Chlamydia and gonorrhoea missed in women on opioid treatment

New Australian surveillance data shows that only one-third of women receiving opioid agonist therapy (OAT) were ever tested for chlamydia or gonorrhoea over a 13-year study period, despite positivity rates when tested being substantially higher than in the general population. The study, published in the journal Sexual Health, analysed data from more than 6,800 women aged 15 to 55 attending services in Australia’s ACCESS surveillance network between 2012 and 2025.

If you are a GP with patients on methadone or buprenorphine, this is an actionable finding. If you are a patient receiving OAT and have never been offered a chlamydia or gonorrhoea test, that is a gap worth raising.

What the data shows

About 60,000 Australians receive opioid agonist therapy daily. Approximately one-third of them are women, according to national data from the AIHW. These are people attending pharmacies, general practices and specialist drug health services on a regular — often daily — basis. Each contact is a potential healthcare touchpoint.

The ACCESS network data showed that of 6,800 women with a current or historical OAT prescription, only about one-third had a recorded chlamydia or gonorrhoea test during the study period. The testing rate was low throughout — not concentrated in early enrolment or later follow-up, but consistently low across the study window.

Among those who were tested, chlamydia positivity was 4% and gonorrhoea positivity was 3%. For women under 30, both rates were higher, at around 7%. Those numbers are meaningful relative to general-population positivity rates; gonorrhoea in particular remains uncommon outside specific risk groups.

Repeat infection was also common: 21% of women who tested positive for chlamydia and were retested had a second positive result. For gonorrhoea the figure was 18%. Repeat infection is a signal that the window between testing events is too wide and that treatment-to-retest pathways are not consistently in place.

Both-and: the care gap and where it sits

Study senior author Jason Asselin said sexual healthcare can easily “fall through the gaps” for women who use drugs and argued for routine STI testing integrated into alcohol and other drug services, needle and syringe programs, and harm-reduction settings.

Associate Professor Marguerite Tracy offered a different emphasis: stigma, discrimination, cost and access remain the structural barrier, and general practice — already the primary setting for ongoing OAT prescribing — is best placed to provide comprehensive, continuous care rather than fragmenting STI services into a separate pathway.

Both perspectives are responding to the same underlying reality: the testing gap exists. Where they differ is on where the solution should be located — in specialist drug health services, harm-reduction settings, or in the ongoing GP relationship.

For most women on OAT in Australia, the GP is already the OAT prescriber. Current Australian STI Management Guidelines say that chlamydia and gonorrhoea testing in people who use drugs should be “considered.” That framing — “considered” — is clinically permissive rather than directive. It leaves the decision to individual clinical judgment, which means it also leaves the gap open. Asselin and Tracy both suggest the framing needs to move toward routine, embedded, opt-out testing rather than an optional clinical prompt.

There is a systemic dimension here too. Tracy called for adequate remuneration for complex, long consultations and better access to timely drug health advice. An OAT review consultation that is adequately remunerated and time-protected is far more likely to include a sexual health conversation than one squeezed into a 10-minute bulk-billed slot already dominated by script renewal and monitoring bloods.

2 cents

The practical upshot is fairly clear, and it sits in general practice.

For patients: if you are currently receiving opioid agonist therapy and you have not been offered or had a chlamydia or gonorrhoea test recently, it is reasonable to raise it with your GP at your next OAT review. Both tests are simple and can be completed on a urine sample or a self-collected swab. There is no diagnostic threshold to reach — a test is a test.

For GPs: the ACCESS data makes a reasonable case that the current “consider” prompt in the guidelines is not translating into practice. An annual STI screen bundled into OAT review appointments — offered routinely, with opt-out framing rather than opt-in — is aligned with what the evidence would support, and with what Tracy and other experts in this space have been arguing. The infrastructure is already there: the patients are attending regularly, the scripts are being reviewed, the relationship exists. The testing is the step that is being skipped.

Verdict: yes — actionable findings from a well-designed surveillance study, with a clear direction for general practice.

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Sources cited

1. Higher STI rates in women prescribed opioid treatment — newsGP, RACGP, 30 October 2026
2. Chlamydia and gonorrhoea testing and positivity among women with a history of OAT prescriptions — Sexual Health, 2026
3. Australian STI Management Guidelines — people who use drugs
4. National Opioid Pharmacotherapy Statistics Annual Data (NOPSAD) — AIHW