The Interaction Between Sexually Transmissible Infections And Human Immunodeficiency Virus Infection In Homosexual Men
Funder
National Health and Medical Research Council
Funding Amount
$635,931.00
Summary
This project examines the inter-relationship between HIV infection and sexually transmitted infections (STIs) in homosexual men. The overall goal of the projet is to inform the development of STI prevention and treatment strategies which may be important in reducing HIV incidence in this population. Homosexual men comprise over 80% of people diagnosed with HIV infecton in Australia, and in many developed nations are one of the largest groups affected by HIV. Rates of other STIs are also increase ....This project examines the inter-relationship between HIV infection and sexually transmitted infections (STIs) in homosexual men. The overall goal of the projet is to inform the development of STI prevention and treatment strategies which may be important in reducing HIV incidence in this population. Homosexual men comprise over 80% of people diagnosed with HIV infecton in Australia, and in many developed nations are one of the largest groups affected by HIV. Rates of other STIs are also increased in homosexual men. Currently, HIV rates are increasing in Australia and in many developed countries. We are in need of new and effective methods of HIV prevention. Data in heterosexuals suggest that where STIs are common, the early detection and treatment of these infections may help reduce HIV incidence. There are few data on this relationship in homosexual men. We propose to utilise an existing Sydney cohort of homosexual men to collect data on biologic tests for STIs, history of recent diagnosis of STIs, and symptoms, to allow a comprehensive description of the epidemiology of STIs and their overlap with HIV. The quality of data on the interaction between HIV and STIs in this cohort will be superior to any previously collected in homosexual men, as it will include data on self-reported doctor diagnosed illness, state of the art biologic testing, and symptom data, for the full spectrum of important STIs. The results of this study will be helpful in determining strategies for HIV and STI screening, education and control in the population which comprises the great majority of cases of HIV infection in Australia, and one of the largest risk groups for HIV infection in the developed world. Screening coupled with treatment of asymptomatic STIs may be an effective new approach to HIV prevention in this population.Read moreRead less
False Positives In The Diagnosis Of Sexually Transmitted Chlamydia Trachomatis Infection In Children
Funder
National Health and Medical Research Council
Funding Amount
$724,313.00
Summary
Chlamydia trachomatis causes sexually transmitted infections, and also the eye disease trachoma. The detection of Chlamydia in urine sample from a child can be seen as evidence for sexual abuse. We will assess the potential impacts of three mechanisms that could conceivably lead to urogenital Chlamydia diagnosis in a child in the absence of sexual abuse: contamination of the urogenital site with ocula Chlamydia, contamination of urine samples after collection, and diagnostic test malfunction.
Regulatory Networks Controlling Virulence In Neisseria Gonorrhoeae And Neisseria Meningitidis.
Funder
National Health and Medical Research Council
Funding Amount
$300,773.00
Summary
Bacteria that cause disease produce substances called virulence determinants, often on their cell surface. These virulence determinants are either directly involved in allowing infection to take place, or cause the damage that we recognize as an infectious disease. Some virulence determinants are produced all the time, while others are only made in particular conditions - their expression is regulated. To target efforts in the development of new vaccines and treatments, it is important to identi ....Bacteria that cause disease produce substances called virulence determinants, often on their cell surface. These virulence determinants are either directly involved in allowing infection to take place, or cause the damage that we recognize as an infectious disease. Some virulence determinants are produced all the time, while others are only made in particular conditions - their expression is regulated. To target efforts in the development of new vaccines and treatments, it is important to identify all the virulence determinants produced by a particular bacterial species, but also to know which are regulated, and the environmental signals that determine their expression. It can be just as important to know whether a virulence determinant is constantly expressed, and therefore represents an invariant target. Neisseria gonorrhoeae and Neisseria meningitidis are two important disease-causing bacteria that exclusively infect humans and cause gonorrhoea, and meningitis. The complete DNA sequence of both of these bacteria is currently being determined. From computer analysis of these data, it appears that these bacteria have few of the specific regulatory systems that are present in other bacteria. The availability of DNA sequencing data enables an alternative and much more systematic approach to the identification and study of the regulation of virulence determinants. Because of the limited repertoire of regulatory systems still present in N. gonorrhoeae and N. meningitidis, it is feasible to mutate each and determine which are involved in regulation of virulence determinants. We will also be able to identify genes regulated by each system, determine how regulation is achieved, and use this information to identify any presently unknown virulence genes controlled by the same system. Such an analysis has never been previously achieved for any bacterial species, because of the number and complexity of the regulatory systems usually present.Read moreRead less
Adolescent Males' Beliefs And Feelings About The Consequences Of A Partner's Pregnancy: A Survey And Intervention Study
Funder
National Health and Medical Research Council
Funding Amount
$170,095.00
Summary
Each year, in Australia, approximately 28,000 adolescents become pregnant. The psychological, social and financial cost of adolescent pregnancy in Australia is substantial, in both the long and short term. An unexpected finding in North American studies is that a substantial number of adolescent pregnancies occur by design. Prevention programs in Australia and elsewhere assume adolescents do not wish to become pregnant and focus on educating adolescents about causes rather than consequences. Res ....Each year, in Australia, approximately 28,000 adolescents become pregnant. The psychological, social and financial cost of adolescent pregnancy in Australia is substantial, in both the long and short term. An unexpected finding in North American studies is that a substantial number of adolescent pregnancies occur by design. Prevention programs in Australia and elsewhere assume adolescents do not wish to become pregnant and focus on educating adolescents about causes rather than consequences. Research conducted by one of us (JAQ) found that over 75% of pregnant teenagers said they had deliberately become pregnant. Another of us (JTC) studied 1,500 Australian adolescents attitudes and beliefs about pregnancy and parenthood. The findings showed high levels of idealisation, especially in males. Males have been largely neglected in adolescent pregnancy research. The first component of this study is a survey of 500 adolescents to investigate their attitudes and beliefs about pregnancy occurring in a sexual partner, and the consequences of that event for them both. The assessment tool is a computer role-play simulation with its starting point the announcement of a pregnancy. The intervention study involves 300 adolescents and comprises viewing and discussing a video in which 4 adolescent males talk about their experiences of the consequences of pregnancy in a sexual partner. The use of 4 groups with different sequences of assessment and intervention will enable us to ascertain the effectiveness of the intervention. Of particular interest is whether the video or the role-play makes any impact on idealised attitudes and beliefs. This research is the first undertaken on adolescent male attitudes and beliefs using a computer role-play. It will provide essential information for the development of effective, male-oriented prevention programs which focus on consequences as well as causes of adolescent pregnancy.Read moreRead less
Surveillance Of LGV Chlamydia Trachomatis Types Among Men Who Have Sex With Men (MSM)
Funder
National Health and Medical Research Council
Funding Amount
$194,875.00
Summary
Chlamydia is a common sexually transmitted infection (STI) caused by the bacterium, Chlamydia trachomatis (CT). Annually, 50 million new cases of chlamydia are estimated to occur worldwide which if untreated, can lead to serious complications such as pelvic inflammatory disease and infertility in women and epididymitis in men. Over the past decade, there has been a sharp increase in diagnoses of chlamydia in Australia, coinciding with a reported upsurge in sexual risk behaviour (increased partne ....Chlamydia is a common sexually transmitted infection (STI) caused by the bacterium, Chlamydia trachomatis (CT). Annually, 50 million new cases of chlamydia are estimated to occur worldwide which if untreated, can lead to serious complications such as pelvic inflammatory disease and infertility in women and epididymitis in men. Over the past decade, there has been a sharp increase in diagnoses of chlamydia in Australia, coinciding with a reported upsurge in sexual risk behaviour (increased partner numbers and-or practices of unprotected sex), particularly among men who have sex with men (MSM). In addition, there are current outbreaks of an invasive CT strain, causing lymphogranuloma venereum (LGV), throughout Western Europe, with cases now reported in the USA. LGV can lead to severe anogenital ulcers, which can increase transmission of HIV, hepatitis C, and other STIs. With growing international travel, the likelihood of LGV outbreaks in Australia, particularly in MSM, is increased. Recently, isolated cases of LGV have been noted in MSM attending Sydney and Melbourne Sexual Health Centres, indicating LGV is possibly already in circulation. Since we know little about circulating CT types in Australia it would be difficult to assess the burden of an LGV outbreak. Due to increasing CT infections and likely risk of increased HIV transmission, particularly with LGV strains, surveillance of CT genotypes in Australia, especially in MSM, is important. The purpose of this study is to type CT strains in our population by looking at their genetic makeup. CT-positive specimens from Melbourne and Sydney will be used to identify CT types in circulation and to assess if LGV types are present. The knowledge obtained from this study will be novel and invaluable, and could contribute considerably to the development of improved disease prevention and intervention strategies, including the design of vaccines.Read moreRead less
Regulatory Networks Controlling Virulence In Neisseria Gonorrhoeae And Neisseria Meningitidis.
Funder
National Health and Medical Research Council
Funding Amount
$147,500.00
Summary
Bacteria that cause disease produce substances called virulence determinants, often on their cell surface. These virulence determinants are either directly involved in allowing infection to take place, or cause the damage that we recognize as an infectious disease. Some virulence determinants are produced all the time, while others are only made under particular conditions, that is, their expression is regulated. To target efforts in the development of new vaccines and treatments, it is importan ....Bacteria that cause disease produce substances called virulence determinants, often on their cell surface. These virulence determinants are either directly involved in allowing infection to take place, or cause the damage that we recognize as an infectious disease. Some virulence determinants are produced all the time, while others are only made under particular conditions, that is, their expression is regulated. To target efforts in the development of new vaccines and treatments, it is important to identify all the virulence determinants produced by a particular bacterial species, but also to know which are regulated, and the environmental signals that determine their expression. Neisseria gonorrhoeae and Neisseria meningitidis are two important disease-causing bacteria that exclusively infect humans and cause gonorrhoea, and meningitis. The complete DNA sequence of both of these bacteria is now known. From computer analysis of these data, it appears that these bacteria have few of the specific regulatory systems that are present in other bacteria. Because of the limited repertoire of regulatory systems still present in N. gonorrhoeae and N. meningitidis, it is feasible to mutate each one and determine which are involved in regulation of virulence determinants. We have made copies of every individual gene found in the DNA sequence of these bacteria and have attached each one individually to a glass slide to form a microarray measuring 18mm x 18mm. This microarray will allow us to monitor the expression of every gene in these bacteria in response to environmental signals. This information will be used to identify all the virulence genes controlled by each regulatory system. Such an analysis has never been previously achieved for any bacterial species, because of the number and complexity of the regulatory systems usually present.Read moreRead less
Development Of Novel Vaccine Strategies To Prevent Genital Tract Chlamydial Infection
Funder
National Health and Medical Research Council
Funding Amount
$408,556.00
Summary
Genital tract chlamydial infection is the most common bacterial sexually transmitted disease world wide with 4-5 million cases occurring annually throughout the world. The incidence of chlamydial infection is increasing in the Australian population. The majority of infections in women are asymptomatic and, if untreated, go on to cause pelvic inflammatory disease, ectopic pregnancy and infertility. These conditions can be life threatening and are a significant public health cost. In the proposal ....Genital tract chlamydial infection is the most common bacterial sexually transmitted disease world wide with 4-5 million cases occurring annually throughout the world. The incidence of chlamydial infection is increasing in the Australian population. The majority of infections in women are asymptomatic and, if untreated, go on to cause pelvic inflammatory disease, ectopic pregnancy and infertility. These conditions can be life threatening and are a significant public health cost. In the proposal we will develop novel vaccine strategies, involving both intranasal immunisation and immunisation by direct application to the skin, to induce protection against genital tract chlamydial infection. These studies will lay the basis for human trials of a vaccine to prevent what is now the most common STD in Australia. Such a vaccine to target this chronic infection would represent a major advance in preventive healthcare for the maintenance of good health.Read moreRead less
Screening For Chlamydia Trachomatis With Routine Pap Smears In General Practice: A Randomised Controlled Trial
Funder
National Health and Medical Research Council
Funding Amount
$350,500.00
Summary
Genital chlamydia infection is the most commonly reported infectious disease in Australia. Notifications have increased three fold since 1995; five-fold in the ACT and surveillance data underestimate the true incidence of the disease in the community. Chlamydia is associated with immediate morbidity in men and women including urethritis, epididymo-orchitis, cervicitis, and pelvic pain and long-term complications including pelvic inflammatory disease, ectopic pregnancy and tubal factor infertilit ....Genital chlamydia infection is the most commonly reported infectious disease in Australia. Notifications have increased three fold since 1995; five-fold in the ACT and surveillance data underestimate the true incidence of the disease in the community. Chlamydia is associated with immediate morbidity in men and women including urethritis, epididymo-orchitis, cervicitis, and pelvic pain and long-term complications including pelvic inflammatory disease, ectopic pregnancy and tubal factor infertility. The economic costs of Chlamydial infection in Australia have been estimated to be as high as $160 million each year. In the ACT 73.8% of chlamydial infections occur in the 20-40 year old group. Between 60 and 70% of women in this age range participate in Pap screening every two years. While targeted screening for Chlamydia in women is effective in the US, there are few studies that investigate its value in an Australian setting. In this randomised controlled clinical trial we aim to test the novel hypothesis that the routine offer of chlamydia testing to women between 20 and 40 years who undergo Pap screening significantly increases the detection of Chlamydia in that population. This is the first randomised-controlled trial of its type and is an extension of a current non-randomised pilot study of linked Chlamydia-Pap screening in the primary care setting. The aim is to determine if the program can be incorporated more widely in the ACT. The study will: Measure the impact of linked chlamydia-Pap screening on chlamydia screening participation rates More accurately determine the epidemiology of genital chlamydial infection in this age group and social setting; Undertake an economic evaluation of this approach; Determine if promoting the Pap smear as an opportunity for chlamydial screening increases the uptake of Pap screening in younger women Aid in the development of a National Chlamydia Screening strategyRead moreRead less
Towards A Chlamydia Vaccine For Males: The Key Role Of Mucosal IgA
Funder
National Health and Medical Research Council
Funding Amount
$418,978.00
Summary
Genital Chlamydia infections are the most common sexually transmitted infection in Australia with annual health costs of 90-160 million dollars. Infection rates in 15-29 olds are increasing at 15-20% per year in both females and males. Antibiotics are currently the treatment of choice, however antibiotic resistance is increasing and most infections are asymptomatic and not treated in the absence of screening programs. This project aims to develop a Chlamydia vaccine tailored to protect males .