Risk factors for urethral gonorrhoea infection among heterosexual males in Melbourne, Australia: 2007–17

Abstract

Background Since 2014 there has been an increase in gonorrhoea among heterosexuals in Australia. Sex with a partner from a country with high gonorrhoea prevalence has been identified as a risk factor for gonorrhoea in heterosexual females, but risk factors for heterosexual males remain unclear. This study determined risk factors for gonorrhoea among heterosexual males. Methods: Retrospective analysis was performed among heterosexual males attending Melbourne Sexual Health Centre (MSHC) between 1 January 2007 and 31 December 2017. Countries for overseas sexual partners were stratified as high-prevalence countries (HPC) or low-prevalence countries (LPC) based on the incidence of gonorrhoea. Results: The annual gonorrhoea positivity increased from 0.72% in 2007 to 1.33% in 2017 (Ptrend <0.001). Males attending MSHC as a contact of gonorrhoea had the highest odds of testing positive (adjusted odds ratio (aOR) 7.46; 95% confidence interval (CI) 4.46–12.49), followed by males identifying as Aboriginal and Torres Strait Islander (aOR 2.57; 95% CI 1.30–5.09), males who had injected drugs in the past 12 months (aOR 2.44; 95% CI 1.39–4.30) and males who had sex with a female from an HPC (aOR 2.18; 95% CI 1.77–2.68). Males aged ≥35 were at higher risk than those aged ≤24 years (aOR 1.44; 95% CI 1.14–1.82). Gonorrhoea positivity increased among males who had sex with females from an LPC (from 0.60% to 1.33%; Ptrend = 0.004) but remained the same over time among males who had sex with females from an HPC (2.14%; Ptrend = 0.143). Conclusions: There was an 80% increase in urethral gonorrhoea among heterosexual males between 2007 and 2017. Having sex with a female from an HPC is a significant risk factor for gonorrhoea. Gonorrhoea positivity among men having sex with a female from an HPC did not change over time, suggesting this risk factor has become less important.

Clinical presentation of asymptomatic and symptomatic women who tested positive for genital gonorrhoea at a sexual health service in Melbourne, Australia

“…This increase has also been reported among women in other high-income countries such as England, Spain or the USA [6][7][8][9][10]. The rise in gonorrhoea cases has also been observed in MSM and heterosexual men [11]. Overall, there was an 80% increase in the notification rate of gonorrhoea (from 65.5 to 118.0 per 100 000) between 2013 and 2017 in the total Australian population.…”

Clinical presentation of asymptomatic and symptomatic heterosexual men who tested positive for urethral gonorrhoea at a sexual health clinic in Melbourne, Australia

“…Similar rises are reported in other countries such as the US and UK [2]. The increase in gonorrhoea cases had until recently been occurring primarily in gay, bisexual and other men who have sex with men (MSM) [3][4][5][6].…”

Gonorrhoea: tackling the global epidemic in the era of rising antimicrobial resistance

“…To better understand the rise of NG in heterosexuals, the study by Phillips et al examines a decade of data (2007-17) from Melbourne, Australia, to explore the risk factors associated with NG detection among heterosexual males. 11 They report an 80% increase in urethral gonorrhoea diagnosis among high-risk and symptomatic heterosexual males between 2007 and 2017, and highlight the need to better characterise the rise of NG in heterosexual networks to inform public health campaigns.…”