title: Was an epidemic of gonorrhoea among heterosexuals attending an Adelaide sexual health services associated with variations in sex work policing policy?
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: School 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.
authors.forename: Bin
authors.initials: B
authors.lastname: Li
authors.affiliation: School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Peng
authors.initials: P
authors.lastname: Bi
authors.affiliation: Communicable 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.
authors.forename: Russell
authors.initials: R
authors.lastname: Waddell
authors.affiliation: Central Clinical School, Monash University, Melbourne, Victoria, Australia Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.
authors.forename: Eric Pf
authors.initials: EP
authors.lastname: Chow
authors.affiliation: The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia Sydney Sexual Health Centre, Sydney Hospital, New South Wales, Australia.
authors.forename: Basil
authors.initials: B
authors.lastname: Donovan
authors.affiliation: Sydney Sexual Health Centre, Sydney Hospital, New South Wales, Australia.
authors.forename: Anna
authors.initials: A
authors.lastname: McNulty
authors.affiliation: Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.
authors.forename: Glenda
authors.initials: G
authors.lastname: Fehler
authors.affiliation: School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Bebe
authors.initials: B
authors.lastname: Loff
authors.affiliation: School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Hana
authors.initials: H
authors.lastname: Shahkhan
authors.affiliation: Central Clinical School, Monash University, Melbourne, Victoria, Australia Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Fairley
mesh_terms: D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data; D058872:Epidemics / Q000517:prevention & control / Q000706:statistics & numerical data*; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D006291:Health Policy; D020010:Heterosexuality; D006801:Humans; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D034121:Reproductive Health Services; D012189:Retrospective Studies; D012307:Risk Factors; D011477:Sex Work / Q000331:legislation & jurisprudence*; D060386:Sex Workers / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D012725:Sexual Behavior; D057545:Social Stigma; D013021:South Australia / Q000453:epidemiology; D014739:Victoria / Q000453:epidemiology
keywords: GONORRHOEA; PROSTITUTION; PUBLIC HEALTH; SEXUAL HEALTH