In three of the four programs, there was some evidence that clinical best practice and well coordinated sexual health programs can reduce STI prevalence in remote Aboriginal communities.

Objective: To assess the impact of a long‐term comprehensive control program for sexually transmitted infections (STIs) in remote Aboriginal communities in Central Australia, and to investigate a recent rise in gonorrhoea prevalence. Design: STI prevalence was determined from annual, cross‐sectional, population‐wide, age‐based screening, 1996–2006. During 2006, gonococcal isolates were obtained by on‐site culture and tested for antimicrobial susceptibility. Setting: Six remote clinics on the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands, South Australia, which are served by Nganampa Health Council, an Aboriginal community‐controlled health service. Participants: All resident Aboriginal people aged 14–40 years at the commencement date of each annual population‐wide screen. Main outcome measures: Multivariable logistic regression models were used to compare prevalence of chlamydial infection, gonorrhoea and syphilis measured during each annual population‐wide screen; antimicrobial susceptibility of gonococcal isolates obtained in 2006. Results: Between 1996 and 2003, there was a significant reduction in prevalence of gonorrhoea and chlamydial infection, by 67% and 58%, respectively. Subsequently, chlamydia prevalence rate plateaued, but there was a rapid rise in prevalence of gonorrhoea. Syphilis prevalence decreased linearly over the study period (odds ratio, 0.81; P < 0.001). During the first 6 months of 2006, 89 gonococcal isolates were obtained, 39 through on‐site culture during the 6‐week screening period, and all were sensitive to penicillin (in the less‐sensitive category). Conclusions: The decrease in STI prevalence asssociated with the program was maintained until 2006 for chlamydial infection and syphilis, but not for gonorrhoea, which rose in prevalence after 2003. There was no change in antimicrobial resistance to explain this rise, and gonorrhoea transmission dynamics and travel of core transmitters to regions without STI control programs might be responsible.

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Sexually transmitted infections (STIs) are endemic in remote Central Australia in Aboriginal communities, but usually don?t prompt individuals to seek testing or treatment. Untreated, a proportion of such infections result in ectopic pregnancies, miscarriages, infertility and enhanced transmission of HIV. The majority of STIs in Central Australia can be diagnosed with current nucleic acid amplification test (NAAT) technologies and treated with single-dose antibiotic treatment. Successful long-term STI control has been achieved in some areas of remote Central Australia by increasing access to testing and treatment for STIs as part of a comprehensive program. Successful control of gonorrhoea also depends on adequate antimicrobial surveillance, which is particularly difficult to achieve in remote areas of Australia.