No-one quite knows why gonorrhoea rates are rising, but we do know where the hotspots are
Young, urban-dwelling heterosexuals have put the clap back on the map, with Kirby Institute research revealing the current rising rates of infection are being driven by this historically low-risk group.
In the last five years, gonorrhoea rates have risen 63% overall, almost doubling in major cities and rising 126% among urban women, according to this year’s Annual Surveillance Report.
While syphilis rates have also doubled over the last five years, the institute found rates of HIV have been stable at around 1000 new infections per year and that more than 30,000 people have been cured of hepatitis C since new treatments became available.
Associate Professor Rebecca Guy, co-author of the report, said it wasn’t clear what was behind the increase in gonorrhoea notifications, but one speculation was that changing sexual behaviours, such as increasing use of hook-up apps, such as Tinder, could explain it.
“Surveys suggest that between 10% and 50% of people are using Tinder to find sexual partners, and that that people who use Tinder have more sexual partners,” she said.
But this could be interpreted in two different ways, Professor Guy explained.
“The first is just that more sexually active people are using Tinder, and the second explanation is that Tinder is [enabling] people to find more sexual partners. The surveys can’t disentangle those two explanations.”
Gonorrhoea could be more infectious than some other STIs, transmitted through either oral, vaginal or anal sex, she said.
As a result, oral transmission could occur in people who would otherwise use condoms during sex, and the sore throat signifying an infection might go unnoticed.
Clinical guidelines recommend offering opportunistic testing for gonorrhoea to all at-risk young people at least once a year, with experts emphasising the statistic that four in five women who are infected are asymptomatic.
“Data in the report show that when 15- to 29-year-olds attend general practice, about 20% of women have a chlamydia and gonorrhoea test, and only 10% of men,” Professor Guy said.
But the statistics also show that gonorrhoea infections are not limited to younger people, with rates increasing among those aged 25 to 39 as well.
“Most sexually transmitted infections will largely affect young people, but gonorrhoea is also increasing in people in people in their 30s,” she said. “That really supports the consideration of testing in that broader age range.”
While concerns are growing about reduced antibiotic susceptibility in gonorrhoea, Professor Guy said that ceftriaxone and azithromycin together were still a “highly effective strategy” for Australian patients.
Despite gonorrhoea rates increasing among urban heterosexuals, both it and syphilis are still largely diagnosed in gay and bisexual men in big cities and in young heterosexual Aboriginal and Torres Strait Islander people in remote areas.
Gonorrhoea notifications are still sevenfold higher among Aboriginal and Torres Strait Islanders, syphilis is fivefold higher and chlamydia threefold higher.
