Are young women who binge drink or use cannabis more or less likely to undergo chlamydia testing?
Researchers from CRE WaND set out to investigate the associations between cannabis use, binge drinking and chlamydia testing in a cohort of young Australian women. The results are encouraging.
Chlamydia trachomatis is the most frequently notified sexually transmitted infection (STI) in Australia. Most infections occur in people aged 15-29, with 79% of notifications in Australia in this age group. While the rate of notifications is similar for both men and women, the impacts of a chlamydia infection are potentially greater for women as they are less likely to have symptoms. If left untreated, a chlamydia infection can lead to long-term health impacts like pelvic inflammatory disease and infertility.
The disproportionate burden of chlamydia infection in young people may be because they are more likely to engage in risky sexual behaviours such as unprotected sex and having multiple partners. Previous research suggests that cannabis use and risky levels of alcohol consumption, separately and in combination, have direct effects on sexual decisions and have been associated with a greater likelihood of high-risk sexual contact and infection transmission.
Chlamydia screening in young Australian women
We wanted to know if young women who use cannabis or binge drink (both behaviours that potentially precipitate risky sexual practices) were more or less likely to undergo chlamydia testing.
We analysed data from just over fourteen thousand sexually active women from the 1989-1995 cohort of the Australian Longitudinal Study on Women’s Heath. Participants in the study reported their cannabis use and alcohol consumption in each of five surveys – from Survey 1 (2013, 18-23 years old) to Survey 5 (2017, 22-27 years old). Data on chlamydia tests were sourced through data linkage to the Medicare Benefits Schedule (MBS) Items Database.
Among women born in 1989-95, annual chlamydia testing prevalence declined as women got older – from 30% (in 2013) to 27% (in 2017).
Testing was highest among women who had reported recent cannabis use and women who had five or more alcoholic drinks on any one occasion at least weekly.
The likelihood of being tested increased with recency of cannabis use and frequency of heavy drinking. This association lessened when we accounted for other social demographic, health, and behavioural factors such as age, education, partner status, Body Mass Index (BMI), symptoms, prior STI infections, and smoking status. Strong drivers for testing also included having a history of chlamydia infection and not having a partner (especially among women with a BMI of less than 25 kg/m2).
Women who reported cannabis use in the last 12 months and binge drank at least monthly had the highest likelihood of having a chlamydia test compared to women who had not recently used cannabis and never binge drank.
Implications for policy and practitioners
The Royal Australian College of General Practitioners recommends opportunistically offering screening for chlamydia infection in sexually active young people aged 15-29 years. Testing is available free of charge in a variety of settings, including general practices and sexual health clinics.
These results are encouraging, as they indicate that the women in our study are aware of the implications of their risky behaviour and either seek out testing with their general practitioner or are responsive to suggestions by their GP to have a test.
However, further work is needed to increase the frequency of testing among young women. A number of countries, including the United Kingdom, have National Chlamydia screening programs and recommend annual screening for young people.
Wilson Louise Forsyth, Dobson Annette Jane, Doust Jenny, Mishra Gita Devi (2022) Socioeconomic, behavioural and health factors associated with chlamydia testing in sexually active young women: an Australian observational cohort study. Sexual Health 19, 112-121.
The research on which this paper is based was conducted as part of the Australian Longitudinal Study on Women’s Health by the University of Queensland and the University of Newcastle. We are grateful to the Australian Government Department of Health and Aged Care for funding and to the women who provided the survey data. The authors acknowledge the Australian Government Department of Health and Aged Care for providing MBS data and the Australian Institute of Health and Welfare (AIHW) as the integrating authority.
NHMRC Centre of Research Excellence on Women and Non-communicable Diseases: Prevention and Detection
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