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Open Access Highly Accessed Research article

Trends in chlamydia and gonorrhea positivity among heterosexual men and men who have sex with men attending a large urban sexual health service in Australia, 2002-2009

Lenka A Vodstrcil12, Christopher K Fairley12*, Glenda Fehler2, David Leslie3, Jennifer Walker1, Catriona S Bradshaw24 and Jane S Hocking15

Author Affiliations

1 Melbourne School of Population Health, The University of Melbourne, Vic, Australia

2 Melbourne Sexual Health Centre, Alfred Hospital, Vic, Australia

3 Victorian Infectious Diseases Reference Laboratory, Vic, Australia

4 Department of Epidemiology and Preventive Medicine, Monash University, Vic, Australia

5 Centre for Women's Health, Gender and Society, Melbourne School of Population Health, The University of Melbourne, Parkville, Vic, Australia

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BMC Infectious Diseases 2011, 11:158  doi:10.1186/1471-2334-11-158

Published: 5 June 2011

Abstract

Background

To determine whether chlamydia positivity among heterosexual men (MSW) and chlamydia and gonorrhea positivity among men who have sex with men (MSM), are changing.

Methods

Computerized records for men attending a large sexual health clinic between 2002 and 2009 were analyzed. Chlamydia and gonorrhea positivity were calculated and logistic regression used to assess changes over time.

Results

17769 MSW and 8328 MSM tested for chlamydia and 7133 MSM tested for gonorrhea. In MSW, 7.37% (95% CI: 6.99-7.77) were chlamydia positive; the odds of chlamydia positivity increased by 4% per year (OR = 1.04; 95% CI: 1.01-1.07; p = 0.02) after main risk factors were adjusted for. In MSM, 3.70% (95% CI: 3.30-4.14) were urethral chlamydia positive and 5.36% (95% CI: 4.82-5.96) were anal chlamydia positive; positivity could not be shown to have changed over time. In MSM, 3.05% (95% CI: 2.63-3.53) tested anal gonorrhea positive and 1.83% (95% CI: 1.53-2.18) tested pharyngeal gonorrhea positive. Univariate analysis found the odds of anal gonorrhea positivity had decreased (OR = 0.93; 95% CI: 0.87-1.00; p = 0.05), but adjusting for main risk factors resulted in no change. Urethral gonorrhea cases in MSM as a percentage of all MSM tested for gonorrhea also fell (p < 0.001).

Conclusions

These data suggest that chlamydia prevalence in MSW is rising and chlamydia and gonorrhea prevalence among MSM is stable or declining. High STI testing rates among MSM in Australia may explain differences in STI trends between MSM and MSW.

Keywords:
Chlamydia; Gonorrhea; Men who have sex with men; Heterosexual men; Positivity