title: High chlamydia and gonorrhoea repeat positivity in remote Aboriginal communities 2009-2011: longitudinal analysis of testing for re-infection at 3 months suggests the need for more frequent screening.
abstract: Background Extremely high rates of diagnosis of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) have been recorded in remote communities across northern and central Australia. Re-testing at 3 months, after treatment administered, of CT or NG is recommended to detect repeat infections and prevent morbidity and ongoing transmission.
  
  
  
  Baseline CT and NG laboratory data (2009-2010) from 65 remote health services participating in a cluster randomised trial was used to calculate the proportion of individuals re-tested after an initial CT or NG diagnosis at <2 months (not recommended), 2-4 months (recommended) and 5-12 months and the proportion with repeat positivity on re-test. To assess if there were difference in re-testing and repeat positivity by age group and sex, t-tests were used.
  
  
  
  There was a total of 2054 people diagnosed with CT and/or NG in the study period; 14.9% were re-tested at 2-4 months, 26.9% at 5-12 months, a total of 41.8% overall. Re-testing was higher in females than in males in both the 2-4-month (16.9% v. 11.5%, P<0.01) and 5-12-month (28.9% v. 23.5%, P=0.01) periods. Women aged 25-29 years had a significantly higher level of re-testing 5-12 months post-diagnosis than females aged 16-19 years (39.8% v. 25.4%, P<0.01). There was a total of 858 people re-tested at 2-12 months and repeat positivity was 26.7%. There was higher repeat NG positivity than repeat CT positivity (28.8% v. 18.1%, P<0.01).
  
  
  
  Just under half the individuals diagnosed with CT or NG were re-tested at 2-12 months post-diagnosis; however, only 15% were re-tested in the recommended time period of 2-4 months. The higher NG repeat positivity compared with CT is important, as repeat NG infections have been associated with higher risk of pelvic inflammatory disease-related hospitalisation. Findings have implications for clinical practice in remote community settings and will inform ongoing sexual health quality improvement programs in remote community clinics.
authors.affiliation: Centre for Disease Control, Department of Health, PO Box 40596, Casuarina, NT 0811, Australia.
authors.forename: Linda
authors.initials: L
authors.lastname: Garton
authors.affiliation: Kirby Institute, University of New South Wales (UNSW), Sydney, NSW 2052, Australia.
authors.forename: Amalie
authors.initials: A
authors.lastname: Dyda
authors.affiliation: Kirby Institute, University of New South Wales (UNSW), Sydney, NSW 2052, Australia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Guy
authors.affiliation: Menzies School of Health Research, PO Box 41096, Casuarina, Darwin, NT 0811, Australia.
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Silver
authors.affiliation: Kirby Institute, University of New South Wales (UNSW), Sydney, NSW 2052, Australia.
authors.forename: Skye
authors.initials: S
authors.lastname: McGregor
authors.affiliation: Kirby Institute, University of New South Wales (UNSW), Sydney, NSW 2052, Australia.
authors.forename: Belinda
authors.initials: B
authors.lastname: Hengel
authors.affiliation: Menzies School of Health Research, PO Box 41096, Casuarina, Darwin, NT 0811, Australia.
authors.forename: Alice
authors.initials: A
authors.lastname: Rumbold
authors.affiliation: Menzies School of Health Research, PO Box 41096, Casuarina, Darwin, NT 0811, Australia.
authors.forename: Debbie
authors.initials: D
authors.lastname: Taylor-Thomson
authors.affiliation: Lismore Sexual Health Service, New South Wales Health, Sydney, NSW 2480, Australia.
authors.forename: Janet
authors.initials: J
authors.lastname: Knox
authors.affiliation: Kirby Institute, University of New South Wales (UNSW), Sydney, NSW 2052, Australia.
authors.forename: Lisa
authors.initials: L
authors.lastname: Maher
authors.affiliation: Kirby Institute, University of New South Wales (UNSW), Sydney, NSW 2052, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Kaldor
authors.affiliation: South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, SA 5001, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Ward
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia / Q000453:epidemiology; D002690:Chlamydia Infections / Q000175:diagnosis / Q000453:epidemiology / Q000208:ethnology*; D002692:Chlamydia trachomatis; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis / Q000453:epidemiology / Q000208:ethnology*; D006801:Humans; D008297:Male; D009344:Neisseria gonorrhoeae; D055815:Young Adult