A single study conducted in a large urban sexual health clinic found a lower prevalence in Indigenous 6. Just one study reported prevalence estimates over time [ 69 , 70 ], finding that prevalence decreased for both men and women over the first study period — , from 8. However, this was linked to the introduction of a sexual health intervention, and the falls were not significant [ 69 ]. Chlamydia in Indigenous Australians. Meta-analysis of chlamydia prevalence estimated in Aboriginal and Torres Strait Islander individuals.
Sixteen studies 19 papers were identified that measured chlamydia prevalence in MSM [ 38 , 39 , 44 - 46 , 48 , 79 - 91 ] Additional file 4. Sample sizes ranged from 80 [ 82 ] to 11, [ 91 ], and settings included sexual health centres 11 studies [ 38 , 39 , 44 - 46 , 48 , 79 , 81 , 84 , 85 , 89 - 91 ], hospitals and other clinical settings 3 [ 85 , 86 , 90 ], and male-only entertainment or sex-on-premises venues SOPVs; 4 [ 79 - 81 , 83 ]. Overall, 12 studies reported prevalence estimates for urethral infection, 10 for rectal infection, and 10 for pharyngeal infection, while five did not provide site-specific estimates.
Urethral infection prevalence ranged from 1. Estimates for pharyngeal infection were low, ranging from 0. A large well-conducted cohort study found the prevalence of rectal and urethral chlamydia at the time of recruitment to be higher among HIV-positive compared with HIV-negative men 5. The pooled prevalence for rectal chlamydia was 5. The pooled prevalence for urethral chlamydia among men tested at SOPVs was 2. Chlamydia in men who have sex with men MSM.
Meta-analysis of chlamydia prevalence estimated in men who have sex with men MSM. Twelve papers were identified that estimated chlamydia prevalence in potentially high-risk populations [ 18 , 38 , 44 , 60 , 78 , 89 , 92 - 97 ] Additional file 5.
Five measured chlamydia prevalence in sex workers legal and illegal [ 38 , 44 , 92 - 94 ], four in individuals in prison or juvenile detention [ 18 , 78 , 95 , 96 ], two in drug users [ 60 , 97 ], and one in STI contacts [ 89 ].
Prevalence in sex workers ranged from 1. Three of the five studies did not differentiate between male and female sex workers, although all had predominantly female participants [ 38 , 92 , 93 ]. Brothel workers had lower prevalence estimates in two studies, compared with street sex workers [ 92 , 93 ].
However, a study of illegal brothel sex workers in Western Australia found a low prevalence of 2. Two clinical audits conducted at sexual health centres found divergent estimates of 3. A larger study conducted across male and female prisons in both metropolitan and regional locations recorded an overall prevalence of 7.
For the juvenile detainees, chlamydia prevalence for females was measured at over 20 per cent in two separate studies [ 18 , 96 ], higher than for male juveniles range 2. The highest prevalence We found that chlamydia prevalence estimates were highly variable, with rates generally higher among young Australians, Indigenous Australians, and MSM.
Other high-risk populations, including youth clinic attendees, pregnant teenagers and prison inmates, were also found to have higher prevalence estimates. This review builds considerably on the earlier review by Vajdic et al. Measuring the true prevalence of chlamydia in a community is a challenging task, with non-population-based studies frequently suffering from sampling bias and low participation rates [ 98 , 99 ]. Studies utilising population-based data on chlamydia prevalence are rare, both in Australia and the UK [ 12 , ], and this review identified just one survey that recruited participants from the general population.
Both community-based and clinic-based sampling is subject to participation bias: community-based sampling often relies on convenience sampling, where participants are able to self-select; and clinic-based sampling is likely to bias towards symptomatic and higher risk participants, and towards more health care—seeking, and therefore well-educated, Australian-born participants [ 34 ].
This can also be true of population-based studies [ 16 ]. Sexual health centre studies can be particularly susceptible to bias towards symptomatic and high-risk groups, although as a research setting, they can provide large sample sizes at low costs, especially through clinic audits. Community-based studies are important for estimating chlamydia prevalence as notification rates are known to under-estimate infection levels, as they are highly influenced by testing rates.
The only population-based estimate identified in this review reported a prevalence of 3. A key factor that limits the conclusions that can be drawn from the studies included in the review is the high level of heterogeneity both within and between the populations studied. In most key populations reviewed, pooled prevalence estimates could not be calculated, even after stratifying data by age and sex of individuals tested.
This was particularly true for female data. Although we calculated pooled prevalence estimates within the different population sub-groups, it is important that these be interpreted with caution and only indicative of the true prevalence. Only seven individual studies determined time trends [ 18 , 36 , 43 , 44 , 48 , 69 ], three finding a statistically significant increase in prevalence over time [ 36 , 43 , 48 ]; and two reporting no change over time [ 18 , 44 ].
One study in an Indigenous community found a decrease over time, however, this was associated with an STI intervention to increase testing rates [ 69 ]. Despite the variability, the studies by Vodstrcil et al. Both Australian and international data show that sexual risk behaviour has changed over the last decade with increasing numbers of sex partners reported by young adults.
The National Survey of Sexual Attitudes and Lifestyles, a sexual behaviour survey conducted in the United Kingdom in and again in [ ] showed that the number of heterosexual partners in the preceding five years increased significantly for both sexes. Similar to previous systematic reviews in both the UK and Australia [ 12 , ], we found that the study setting influenced the prevalence estimates reported; however, significant heterogeneity again hampered comparisons in most cases.
For men, prevalence was higher in sexual health and family planning clinics compared with GP and community-based settings. GP-based studies, similar to those conducted by Vodstrcil et al. Between-setting comparisons are especially fraught for men; only one study conducted in general practice reported prevalence among men alone [ 32 ], and no studies reported chlamydia prevalence in heterosexual men from a population-based sample. Where studies reported age-based estimates, younger participants had higher prevalence estimates than older participants.
We also found high rates among disadvantaged youth and young people attending youth clinics. These findings of increased chlamydia among young men and women echo those findings in overseas prevalence studies [ 98 , 99 ]. Higher female notification rates can probably be attributed to differences in chlamydia testing rates.
As chlamydia testing rates increase in Australia, notification data will be able to provide a better estimate of the population prevalence of chlamydia. We found that prevalence estimates were comparable among heterosexual men and women; however, the picture is neither complete nor consistent.
In the general practice setting, no studies directly compare prevalence between men and women; and in sexual health clinics, prevalence tended to be higher among men. This is probably because men are more likely to attend a sexual health centre due to the presence of urethral symptoms [ ].
Curiously, fifteen studies were identified that did not report male and female data separately, thereby excluding the data from calculations of pooled prevalence estimates. A number of recent studies reporting chlamydia prevalence in men attending sporting clubs [ 21 , 22 , 24 , 25 ] and general practices [ 32 ] have started to address the predominance of female studies, which has been previously noted [ 12 ]; however, there remains a need for additional studies that directly compare men and women in community and clinical settings.
Similar discrepancies between notification data and population-based prevalence surveys have also been observed in the USA. In , the notification rate reported to the Centers for Disease Control and Prevention was 2.
These data underscore the fact that at low testing rates, notification data do not provide a full picture of the prevalence of chlamydia infection in the community. In contrast to heterosexual men, several studies explored chlamydia prevalence among MSM, with most providing estimates from multiple anatomical sites Additional file 4. In line with data from the UK and USA [ , ], prevalence was highest in rectal swabs compared with urethral samples, and lowest in pharyngeal swabs.
This highlights the importance of rectal chlamydia screening in MSM and the need to include both urethral and rectal sampling when conducting chlamydia prevalence surveys in this population group as recommended in national guidelines [ ]. Unfortunately, Australian national notification data do not include site of infection nor sexual orientation, thereby reducing our ability to monitor trends in this population group over time.
The key gaps identified by Vajdic et al. The further advances in information technology including improvements in medical records software, the development of data extraction software [ ] and data linkage [ ], will facilitate the collection of standardised and detailed socio-demographic, behavioural and clinical data including presence or absence of chlamydia-related symptoms from sentinel sites.
This will allow trends to be evaluated over time within different risk groups, adjusting for any changes in behavioural data and clinical presentation. It is vital that such surveillance systems continue to be funded.
This comprehensive systematic review identified 76 studies reporting prevalence data for individuals tested for anogenital or pharyngeal chlamydia and provides an up-to-date summary of the underlying burden of chlamydia in Australian populations. The review highlights that the burden of chlamydia in Australia is greatest among young adults, Indigenous populations and MSM and identifies important gaps in the surveillance and monitoring of chlamydia infection in Australia. Given that that the Australian Government is currently pilot testing chlamydia screening as a national program and State Governments continue to fund chlamydia control activities, it is vital that good sentinel surveillance systems continue.
DL and DCN conducted the literature search and systematic review. JSH performed the meta-analysis. All authors read and approved the final manuscript. Studies reporting chlamydia prevalence data, identified in sexual health clinics, youth services and other clinical settings. DOC 89 kb. Studies reporting chlamydia prevalence data, identified in pregnant women. Melb, Melbourne; NA, not applicable; n. DOC 41 kb. Studies reporting chlamydia prevalence data, identified in Indigenous Australians.
DOC 53 kb. Studies reporting chlamydia prevalence data, identified in men who have sex with men. DOC 54 kb. Studies reporting chlamydia prevalence data, identified in high-risk populations. DOC 48 kb. National Center for Biotechnology Information , U.
BMC Infect Dis. Published online May Author information Article notes Copyright and License information Disclaimer. Corresponding author. Dyani Lewis: ua. Received Nov 30; Accepted Apr 3. This article has been cited by other articles in PMC.
Associated Data Supplementary Materials Additional file 1: Studies reporting chlamydia prevalence data, identified in sexual health clinics, youth services and other clinical settings. Additional file 2: Studies reporting chlamydia prevalence data, identified in pregnant women. Additional file 3: Studies reporting chlamydia prevalence data, identified in Indigenous Australians.
Additional file 4: Studies reporting chlamydia prevalence data, identified in men who have sex with men. Additional file 5: Studies reporting chlamydia prevalence data, identified in high-risk populations. Abstract Background Chlamydia trachomatis is a common sexually transmitted infection in Australia. Results Seventy-six studies met the inclusion criteria for the review. 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.
Keywords: Chlamydia, Meta-analysis, Prevalence, Systematic review. Background Chlamydia trachomatis here after referred to as chlamydia is the most commonly diagnosed bacterial sexually transmitted infection STI in Australia [ 1 , 2 ]. Methods Review strategy The electronic bibliographic database Medline was searched for English-language articles published between and July Open in a separate window.
Figure 1. Table 1 Studies reporting chlamydia prevalence data, identified in general practice or community settings. F 15—35 n. F 17—39 — 4 1. Figure 2. Sexual health centres, youth health services and other clinical settings There were 24 studies 23 papers; 2 abstracts reporting chlamydia prevalence estimates in clients attending sexual health or family planning clinics 14 studies [ 34 - 48 ], youth centres 8 [ 18 , 23 , 28 , 45 , 49 - 53 ] and other clinical settings 4 [ 45 , 54 - 56 ] Additional file 1.
Figure 3. Figure 4. Indigenous Australians Prevalence estimates for Indigenous Australians were reported in 16 reviewed studies 17 papers; 1 abstract [ 18 , 23 , 44 , 59 , 63 , 64 , 68 - 78 ] Additional file 3. Figure 5. Men who have sex with men MSM Sixteen studies 19 papers were identified that measured chlamydia prevalence in MSM [ 38 , 39 , 44 - 46 , 48 , 79 - 91 ] Additional file 4.
Figure 6. High-risk populations Twelve papers were identified that estimated chlamydia prevalence in potentially high-risk populations [ 18 , 38 , 44 , 60 , 78 , 89 , 92 - 97 ] Additional file 5. Discussion We found that chlamydia prevalence estimates were highly variable, with rates generally higher among young Australians, Indigenous Australians, and MSM. In most cases, chlamydia is curable with this simple treatment. Symptoms should start to improve in a few days and disappear after a week or two.
We recommend a follow-up test three months after treatment to confirm the all-clear. GPs routinely test pregnant women for chlamydia during their first antenatal visit. Though rare, babies can contract the infection during delivery. A newborn with the infection risks them developing conjunctivitis and pneumonia.
We can diagnose asymptomatic chlamydia in women in the following ways: — During periodic cervical screening tests which have replaced pap smears. In men, the only real way to detect chlamydia in the absence of symptoms is to be proactive and request a sexual health screening with your GP. Alternatively, we can sometimes detect the infection during fertility tests. Azithromycin and doxycycline tablets are Schedule 4 drugs; therefore, they need to be prescribed by your GP or specialist.
You can catch chlamydia more than once. Sexual partners must get treated with antibiotics even if all their tests come back clear. Doing so in person or over the phone is always best. Melbourne Sexual Health Centre has a great website called www. Through this website, you can notify past partners via SMS, emails or letters. You can do this anonymously if you prefer.
Very common. At the last officially recording in , officials records report , new cases of chlamydia among 15 to 29 year olds. The lack of symptoms in men and women heavily contributes to its prevalence in the community.
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