia.
E Fremantle Hospital, Fremantle, WA 6869, Australia.
F Centre for Population Health, Burnet Institute, Melbourne, Vic. 3181, Australia.
G Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW 2001, Australia.
H See Box 1.
I Corresponding author. Email: Rguy@nchecr.unsw.edu.au
Sexual Health 8(2) 242-247 https://doi.org/10.1071/SH10086
Submitted: 11 July 2010 Accepted: 24 August 2010 Published: 18 May 2011
Objective: To describe the frequency of the 3-month test for re-infection among sexual health service patients in Australia. Methods: We assessed the re-testing rates at 30–120 days after chlamydia infection in men who have sex with men (MSM), heterosexual males and females attending sexual health services across Australia between 2004 and 2008. A χ2-test was used to determine significant differences in re-testing rates according to demographic characteristics and trends over time. Results: In the 5-year period, 10 207 MSM, 28 530 heterosexual males and 31 190 heterosexual females were tested for chlamydia. Of those tested, 9057 (13.0%) were positive. The proportion of patients with chlamydia infection who were re-tested in 30–120 days was 8.6% in MSM, 11.9% in heterosexual males and 17.8% in heterosexual females. Among MSM, chlamydia re-testing rates were lower in men aged <30 years (8.4%) than ≥30 years (12.5%) (P = 0.04) and lower in travellers and migrants (2.9%) than non-travellers (9.9%) (P = 0.002). In heterosexual males, chlamydia re-testing rates were lower in men in regional and rural areas (10.5%) than metropolitan areas (13.5%) (P = 0.017). There was no increasing trend in re-testing rates between 2004 and 2008 (P = 0.787). Of the patients re-tested, 44.1% of MSM were positive, 21.0% of heterosexual males and 16.1% of females. Discussion: The high chlamydia positivity at 30–120 days support recommendations that call for a 3-month test for re-infection following a positive test. The low re-testing rates highlight the need for innovative strategies to increase re-testing.
Additional keywords: re-infection, repeat testing, sexual health clinics.
References Vajdic CM, Middleton M, Bowden FJ, Fairley CK, Kaldor JM. The prevalence of genital Chlamydia trachomatis in Australia 1997–2004: a systematic review. Sex Health 2005; 2 169–83.
| The prevalence of genital Chlamydia trachomatis in Australia 1997–2004: a systematic review.CrossRef | 16335545PubMed |
 Kong F, Hocking J, Kyle-Link C, Chen MY, Hellard ME. Sex and sport: chlamydia screening in rural sporting clubs. BMC Infect Dis 2009; 9 73
| Sex and sport: chlamydia screening in rural sporting clubs.CrossRef | 19470183PubMed |
 Hocking JS, Willis J, Tabrizi S, Fairley CK, Garland SM, Hellard M. A chlamydia prevalence survey of young women living in Melbourne, Victoria. Sex Health 2006; 3 235–40.
| A chlamydia prevalence survey of young women living in Melbourne, Victoria.CrossRef | 17112433PubMed |
 Hocking J, Fairley C, Bradshaw C, Chen M, Tabrizi S, et al. Chlamydia Incidence and Re-Infection Rates Study (CIRIS). Melbourne: University of Melbourne (commissioned by the Chlamydia Targetted Grants Program, Commonwealth Department of Health & Ageing); 2009.
 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 | 1:STN:280:DC%2BD2s3it12ltQ%3D%3D&md5=6a4d88055217c09accd02887fa7d3cdeCAS | 17005541PubMed |
 Haggerty CL, Gottlieb SL, Taylor BD, Low N, Xu F, Ness RB. Risk of sequelae after Chlamydia trachomatis genital infection in women. J Infect Dis 2010; 201 134–55.
| Risk of sequelae after Chlamydia trachomatis genital infection in women.CrossRef |
 Bernstein KT, Marcus JL, Nieri G, Philip SS, Klausner JD. Rectal gonorrhea and chlamydia reinfection is associated with increased risk of HIV seroconversion. J Acquir Immune Defic Syndr 2010; 53 537–43.
| Rectal gonorrhea and chlamydia reinfection is associated with increased risk of HIV seroconversion.CrossRef | 19935075PubMed |
 Lister NA, Smith A, Tabrizi SN, Garland S, Fairley CK. Re-infection of Neisseria gonorrhoeae and Chlamydia trachomatis infections among men who have sex with men. Int J STD AIDS 2006; 17 415–7.
| Re-infection of Neisseria gonorrhoeae and Chlamydia trachomatis infections among men who have sex with men.CrossRef | 1:STN:280:DC%2BD28zgslKqtA%3D%3D&md5=6b7a8bda47694c81416c96a7d25cd771CAS | 16734967PubMed |
 Sexually Transmissible Infections in Gay Men Action Group. Sexually transmitted infection testing guidelines for men who have sex with men (STIGMA guidelines). Sydney: Australasian Chapter of Sexual Health Medicine; 2008.
 Australasian Chapter of Sexual Health Medicine. National management guidelines for sexually transmissible infections. Melbourne: Royal Australasian College of Physicians; 2008.
 Guy R, 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 2010; in press.
| 21090187PubMed |
 StataCorp. Intercooled Stata. 9.0 ed. College Station: Stata Corp; 2004.
 Guy R, Goller JL, Spelman T, El-Hayek C, Gold J, Lim M, et al Does the frequency of HIV and STI testing among MSM in primary care adhere with Australian guidelines? Sex Transm Infect 2010;
| Does the frequency of HIV and STI testing among MSM in primary care adhere with Australian guidelines?CrossRef | 20460263PubMed |
 Malotte CK, Ledsky R, Hogben M, Larro M, Middlestadt S, St. Lawrence JS, et al Comparison of methods to increase repeat testing in persons treated for gonorrhea and/or chlamydia at public sexually transmitted disease clinics. Sex Transm Dis 2004; 31 637–42.
| Comparison of methods to increase repeat testing in persons treated for gonorrhea and/or chlamydia at public sexually transmitted disease clinics.CrossRef | 15502669PubMed |
 Paneth-Pollak R, Klingler EJ, Blank S, Schillinger JA. The elephant never forgets: piloting a chlamydia and gonorrhea retesting reminder postcard in an STD clinic setting. Sex Transm Dis 2010; 37 365–8.
| The elephant never forgets: piloting a chlamydia and gonorrhea retesting reminder postcard in an STD clinic setting.CrossRef | 20473247PubMed |
 Steedman NM, McMillan A. Treatment of asymptomatic rectal Chlamydia trachomatis: is single-dose azithromycin effective? Int J STD AIDS 2009; 20 16–8.
| Treatment of asymptomatic rectal Chlamydia trachomatis: is single-dose azithromycin effective?CrossRef | 1:STN:280:DC%2BD1M%2FksVaquw%3D%3D&md5=46e4c4eaeb8edf0fe7e895fbc3f725a4CAS | 19103887PubMed |
 Sparks R, Helmers JR, Handsfield HH, Totten PA, Holmes KK, Wroblewski JKH, et al Rescreening for gonorrhea and chlamydial infection through the mail: a randomized trial. Sex Transm Dis 2004; 31 113–6.
| Rescreening for gonorrhea and chlamydial infection through the mail: a randomized trial.CrossRef | 14743074PubMed |
 Bloomfield PJ, Steiner KC, Kent CK, Klausner JD. Repeat chlamydia screening by mail, San Francisco. Sex Transm Infect 2003; 79 28–30.
| Repeat chlamydia screening by mail, San Francisco.CrossRef | 1:STN:280:DC%2BD3s%2Fms12htQ%3D%3D&md5=4ef066a166c77c00ea2937d700f3e564CAS | 12576609PubMed |
 Kong FYS, Guy R, Bergeri I, Boyle DJ, Hocking JS, Merritt T, et al. Chlamydia testing rates in general practices across Australia: the Australian Collaboration for Chlamydia Enhanced Sentinel Surveillance (ACCESS). Australasian Sexual Health Conference; 7–9 September 2009; Brisbane.