Trends in gonorrhoea infection and overseas sexual contacts among females attending a sexual health centre in Melbourne, Australia, 2008-2015

Introduction There has been a steady increase in gonorrhoea cases among females in Australian major cities but the reasons remain unclear. The aim of this study was to identify the risk factors associated with gonorrhoea among females attending a sexual health centre in Melbourne. Methods Analysis of retrospective electronic patient records of females aged 16 to 80 years old attending the Melbourne Sexual Health Centre, Australia between 1st January 2008 and 20th March 2015. East and South-East Asian countries were considered as higher-prevalence countries for gonorrhoea. Logistic regression with a generalised estimating equation was used to identify the risk factors associated with gonorrhoea among females. Results Gonorrhoea positivity by culture among females increased from 0.3% in 2008 to 1.2% in 2015 (p(trend) = 0.004). The rise in positivity was greatest in females reporting sex in a higher-prevalence country (0% to 7.4%, p(trend) = 0.026) but only moderate (0.2% to 0.4%, p(trend) = 0.049) in those reporting sex in Australia and/or in lower-prevalence countries. There was no association between gonorrhoea positivity and age, country of birth, number of male partners, condomless sex, or injecting drug use behaviours in the multivariable analysis. Gonorrhoea positivity by culture was significantly associated with presenting as a contact of gonorrhoea (aOR: 74.79; 95% CI: 44.07-126.93) or having sex with someone from a higher-prevalence country (aOR: 2.46; 95% CI: 1.15-5.25) after adjusting for potential confounding factors. Conclusion There has been a recent four-fold increase in gonorrhoea among females attending a sexual health centre in Melbourne. Females who have sex with a partner from a country with higher-prevalence gonorrhoea (i.e. East and South-East Asian countries) are at higher risk of acquiring gonorrhoea. Public health interventions such as safe sex messages targeting travellers are required.