1. Marco Teórico
1.7 Sistema Constructivo
1.8.1 Reglamento para la regulación de los centros de recuperación para
NSW Department of Health data averaged for 2005 to 2007 indicate that the North Coast Area Health Service had the highest notifi cation rate for chlamydia (249 per 100,000 population), while Sydney West Area Health Service had the lowest (116 per 100,000 population, Figure 7.7).
Age group (years)
Services (per 100,000 population)
0 1000 2000 3000 4000 5000 6000 7000 65-74 55-64 45-54 35-44 25-34 15-24 Male Female
Area Health Services
Rate (per 100,000 population)
0 50 100 150 200 250 300 North Coast Hunter New England SE Sydney/ Illawarra* Greater Western NSW Greater Southern North Sydney/ Central Coast* Sydney South West* Sydney West*
Figure 7.6: Chlamydia tests by age group, MBS item 69316, NSW, 2008
Figure 7.7: Chlamydia notifi cations, NSW Area Health Services, 2005 to 2007
Source: Medicare Australia Statistics. Available at: www.medicareaustralia.gov.au/statistics/mbs_item.shtml.
Notes. Data averaged 2005 to 2007, bars represent 95% confi dence intervals. Age-standardised rate. * = Metropolitan Area Health Services.
Source: Population Health Division. Report of the Chief Health Offi cer. Sydney: NSW Department of Health. Available at: www.health.nsw.gov.au/ publichealth/chorep/. Accessed 05Jan2011.
7
141 Chapter 7 – Sexually Transmissible Infections
FPNSW : Reproductive and sexual health in New South Wales and Australia: differentials, trends and assessment of data sources
The terms gonorrhoea and gonococcal infection are often used interchangeably, however, they can also describe different things. A person with gonorrhoea is positive for and displaying symptoms of gonococcal infection; where gonococcal infection merely describes the presence of the bacterium Neisseria gonorrhoeae, however this person may be asymptomatic. The National Notifi able Diseases Surveillance System (NNDSS) only collects information on gonococcal infection, so this term is used when describing data from the NNDSS.
Gonorrhoea is a sexually transmitted bacterial infection that presents with symptoms of abnormal discharge and pain at urination. Infection in women is more likely to be asymptomatic and can lead to pelvic infl ammatory disease (PID), tubal infertility and neonatal infection.29 Current
standard antimicrobial treatment for gonorrhoea has been highly effective. However, resistance is now emerging to both fi rst line and cephalosporin regimens, raising concerns for future treatment options and the potential effects of treatment failure on disease spread.30-32 Furthermore,
gonococcal infection has been shown to amplify HIV transmission risk, and the development of resistant infection may have implications beyond the spread of gonorrhoea alone.33
Infection rates vary within countries geographically, by population subgroup, age and gender.34 Infections are
more prevalent among socio-economically disadvantaged population groups35 and in Australia this particularly
translates into high rates in some Aboriginal and Torres Strait Islander communities.36
Whilst gonorrhoea rates in the Australian general community are relatively low, extremely high rates have been found among residents of Aboriginal and Torres Strait Islander communities in rural and remote areas.22 In urban
populations, gonorrhoea is found most commonly among men who have sex with men, commercial sex workers in non-approved premises, clients of sex workers, and international travellers.29,36-38
7.3.1 Gonococcal infection
notifi cations: Australia
Gonococcal infection notifi cation rates in the Australian general community are relatively low (Figure 7.8). Nonetheless, the National Notifi able Diseases Surveillance System shows a steady rise in gonococcal infection notifi cations in Australia, from 5,448 notifi cations in 1998 to 7,697 notifi cations in 2008, with the notifi cation rate peaking at 41.4 per 100,000 in 2006 (Figure 7.8). Rates in the Northern Territory were substantially higher than all other states (731 per 100,000 population in 2008; about 20 times the national rate of 37 per 100,000), while rates in Western Australia were approximately double the national average (80 per 100,000 in 2008). In both the Northern Territory and Western Australia the higher gonococcal infection notifi cation rates are attributed to high infection rates in the larger Aboriginal and Torres Strait Islander populations in these jurisdictions. Rates for Queensland, New South Wales, South Australia and Victoria have clustered slightly below the national average, withYear
Rate (per 100,000 population*)
Vic Australia NSW Qld Tas NT ACT SA WA 1 10 100 1000 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998
Figure 7.8: Gonococcal infection notifi cations, Australian states and territories, 1999 to 2008
Note: * Axis plotted on logarithmic scale
Source: Communicable Diseases Surveillance National Notifi able Disease Surveillance System 2009, Commonwealth Department of Health and Ageing. Available at: www9.health.gov.au/cda/Source/CDA-index.cfm.
142
Chapter 7 – Sexually Transmissible Infections
FPNSW : Reproductive and sexual health in New South Wales and Australia: differentials, trends and assessment of data sources
the smaller jurisdictions of Tasmania and the ACT showing the lowest rates (generally close to or below 10 cases per 100,000 population.)
In 2008, the highest notifi cation rates were in males of all ages, except in the 15 to 19 year age group (Figure 7.9). There are also gender variations in rates across jurisdictions, with the Northern Territory routinely reporting higher rates of gonococcal infection among females (for example in 2008, 748 per 100,000 in females compared to 677 per 100,000 in males). This is attributed to heterosexual transmission in Aboriginal and Torres Strait Islander communities in the Northern Territory.8,24
7.3.2 Gonorrhoea
notifi cations: New
South Wales
Notifi cation rates for gonococcal infection in NSW have shown an increasing trend over the period 1998 to 2007 (Figure 7.10). Despite the decline in notifi cations from 2006 to 2007 (driven by fewer cases in NSW men), over the ten year period 1998 to 2007 notifi cations increased in NSW by 25%.39
In males, notifi cation rates increased from around 30 per 100,000 in 1998 to almost 45 per 100,000 in 2006, with a decrease to 35 per 100,000 in 2007. In females, while rates have been substantially lower than males, the increase has
been proportionately larger, approximately doubling from 3 per 100,000 to 6 per 100,000 in the period 1998 to 2007. In absolute terms, the number of notifi cations in 1998 was 1,051, which had climbed to 1,722 in 2006 but declined to 1,368 in 2007. In 2008 notifi cations in NSW declined again slightly to 1331.
The increase in notifi cations from 2000 to 2007 has been most pronounced in people aged between 20 and 29 years, as was the decrease from 2006 to 2007 (Figure 7.11). A similar pattern was seen in people aged 35 to 39 years however at lower rates. The largest overall increase was in notifi cations and rates for people aged 20 to 24 years, with a near doubling of the rate of gonorrhoea notifi cations from 2000 to 2007 in this age group. All ages groups up to the age of 44 showed a decline in gonorrhoea rates from either 2005 or 2006.
Rates were lower in older people in NSW (Figure 7.12), and for ages 45 to 54 the rate of gonococcal notifi cations increased overall but showed a similar decline from 2005 or 2006 that was observed in notifi cations for people younger than 45. However, for people 55 and older, notifi cation rates increased from 2005 and did not show any decline from 2006 to 2007. This trend refl ects an increase in gonorrhoea among older MSM who are more likely to engage in unprotected anal intercourse leading to infection with urethral and anal gonorrhoea.38
Age group (years)
Rate (per 100,000 population)
0 20 40 60 80 100 120 140 160 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 Male Female
Figure 7.9: Gonococcal infection notifi cations by age group and gender, Australia, 2008
Source: Communicable Diseases Surveillance National Notifi able Disease Surveillance System 2009, Commonwealth Department of Health and Ageing. Available at: www9.health.gov.au/cda/Source/CDA-index.cfm.
7
143 Chapter 7 – Sexually Transmissible Infections
FPNSW : Reproductive and sexual health in New South Wales and Australia: differentials, trends and assessment of data sources
Year
Rate (per 100,000 population)
All Females Males 0 10 20 30 40 50 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 Year
Rate (per 100,000 population)
20-24 40-44 15-19 25-29 35-39 30-34 0 10 20 30 40 50 60 70 80 2007 2006 2005 2004 2003 2002 2001 2000
Figure 7.10: Gonorrhoea notifi cations by gender, NSW, 1998 to 2007
Figure 7.11: Gonorrhoea notifi cations by age group (15 to 44), NSW, 2000 to 2007
Note: Age standardised rate.
Source: Population Health Division. Report of the Chief Health Offi cer. Sydney: NSW Department of Health. Available at: www.health.nsw.gov.au/publichealth/chorep/. Accessed 05Jan2011.
144
Chapter 7 – Sexually Transmissible Infections
FPNSW : Reproductive and sexual health in New South Wales and Australia: differentials, trends and assessment of data sources