Chlamydia trachomatis infection in Sydney women

BACKGROUND: In Australia, reported rates of Chlamydia trachomatis infection have been rising progressively since the mid-1990s. Opportunistic testing of sexually active young women attending clinical services for other reasons has already been implemented in a number of other countries. AIMS: To help guide chlamydia testing of women, this study aimed to establish factors predictive of chlamydial infection in an Australian clinical setting. METHODS: Women attending a sexual health service in Sydney who tested positive for C. trachomatis by polymerase chain reaction and who did not have any concurrent urogenital infections (n = 170) were compared with chlamydia-negative controls (n = 170). Factors independently associated with chlamydia were determined using logistic regression. RESULTS: Although they were present in only a minority of infected women, symptoms of dysuria [adjusted odds ratio (AOR) = 3.2 (95% CI: 1.2-9.1), P = 0.03] and postcoital bleeding [AOR = 2.7 (95% CI: 1.0-7.1), P < 0.05] were each independently associated with chlamydia. Symptoms of vaginal discharge (P = 0.3), abdominal pain (P = 0.2), or intermenstrual bleeding (P = 0.1) did not help to discriminate between infected and uninfected women. The following factors were independently associated with chlamydia: younger age (P = 0.003); being overseas-born [AOR = 2.3 (95% CI: 1.3-4.0), P = 0.005]; sex with a partner from overseas [AOR = 2.0 (95% CI: 1.3-12.3), P = 0.01]; and sex with a partner known or suspected to be chlamydia-infected [AOR = 7.4 (95% CI: 3.6-15.0), P < 0.001]. CONCLUSIONS: Chlamydia testing is clinically indicated in sexually active young women with dysuria, postcoital bleeding or contact with a suspected chlamydia-infected partner. Consideration should be given to enhanced screening programs for travelling and migrant men and women in Australian cities.