Incidence of gonorrhoea has soared by 63% over the past five years, new data shows

The Kirby Institute at UNSW Sydney has released its latest Annual Surveillance Report on HIV, viral hepatitis and other sexually transmitted infections.

Both syphilis and gonorrhoea are on the rise, according to the report, while HIV diagnoses are stable as gay and bisexual men are increasing their uptake of medicines to prevent the spread of the virus.

Hepatitis

The report showed that between March and December 2016 an estimated 30,434 people have been cured of hepatitis C, due to the availability of the new Direct Acting Antivirals.

“The new therapies have been game-changing for hepatitis C in Australia,” says Associate Professor Jason Grebely from the Viral Hepatitis Clinical Research Program at the Kirby Institute.

“Our estimates indicate that the number of people with hepatitis C who have advanced liver disease has fallen for the first time in 10 years.

“This is excellent news, but to achieve hepatitis C elimination in Australia we must sustain our efforts to ensure all people living with hepatitis C are tested and have access to these cures.”

The report also shows that over the past five years hepatitis B diagnoses have declined by 27% in people aged less than 25 years, reflecting the impact of the infant and adolescent vaccination programs.

However, only 63% of the estimated 230,000 people living with chronic hepatitis B in Australia by the end of 2016 were diagnosed. Of those, only 27% were having appropriate clinical monitoring tests for their infection.

Meanwhile, health stakeholders again called for improved access to pre-exposure prophylaxis (PrEP) to help prevent the transmission of HIV.

STIs

Gonorrhoea’s rise has been particularly notable among young heterosexual people in major cities, the report found.

“Up until recently, gonorrhoea had been uncommon in young heterosexual people living in major cities,” says Associate Professor Rebecca Guy, head of the Surveillance, Evaluation and Research Program at the Kirby Institute.

“Rising rates in this group highlight the need for initiatives to raise awareness among clinicians and young people about the importance of testing.”

“With the national strategies for HIV, hepatitis and STIs up for review, reducing STIs in young people will be an important target.”  

Infectious syphilis has also been reappearing since 2011 among young Aboriginal and Torres Strait Islander people in regional and remote areas of Northern Australia.

“Initiatives underway to address the syphilis resurgence include enhanced testing and treatment, and culturally appropriate health promotion campaigns,” says Associate Professor James Ward, head of Infectious Diseases Research, Aboriginal Health Infection and Immunity, South Australian Health and Medical Research Institute.

“Comprehensive strategies are needed to reduce STIs in Aboriginal and Torres Strait Islander peoples.”

Among Aboriginal and Torres Strait Islander Australians, chlamydia and gonorrhoea rates were three and seven times higher than in the non-Indigenous population. These gaps were widest in regional and remote areas.

HIV

HIV diagnoses have remained stable for the last five years, with 1,013 new diagnoses in 2016.

A report by UNSW’s Centre for Social Research in Health, released alongside the Kirby report, shows an increasing use of HIV medications to prevent the spread of HIV by gay and bisexual men.

The proportion of non-HIV-positive gay men who reported pre-exposure prophylaxis (PrEP) use in the six months prior to the annual Gay Community Periodic Surveys increased from 2% in 2013 to 5% in 2016, with the increase mostly seen between 2015 and 2016, suggesting PrEP uptake boosted by increased availability through the large state-funded PrEP access programs in NSW, Victoria and Queensland in 2016.

A/Prof Guy says that in order for HIV rates to decline, instead of merely stabilise, a number of approaches need to be taken, including PrEP.

“PrEP is highly effective, but access at the moment in Australia is only through clinical trials,” she says.

“PreP is currently being considered by the Pharmaceutical Benefits Advisory Committee or BPAC to be listed on the Pharmaceutical Benefits Scheme or PBS and if approved, this would provide affordable equitable access in Australia.”

The report recorded the highest level of HIV treatment to date, with 88% of HIV-positive gay and bisexual men reporting being on antiretroviral treatment. The majority of these men have an undetectable viral load and are thus no longer infectious.

ART treatment coverage has increased from 57% in 2007.

Gay and bisexual men are reporting a number of different strategies to protect themselves, including frequent HIV testing, comprehensive STI testing, consistent condom use and “serosorting,” in which men seek out partners with the same HIV status as themselves.