Was an Epidemic of Gonorrhoea among Heterosexuals Attending an Adelaide Sexual Health Services Associated with Variations in Sex Work Policing Policy?
BACKGROUND:
A
review of historical trends in gonococcal diagnoses made at the Adelaide Sexual
Health Clinic (ASHC), South Australia, identified a substantial rise in
diagnoses among heterosexuals between 2006 and 2010. Sex work is illegal in South
Australia, regulated in Victoria and legal in New South Wales. This and other
factors that could have influenced the epidemic were explored in this analysis.
METHODS:
Retrospective
analyses of gonorrhoea diagnoses made by sexual health services between 1990
and 2012 in three Australian state capitals, Melbourne (Victoria) and Sydney
(New South Wales) were undertaken.
RESULTS:
At the
ASHC the proportion of gonorrhoea diagnoses was higher between 2006 and 2010
among heterosexual men (5.34% vs 0.84%, p<0.001), non-sex worker women
(0.64% vs 0.28%, p<0.001) and female sex workers (FSWs) (1.75% vs 0.24%,
p<0.001) compared with other years. This relationship was not seen at the
Melbourne Sexual Health Clinic and corresponding data from the Sydney Sexual
Health Centre showed that FSWs were less likely to have gonorrhoea between 2006
and 2010 than the other groups (p=0.746, p=0.522, p=0.024, respectively). At
ASHC FSWs were significantly more likely to be diagnosed between 2006 and 2010
(OR 2.8, 95% CI 1.48 to 5.27, p=0.002). Charges against sex workers peaked in
2007/2008.
CONCLUSIONS:
A
substantial, self-limiting rise in diagnoses of heterosexual gonorrhoea was
seen in Adelaide FSWs between 2006 and 2010. Removing barriers to condom use is
vital to the prevention of HIV and STI transmission.
- 1School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia Adelaide Sexual Health Clinic (ASHC, known as Clinic 275), Infectious Disease Unit, Royal Adelaide Hospital, Adelaide, South Australia Australia.
- 2School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia.
- 3Communicable Disease Control Branch, SA Health, Adelaide, South Australia, Australia Infectious Diseases Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia Microbiology and infectious Diseases, Flinders Medical Centre, Adelaide, South Australia, Australia.
- 4Central Clinical School, Monash University, Melbourne, Victoria, Australia Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.
- 5The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia Sydney Sexual Health Centre, Sydney Hospital, New South Wales, Australia.
- 6Sydney Sexual Health Centre, Sydney Hospital, New South Wales, Australia.
- 7Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.
- 8School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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