In a quiet but pointed finding, researchers tracking more than six thousand Australian women on opioid agonist therapy have found that sexually transmitted infections are running higher among them than they should, and that most of these women are never tested for them at all. The women, many of whom have lived through the tangled circumstances that often accompany drug dependence, are being treated for their addiction yet slipping through the gaps of their sexual health care. The question the study poses is not only medical but deeply human: whether care arrives where people actually stand, o
Women on opioid treatment face higher chlamydia and gonorrhoea rates, with testing gaps and stigma cited as barriers
Women on opioid agonist therapy face higher chlamydia and gonorrhoea infection rates, and about one-fifth of those who test positive for chlamydia are reinfected.
Only one in three had a recorded chlamydia or gonorrhoea test
Mark
The headline number is that only a third were tested. Why does that matter more than the infection rates?
Mimi
Because the infection rates only describe women who were tested. If two-thirds weren't, the true picture is unclear, and Tracy says it's reasonable to suspect many remain untested.
Luke
Careful, though. The one-third figure is testing recorded at an ACCESS service. A woman tested elsewhere wouldn't show up, so it's a floor on testing, not proof she was never tested.
Mark
So the 3% and 4% positivity could be off in either direction?
Luke
Possibly. The source doesn't say how the tested group differs from the untested. We can't say the rates apply to all women on OAT.
Mimi
Still, the under-30 figure of around 7% is hard to ignore, and so is repeat infection: 21% for chlamydia and 18% for gonorrhoea among those retested.
Luke
Those repeat figures also only cover women who came back for a retest, which is a subset.
Mark
Asselin and Tracy seem to disagree on where testing should happen.
Mimi
Partly. Asselin wants testing built into drug services and harm-reduction settings. Tracy says that could help access but risk fragmenting care, and she favours general practice with proper support.
Luke
Neither claims to have tested which model works. Those are expert views, not study findings.
Mark
And the guidelines?
Mimi
They're explicit on blood-borne viruses but say only that chlamydia and gonorrhoea testing should be considered. That wording leaves room for the gap.
El Pulso
- Roughly one in three women on opioid treatment had any chlamydia or gonorrhoea test recorded, leaving most infections potentially hidden.
- Among young women under 30, infection rates reach around seven percent, a figure that alarms clinicians watching a treatable problem quietly spread.
- One in five women who tested positive for chlamydia was infected again on retest, exposing how easily treatment fails to hold when care is fragmented.
- Cost, distance, and stigma keep women from the testing clinics, and researchers are urging that screening move into drug services and general practice now.
- Warnings that splitting care across separate services could fracture the continuity these patients need are pushing GPs to demand payment and support for long consultations.
In a quiet but pointed finding, researchers tracking more than six thousand Australian women on opioid agonist therapy have found that sexually transmitted infections are running higher among them than they should, and that most of these women are never tested for them at all. The women, many of whom have lived through the tangled circumstances that often accompany drug dependence, are being treated for their addiction yet slipping through the gaps of their sexual health care. The question the study poses is not only medical but deeply human: whether care arrives where people actually stand, or whether it asks them to walk, again and again, toward a door they have little reason to open. Those who work in general practice argue that the answer lies in bringing routine care closer to the places these women already visit.
A study of more than 6,800 women across Australia has revealed a troubling gap in care. Women receiving opioid agonist therapy, the methadone and buprenorphine treatment that helps many manage dependence, are testing positive for chlamydia and gonorrhoea at higher rates than expected. Yet only about one in three had any recorded test for these infections at all.
The women studied were aged 15 to 55, and their records came from the ACCESS surveillance network, which includes several general practices, covering the years 2012 to 2025. Among those tested, around 4 percent were positive for chlamydia and 3 percent for gonorrhoea, rising to roughly 7 percent in women under 30. Many were also reinfected: about one in five women treated for chlamydia tested positive again on retest.
Jason Asselin, the study's senior author, described a tangle of health and social challenges that allows sexual health to slip through the cracks. He argued that no one should have to seek out a separate service to receive basic care, and suggested that testing be built into the services women already use, from alcohol and drug programs to needle and syringe services.
Marguerite Tracy of the RACGP agreed that many women likely remain untested for infections that are highly treatable. She pointed to stigma, cost and access as persistent obstacles, and to a growing population on treatment: around 60,000 Australians receive OAT daily, a third of them women, with prescribing spread across GPs and specialists.
Tracy also warned that moving screening into drug health services alone could widen access while fragmenting care. She argued that general practice is the natural home for comprehensive, continuous care, and called for payment structures that recognise long consultations, faster access to drug service advice, and real support for shared care between GPs and specialists.
A study of more than 6800 women in Australia has found that only about one in three had a recorded test for chlamydia or gonorrhoea at the services in the research network. All of them had been prescribed opioid agonist therapy, known as OAT, which includes methadone and buprenorphine. For those who were tested, the results were worse than expected.
The women were aged 15 to 55. Their records came from services in Australia's ACCESS surveillance network, which includes several general practices, and covered 2012 to 2025. Among the women who were tested, 3% were positive for gonorrhoea and 4% for chlamydia. In women under 30 the figure rose to around 7% overall.
Repeat infection was also common. Of the women who tested positive for chlamydia and were later retested, 21% had at least one further positive chlamydia result. After a gonorrhoea diagnosis, 18% of those retested had another positive gonorrhoea test.
Jason Asselin, the study's senior author, said the findings reflect a complex mix of health and social challenges faced by women who use drugs, and show how easily sexual health can slip through the gaps. He said the study raises the question of whether sexual healthcare is reaching women where and when they need it. In his view, nobody should be expected to navigate a separate health service every time they need care. He pointed to an opportunity to make STI testing a more routine part of services women already use, including alcohol and other drug services, needle and syringe programs and other harm-reduction settings.
Associate Professor Marguerite Tracy, a member of the RACGP's Expert Committee – Quality Care, said it is reasonable to suspect that many women remain untested for what are very treatable infections. She said stigma, discrimination, cost and access remain significant barriers for many people.
The scale of the treatment population is large. Around 60,000 Australians receive OAT daily, and a third of them are women. Prescribing is spread across GPs, addiction medicine specialists and addiction psychiatrists, with 3123 authorised OAT prescribers in Australia in 2023. Tracy told newsGP that as more treatments for opioid dependence arrive, safe treatment in general practice should become more normal. She described general practice as the place where comprehensive, continuous care is best delivered, noting that people on OAT have much higher illness and death rates, mainly from chronic conditions unrelated to drugs. GPs, she said, are experts in sexual health screening and treatment, and that applies equally to patients on OAT.
Current Australian STI management guidelines are explicit about testing for blood-borne viruses in this population, but say chlamydia and gonorrhoea testing should only be considered. The study concludes that ensuring sexual healthcare is accessible and non-stigmatising for women who inject drugs is crucial.
Tracy also cautioned that putting screening and treatment into drug health services could widen access to STI testing but risks fragmenting care. It would not address the underlying need for people on OAT to receive comprehensive healthcare, which she said is best provided in general practice. She called for support for GPs and practices, including adequate payment structures for long and complex consultations, better access to alcohol and drug services for timely advice, and support for shared care.
Citas Notables
There is an opportunity to make STI testing and sexual healthcare a more routine part of services women may already be using.— Jason Asselin, study senior author
It is reasonable to suspect many remain untested for very treatable infections, but stigma, discrimination, cost and access remain significant barriers.— Associate Professor Marguerite Tracy, RACGP (paraphrased)
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