Looks like the kids are all right after all, at least in Queensland.
There’s been a substantial and sustained decline in chlamydia notifications in 15–19-year-olds since 2010 in QLD, according to Queensland Health.
Finally, some positive STI news!
We’ve seen significantly higher rates of STIs in line with increased testing nationally, and chlamydia is the most common bacterial STI in Australia.
But recent analysis of 20 years’ worth of ABS data for Queensland show the state may be heading in the right direction.
Chlamydia notifications per 100,000 people in those aged 15-19 years almost quadrupled between 2000 and 2010, but then a downward trend began, which was sustained until the end of the dataset in 2019.
Total number of notifications started at around 1400 in the year 2000, peaked at just over 6000, before dropping to 4700 in 2019.
For the 20-24 age bracket, national trends have consistently shown this to be the group with the highest chlamydia prevalence.
This was true of the QLD data, but there was a significant flattening out of the curve since the 2010 peak. Total notifications were just over 1500 at the start of the century, peaking at nearly 7000 in 2010, and continuing to rise slowly over the next 9 years to 8000.
Can I get a hallelujah?
The shifts are likely in part due to improved sexual health awareness, Dr Amalie Dyda, infectious disease epidemiologist, academic at the University of Queensland School of Public Health and affiliate of Queensland Digital Health Centre, told The Medical Republic.
She also noted increased condom use, improved partner notification and better access to testing and education in younger people.
Researchers highlighted the National Australian Survey of Secondary Students and Sexual Health from 1992-2018, which covered the majority of the study period.
It showed that the number of students who report having engaged in penetrative and oral sex has not significantly changed, but that general STI knowledge improved by 25%.
Increased chlamydia knowledge specifically corresponded with national efforts in the late 1990’s and early 2000’s to raise awareness among young people, researchers said. Knowledge scores in the survey increased for males and females in year 10 and 12, fitting perfectly into the age bracket which has since shown decreased rates in the QLD research.
The survey also showed that students were increasingly having sex with partners closer to their own age, and fewer reported partners aged 20 or older. This trend toward relationships within the 15–19-year-old age range, where chlamydia prevalence is lower, may have reduced the risk of exposure and transmission.
“Behaviours that increase the risk of transmission appear to be decreasing,” said Dr Dyda.
She noted that the changes in sexual behaviour in young people seen in studies include delayed sexual debut.
“Additionally, the AIHW reports that alcohol usage in young people is decreasing. In 2022–2023, approximately 31% of people aged 14-17 had consumed alcohol in the previous 12 months, compared to approximately 69% in 2001.”
The impact of social media and digital technology on behaviour and sexual networking is likely having an impact, she said, but it’s yet unknown specifically what those impacts are. Social media can increase the ability of young people to meet others from further geographic locations, impacting sexual networks and enabling communication.
“Data suggest that the use of anonymous digital tools for partner notification are helping, but we are unable to say by how much at this stage,” she said.
“Digital partner notification services (e.g., Let Them Know) have shown they are feasible with significant and increasing uptake across Australia.”
She explained that thesex-differences in the QLD dataset were reflective of national trends, as females consistently report higher notifications than males.
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“This is likely due to more frequent testing in women, particularly during reproductive health visits and more asymptomatic cases in men which can also lead to further under diagnosis.”
When broken down to specific ages for females, rates for 15–18-year-olds all declined from 2010 in QLD. Rates for females aged 19-24 increased since the peak but reflect the significant flattening of the curve.
I think “yaaaas queen” is an appropriate sentiment.
While cases numbers remained far higher at the end of the dataset than the beginning, the ratio of positive specimens to testing showed some declining rates despite increased testing.
Positive chlamydia tests among 15–24-year-olds dropped from 27% to 13% between 2010 and 2019. The same pattern was seen in females, with positivity rates declining from 24% in 2007 to 12% in 2019.
Whilst important to celebrate small victories such as these, Dr Dyda said ensuring improvements in health are available to all populations within Australia is of critical importance.
“There is a disproportionate burden among Aboriginal and Torres Strait Islander populations, which remains a serious health and equity issues in Australia,” she said.
“Similarly, the difference highlighted between urban and remote notifications has also been found in many previous studies.”
This research is a positive sign locally, she said, but not necessarily a national systemic achievement. While the reduction in 15–19-year-olds suggest that targeted interventions are helping, rates are continuing to rise in other age groups.
“This suggests that systemic gaps remain and that we must continue focusing on testing and prevention strategies,” she said.
