Open Access Highly Accessed Research article

Analysis of laboratory testing results collected in an enhanced chlamydia surveillance system in Australia, 2008–2010

Wayne Dimech1*, Megan SC Lim23, Caroline Van Gemert23, Rebecca Guy4, Douglas Boyle5, Basil Donovan46, Margaret Hellard23 and behalf of the ACCESS collaboration

Author Affiliations

1 NRL, 4th Floor Healy Building, 41 Victoria Parade, Fitzroy 3065, Australia

2 Burnet Institute, Centre for Population Health, 85 Commercial Road, Melbourne, Victoria 3004, Australia

3 Monash University, School of Population Health and Preventive Medicine, 99 Commercial Rd, Melbourne 3004, Australia

4 The Kirby Institute, Sexual Health Program, University of New South Wales, Sydney, NSW 2052, Australia

5 GRHANITE Health Informatics Unit, Rural Health Academic Centre, Melbourne Medical School, University of Melbourne, 49 Graham Street, Shepparton, Victoria 3630, Australia

6 Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW 2000, Australia

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BMC Infectious Diseases 2014, 14:325  doi:10.1186/1471-2334-14-325

Published: 12 June 2014



Chlamydial infection is the most common notifiable disease in Australia, Europe and the US. Australian notifications of chlamydia rose four-fold from 20,274 cases in 2002 to 80,846 cases in 2011; the majority of cases were among young people aged less than 29 years. Along with test positivity rates, an understanding of the number of tests performed and the demographics of individuals being tested are key epidemiological indicators. The ACCESS Laboratory Network was established in 2008 to address this issue.


The ACCESS Laboratory Network collected chlamydia testing data from 15 laboratories around Australia over a three-year period using data extraction software. All chlamydia testing data from participating laboratories were extracted from the laboratory information system; patient identifiers converted to a unique, non-reversible code and de-identified data sent to a single database. Analysis of data by anatomical site included all specimens, but in age and sex specific analysis, only one testing episode was counted.


From 2008 to 2010 a total of 628,295 chlamydia tests were referred to the 15 laboratories. Of the 592,626 individual episodes presenting for testing, 70% were from female and 30% from male patients. In female patients, chlamydia positivity rate was 6.4% overall; the highest rate in 14 year olds (14.3%). In male patients, the chlamydia positivity rate was 9.4% overall; the highest in 19 year olds (16.5%). The most common sample type was urine (57%). In 3.2% of testing episodes, multiple anatomical sites were sampled. Urethral swabs gave the highest positivity rate for all anatomical sites in both female (7.7%) and male patients (14%), followed by urine (7.6% and 9.4%, respectively) and eye (6.3% and 7.9%, respectively).


The ACCESS Laboratory Network data are unique in both number and scope and are representative of chlamydia testing in both general practice and high-risk clinics. The findings from these data highlight much lower levels of testing in young people aged 20 years or less; in particular female patients aged less than 16 years, despite being the group with the highest positivity rate. Strategies are needed to increase the uptake of testing in this high-risk group.

Chlamydia trachomatis; ACCESS laboratory network; Surveillance; Sexually transmitted infection