Melbourne’s gonorrhoea case surge: experts call for better sex education

The surge in gonorrhoea cases in several disadvantaged suburbs in Melbourne cannot be defeated without mandatory STD awareness and sex education campaigns, a sexual health expert says.

New research from Alfred Health, which mapped gonorrhoea cases for over a decade, has found clusters of cases penetrating some of the most impoverished outer suburbs of Melbourne, including Melton, Brimbank, and Casey.

STI epidemiologist and lead author of the Alfred Health research, Associate Professor Eric Chow, said he could not rule in or out any specific reason for the rise, but increasing education for people in disadvantaged areas could be an effective measure.

“I think they need to be aware of how STDs are transmitted. They need to understand their sexual health, its issues, and how to recognise the symptoms, and if they have symptoms, they probably need to go to a doctor to seek health care,” he said.

Gonorrhoea, also “the clap”, is a sexually transmitted infection caused by a bacterium that infects the urethra, cervix, anus, throat or eyes. Symptoms include irregular vaginal discharge, pain and discomfort during urination, and sore and dry throat.

According to the study by Alfred Research, Victoria recorded 7051 gonorrhoea cases in 2021, compared to about 6500 cases in 2020. Likely affected by the Coronavirus in terms of lower rates of testing and fewer casual sexual encounters, these numbers followed a sharp rise in cases over the previous few years.

There are probably more cases, but “embarrassment” associated with STD testing is keep some people away.

But Associate Professor Chow said he was concerned that people in these areas were reluctant to get tested and he warned that a rise in STD testing would probably reveal a rise in cases.

Alfred Health has established the Victorian Sexual Health Network, which includes a network of bulk-billed GP sexual health clinics, to make screening for people in the outer areas of Melbourne easily accessible. 

Dr Sal Clark, a lecturer in sociology and gender studies at the Swinburne University of Technology, said that the evidence suggests that STDs have a very strong correlation with the type of sex education received in schools.

The “abstinence-only” programs are inefficient because they only teach avoidance of sexual activity, she said.

On the flip side of that, a lot of evidence suggests that when young people receive comprehensive sex education, about the things that are normally not talked about like mechanics of sex, navigating sexual practices, sexual health and boundaries, they are much more prepared to have these kinds of conversations with their sexual partners about how to practice safe sex.

Dr Clark said that STDs are one of those areas where “knowledge is power against reckless sexual behaviour”.

The problematic absence of a comprehensive and detailed sex education policy contributes to the spread of STDs in socially disadvantaged areas, she said.

Associate Professor Marcus Chen, from Melbourne Sexual Health Centre, said there was a sense of “marginalisation” linked to the outbreak of gonorrhoea in the outer suburbs of Melbourne.

“There’s obviously something driving new infections, but if testing and treatment was sufficient to offset it, then you wouldn’t get a worsening epidemic, which is what we are seeing,” he told The Sydney Morning Herald.

Associate Professor Chow said the social stigma associated with poor sex education exacerbates the problem in disadvantaged areas.

Jesuit Social Services has recently released the report titled ‘Dropping off the Edge’, which unveils the complex and entrenched disadvantages of a small but persistent number of locations across Australia.

The group’s general manager of strategic communication and engagement, Andrew Yule, said that the overlaying of sexually transmitted diseases in the areas that the report recognised as educationally disadvantageous is a serious concern.

“We found that people spoke about needing access to health services and cultural services, which was sometimes lacking and sometimes not communicated very well to them, so sometimes people were not aware of what was available to them,” he said.

Dr Clark said access to free condoms could mitigate the problem.

However, Associate Professor Chow said distributing free condoms could help tackle the issue “only if people use them”.

I think even if you spend pounds on any campaign, be it distributing free condoms, it will not work until you educate people about its necessity.

“So, it’s not only condoms but the education that comes into the package that needs to be distributed to the masses,” he said.

Mr Yule said it was essential to have direct engagement with communities while framing any welfare policy for them.

“We know from our community-building work and social services, that you need the community themselves to be championing any response, otherwise it cannot be effective,” he said.

“Therefore, engaging with those communities and having them come up with the solutions and then having them be part of the implementation of the solutions is critically important.”

The report issued by Chief Health Officer Professor Brett Sutton in 2021 before the release of the Alfred Health study, warned against the alarming spike in syphilis infections in the disadvantaged areas of Melbourne. Accordingly, the geographical overlapping of gonorrhoea with the syphilis surge is concerning.

The Victorian Sexual Health Network has general practice clinics in Hillside, Clayton, and Tarneit, in response to the rising rates of syphilis and gonorrhoea.