Register      Login
Sexual Health Sexual Health Society
Publishing on sexual health from the widest perspective

Chlamydia at an inner metropolitan sexual health service in Sydney, NSW: Australian Collaboration for Chlamydia Enhanced Sentinel Surveillance (ACCESS) Project

Neil Franklin A , Catherine C. O’Connor E H I , Miranda Shaw E , Rebecca Guy A , Andrew Grulich A , Christopher K. Fairley B , Marcus Y. Chen B , Margaret Hellard C , Bridget Dickson D , Lewis Marshall F , Basil Donovan A G and on behalf of the ACCESS Collaboration
+ Author Affiliations
- Author Affiliations

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

B School of Population Health, University of Melbourne, and Melbourne Sexual Health Centre, Melbourne, Vic. 3053, Australia.

C Centre for Population Health, Macfarlane Burnett Institute for Medical Research and Public Health, Melbourne, Vic. 3000, Australia.

D CaraData Pty Ltd, Parkwood, Qld 4214, Australia.

E Sexual Health Service, Community Health, RPA Hospital, SSWAHS, Camperdown, NSW 2050, Australia.

F Fremantle Hospital, Fremantle, WA 6969, Australia.

G Sydney Sexual Health Centre, Sydney Hospital, Liverpool, NSW 2170, Australia.

H South-Western Clinical School, The University of New South Wales, Sydney, NSW 2052, Australia.

I Corresponding author. Email:

Sexual Health 7(4) 478-483
Submitted: 22 November 2009  Accepted: 11 May 2010   Published: 10 November 2010


Background: Australia has a widely dispersed network of public sexual health services that test large numbers of people from high prevalence populations for genital Chlamydia trachomatis infection. These populations include young sexually active heterosexuals, men who have sex with men, sex workers and Aboriginal and Torres Strait Islander people. The Australian Collaboration for Chlamydia Enhanced Sentinel Surveillance (ACCESS) Project was established to monitor chlamydia testing rates and positivity rates at a national level, which in turn will help interpret trends in chlamydia diagnoses reported through passive surveillance. The ACCESS Project is the first time that chlamydia-related data including priority population and testing denominators has been collated at a national level. The present paper reports on chlamydia testing and positivity rates in a sexual health service in the inner west of Sydney between 2004 and 2008 and compares these to published national data from the ACCESS Project in sexual health services. Methods: Chlamydia positivity and testing rates at an inner western Sydney sexual health service were compared with aggregate data from the ACCESS Project obtained from 14 sexual health services across Australia. Using a standardised extraction program, retrospective de-identified line-listed demographic and chlamydia testing data on all patients were extracted from patient management systems. Results: Over the 5-year period, 5145 new patients attended the inner-west sexual health service. Almost 66% had a chlamydia test at first visit and there was no significant difference in this testing rate when compared with the ACCESS Project national rate for sexual health services (67.0%; odds ratio [OR] 0.94, 95% confidence intervals 0.88–1.00). The testing rate increased over time from 61% in 2004 to 70% in 2008. There were 281 chlamydia diagnoses at this service, giving an overall chlamydia positivity rate of 9.3%, significantly higher than the ACCESS Project national rate of 8.2% (OR 1.16, 95% confidence intervals 1.02–1.32). Discussion: Testing rates were similar and positivity rates for Chlamydia trachomatis were higher in this sexual health service in Sydney than national trends.

Additional keywords: STI testing.


ACCESS is a collaboration between the National Centre in HIV Epidemiology and Clinical Research, the Burnet Institute, the National Serology Reference Library, and the National Perinatal Statistics Unit. It is funded by the Department of Health and Ageing, as part of the national Chlamydia Pilot Program. The Australian Collaboration for Chlamydia Enhanced Sentinel Surveillance (ACCESS) is funded through the Australian Government Department of Health and Ageing Chlamydia Pilot Program.

ACCESS Sexual Health Coordinating Committee

Professor Basil Donovan, Dr Rebecca Guy, Professor Andrew Grulich, Professor John Kaldor, Neil Franklin, the National Centre in HIV Epidemiology and Clinical Research, Sydney, NSW; Dr Christopher Fairley (Chair), Dr Marcus Chen, Melbourne Sexual Health Clinic, Melbourne, Vic.; Bridget Dickson, Caradata, Parkwood, Qld; Dr Lewis Marshall, WA Sexual Health Services, Fremantle, WA; Associate Professor Catherine O’Connor, Committee of Medical Directors of NSW Sexual Health Services, Sydney, NSW; Associate Professor Margaret Hellard, Burnett Institute, Melbourne, Vic.

ACCESS Sexual Health Services

Dr Kelaart, Mairead Hetherington, Alice Springs Clinic 34, Alice Springs, NT; Professor Frank Bowden, Dr Sarah Martin, Canberra Sexual Health Centre, Canberra, ACT; Dr Nathan Ryder, Heng Lu, Sydney Sexual Health Centre, Sydney, NSW; Dr Brian Mulhall, Amanda Rickett , Coffs Harbour Sexual Health, Coffs Harbour, NSW; Peter Knibbs, Dr Catherine Pell, Darwin Clinic 34, Darwin, NT; Associate Professor Darren Russell, Sandra Downing, Dolls House Sexual Health Clinic, Cairns, Qld; Dr Lewis Marshall, Fremantle Hospital, Fremantle, WA; Dr John Chua, May Ngieng, Gold Coast Sexual Health, Gold Coast, Qld; Michael Bolton, Alison Kincaid, Greater Southern Area Health Service, NSW; Dr Maree O’Sullivan, Houlihan Nives, Hobart Sexual Health Service, Hobart, Tas.; Dr Debbie Allen, Paul Maudlin, Holden St Sexual Health Centre, Gosford, NSW; Dr Catriona Ooi, Martin O’Connor, Hunter New England Sexual Health Service, Newcastle, NSW; Dr Ingrid Van Beek, Dr Craig Rogers, Heng Lu, Kirketon Road Centre, Sydney, NSW; Dr David J Smith, Cecily Gray, Lismore/Tweed Heads Sexual Health Service, Lismore, NSW; Christopher Fairley, Marcus Chen, A Afrizal, Melbourne Sexual Health Centre, Melbourne, Vic.; Tim lynch, Fiona D’Aquino, Orange Sexual Health Centre, Orange, NSW; David Jardine, Dee Archbold, Princess Alexandra Sexual Health, South Brisbane, Qld; Associate Professor Catherine O’Connor, Seven Guney, RPA Sexual Health Clinic, Camperdown, NSW; Dr Stephen Davies, Amanda Rickett, Royal North Shore Hospital Sexual Health, North Sydney, NSW; Dr Katerina Lagios, Sangeetha Eswarappa, SWAHS: Eastern Division, NSW; Jane Shakeshaft, SWAHS: Western Division, NSW; Associate Professor Katherine Brown, Victoria McGrath, Sydney South Illawarra Health Service, Wollongong, NSW; Dr Pam Konecny, Heng Lu, St George Short St Sexual Health Centre, Kogarah, NSW; Dr Arun Menon, Angela Cooper, Townsville Sexual Health Service, Townsville, Qld.


[1] National Centre in HIV Epidemiology and Clinical Research. HIV/AIDS, viral hepatitis and sexually transmissible infections in Australia Annual Surveillance Report 2009. Sydney, NSW: National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales; 2009. pp. 14–26.

[2] Australian Government Department of Health and Ageing. National Notifiable Diseases Surveillance System. Canberra: Australian Government Department of Health and Ageing; 2009.

[3] Lind I,  Bollerup AC,  Farholt S,  Hoffmann S. Laboratory surveillance of urogenital Chlamydia trachomatis infections in Denmark 1988–2007. Scand J Infect Dis 2009; 41 334–40.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[4] Kløvstad H,  Aavitsland P. Chlamydia trachomatis infections in Norway, 1986 to 2006, surveillance data. Sex Transm Dis 2009; 36 17–21.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[5] Low N,  Bender N,  Nartey L,  Shang A,  Stephenson JM. Effectiveness of chlamydia screening: systematic review. Int J Epidemiol 2009; 38 435–48.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[6] Owusu-Edusei K,  Owens CJ. Monitoring county-level chlamydia incidence in Texas, 2004–2005: application of empirical Bayesian smoothing and Exploratory Spatial Data Analysis (ESDA) methods. Int J Health Geogr 2009; 8 12.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[7] Evans C,  Das C,  Kinghorn G. A retrospective study of recurrent chlamydia infection in men and women: is there a role for targeted screening for those at risk? Int J STD AIDS 2009; 20 188–92.
Crossref | GoogleScholarGoogle Scholar | CAS | PubMed |

[8] Chen MY,  Rohrsheim R,  Donovan B. Chlamydia trachomatis infection in Sydney women. Aust NZ J Obstet Gynaecol 2005; 45 410–3.
Crossref | GoogleScholarGoogle Scholar |

[9] Kong FY,  Hocking JS,  Link CK,  Chen MY,  Hellard ME. Sex and sport: chlamydia screening in rural sporting clubs. BMC Infect Dis 2009; 9 73.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[10] Williams H,  Tabrizi SN,  Lee W,  Kovacs GT,  Garland S. Adolescence and other risk factors for Chlamydia trachomatis genitourinary infection in women in Melbourne, Australia. Sex Transm Infect 2003; 79 31–4.
Crossref | GoogleScholarGoogle Scholar | CAS | PubMed |

[11] Chen MY,  Donovan B. Screening for genital Chlamydia trachomatis infection: are men the forgotten reservoir? Med J Aust 2003; 179 124–5.
PubMed |

[12] Chen MY,  Donovan B. Genital Chlamydia trachomatis infection in Australia: epidemiology and clinical implications. Sex Health 2004; 1 189–96.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[13] Chen MY,  Fairley CK,  De Guingand D,  Hocking J,  Tabrizi S,  Wallace EM,, et al. Screening pregnant women for chlamydia: what are the predictors of infection? Sex Transm Infect 2009; 85 31–5.
Crossref | GoogleScholarGoogle Scholar | CAS | PubMed |

[14] Chen MY,  Fairley CK,  Donovan B. Nowhere near the point of diminishing returns: correlations between chlamydia testing and notification rates in New South Wales. Aust NZ J Public Health 2005; 29 249–53.
Crossref | GoogleScholarGoogle Scholar | CAS |

[15] Chen MY,  Karvelas M,  Sundararajan V,  Hocking JS,  Fairley CK. Evidence for the effectiveness of a chlamydia awareness campaign: increased population rates of chlamydia testing and detection. Int J STD AIDS 2007; 18 239–43.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[16] Chen MY,  Rohrsheim R,  Donovan B. The differing profiles of symptomatic and asymptomatic Chlamydia trachomatis-infected men in a clinical setting. Int J STD AIDS 2007; 18 384–8.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[17] Cheney K,  Chen MY,  Donovan B. Chlamydia trachomatis infection among antenatal women in Sydney. Aust N Z J Public Health 2006; 30 85–7.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[18] 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.
Crossref | GoogleScholarGoogle Scholar | CAS | PubMed |

[19] Lister NA,  Smith A,  Read T,  Fairley CK. Testing men who have sex with men for Neisseria gonorrhoeae and Chlamydia trachomatis prior to the introduction of guidelines at an STD clinic in Melbourne. Sex Health 2004; 1 47–50.
Crossref | GoogleScholarGoogle Scholar | CAS | PubMed |

[20] 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 Infect 1999; 75 431–4.
Crossref | GoogleScholarGoogle Scholar | CAS | PubMed |

[21] NSW Health Department Notifiable Diseases Database System (NDD). Sydney: (HOIST), Communicable Diseases Branch and Epidemiology and Surveillance Branch, NSW Health Department; 2009.

[22] Rissel C,  Smith A,  Richters J,  Grulich A,  De Visser R. The Australian study of health and relationships: results for central Sydney, inner-eastern Sydney, and New South Wales. NSW Public Health Bull 2003; 14 133–43.
Crossref | GoogleScholarGoogle Scholar |

[23] Hocking JS,  Parker RM,  Pavlin N,  Fairley CK,  Gunn JM. What needs to change to increase chlamydia screening in general practice in Australia? The views of general practitioners. BMC Public Health 2008; 8 425.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[24] Pavlin NL,  Parker R,  Fairley CK,  Gunn JM,  Hocking J. Take the sex out of STI screening! Views of young women on implementing chlamydia screening in General Practice. BMC Infect Dis 2008; 8 62.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[25] Temple-Smith MJ,  Mak D,  Watson J,  Bastian L,  Smith A,  Pitts M. Conversant or clueless? Chlamydia-related knowledge and practice of general practitioners in Western Australia. BMC Fam Pract 2008; 9 17.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[26] Tomnay JE,  Gebert RL,  Fairley CK. A survey of partner notification practices among general practitioners and their use of an internet resource for partner notification for Chlamydia trachomatis. Sex Health 2006; 3 217–20.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[27] Rissel C , Winchester L . A Demographic Profile of Central Sydney Area Health Service from the 1996 Census. Sydney: Needs Assessment & Health Outcomes Unit, CSAHS; 1998.

[28] Shaw K,  Stephens N,  Coleman D,  O’Sullivan M. Role of the general practitioner in testing for genital Chlamydia trachomatis infection: an analysis of enhanced surveillance data. Sex Health 2009; 6 208–12.
PubMed |