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Objective: To describe trends in chlamydia positivity from 2007 to 2011 among heterosexual people tested for chlamydia at selected clinics that provide services to people at high risk in Victoria, Australia., Design: The Victorian Primary Care Network for Sentinel Surveillance is a prospective system that collates pathology results from laboratories and demographic and behavioural data from a questionnaire., Setting: Two sexual health clinics and six other primary care clinics that target young people and women at high risk., Participants: All clients tested for chlamydia at sentinel clinics. Individuals aged less than 16 years, sex workers, or those reporting any same-sex sexual partners in the past 12 months were excluded from the analysis., Main Outcome Measures: Chlamydia positivity trends were assessed using three-level random-effects Poisson regression, with clinic and subject treated as nested random factors. Models were offset for total number of tests and adjusted for relevant covariates., Results: Between 2007 and 2011, chlamydia positivity among 31 682 tests in women increased from 5.1% to 6.3%, and positivity among 23 771 tests in men increased from 7.4% to 8.2%. Adjusting for age, country of birth, number of sex partners, condom use, and presence of symptoms, chlamydia positivity increased between 2007 and 2011 significantly among women (incidence rate ratio [IRR], 1.29; 95% CI, 1.11-1.50) and non-significantly among men (IRR, 1.07; 95% CI, 0.92-1.23). Over time, a decrease in reported inconsistent condom use was also observed in both men and women; however, men became more likely to report more than one partner in the past year., Conclusion: We identified a concerning increase in chlamydia positivity over time, particularly among young women.

Objectives: To assess notification trends for chlamydia and gonorrhoea infections in Indigenous Australians compared with non-Indigenous Australians in 2000-2009., Design and Setting: We assessed trends in national notification rates using univariate Poisson regression and summary rate ratios., Main Outcome Measures: Crude notification rates and summary rate ratios, by Indigenous status, sex, age and area of residence., Results: Over the 10-2012 period studied, chlamydia notification rates per 100,000 increased by 80% from 1383 in 2000 to 2494 in 2009 among Indigenous people, and by 335% from 51 in 2000 to 222 in 2009 among non-Indigenous people. The Indigenous versus non-Indigenous summary rate ratio was 23.92 (95% CI, 23.65-24.19; P<0.001). Gonorrhoea notification rates per 100,000 increased by 22% from 1347 in 2000 to 1643 in 2009 among Indigenous people, and by 70% from 10 in 2000 to 17 in 2009 among non-Indigenous people. The gonorrhoea summary notification rate ratio in Indigenous compared with non-Indigenous people was 173.78 (95% CI, 170.81-176.80; P<0.001). In Indigenous people, the highest chlamydia and gonorrhoea notification rates were in women, 15-19-2012-olds, and those living in remote areas., Conclusions: Chlamydia and gonorrhoea notification rates have increased in both populations but were higher among Indigenous people. Our findings highlight the need for targeted prevention programs for young people, especially Indigenous Australians residing in remote areas.

Objective: To describe recent trends among men who have sex with men (MSM) in age at diagnosis of HIV in Victoria., Design and Setting: Analysis of Victorian HIV surveillance data from (i) passive surveillance (2000-2009) and (ii) the Victorian Primary Care Network for Sentinel Surveillance (VPCNSS) (2006-2009). Age-trend comparisons were made using syphilis and gonorrhoea enhanced surveillance., Main Outcome Measures: HIV diagnoses, HIV testing and behavioural indicators by year and age group among MSM., Results: Following a period of sustained increase between 2000 and 2007, the median age at HIV diagnosis among MSM declined significantly, from 38.8 years in 2007 to 35.3 years in 2008 (P=0.023), remaining at 35.9 years in 2009. Between 2007 and 2008, the median age of syphilis and gonorrhoea notifications also declined, from 40.6 to 36.0 years and from 32.3 to 29.3 years, respectively. The median age of HIV testing among MSM in the VPCNSS population remained constant between 2006 and 2009, at 33.0 years. Compared with older MSM, those aged less than 35 years were more likely to have never previously been tested for HIV (relative risk [RR], 1.36 [95% CI, 1.30-1.41]); to not know the HIV status of their regular partner (RR, 1.11 [95% CI, 1.01-1.21]); and to report inconsistent condom use with casual partners (RR, 1.07 [95% CI, 1.01-1.14]) and regular partners (RR, 1.07 [95% CI, 1.00-1.14])., Conclusions: Younger MSM in Victoria may be at increasing risk of HIV infection. Enhanced methods of monitoring HIV and sexually transmitted infection transmission in younger MSM are needed, as well as prevention messages to target this group, who may not fully understand their HIV risk.