Adolescence and other risk factors for Chlamydia trachomatis genitourinary infection in women in Melbourne, Australia

Objective: To establish the prevalence of and risk factors for Chlamydia trachomatis infection to determine the role of universal versus targeted testing. Methods: A prospective study of 1107 women attending two sexual and reproductive health clinics in Melbourne, Australia, was carried out. A questionnaire was used to establish risk factors. Urine samples were tested for C trachomatis by PCR. The main outcome measures were prevalence of and risk factors for C trachomatis infection. Results: Of 1107 recruitable women, 851 (76.9%) consented and were successfully tested. C trachomatis was detected in 18 (4.8% (95% CI 2.9 to 7.5)) of 373 women in the inner city and eight (1.7% (95% CI (0.7 to 3.3)) of 478 women in the suburban clinic. Of women under 25 years, 17 (6.2% (95% CI 3.7 to 9.8)) of 273 in the inner city in contrast with three (1.7% (95% CI 0.4 to 5.0)) of 174 in the suburban clinic were infected. In the inner city clinic, age under 25 years (OR 5.4 (95% CI 0.7 to 41.5)), vaginal discharge (OR 4.1 (95% CI 1.5 to 11.1)) and recent change of sexual partner (OR 4.6 (95% CI 1.6 to 12.9)) were associated with C trachomatis. In contrast, in the suburban clinic, only vaginal discharge (OR 3.5 (95% CI 0.9 to 14.3)) and recent change of sexual partner (OR 3.4 (95% CI 0.8 to 15.7)) were identified as risk factors. Multivariate analysis showed that recent change of partner (OR 4.5 (95% CI 1.5 to 13.8)) was the most strongly associated independent risk factor for infection in the inner city clinic. clinic. Conclusion: The high prevalence of C trachomatis indicates that universal testing should be undertaken in the inner city clinic. Young age may not be a risk factor for C trachomatis in more affluent populations with lower prevalence rates. No risk factors were identified with sufficient sensitivity and specificity to be useful for targeted testing. Prevalence and identifiable risk factors for C trachomatis are not transferable between populations, even in the same city.