Vajdic Claire M, Middleton Melanie, Bowden Francis J, Fairley Christopher K, Kaldor John M
National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia.
Sex Health. 2005;2(3):169-83. doi: 10.1071/sh05018.
To determine by systematic review the prevalence of genital chlamydial infection in Australia between 1997 and 2004.
Electronic literature databases, reference lists, and conference proceedings were searched and health agencies and jurisdictions were contacted for published and unpublished reports. Studies were eligible if they offered a diagnostic nucleic acid amplification test to consecutive individuals presenting during the study period. As a summary measure of the available data, mean prevalence rates, weighted by sample size and irrespective of participant age, were calculated for the population sub-groups.
40 studies of 50 populations and 40,587 individuals met the inclusion criteria, but only one of these was population-based. The use of non-systematic methodologies prevented an assessment of time trends and a statistical comparison of population sub-groups. The mean overall prevalence of genital chlamydial infection was 4.6% (95% CI 4.4-4.8%), reflecting over-sampling of high-risk groups. The mean community-based rates were 7.5% (95% CI 6.4-8.6%) and 8.7% (95% CI 7.9-9.7%) for Indigenous men and women, and 1.5% (95% CI 1.1-1.9%) and 1.4% (95% CI 0.9-2.0%) for non-Indigenous men and women. The overall mean estimates for other groups were 3.3% (95% CI 3.0-3.7%) for female attendees of sexual health and related clinics, 5.6% (95% CI 4.9-6.4%) for adolescents and young adults, 3.3% (95% CI 2.8-3.9%) for sex workers, and 1.6% (95% CI 1.2-2.0%) for urethral infection in men who have sex with men. Clinic-based estimates were generally, although not consistently, higher than community-based estimates. There is no serial population-based data for sexually active young men and women, but the available age-specific rates suggest under-ascertainment by the routine surveillance systems.
The prevalence of genital chlamydial infection in Indigenous Australians and young adults is unacceptably high and quality epidemiological studies are urgently required to supplement the routinely collected national notification data.
通过系统评价确定1997年至2004年澳大利亚生殖器衣原体感染的患病率。
检索电子文献数据库、参考文献列表和会议论文集，并联系卫生机构和辖区获取已发表和未发表的报告。如果研究对研究期间连续就诊的个体提供诊断性核酸扩增检测，则该研究符合纳入标准。作为可用数据的汇总指标，按样本量加权且不考虑参与者年龄，计算人群亚组的平均患病率。
对50个人群和40587名个体的40项研究符合纳入标准，但其中只有一项是以人群为基础的。非系统方法的使用妨碍了对时间趋势的评估以及人群亚组的统计比较。生殖器衣原体感染的总体平均患病率为4.6%（95%可信区间4.4 - 4.8%），反映了对高危人群的过度抽样。原住民男性和女性基于社区的患病率分别为7.5%（95%可信区间6.4 - 8.6%）和8.7%（95%可信区间7.9 - 9.7%），非原住民男性和女性分别为1.5%（95%可信区间1.1 - 1.9%）和1.4%（95%可信区间0.9 - 2.0%）。其他组的总体平均估计患病率为：性健康及相关诊所女性就诊者3.3%（95%可信区间3.0 - 3.7%），青少年和青年5.6%（95%可信区间4.9 - 6.4%），性工作者3.3%（95%可信区间2.8 - 3.9%），男男性行为者尿道感染1.6%（95%可信区间1.2 - 2.0%）。基于诊所的估计患病率一般（但并非始终）高于基于社区的估计患病率。没有关于性活跃青年男性和女性的连续人群数据，但现有的年龄特异性患病率表明常规监测系统存在漏报情况。
澳大利亚原住民和青年成人中生殖器衣原体感染的患病率高得令人无法接受，迫切需要高质量的流行病学研究来补充常规收集的全国通报数据。
