The prevalence of Chlamydia trachomatis infection in Australia: a systematic review and meta-analysis

BMC Infectious Diseases

Jane S Hocking³  Christopher K Fairley²  Marcus Y Chen²  Hammad Ali¹  Rebecca J Guy¹  Danielle C Newton³  Dyani Lewis³ 

[1] The Kirby Institute, University of New South Wales, Darlinghurst, New South Wales, Australia;Melbourne Sexual Health Centre, Alfred Hospital, Carlton, Victoria, Australia;School of Population Health, University of Melbourne, Carlton, Victoria, Australia

关键词: Systematic review;    Prevalence;    Meta-analysis;    Chlamydia;   

Others  :  1175378
DOI  :  10.1186/1471-2334-12-113

 received in 2011-11-30, accepted in 2012-04-03,  发布年份 2012

【 摘 要 】

Background

Chlamydia trachomatis is a common sexually transmitted infection in Australia. This report aims to measure the burden of chlamydia infection by systematically reviewing reports on prevalence in Australian populations.

Methods

Electronic databases and conference websites were searched from 1997–2011 using the terms ‘Chlamydia trachomatis’ OR ‘chlamydia’ AND ‘prevalence’ OR ‘epidemiology’ AND ‘Australia’. Reference lists were checked and researchers contacted for additional literature. Studies were categorised by setting and participants, and meta-analysis conducted to determine pooled prevalence estimates for each category.

Results

Seventy-six studies met the inclusion criteria for the review. There was a high level of heterogeneity between studies; however, there was a trend towards higher chlamydia prevalence in younger populations, Indigenous Australians, and those attending sexual health centres. In community or general practice settings, pooled prevalence for women <25 years in studies conducted post-2005 was 5.0% (95% CI: 3.1, 6.9; five studies), and for men <30 years over the entire review period was 3.9% (95% CI: 2.7, 5.1; six studies). For young Australians aged <25 years attending sexual health, family planning or youth clinics, estimated prevalence was 6.2% (95% CI: 5.1, 7.4; 10 studies) for women and 10.2% (95% CI: 9.5, 10.9; five studies) for men. Other key findings include pooled prevalence estimates of 22.1% (95% CI: 19.0, 25.3; three studies) for Indigenous women <25 years, 14.6% (95% CI: 11.5, 17.8; three studies) for Indigenous men <25 years, and 5.6% (95% CI: 4.8, 6.3; 11 studies) for rectal infection in men who have sex with men. Several studies failed to report basic demographic details such as sex and age, and were therefore excluded from the analysis.

Conclusions

Chlamydia trachomatis infections are a significant health burden in Australia; however, accurate estimation of chlamydia prevalence in Australian sub-populations is limited by heterogeneity within surveyed populations, and variations in sampling methodologies and data reporting. There is a need for more large, population-based studies and prospective cohort studies to compliment mandatory notification data.

【 授权许可】

   
2012 Lewis et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Newman L, Stirzaker S, Knuckey D, Robinson K, Hood J, Knope K, Fitzsimmons G, Martin N, Siripol S, Gajanayake I, Kaczmarek M, Barr I, Hii A, Foxwell R, Owen R, Wright P, Fitzsimmons G, Sanders L, Barry C, Barker S, Ormond J, Liu C: Australia’s notifiable disease status, 2008: annual report of the National Notifiable Diseases Surveillance System. Commun Dis Intell 2010, 34:157-224.
• [2]National Notifiable Diseases Surveillance System,. http://www9.health.gov.au/cda/source/cda-index.cfm webcite
• [3]Cates W, Wasserheit JN: Genital chlamydial infections: Epidemiology and reproductive sequelae. Am J Obstet Gynecol 1991, 164:1771-1781.
• [4]Haggerty CL, Gottlieb SL, Taylor BD, Low N, Xu FJ, Ness RB: Risk of sequelae after Chlamydia trachomatis genital infection in women. J Infect Dis 2010, 202:S134-S155.
• [5]Schachter J: Biology of Chlamydia trachomatis. In Sexually Transmitted Diseases. Edited by Holmes K, Sparling P, Stamm W, Piot P, Wasserheit J, Corey L, Cohen MS. McGraw-Hill, New York; 2008:555-574.
• [6]Weström L, Joesoef R, Reynolds G, Hagdu A, Thompson SE: Pelvic inflammatory disease and fertility: a cohort study of 1,844 women with laparoscopically verified disease and 657 control women with normal laparoscopic results. Sex Transm Dis 1992, 19:185-192.
• [7]Fernandez JL, Ramos B, Santiso R, Agarwal A, Gosalvez J, Gallegos G: Frequency of sperm cells with fragmented DNA in males infected with Chlamydia trachomatis and Mycoplasma sp, determined with the sperm chromatin dispersion (SCD) test. Fertil Steril 2007, 88:S5-S5.
• [8]Idahl A, Boman J, Kumlin U, Olofsson JI: Demonstration of Chlamydia trachomatis IgG antibodies in the male partner of the infertile couple is correlated with a reduced likelihood of achieving pregnancy. Hum Reprod 2004, 19:1121-1126.
• [9]Fleming DT, Wasserheit JN: From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm Infect 1999, 75:3-17.
• [10]The Kirby Institute: Bloodborne viral and sexually transmitted infections in Aboriginal and Torres Strait Islander People: Surveillance and Evaluation Report 2011. University of New South Wales, Sydney; 2011.
• [11]Kong FYS, Guy RJ, Hocking JS, Merritt T, Pirotta M, Heal C, Bergeri I, Donovan B, Hellard ME: Australian general practitioner chlamydia testing rates among young people. Med J Aust 2011, 194:249-252.
• [12]Vajdic CM, Middleton M, Bowden FJ, Fairley CK, Kaldor JM: The prevalence of genital Chlamydia trachomatis in Australia 1997–2004: a systematic review. Sex Health 2005, 2:169-183.
• [13]Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009, 6:e1000097.
• [14]White R, Perry KRW: Chlamydia trachomatis Nucleic Acid Amplification Tests (NAATs): Review of evaluation literature. Health Protection Agency, London; 2004.
• [15]Higgins JPT, Thompson SG, Deeks JJ, Altman DG: Measuring inconsistency in meta-analyses. BMJ 2003, 327:557-560.
• [16]Hocking JS, Willis J, Tabrizi S, Fairley CK, Garland SM, Hellard M: A chlamydia prevalence survey of young women living in Melbourne, Victoria. Sex Health 2006, 3:235-240.
• [17]Debattista J, Lines D, James M, Patten J: Early detection of Chlamydia trachomatis in university residential colleges. Venereol Interdiscipl Int J Sex Health 1999, 12:35-36.
• [18]Debattista J, Martin P, Jamieson J, Crane K, Dolton I, Russell-Hall S, DeSilva J, Hargrave R, Robinson T, Ryan N, Mortlock M: Detection of Chlamydia trachomatis in an Australian high school student population. Sex Transm Infect 2002, 78:194-197.
• [19]Bowden FJ, O’Keefe EJ, Primrose R, Currie MJ: Sexually transmitted infections, blood-borne viruses and risk behaviour in an Australian senior high school population–the SHLiRP study. Sex Health 2005, 2:229-236.
• [20]Davis B, Schmidt M, O’Keefe E, Currie M, Baynes A, Bavinton T, McNiven M, Bowden F: ‘Stamp Out Chlamydia’ project - Bringing chlamydia screening to tertiary students in the Australian Capital Territory. Sex Health 2007, 4:287.
• [21]Gold J, Hocking J, Hellard M: The feasibility of recruiting young men in rural areas from community football clubs for STI screening. Aust N Z J Public Health 2007, 31:243-246.
• [22]Wade AJ, Hocking JS, Hellard ME: Chlamydia trachomatis prevalence in heterosexual men in Melbourne: a community-based study. Sex Health 2007, 4:137-138.
• [23]Buhrer-Skinner M, Muller R, Menon A, Gordon R: Novel approach to an effective community-based chlamydia screening program within the routine operation of a primary healthcare service. Sex Health 2009, 6:51-56.
• [24]Kong FYS, Hocking JS, Link CK, Chen MY, Hellard ME: Sex and sport: chlamydia screening in rural sporting clubs. BMC Infect Dis 2009, 9:5. BioMed Central Full Text
• [25]Kong FYS, Hocking JS, Link CK, Chen MYC, Hellard ME: Sex and sport: sexual risk behaviour in young people in rural and regional Victoria. Sex Health 2010, 7:205-211.
• [26]Sacks-Davis R, Gold J, Aitken CK, Hellard ME: Home-based chlamydia testing of young people attending a music festival–who will pee and post? BMC Public Health 2010, 10:376. BioMed Central Full Text
• [27]Davies SC, Karagiannis T, Headon V, Wiig R, Duffy J: Prevalence of genital chlamydial infection among a community sample of young international backpackers in Sydney, Australia. Int J STD AIDS 2011, 22:160-164.
• [28]Heal C, Jones B, Veitch C, Lamb S, Hodgens S, Browning S, Butler H, Carey M: Screening for chlamydia in general practice. Aust Fam Physician 2002, 31:779-782.
• [29]Chiang DTW, Tan EIL, Baldam A: Incidence of chlamydia infection among asymptomatic women presented for routine Papanicolaou smear: experience in South-Western Victoria. Australia. Rural Remote Health 2006, 6:633.
• [30]Toyne H, Glasgow N, McGuiness C, Bowden FJ, Currie MJ: Screening for chlamydia with the Pap test. Aust Fam Physician 2006, 35:743-744.
• [31]Bowden FJ, Currie MJ, Toyne H, McGuiness C, Lim LL, Butler JR, Glasgow NJ: Screening for Chlamydia trachomatis at the time of routine Pap smear in general practice: a cluster randomised controlled trial. Med J Aust 2008, 188:76-80.
• [32]Hince D, Brett T, Mak D, Bulsara M, Moorhead R, Arnold-Reed D: Opportunistic screening for chlamydia in young men. Aust Fam Physician 2009, 38:734-737.
• [33]Bilardi JE, Fairley CK, Temple-Smith MJ, Pirotta MV, McNamee KM, Bourke S, Gurrin LC, Hellard M, Sanci LA, Wills MJ, Walker J, Chen MY, Hocking JS: Incentive payments to general practitioners aimed at increasing opportunistic testing of young women for chlamydia: a pilot cluster randomised controlled trial. BMC Public Health 2010, 10:70. BioMed Central Full Text
• [34]Walker J, Fairley CK, Bradshaw CS, Tabrizi SN, Chen MY, Twin J, Taylor N, Donovan B, Kaldor JK, McNamee K, Urban E, Walker S, Currie M, Birden H, Bowden FJ, Gunn J, Pirotta M, Gurrin LC, Harindra V, Garland SM, Hocking JS: The difference in determinants of Chlamydia trachomatis and Mycoplasma genitalium in a sample of young Australian women. BMC Infect Dis 2011, 11:35. BioMed Central Full Text
• [35]Bowden FJ: Reappraising the value of urine leukocyte esterase testing in the age of nucleic acid amplification. Sex Transm Dis 1998, 25:322-326.
• [36]Donovan B: Rising prevalence of genital Chlamydia trachomatis infection in heterosexual patients at the Sydney Sexual Health Centre, 1994 to 2000. Commun Dis Intell 2002, 26:51-55.
• [37]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, 79:31-34.
• [38]Hocking J, Fairley CK: Do the characteristics of sexual health centre clients predict chlamydia infection sufficiently strongly to allow selective screening? Sex Health 2005, 2:185-192.
• [39]Hocking J, Fairley CK: Associations between condom use and rectal or urethral chlamydia infection in men. Sex Transm Dis 2006, 33:256-258.
• [40]Bateson DJ, Weisberg E, Lota H: Chlamydia trachomatis infection in the family planning clinical setting across New South Wales. Sex Health 2006, 3:15-20.
• [41]Brandenburger Y, Currie MJ, Bowden FJ: Factors prompting men subsequently diagnosed with chlamydia to use a sexual health service. Sex Health 2007, 4:77-78.
• [42]McIver CJ, Rismanto N, Smith C, Naing ZW, Rayner B, Lusk MJ, Konecny P, White PA, Rawlinson WD: Multiplex PCR testing detection of higher-than-expected rates of cervical mycoplasma, ureaplasma, and trichomonas and viral agent infections in sexually active australian women. J Clin Microbiol 2009, 47:1358-1363.
• [43]O’Rourke KM, Fairley CK, Samaranayake A, Collignon P, Hocking JS: Trends in chlamydia positivity over time among women in Melbourne Australia, 2003 to 2007. Sex Transm Dis 2009, 36:763-767.
• [44]Franklin N, O’Connor CC, Shaw M, Guy R, Grulich A, Fairley CK, Chen MY, Hellard M, Dickson B, Marshall L, Donovan B: Chlamydia at an inner metropolitan sexual health service in Sydney, NSW: Australian Collaboration for Chlamydia Enhanced Sentinel Surveillance (ACCESS) Project. Sex Health 2010, 7:478-483.
• [45]Goller JL, Guy RJ, Gold J, Lim MSC, El-Hayek C, Stoove MA, Bergeri I, Fairley CK, Leslie DE, Clift P, White B, Hellard ME: Establishing a linked sentinel surveillance system for blood-borne viruses and sexually transmissible infections: methods, system attributes and early findings. Sex Health 2010, 7:425-433.
• [46]Guy R, Wand H, Franklin N, Fairley CK, Chen MY, O’Connor CC, Marshall L, Grulich AE, Kaldor JM, Hellard M, Donovan B: Re-testing for chlamydia at sexual health services in Australia, 2004–08. Sex Health 2011, 8:242-247.
• [47]McKechnie ML, Hillman RJ, Jones R, Lowe PC, Couldwel DL, Davies SC, King F, Kong FR, Gilbert GL: The prevalence of urogenital micro-organisms detected by a multiplex PCR-reverse line blot assay in women attending three sexual health clinics in Sydney, Australia. J Med Microbiol 2011, 60:1010-1016.
• [48]Vodstrcil LA, Fairley CK, Fehler G, Leslie D, Walker J, Bradshaw CS, Hocking JS: 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. BMC Infect Dis 2011, 11:158. BioMed Central Full Text
• [49]Rosenthal DA, Fairley CK, Garland SM, Tebrizi SN, Raynor K, Edwards C, Gregson S, Walsh J: Homeless young people: an important risk group for sexually transmitted infections. Med J Aust 2000, 172:244.
• [50]Cole R, Jasiak S: What do you get when you fall in love?: Warehouse Youth Health Centre chlamydia audit. Aust J Adv Nurs 2004, 22:19-24.
• [51]Jones S, Barker S, Athan E, Graves S: The tip of the iceberg: opportunistic screening for Chlamydia trachomatis in asymptomatic patients attending a young people’s health clinic reveals a high prevalence–a pilot study. Sex Health 2004, 1:115-119.
• [52]Kang M, Rochford A, Johnston V, Jackson J, Freedman E, Brown K, Mindel A: Prevalence of Chlamydia trachomatis infection among ‘high risk’ young people in New South Wales. Sex Health 2006, 3:253-254.
• [53]Gilbert J, Ryder N, McNulty AM: Drop-in versus appointments for youth - are more ‘at risk’ youth attending the satellite sexual health cinic since it became a drop in only clinic? Sex Health 2009, 6:352.
• [54]Debattista J, Gazzard CM, Wood RN, Allan JA, Allan JM, Scarman A, Mortlock M, Timms P, Knox CL: Interaction of microbiology and pathology in women undergoing investigations for infertility. Infect Dis Obstet Gynecol 2004, 12:135-145.
• [55]Petersen RW, Tabrizi SN, Garland S, Quinlivan JA: Prevalence of Chlamydia trachomatis in a public colposcopy clinic population. Sex Health 2007, 4:133-136.
• [56]Dykstra CA, Flexman J, Fatovich D, McCloskey JC: Royal Perth Hospital emergency department screening project for Chlamydia trachomatis. Sex Health 2008, 5:382.
• [57]Bowden FJ, Paterson BA, Tabrizi SN, Fairley CK, Garland SM: Using self-administered tampons to diagnose STDs. AIDS Patient Care STDS 1998, 12:29-32.
• [58]Garland SM, Tabrizi S, Hallo J, Chen S: Assessment of Chlamydia trachomatis prevalence by PCR and LCR in women presenting for termination of pregnancy. Sex Transm Infect 2000, 76:173-176.
• [59]Garrow SC, Smith DW, Harnett GB: The diagnosis of chlamydia, gonorrhoea, and trichomonas infections by self obtained low vaginal swabs, in remote northern Australian clinical practice. Sex Transm Infect 2002, 78:278-281.
• [60]Quinlivan JA, Evans SF: The impact of continuing illegal drug use on teenage pregnancy outcomes - a prospective cohort study. BJOG 2002, 109:1148-1153.
• [61]Quinlivan JA, Petersen RW, Davy M, Evans SF: Abnormal pap smears in teenage mothers and the association with domestic violence, homelessness, and chlamydia. J Low Genit Tract Dis 2004, 8:112-117.
• [62]Cheney K, Chen MY, Donovan B: Chlamydia trachomatis among antenatal women in Sydney. Aust N Z J Public Health 2006, 30:85-87.
• [63]Panaretto KS, Lee HM, Mitchell MR, Larkins SL, Manessis V, Buettner PG, Watson D: Prevalence of sexually transmitted infections in pregnant urban Aboriginal and Torres Strait Islander women in northern Australia. Aust N Z J Obstet Gynaecol 2006, 46:217-224.
• [64]Lenton JA, Freedman E, Hoskin K, Knight V, Turley D, Balding B, Kennedy C, Chen MY, McNulty A: Chlamydia trachomatis infection among antenatal women in remote far west New South Wales, Australia. Sex Health 2007, 4:139-140.
• [65]Cheney K, Wray L: Chlamydia and associated factors in an under 20s antenatal population. Aust N Z J Obstet Gynaecol 2008, 48:40-43.
• [66]Combs BG, Kwan KSH, Giele CM, Mak DB: Audit of antenatal testing of sexually transmissible infections and blood borne viruses at Western Australian hospitals. Sex Health 2008, 5:390.
• [67]Chen MY, Fairley CK, De Guingand D, Hocking JS, Tabrizi S, Wallace EM, Grover S, Gurrin L, Carter R, Pirotta M, Garland S: Screening pregnant women for chlamydia: what are the predictors of infection? Sex Transm Infect 2009, 85:31-35.
• [68]Ward J, Goller J, Bergeri I, Kong F, Franklin N, Sullivan L, Dimech W, Kaldor JM, Donovan B, Hellard M, Guy R: Understanding epidemiology of chlamydia related to Aboriginal and Torres Strait Islander people: first results from the ACCESS network project. Australasian Sexual Health Conference, Sydney; 2010.
• [69]Miller PJ, Torzillo PJ, Hateley W: Impact of improved diagnosis and treatment on prevalence of gonorrhoea and chlamydial infection in remote Aboriginal communities on Anagu Pitjantjatjara Lands. Med J Aust 1999, 170:429-432.
• [70]Huang R-L, Torzillo PJ, Hammond VA, Coulter ST, Kirby AC: Epidemiology of sexually transmitted infections on the Anangu Pitjantjatjara Yankunytjatjara Lands: results of a comprehensive control program. Med J Aust 2008, 189:442-445.
• [71]Knox J, Tabrizi SN, Miller P, Petoumenos K, Law M, Chen S, Garland SM: Evaluation of self-collected samples in contrast to practitioner-collected samples for detection of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis by polymerase chain reaction among women living in remote areas. Sex Transm Dis 2002, 29:647-654.
• [72]Miller GC, McDermott R, McCulloch B, Fairley CK, Muller R: Predictors of the prevalence of bacterial STI among young disadvantaged Indigenous people in north Queensland, Australia. Sex Transm Infect 2003, 79:332-335.
• [73]Latif A, Smith K: STI screening conducted in NT Department of Health and Community Services and Community Controlled Health Services in Central Australia in 2004. NT Dis Control Bull 2004, 11:18-20.
• [74]Panaretto KS, Dallachy D, Manessis V, Larkins S, Tabrizi S, Upcroft J, Garland S: Cervical smear participation and prevalence of sexually transmitted infections in women attending a community-controlled Indigenous health service in north Queensland. Aust N Z J Public Health 2006, 30:171-176.
• [75]Spurling GKP, Hayman NE, Cooney AL: Adult health checks for Indigenous Australians: the first year’s experience from the Inala Indigenous Health Service. Med J Aust 2009, 190:562-564.
• [76]Fairbairn AP, Tyler H, Su J-Y, Tilley EL: Risk factors and associations for the diagnosis of sexually transmitted infections in Aboriginal women presenting to the Alice Springs Hospital emergency department. Emerg Med Australas 2010, 22:216-223.
• [77]Goller J, Ward J, Saunders M, Bergeri I, Kaldor J, Williams S, Waples-Crowe P, Moore E, Hunt J, Scrimgeour D, Boyle D, Couzos S, Donovan B, Hellard M: A snapshot of chlamydia testing and positivity in eight Aboriginal Community Controlled Health Services: Useful information for local quality improvement. Australasian Sexual Health Conference, Sydney; 2010.
• [78]Templeton DJ, Tyson BA, Meharg JP, Habgood KE, Bullen PM, Malek S, McLean R: Aboriginal health worker screening for sexually transmissible infections and blood-borne viruses in a rural Australian juvenile correctional facility. Sex Health 2010, 7:44-48.
• [79]Debattista J, Dwyer J, Orth D, Lister G, Patten J: Community screening for Neisseria gonorrhoeae and Chlamydia trachomatis among patrons of sex-on-premises venues: two years later. Venereol Interdiscipl Int J Sex Health 2000, 13:105-109.
• [80]Debattista J, Clementson C, Mason D, Dwyer J, Argent S, Woodward C, Dean J, Buks L, Copley M, Hinwood G, Benfield C, Walton P: Screening for Neisseria gonorrhoeae and Chlamydia trachomatis at entertainment venues among men who have sex with men. Sex Transm Dis 2002, 29:216-221.
• [81]Lister NA, Smith A, Tabrizi S, Hayes P, Medland NA, Garland S, Fairley CK: Screening for Neisseria gonorrhoeae and Chlamydia trachomatis in men who have sex with men at male-only saunas. Sex Transm Dis 2003, 30:886-889.
• [82]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.
• [83]Lister NA, Smith A, Tabrizi SN, Garland S, Hayes P, Fairley CK: Comprehensive clinical care on-site in men-only saunas: confidential STI/HIV screening outreach clinic. Int J STD AIDS 2005, 16:794-798.
• [84]Lister NA, Smith A, Fairley CK: Introduction of screening guidelines for men who have sex with men at an STD clinic, the Melbourne Sexual Health Centre, Australia. Sex Health 2005, 2:241-244.
• [85]Currie MJ, Martin SJ, Soo TM, Bowden FJ: Screening for chlamydia and gonorrhoea in men who have sex with men in clinical and non-clinical settings. Sex Health 2006, 3:123-126.
• [86]Hamlyn E, McAllister J, Winston A, Sinclair B, Amin J, Carr A, Cooper DA: Is screening for sexually transmitted infections in men who have sex with men who receive non-occupational HIV post-exposure prophylaxis worthwhile? Sex Transm Dis 2006, 82:21-23.
• [87]Jin F, Prestage GP, Zablotska I, Rawstorne P, Kippax SC, Donovan B, Cunningham PH, Templeton DJ, Kaldor JM, Grulich AE: High rates of sexually transmitted infections in HIV positive homosexual men: data from two community based cohorts. Sex Transm Infect 2007, 83:397-399.
• [88]Templeton DJ, Jin F, Imrie J, Prestage GP, Donovan B, Cunningham PH, Kaldor JM, Kippax S, Grulich AE: Prevalence, incidence and risk factors for pharyngeal chlamydia in the community based Health in Men (HIM) cohort of homosexual men in Sydney, Australia. Sex Transm Infect 2008, 84:361-363.
• [89]McNulty A, Teh MF, Freedman E: Patient delivered partner therapy for chlamydial infection–what would be missed? Sex Transm Dis 2008, 35:834-836.
• [90]Teague R, Mijch A, Fairley CK, Sidat M, Watson K, Boyd K, Chen MY: Testing rates for sexually transmitted infections among HIV-infected men who have sex with men attending two different HIV services. Int J STD AIDS 2008, 19:200-202.
• [91]Guy RJ, Wand H, Franklin N, Fairley CK, Chen MY, O’Connor CC, Marshall L, Grulich AE, Kaldor JM, Hellard ME, Donovan B: Chlamydia trends in men who have sex with men attending sexual health services in Australia, 2004–2008. Sex Transm Dis 2011, 38:339-346.
• [92]Morton AN, Wakefield T, Tabrizi SN, Garland SM, Fairley CK: An outreach programme for sexually transmitted infection screening in street sex workers using self-administered samples. Int J STD AIDS 1999, 10:741-743.
• [93]Morton AN, Tabrizi SN, Garland SM, Lee PJ, Reid PE, Fairley CK: Will the legalisation of street sex work improve health? Sex Transm Infect 2002, 78:309.
• [94]O’Connor JL, Harcourt C, Wand H, Egger S, Fairley CK, Kaldor JM, Marshall L, Bates JL, Donovan B: The sex industry in Perth before decriminalisation. Sex Health 2008, 5:384.
• [95]Mak DB, Johnson GH, Marshall LJ, Mein JK: Control of genital chlamydial infection in the Kimberley region of Western Australia. Med J Aust 2004, 180:45.
• [96]Watkins RE, Mak DB, Connelly C: Testing for sexually transmitted infections and blood borne viruses on admission to Western Australian prisons. BMC Public Health 2009, 9:385. BioMed Central Full Text
• [97]Bradshaw CS, Pierce LI, Tabrizi SN, Fairley CK, Garland SM: Screening injecting drug users for sexually transmitted infections and blood borne viruses using street outreach and self collected sampling. Sex Transm Infect 2005, 81:53-58.
• [98]Macleod J, Salisbury C, Low N, McCarthy A, Sterne JAC, Holloway A, Patel R, Sanford E, Morcom A, Horner P, Smith GD, Skidmore S, Herring A, Caul O, Hobbs FDR, Egger M: Coverage and uptake of systematic postal screening for genital Chlamydia trachomatis and prevalence of infection in the United Kingdom general population: cross sectional study. BMJ 2005, 330:940-942.
• [99]Fenton KA, Korovessis C, Johnson AM, McCadden A, McManus S, Wellings K, Mercer CH, Carder C, Copas AJ, Nanchahal K, Macdowall W, Ridgway G, Field J, Erens B: Sexual behaviour in Britain: reported sexually transmitted infections and prevalent genital Chlamydia trachomatis infection. Lancet 1851, 2001:358.
• [100]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, 80:354-362.
• [101]Johnson AM, Mercer CH, Erens B, Copas AJ, McManus S, Wellings K, Fenton KA, Korovessis C, Macdowall W, Nanchahal K, Purdon S, Field J: Sexual behaviour in Britain: partnerships, practices, and HIV risk behaviours. Lancet 2001, 358:1835-1842.
• [102]Rissel CE, Richters J, Grulich AE, Visser ROd, Smith AMA: Sex in Australia: First experiences of vaginal intercourse and oral sex among a representative sample of adults. Aust N Z J Public Health 2003, 27:131-137.
• [103]Smith AMA, Rissel CE, Richters J, Grulich AE, de Visser RO: Sex in Australia: The rationale and methods of the Australian study of health and relationships. Aust N Z J Public Health 2003, 27:106-117.
• [104]Morgan J, Haar J: Who goes to a sexual health clinic? Gender differences in service utilisation. N Z Med J 2008, 121:44-49.
• [105]Centers for Disease Control and Prevention: Sexually Transmitted Disease Surveillance 2010. U.S. Department of Health and Human Services, Atlanta; 2011.
• [106]Datta SD, Sternberg M, Johnson RE, Berman S, Papp JR, McQuillan G, Weinstock H: Gonorrhea and Chlamydia in the United States among Persons 14 to 39 Years of Age, 1999 to 2002. Ann Intern Med 2007, 147:89-96.
• [107]Annan NT, Sullivan AK, Nori A, Naydenova P, Alexander S, McKenna A, Azadian B, Mandalia S, Rossi M, Ward H, Nwokolo N: Rectal chlamydia - a reservoir of undiagnosed infection in men who have sex with men. Sex Transm Infect 2009, 85:176-179.
• [108]Kent CK, Chaw JK, Wong W, Liska S, Gibson S, Hubbard G, Klausner JD: Prevalence of rectal, urethral, and pharyngeal chlamydia and gonorrhea detected in 2 clinical settings among men who have sex with men: San Francisco, California, 2003. Clin Infect Dis 2005, 41:67-74.
• [109]STIs in Gay Men Action Group (STIGMA): Sexually transmitted infection testing guidelines for men who have sex with men. STIs in Gay Men Action Group (STIGMA), Sydney; 2010.
• [110]Department of Health and Ageing: Second National Sexually Transmissible Infections Strategy: 2010–2013. Commonwealth of Australia, Barton; 2010.
• [111]Liaw S-T, Boyle DIR: Primary care informatics and integrated care. Stud Health Technol Inform 2010, 151:255-268.
• [112]Mak DB, Watkins RE: Improving the accuracy of Aboriginal and non-Aboriginal disease notification rates using data linkage. BMC Health Serv Res 2008, 8:118. BioMed Central Full Text