Sexual health needs being missed among women prescribed opioid treatment

New Australian research has identified high levels of chlamydia and gonorrhoea positivity among women with a history of opioid agonist therapy, prompting calls for sexual healthcare to be better integrated into drug and alcohol and harm-reduction services. 

A national study led by Burnet Institute researchers analysed health data from 6,850 women aged 15 to 55 who had been prescribed opioid agonist therapy (OAT), including methadone or buprenorphine, at services participating in Australia’s ACCESS surveillance network between 2012 and 2025.  

Only 2,303 women, 34 per cent of the cohort, had a recorded chlamydia or gonorrhoea test at an ACCESS service during the study period. Among people tested, overall positivity was 4 per cent for chlamydia and 3 per cent for gonorrhoea.  

The findings were particularly concerning among younger women. 

Among women aged under 30, chlamydia positivity was around 7 per cent overall, while gonorrhoea positivity was 4 per cent. Annual gonorrhoea positivity among younger women increased substantially over the study period, reaching 14 per cent in 2020, with the study finding a significant upward trend.  

Burnet Head of Surveillance and Data Linkage, and study senior author, Jason Asselin said the findings pointed to an important gap in sexual healthcare for women who use drugs. 

“The study tells us we need to think much more carefully about whether sexual healthcare is reaching women where and when they need it.” 

The researchers said women with a history of injecting drugs can face barriers to accessing sexual healthcare including stigma and discrimination, cost, transport, childcare, service opening hours and competing priorities. These challenges can be compounded by factors including housing instability, trauma and violent or coercive relationships.  

Jason said providing sexual health services through settings women already know and trust could help overcome some of those barriers. 

“We shouldn’t necessarily expect someone to navigate a completely separate health service every time they need care,” he said. 

“There is an opportunity to make STI testing and sexual healthcare a more routine part of services women may already be using, including alcohol and other drug services, needle and syringe programs and other harm-reduction settings. 

“The aim should be care that is easy to access, non-stigmatising and designed with the women who use these services.” 

The study found repeat infection was also relatively common. Of women who tested positive for chlamydia and were subsequently retested within ACCESS, 21 per cent had at least one further positive chlamydia test. Among women retested after a gonorrhoea diagnosis, 18 per cent had another positive gonorrhoea test. 

Researchers said successful approaches developed in hepatitis C care – including peer involvement, community co-design and streamlined, low-threshold models of care – could help inform future sexual health services for women who use drugs.  

“This study gives us an important signal, but it doesn’t tell us the whole story,” Jason said. 

“We need a better understanding of STI testing, infection and access to care among women who use drugs so that services can be designed around their actual needs.” 

The researchers cautioned that the study only captured testing undertaken within the ACCESS network and could not determine whether women received STI testing elsewhere. A history of OAT prescription was also used as a proxy for a history of injecting drug use, meaning women were not necessarily receiving OAT or injecting drugs at the time they were tested.  

The study used data from 69 health services across every Australian state and territory participating in ACCESS, Australia’s national sentinel surveillance network for sexually transmissible infections and blood-borne viruses supported by the Australian Centre for Disease Control.