Chlamydia retesting remains low among young women in Australia: an observational study using sentinel surveillance data, 2018–2022
Stephanie C. Munari A B * , Anna L. Wilkinson A B C , Jason Asselin A , Louise Owen D , Phillip Read E , Robert Finlayson F , Sarah Martin G H , Charlotte Bell I J , Catherine C. O’Connor K , Allison Carter K L M , Rebecca Guy K , Anna McNulty N , Rick Varma N , Eric P. F. Chow B O P , Christopher K. Fairley O P , Basil Donovan K , Mark Stoove A , Jane L. Goller B , Jane Hocking B , Margaret E. Hellard A B Q andA
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Abstract
Chlamydia remains the most notified bacterial sexually transmissible infection in Australia with guidelines recommending testing for re-infection at 3 months post treatment. This paper aimed to determine chlamydia retesting and repeat positivity rates within 2–4 months among young women in Australia, and to evaluate what factors increase or decrease the likelihood of retesting.
Chlamydia retesting rates among 16–29-year-old women were analysed from Australian Collaboration for Coordinated Enhanced Sentinel Surveillance of sexually transmissible infection and bloodborne virus (ACCESS) sentinel surveillance data (n = 62 sites). Among women with at least one positive test between 1 January 2018 and 31 August 2022, retesting counts and proportions within 2–4 months were calculated. Logistic regression was performed to assess factors associated with retesting within 2–4 months.
Among 8758 women who were positive before 31 August 2022 to allow time for follow up, 1423 (16.2%) were retested within 2–4 months, of whom 179 (12.6%) tested positive. The odds of retesting within 2–4 months were 25% lower if tested in a coronavirus disease 2019 (COVID-9) pandemic year (2020–2022) (aOR = 0.75; 95% CI 0.59–0.95). Among 9140 women with a positive test before 30 November 2022, 397 (4.3%) were retested too early (within 7 days to 1 month) and 81 (20.4%) of those were positive.
Chlamydia retesting rates remain low with around a sixth of women retested within 2–4 months in line with guidelines. Re-infection is common with around one in eight retesting positive. An increase in retesting is required to reduce the risk of reproductive complications and onward transmission.
Keywords: chlamydia, primary care, re-infection, retesting, sexual health, sexually transmissible infection, surveillance, women.
References
2 Peipert JF. Clinical practice. Genital chlamydial infections. N Engl J Med 2003; 349(25): 2424-2430.
| Crossref | Google Scholar | PubMed |
3 Geisler WM. Duration of untreated, uncomplicated Chlamydia trachomatis genital infection and factors associated with chlamydia resolution: a review of human studies. J Infect Dis 2010; 201(S2): 104-113.
| Crossref | Google Scholar |
4 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(S2): 134-155.
| Crossref | Google Scholar |
5 Walker J, Tabrizi SN, Fairley CK, Chen MY, Bradshaw CS, Twin J, et al. Chlamydia trachomatis incidence and re-infection among young women – behavioural and microbiological characteristics. PLoS ONE 2012; 7(5): e37778.
| Crossref | Google Scholar | PubMed |
6 Davies B, Ward H, Leung S, Turner KME, Garnett GP, Blanchard JF, et al. Heterogeneity in risk of pelvic inflammatory diseases after chlamydia infection: a population-based study in Manitoba, Canada. J Infect Dis 2014; 210(suppl 2): S549-S555.
| Crossref | Google Scholar | PubMed |
7 Bowring AL, Gouillou M, Guy R, Kong FYS, Hocking J, Pirotta M, et al. Missed opportunities—low levels of chlamydia retesting at Australian general practices, 2008–2009. Sex Transm Infect 2012; 88(5): 330-334.
| Crossref | Google Scholar | PubMed |
8 Guy R, Wand H, Franklin N, Fairley CK, Chen MY, O’Connor CC, et al. Re-testing for chlamydia at sexual health services in Australia, 2004-08. Sex Health 2011; 8(2): 242-7.
| Crossref | Google Scholar | PubMed |
9 Gray RT, Callander D, Hocking JS, McGregor S, McManus H, Dyda A, et al. Population-level diagnosis and care cascade for chlamydia in Australia. Sex Transm Infect 2020; 96(2): 131-136.
| Crossref | Google Scholar | PubMed |
10 van Bergen JEAM, Hoenderboom BM, David S, Deug F, Heijne JCM, van Aar F, et al. Where to go to in chlamydia control? From infection control towards infectious disease control. Sex Transm Infect 2021; 97(7): 501-506.
| Crossref | Google Scholar | PubMed |
11 Hocking JS, Temple-Smith M, Guy R, Donovan B, Braat S, Law M, et al. Population effectiveness of opportunistic chlamydia testing in primary care in Australia: a cluster-randomised controlled trial. Lancet 2018; 392(10156): 1413-1422.
| Crossref | Google Scholar | PubMed |
12 Australian STI Management Guidelines For Use In Primary Care. Chlamydia. 2022. Available at https://sti.guidelines.org.au/sexually-transmissible-infections/chlamydia/ [cited 5 January 2023]
13 Herzog SA, Althaus CL, Heijne JCM, Oakeshott P, Kerry S, Hay P, et al. Timing of progression from Chlamydia trachomatis infection to pelvic inflammatory disease: a mathematical modelling study. BMC Infect Dis 2012; 12: 187.
| Crossref | Google Scholar | PubMed |
14 Callander D, Moreira C, El-Hayek C, Asselin J, van Gemert C, Watchirs Smith L, et al. Monitoring the control of sexually transmissible infections and blood-borne viruses: protocol for the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS). JMIR Res Protoc 2018; 7(11): e11028.
| Crossref | Google Scholar | PubMed |
15 Australasian Society for HIV Viral Hepatitis and Sexual Health Medicine (ASHM). Sex work. 2019. Available at https://hivlegal.ashm.org.au/sex-work/ [cited 14 July 2023]
16 Australian STI Management Guidelines For Use In Primary Care. Sex workers. 2021. Available at https://sti.guidelines.org.au/populations-and-situations/sex-workers/ [ cited 19 September 2023]
17 Victorian Government. Decriminalising sex work in Victoria. Victorian Government; 2023. Available at https://www.vic.gov.au/sex-work-decriminalisation [cited 28 June 2023]
18 Kong FYS, Guy RJ, Hocking JS, Merritt T, Pirotta M, Heal C, et al. Australian general practitioner chlamydia testing rates among young people. Med J Aust 2011; 194(5): 249-252.
| Crossref | Google Scholar | PubMed |
19 Yeung AH, Temple-Smith M, Fairley CK, Vaisey AM, Guy R, 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(3): 170-175.
| Crossref | Google Scholar | PubMed |
20 Hui BB, Hocking JS, Braat S, Donovan B, Fairley CK, Guy R, et al. Intensified partner notification and repeat testing can improve the effectiveness of screening in reducing Chlamydia trachomatis prevalence: a mathematical modelling study. Sex Transm Infec 2022; 98(6): 414-419.
| Crossref | Google Scholar | PubMed |
21 Price MJ, Ades AE, Soldan K, Welton NJ, Macleod J, Simms I, et al. The natural history of Chlamydia trachomatis infection in women: a multi-parameter evidence synthesis. Health Technol Assess 2016; 20(22): 1-250.
| Crossref | Google Scholar | PubMed |
22 Smith KS, Hocking JS, Chen MY, Fairley CK, McNulty AM, Read P, et al. Dual intervention to increase chlamydia retesting: a randomized controlled trial in three populations. Am J Prev Med 2015; 49(1): 1-11.
| Crossref | Google Scholar | PubMed |
23 Downing SG, Cashman C, McNamee H, Penney D, Russell DB, Hellard ME. Increasing chlamydia test of re-infection rates using SMS reminders and incentives. Sex Transm Infect 2013; 89(1): 16-19.
| Crossref | Google Scholar | PubMed |
24 Goller JL, Coombe J, Temple-Smith M, Bittleston H, Sanci L, Guy R, et al. Management of Chlamydia Cases in Australia (MoCCA): protocol for a non-randomised implementation and feasibility trial. BMJ Open 2022; 12(12): e067488.
| Crossref | Google Scholar | PubMed |
25 Unemo M, Bradshaw CS, Hocking JS, de Vries HJC, Francis SC, Mabey D, et al. Sexually transmitted infections: challenges ahead. Lancet Infect Dis 2017; 17(8): e235-e279.
| Crossref | Google Scholar | PubMed |
26 Coombe J, Goller J, Vaisey A, Bourne C, Sanci L, Bateson D, et al. New best practice guidance for general practice to reduce chlamydia-associated reproductive complications in women. Aust J Gen Pract 2021; 50(1–2): 50-54.
| Crossref | Google Scholar | PubMed |