title: Chlamydia prevalence in young attenders of rural and regional primary care services in Australia: a cross-sectional survey.
abstract: OBJECTIVE
  To estimate chlamydia prevalence among 16-29-year-olds attending general practice clinics in Australia.
  
  
  METHODS
  A cross-sectional survey was conducted from May 2010 to December 2012. Sexually experienced 16-29-year-olds were recruited from 134 general practice clinics in 54 rural and regional towns in four states and in nine metropolitan clinics (consecutive patients were invited to participate). Participants completed a questionnaire and were tested for chlamydia.
  
  
  METHODS
  Chlamydia prevalence.
  
  
  RESULTS
  Of 4284 participants, 197 tested positive for chlamydia (4.6%; 95% CI, 3.9%-5.3%). Prevalence was similar in men (5.2% [65/1257]; 95% CI, 3.9%-6.4%) and women (4.4% [132/3027]; 95% CI, 3.5%-5.2%) (P = 0.25) and high in those reporting genital symptoms or a partner with a sexually transmissible infection (STI) - 17.0% in men (8/47; 95% CI, 2.8%-31.2%); 9.5% in women (16/169; 95% CI, 5.1%-13.8%). Nearly three-quarters of cases (73.4% [130/177]) were diagnosed in asymptomatic patients attending for non-sexual health reasons, and 83.8% of all participants (3258/3890) had attended for non-sexual health reasons. Prevalence was slightly higher in participants from rural and regional areas (4.8% [179/3724]; 95% CI, 4.0%-5.6%) than those from metropolitan areas (3.1% [17/548]; 95% CI, 1.5%-4.7%) (P = 0.08). In multivariable analysis, increasing partner numbers in previous 12 months (adjusted odds ratio [AOR] for three or more partners, 5.11 [95% CI, 2.35-11.08]), chlamydia diagnosis in previous 12 months (AOR, 4.35 [95% CI, 1.52-12.41]) and inconsistent condom use with most recent partner (AOR, 2.90 [95% CI, 1.31-6.40]) were significantly associated with chlamydia in men. In women, increasing partner numbers in previous 12 months (AOR for two partners, 2.59 [95% CI, 1.59-4.23]; AOR for three or more partners, 3.58 [95% CI, 2.26-5.68]), chlamydia diagnosis in previous 12 months (AOR, 3.13 [95% CI, 1.62-6.06]) and age (AOR for 25-29-year-olds, 0.23 [95% CI, 0.12-0.44]) were associated with chlamydia.
  
  
  CONCLUSIONS
  Chlamydia prevalence is similar in young men and women attending general practice. Testing only those with genital symptoms or a partner with an STI would have missed three-quarters of cases. Most men and women are amenable to being tested in general practice, even in rural and regional areas.
authors: Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia. ayeung@unimelb.edu.au.
authors: Anna H
authors: AH
authors: Yeung
authors: General Practice and Primary Health Care Academic Centre, University of Melbourne, Melbourne, VIC, Australia.
authors: Meredith
authors: M
authors: Temple-Smith
authors: Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
authors: Christopher K
authors: CK
authors: Fairley
authors: Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
authors: Alaina M
authors: AM
authors: Vaisey
authors: Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
authors: Rebecca
authors: R
authors: Guy
authors: Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
authors: Matthew G
authors: MG
authors: Law
authors: Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
authors: Nicola
authors: N
authors: Low
authors: Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
authors: Amie L
authors: AL
authors: Bingham
authors: General Practice and Primary Health Care Academic Centre, University of Melbourne, Melbourne, VIC, Australia.
authors: Jane
authors: J
authors: Gunn
authors: Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
authors: John
authors: J
authors: Kaldor
authors: Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
authors: Basil
authors: B
authors: Donovan
authors: Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
authors: Jane S
authors: JS
authors: Hocking
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D001315:Australia / Q000453:epidemiology; D002690:Chlamydia Infections / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D011320:Primary Health Care; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data; D055815:Young Adult