Prevalence of genital and oropharyngeal chlamydia and gonorrhoea among female sex workers in Melbourne, Australia, 2015–2017: need for oropharyngeal testing

Abstract

ObjectiveThe Victorian legislation requires sex workers to have quarterly screening for genital chlamydia and gonorrhoea, but screening for oropharyngeal infection is not mandatory in Victoria, Australia. In 2017, oropharyngeal screening for gonorrhoea and chlamydia was added as part of the routine quarterly screening for sex workers attending the Melbourne Sexual Health Centre (MSHC). The aim of this study was to examine the prevalence of oropharyngeal gonorrhoea and chlamydia among female sex workers (FSW).MethodsWe included females who (1) self-identified as sex workers or were attended MSHC for a sex work certificate and (2) had tested for any STI or HIV, between March 2015 and December 2017. The prevalence of HIV, syphilis, chlamydia and gonorrhoea was calculated.ResultsThere were 8538 FSW consultations among 2780 individuals during the study period. There was a twofold increase in genital gonorrhoea (from 0.5% (95% CI 0.3% to 0.9%) to 1.1% (95% CI 0.8% to 1.5%); ptrend=0.047) and a 1.5-fold increase in genital chlamydia (from 2.2% (95% CI 1.6% to 2.8%) to 3.2% (95% CI 2.6% to 3.8%); ptrend=0.031) during the period. Overall, the prevalence of HIV (0.2% (95% CI 0.1% to 0.3%)) and syphilis (0.1% (95% CI 0.0% to 0.2%)) remained low and did not change over time. In 2017, the prevalence of oropharyngeal gonorrhoea was 2.0% (95% CI 1.6% to 2.6%) and oropharyngeal chlamydia was 2.1% (95% CI 1.6% to 2.7%). Among FSW who were tested positive for gonorrhoea and chlamydia, 55% (n=41) and 34% (n=45) only tested positive in the oropharynx but not genital for gonorrhoea and chlamydia, respectively.ConclusionThe prevalence of oropharyngeal gonorrhoea and chlamydia is similar to the prevalence at genital sites and is often independent of genital infection. It is important to test the oropharynx and genital site for chlamydia and gonorrhoea among FSW.

Clinical presentation of asymptomatic and symptomatic women who tested positive for genital gonorrhoea at a sexual health service in Melbourne, Australia

“…It is considered that the current epidemic of gonorrhoea mainly affects men, particularly gay, bisexual and other men who have sex with men (MSM) in Australia [1,2]. Gonorrhoea is deemed to be uncommon among women in major Australian cities (<1% in the population); however rises have been observed in the 2010s [3][4][5]. This increase has also been reported among women in other high-income countries such as England, Spain or the USA [6][7][8][9][10].…”

Are genital examinations necessary for STI screening for female sex workers? An audit of decriminalized and regulated sex workers in Melbourne, Australia

“…3% for genital chlamydia and 1% for genital gonorrhoea) and the proportion of FSW who condom with their male client is relatively high (i.e. 97% for penile-vaginal sex) [4,12]. As STI prevalence among FSW varies greatly, we highly recommend that other clinics complete their own investigation like that of the present study before implementing changes to clinical practice.…”

“…However, these examinations take up significant clinic and staff time and resources that could otherwise be allocated to other clients at a greater risk of HIV/STI. Given FSW in Australia have a substantially lower prevalence of HIV/STI than women who are not sex workers attending sexual health clinics [2][3][4], it is questionable whether it is necessary to perform genital examinations among FSW who are asymptomatic. This study aimed to determine the proportion of asymptomatic FSW diagnosed with anogenital herpes or warts during routine genital examinations.…”

Seasonal variations in kissing and sexual activities among men who have sex with men in Melbourne, Australia: implications for seasonal sexually transmissible infection preventions and interventions

“…Rises in gonorrhoea cases have been reported not only in gay, bisexual and other men who have sex with men (MSM), but also in other populations such as female sex workers and heterosexuals worldwide. [1][2][3][4][5] The rise of the epidemic is complex and is not well understood. Seasonal variations in human infectious diseases, including some sexually transmissible infections (STIs) such as genital herpes, chlamydia and gonorrhoea, have been observed.…”