High rates of chlamydia found among 12- to 16-year-olds attending a rural sexual health clinic: implications for practiceJane Elizabeth Tomnay A D , Lauren Coelli B and Jane Simone Hocking C
A Centre for Excellence in Rural Sexual Health, Department of Rural Health, University of Melbourne, 49 Graham Street, Shepparton, Vic. 3630, Australia.
B Gateway Health, 155 High Street, Wodonga, Vic. 3690, Australia.
C Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Level 3, 207 Bouverie Street, Carlton South, Vic. 3053, Australia.
D Corresponding author. Email: email@example.com
Sexual Health 13(2) 193-195 http://dx.doi.org/10.1071/SH15140
Submitted: 14 July 2015 Accepted: 24 November 2015 Published: 18 January 2016
Background: Chlamydia is the most commonly diagnosed bacterial sexually transmissible infection (STI) and is asymptomatic in ~80% of women. If untreated, potential consequences include pelvic inflammatory disease, ectopic pregnancy and infertility. Methods: In 2014, a retrospective audit was undertaken at a rural service to determine what proportion of patients were aged 12–16 years, infected with chlamydia and their reasons for attending the clinic. Results: There were 111 patients aged 12–16 years attending during 2011–2014; 104 (95%) were female. One hundred and ninety-four chlamydia tests were conducted, with the proportion of patients having at least one test annually being 100% in 2011, 81% in 2012, 72% in 2013 and 78% in 2014. There was no difference in the proportion tested by age during the study (P = 0.59). Forty-six tests were positive for chlamydia (23.7%; 95%CI: 17.8%, 30.9%) with proportions decreasing with increasing age from 46.7% (95%CI: 16.4%, 79.5%) in 12- or 13-year-olds to 15.5% (95%CI: 9.4%, 24.2%) in 16-year-olds (P = 0.02). The reasons for attending when a chlamydia test was ordered included: (i) fear of pregnancy (18.3%, 34/185); (ii) symptoms (16.7%, 31/185); (iii) STI test/treatment (32.4%, 60/185); and (iv) contraception (32.4%, 60/185). Only 29.7% (33/111) would have been tested if symptoms or requesting a test were impetus. Conclusion: Sexually active 12- to 16-year-olds should be tested for chlamydia, and establishing their sexual history is crucial. Amending the current Australian guidelines to annual testing of any sexually active person under the age of 30 years should be considered.
References Australian Government Department of Health. National notifiable diseases surveillance system. Chalmydia report 2014. Available online at: http://www9.health.gov.au/cda/source/rpt_4.cfm [verified 25 May 2015].
 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.
| Chlamydia trachomatis in the United Kingdom: a systematic review and analysis of prevalence studies.CrossRef | 1:STN:280:DC%2BD2cvptFantg%3D%3D&md5=7ef08610ae91f4231427abd3e62b3f7cCAS | 15459402PubMed |
 Yeung AH, Temple-Smith M, Fairley CK, Vaisey AM, Guy R, Law MG, Low N, Bingham AL, Gunn J, Kaldor J, Donovan B, Hocking JS. 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 | 24528434PubMed |
 Peipert J. Genital chlamydial infections. N Engl J Med 2003; 349 2424–30.
| Genital chlamydial infections.CrossRef | 1:CAS:528:DC%2BD3sXpvFGqur0%3D&md5=c8b8f1e2408b36807c8c27d049d2bd6fCAS | 14681509PubMed |
 Hillis SD, Owens LM, Marchbanks PA, Amsterdam LE, Mac Kenzie WR. Recurrent chlamydial infections increase the risks of hospitalisation for ectopic pregnancy and pelvic inflammatory disease. Am J Obstet Gynecol 1997; 176 103–7.
| Recurrent chlamydial infections increase the risks of hospitalisation for ectopic pregnancy and pelvic inflammatory disease.CrossRef | 1:STN:280:DyaK2s7ns1Gmuw%3D%3D&md5=e952f8aeaf49507b69b352c1aebcc798CAS | 9024098PubMed |
 Royal Australian College of General Practitioners. Guidelines for preventive activities in general practice, 8th edn. Melbourne 2012. Available online at: http://www.racgp.org.au/your-practice/guidelines/redbook/communicable-diseases/stis/ [verified 25th June 2015].
 Department of Health Australian Government. 3rd National Sexually Transmissible Infections (STI) Strategy 2014–2017. Available online at: http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-bbvs-sti [verified 25 May 2015].
 Dimech W, Lim M, Gemert C, Guy R, Boyle D, Donovan B, Hellard M. Analysis of laboratory testing results collected in an enhanced chlamydia surveillance system in Australia, 2008–2010. BMC Infect Dis 2014; 14 325
| Analysis of laboratory testing results collected in an enhanced chlamydia surveillance system in Australia, 2008–2010.CrossRef | 24920016PubMed |
 Tomnay J, Bourke L, Fairley C. Exploring the acceptability of online sexually transmissible infection testing for rural young people in Victoria. Aust J Rural Health 2014; 22 40–4.
| Exploring the acceptability of online sexually transmissible infection testing for rural young people in Victoria.CrossRef | 24460999PubMed |
 Joesoef M, Weinstock H, Kent C, Chow J, Boudov M, Parvez F, Cox T, Licoln T, Miller JL, Sternberg M, the Corrections STD Prevalence Monitoring Group Sex and age correlates of chlamydia prevalence in adolescents and adults entering correctional facilities, 2005: implications for screening policy. Sex Transm Dis 2009; 36 S67–71.
| Sex and age correlates of chlamydia prevalence in adolescents and adults entering correctional facilities, 2005: implications for screening policy.CrossRef | 19125147PubMed |
 Larson A. Health services and the workforce. In Wilkinson D, Blue I, editors. The new rural health. Melbourne: Oxford University Press; 2002. pp. 58–76.
 Warr D. Hillier l. ‘That’s the problem with living in a small town’: privacy and sexual health issues for young rural people. Aust J Rural Health 1997; 5 132–9.
| Hillier l. ‘That’s the problem with living in a small town’: privacy and sexual health issues for young rural people.CrossRef | 1:STN:280:DyaK1c7gtVKluw%3D%3D&md5=0eb9e0a321a4da0ee08c18ad8a8093feCAS | 9437940PubMed |
 Stewart FJ, Rosenthal DA. Rural and urban female secondary school students’ attitudes towards and use of primary care services. Aust J Rural Health 1997; 5 126–31.
| Rural and urban female secondary school students’ attitudes towards and use of primary care services.CrossRef | 1:STN:280:DyaK1c7gtVKlug%3D%3D&md5=9871692d5e3a8eaba4e7fd708a4521d5CAS | 9437939PubMed |
 Quine S, Bernard D, Booth M, Kang M, Usherwood T, Alperstein G, Bennett D. Health and access issues among Australian adolescents: a rural-urban comparison. Rural Remote Health 2003; 3 245–55.
| 1:STN:280:DC%2BD2M3ksFaquw%3D%3D&md5=3d7fd756e52d66e142aaf884828b3fbeCAS | 15882102PubMed |
 Humphreys JS, Mathews-Cowey S, Weinand HC. Factors in accessibility of general practice in rural Australia. Med J Aust 1997; 166 577–80.
| 1:STN:280:DyaK2szksVyjuw%3D%3D&md5=32bd43e1f0909df3aa2aca82857f2d20CAS | 9201176PubMed |
 Bourke L. Rural health consumers perspectives on access, and information. Aust J Rural Health 2001; 9 1–6.
| Rural health consumers perspectives on access, and information.CrossRef | 1:STN:280:DC%2BD3Mnlt1WjsQ%3D%3D&md5=e5621a24123a61746d8db0e4124f063eCAS | 11703259PubMed |
 Bourke L, Humphreys J, Lukaitis F. Health behaviours of young, rural residents: a case study. Aust J Rural Health 2009; 17 86–91.
| Health behaviours of young, rural residents: a case study.CrossRef | 19335598PubMed |
 Humphreys JS. Key considerations in delivering appropriate and accessible health care for rural and remote populations: discussant overview. Aust J Rural Health 2009; 17 34–8.
| Key considerations in delivering appropriate and accessible health care for rural and remote populations: discussant overview.CrossRef | 19161498PubMed |