ORCID Profile
0000-0003-1766-0657
Current Organisations
Inselspital Bern Universitätsklinik für Hals- Nasen- und Ohrenkrankheiten Kopf- und Halschirurgie
,
University of Bern
,
Monash University
,
University of Melbourne
,
Alfred Health
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Publications
Optimising the delivery of sexual health services in Australia: a qualitative study
Publisher: CSIRO Publishing
Date: 2022
DOI: 10.1071/SH22024
Response time to an SMS link for a sexual health survey
Publisher: CSIRO Publishing
Date: 10-03-2022
DOI: 10.1071/SH22021
Abstract: In November 2021, clients attending the Melbourne Sexual Health Centre were invited to participate in the Annual Client Satisfaction Survey by receiving an SMS link at 5:15 pm on the day they attended the clinic. We analysed the response time data and found that most (60% 168/278) in iduals responded to the survey during the time period 5:00–5:59 pm, which was around the time when they received the SMS. We concluded that in iduals responded quickly to the survey via an SMS link.
Duration of gonorrhoea and chlamydia infection at the pharynx and rectum among men who have sex with men: A systematic review
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/SH15175
Abstract: Background Chlamydia and gonorrhoea are the two most common sexually transmissible infections (STI) among men who have sex with men (MSM) worldwide. Infections at the pharynx and rectum are usually asymptomatic however, the natural history of these infections remains unknown. The aim of this study is to estimate the duration of both infections at the extragenital sites from published epidemiological cohort studies. Methods: English peer-reviewed articles were searched from 1 January 2000 to 12 March 2015 in three electronic databases (MEDLINE, EMBASE and Cochrane Central). The prevalence-to-incidence ratio from each study was calculated to reflect the duration of each infection. This review followed the PRISMA guidelines and was registered in PROSPERO (CRD42014007087). Results: There were 2585 records identified, with 1721 abstracts and 52 full-text articles screened, resulting in four studies fulfilling the inclusion criteria. Pharyngeal gonorrhoea (114–138 days) had a shorter duration of infection than rectal gonorrhoea (346 days). In addition, chlamydia had a longer duration of infection at the pharynx (667 days) and rectum (579 days) compared with gonorrhoea infection. Conclusions: Gonorrhoea has a shorter duration of infection than chlamydia, suggesting that annual STI screening will be more effective at diagnosing chlamydia than gonorrhoea. The current STI guidelines recommend screening gonorrhoea and chlamydia at least once a year in MSM it would only detect ~30% of incident pharyngeal gonorrhoea cases, with a mean duration of 4 months.
Trends and Risk Factors for Antimicrobial-Resistant Neisseria gonorrhoeae , Melbourne, Australia, 2007 to 2018
Publisher: American Society for Microbiology
Date: 10-2019
DOI: 10.1128/AAC.01221-19
Abstract: Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a major public health problem. Traditionally, AMR surveillance programs for N. gonorrhoeae have focused mainly on laboratory data to describe the prevalence and trends of resistance. However, integrating in idual-level risk factors (e.g., sexual orientation or international travel) with laboratory data provides important insights into factors promoting the spread of resistant N. gonorrhoeae .
The frequency of kissing as part of sexual activity differs depending on how men meet their male casual sexual partners
Publisher: SAGE Publications
Date: 19-12-2017
Abstract: Previous studies have shown that men who have sex with men (MSM) who use smartphone dating applications (apps) are at higher risk of gonorrhoea, but not HIV. We have hypothesised that kissing may be a risk factor for oropharyngeal gonorrhoea. We measured differences in kissing practices among MSM who use different methods to find male casual sexual partners (CSPs). If MSM who use apps kiss more CSPs, then this may help to explain why these men are at increased risk of gonorrhoea but not HIV. This was a cross-sectional questionnaire-based study of MSM attending Melbourne Sexual Health Centre, Australia, between March and September 2015. We measured differences in kissing practices among MSM who use different methods to find male casual sexual partners (CSPs). The questionnaire included questions about numbers of CSPs, numbers of CSPs kissed, and how men found CSPs. We surveyed 753 MSM with a median age of 29 years (interquartile range 25–36). Six hundred and one men (79.8%) reported using apps to find CSPs in the last three months. Users of apps had a higher number of CSPs than non-users (5.0 vs. 3.2 p 0.001). Users of apps kissed a higher number (4.6 vs. 2.2 p 0.001), and a higher proportion (90.4% vs. 71.0% p 0.001) of CSPs compared to non-users. We are currently investigating whether kissing is a significant mode of transmission of gonorrhoea, and if this proves correct then this study suggests that users of apps would particularly benefit from health promotion that addresses this mode of transmission.
Sex is associated with the persistence of non-optimal vaginal microbiota following treatment for bacterial vaginosis: a prospective cohort study.
Publisher: Wiley
Date: 16-08-2020
Brief Report: Changes in PrEP Use, Sexual Practice, and Use of Face Mask During Sex Among MSM During the Second Wave of COVID-19 in Melbourne, Australia
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2021
International travel as risk factor for Chlamydia trachomatis infections among young heterosexuals attending a sexual health clinic in Melbourne, Australia, 2007 to 2017
Publisher: European Centre for Disease Control and Prevention (ECDC)
Date: 31-10-2019
DOI: 10.2807/1560-7917.ES.2019.24.44.1900219
Abstract: International travel is considered a risk factor for acquiring Chlamydia trachomatis however, there are little empirical data to support this. To examine the prevalence and risk factors for Chlamydia trachomatis infections among heterosexual international travellers (n = 28,786) attending the Melbourne Sexual Health Centre (MSHC), Australia, compared to Australian residents (n = 20,614). We conducted a repeated cross-sectional study and analysed sexual behaviours and chlamydia positivity among heterosexual males and females aged ≤ 30 attending MSHC for the first time between January 2007 and February 2017. ‘Travellers’ were defined as in iduals born outside of Australia who had resided in the country 2 years. Associations between patient characteristics and chlamydia positivity were examined. Chlamydia positivity was higher among travellers (11.2%) compared with Australian residents (8.5% p 0.001). Male travellers had higher chlamydia positivity (12.1%) than Australian males (9.3% p 0.001), as did female travellers (10.4%) compared with Australian females (7.7% p 0.001). Travellers had a higher mean number of sexual partners than Australian residents among males (5.7 vs 4.7 p 0.001) and females (3.6 vs 3.2 p 0.001). Travellers from the United Kingdom, Europe, Ireland and New Zealand accounted for 29.6%, 21%, 8.5% and 5.8% of C. trachomatis infections, respectively. Chlamydia in males and females was associated with younger age (≤ 25), inconsistent condom use, a higher number of sexual partners (≥ 4 partners) and being a traveller (p 0.001). We found that international travel is an independent risk factor for chlamydia among young heterosexual travellers in Australia, who should therefore be a target group for chlamydia prevention.
Potential effect of antiseptic mouthwash on the incidence of Neisseria gonorrhoeae among men who have sex with men: a mathematical modelling study
Publisher: BMJ
Date: 10-2021
DOI: 10.1136/BMJOPEN-2021-052823
Abstract: The incidence of Neisseria gonorrhoeae and its antimicrobial resistance is increasing in many countries. Antibacterial mouthwash may reduce gonorrhoea transmission without using antibiotics. We modelled the effect that antiseptic mouthwash may have on the incidence of gonorrhoea. We developed a mathematical model of the transmission of gonorrhoea between each anatomical site (oropharynx, urethra and anorectum) in men who have sex with men (MSM). We constructed four scenarios: (1) mouthwash had no effect (2) mouthwash increased the susceptibility of the oropharynx (3) mouthwash reduced the transmissibility from the oropharynx (4) the combined effect of mouthwash from scenarios 2 and 3. We used data at three anatomical sites from 4873 MSM attending Melbourne Sexual Health Centre in 2018 and 2019 to calibrate our models and data from the USA, Netherlands and Thailand for sensitivity analyses. Published available data on MSM with multisite infections of gonorrhoea. Incidence of gonorrhoea. The overall incidence of gonorrhoea was 44 (95% CI 37 to 50)/100 person-years (PY) in scenario 1. Under scenario 2 (20%–80% mouthwash coverage), the total incidence increased (47–60/100 PY) and at all three anatomical sites by between 7.4% (5.9%–60.8%) and 136.6% (108.1%–177.5%). Under scenario 3, with the same coverage, the total incidence decreased (20–39/100 PY) and at all anatomical sites by between 11.6% (10.2%–13.5%) and 99.8% (99.2%–100%). Under scenario 4, changes in the incidence depended on the efficacy of mouthwash on the susceptibility or transmissibility. The effect on the total incidence varied (22–55/100 PY), and at all anatomical sites, there were increases of nearly 130% and large declines of almost 100%. The effect of mouthwash on gonorrhoea incidence is largely predictable depending on whether it increases susceptibility to or reduces the transmissibility of gonorrhoea.
Extragenital Mycoplasma genitalium infections among men who have sex with men
Publisher: BMJ
Date: 19-06-2019
DOI: 10.1136/SEXTRANS-2019-054058
Abstract: There are limited data on the prevalence of Mycoplasma genitalium (Mgen) coinfection with rectal chlamydia ( Chlamydia trachomatis (CT)) and rectal gonorrhoea ( Neisseria gonorrhoeae (NG)) infections and few studies examining the prevalence of pharyngeal Mgen in men who have sex with men (MSM). Using transcription-mediated lification assay, this study aimed to determine the proportion of rectal CT and rectal NG infections in MSM who are coinfected with rectal Mgen, and the proportion of MSM with Mgen detected in the pharynx in order to inform clinical practice. This was a cross-sectional study conducted at Melbourne Sexual Health Centre in Australia. Consecutively collected rectal swabs from MSM that tested positive for CT (n=212) or NG (n=212), and consecutively collected pharyngeal s les (n=480) from MSM were tested for Mgen using the Aptima Mycoplasma genitalium Assay (Hologic, San Diego). S les were linked to demographic data and symptom status. Rectal Mgen was codetected in 27 of 212 rectal CT (13%, 95% CI 9 to 18) and in 29 of 212 rectal NG (14%, 95% CI 9 to 19) s les, with no difference in the proportion positive for Mgen. MSM with rectal CT/Mgen coinfection had more sexual partners than those with rectal CT monoinfection (mean 6 vs 11, p=0.06). MSM with rectal NG/Mgen coinfection were more likely to be HIV-positive than those with rectal NG monoinfection (OR=2.96, 95% CI 1.21 to 7.26, p=0.023). MSM with rectal CT/Mgen coinfection were more likely to be using pre-exposure prophylaxis than MSM with rectal NG/Mgen coinfection (OR 0.25, 95% CI 0.10 to 0.65, p=0.002). Pharyngeal Mgen was uncommon and detected in 8 of 464 s les (2%, 95% CI 1% to 3%). Pharyngeal Mgen was associated with having a rectal STI (OR=10.61, 95% CI 2.30 to 48.87, p=0.002), and there was a borderline association with being HIV-positive (p=0.079). These data indicate one in seven MSM treated for rectal CT or rectal NG will have undiagnosed Mgen that is potentially exposed to azithromycin during treatment of these STIs. Rectal Mgen coinfection was associated with specific risk factors which may inform testing practices. Pharyngeal Mgen was uncommon.
Rising Chlamydia and Gonorrhoea Incidence and Associated Risk Factors among Female Sex Workers in Australia: A Retrospective Cohort Study
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2018
Azithromycin 1.5g Over 5 Days Compared to 1g Single Dose in Urethral Mycoplasma genitalium
Publisher: Oxford University Press (OUP)
Date: 24-10-2017
DOI: 10.1093/CID/CIW719
Abstract: We evaluated the impact of extended azithromycin (1.5g over 5 days) on selection of macrolide resistance and microbiological cure in men with Mycoplasma genitalium urethritis during 2013-2015 and compared this to cases treated with azithromycin 1g in 2012-2013. Microbiological cure was determined for men with M. genitalium urethritis treated with azithromycin 1.5g using quantitative polymerase chain reaction specific for M. genitalium DNA on s les 14-100 days post-treatment. Pre- and post-treatment macrolide resistance mutations were detected by sequencing the 23 S gene. There was no difference in proportions with microbiological cure between azithromycin 1.5g and 1g: 62/106 (58% 95% confidence interval [CI], 49%, 68%) and 56/107 (52% 95%CI 42-62%), P = .34, respectively. Also, there was no difference in the proportion of wild-type 23 S rRNA (presumed macrolide sensitive) infections cured after 1.5g and azithromycin 1g: 28/34 (82% 95%CI 65-92%) and 49/60 (82% 95%CI 70-90%), P=1.0, respectively. There was no difference between 1.5g and 1g in the proportions of wild-type infections with post-treatment resistance mutations: 4/34 (12% 95%CI 3-27%) and 11/60 (18% 95%CI 10-30%), respectively, P = .40. Pre-treatment resistance was present in 51/98 (52% 95%CI 42-62%) cases in 2013-2015 compared to 47/107 (44% 95%CI 34-54%) in 2012-2013, P = .25. Extended azithromycin 1.5g was no more effective than a single 1g dose at achieving cure of M. genitalium urethritis and importantly did not reduce the selection of macrolide resistance. Nonmacrolide and new approaches for the treatment of M. genitalium urethritis are required.
Human Papillomavirus Vaccine Course Completion Among Gay and Bisexual Men Who Have Sex With Men From a Time-Limited HPV Vaccination Catch-Up Program in Victoria, Australia
Publisher: Frontiers Media SA
Date: 07-10-2021
DOI: 10.3389/FPUBH.2021.754112
Abstract: Background: To examine completion of the human papillomavirus (HPV) vaccination 3-dose regimen and factors associated with completion among men who have sex with men (MSM) aged ≤ 26 years participating in a time-limited HPV catch-up vaccination program in Victoria, Australia. Methods: MSM who received their first dose of HPV vaccine at Melbourne Sexual Health Centre in 2017 were followed until October 2019. Vaccination completion was defined as those who received three doses. Multivariable logistic regression was performed to examine factors associated with vaccine completion. Results: 931 of 1,947 (47.8%) eligible men received at least one dose of HPV vaccine, 750 (38.5%) received two and 590 (30.3%) received three doses. The median time to receiving the second and third dose was 2.8 (IQR = 2.1–4.8) and 7.2 (IQR = 6.3–10.7) months, respectively. Gay men had higher odds of receiving three doses compared to bisexual men (aOR = 2.17 95%CI: 1.16–4.04). Compared with HIV-negative MSM not taking PrEP, HIV-positive MSM were more like to complete vaccination (aOR = 3.92, 95%CI: 1.62–9.47) but no difference was found compared to HIV-negative men taking PrEP (aOR = 1.55 95%CI: 0.95–2.53). Conclusion: Less than one-third of men aged ≤ 26 years completed the three doses of HPV vaccine. Further studies are needed to understand the barriers of men not completing the vaccine.
Should Asymptomatic Men Who Have Sex With Men Be Screened for Oropharyngeal Chlamydia? Clinical Outcomes From a Cross-Sectional Study
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2018
Adherence to, and acceptability of, Listerine® mouthwash as a potential preventive intervention for pharyngeal gonorrhoea among men who have sex with men in Australia
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/SH16026
Abstract: We investigated whether men who have sex with men (MSM) would use mouthwash daily to prevent pharyngeal gonorrhoea. Ten MSM attending the Melbourne Sexual Health Centre were asked to use a Listerine® alcohol-containing mouthwash daily for 14 days in August 2015. Mouthwash was used at least once daily for 133 of 140 person-days (95% of days 95% confidence interval 90–98%). All 10 men were willing to use mouthwash on a daily basis, and nine men were willing to use mouthwash after oral sex. This study showed that daily use of mouthwash is an acceptable intervention to prevent pharyngeal gonorrhoea in MSM.
Age-Specific Pattern of Anogenital Wart in Men Who Have Sex With Men
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2018
Getting the terminology right in sexual health research
Publisher: BMJ
Date: 29-03-2018
DOI: 10.1136/SEXTRANS-2016-053000
Abstract: The aim of this report was to raise the issue of the definition and classification of partner terminology in men who have sex with men (MSM) research, particularly in regards to ‘fuck buddies’. If definitions in research differ from general consensus in the MSM population, it is possible that public health strategies will be ineffective as the target population may be inaccurate. Thirty semistructured interviews with MSM attending the Melbourne Sexual Health Centre were conducted, focusing on the willingness to change sexual practices to reduce the risk of pharyngeal gonorrhoea. As part of these interviews, men were also asked their views on the terminology they used to describe their relationships and sexual partners. The degree of emotional attachment often defined the type or classification of relationships. There was a consensus among men that partners they engaged with for ‘sex only’ were classified as casual partners and partners with whom there was an emotional attachment or formalisation of the relationship were classified as ‘regular partners’. However, the classification of ‘fuck buddy’ as a regular or casual partner was less clear. Further research is needed to ascertain the ways in which men conceptualise sexual relationships and define or classify partner types, particularly ‘fuck buddy’ relationships. A third category for sexual relationships should be considered to encapsulate fuck buddy relationships.
Incidence, Clearance, and Persistence of Anal Human Papillomavirus in Men Who Have Sex With Men Living With Human Immunodeficiency Virus: Implications for Human Papillomavirus Vaccination
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2019
DOI: 10.1097/OLQ.0000000000000958
Abstract: Men who have sex with men living with human immunodeficiency virus have a high risk of anal cancer. We estimate the likely benefit of human papillomavirus (HPV) vaccination among participants of the Anal Cancer Examination study. Anal swabs were collected for the detection and genotyping of anal HPV DNA by linear array (Roche Diagnostics) in this 2-year multicenter prospective cohort. We calculated the proportion of men, stratified by age, without detectable vaccine type-specific DNA. Overall, 255 men, with a median age of 50 years (interquartile range, 44–56 years) contributed 488.9 person-years of follow-up. After 2 years of follow-up, 149 (58% 95% confidence interval [CI], 52–65) had at least 1 high-risk HPV (HRHPV), and 71 (28%, 95% CI, 22–34) had HPV types 16/18 detected. Assuming that DNA-negative men would receive vaccine protection, vaccination at baseline could potentially prevent HRHPV infection in 10.2% of men (95% CI, 6.8–14.6, 26 of 255) 2 years later from incident HRHPV covered by the bivalent and quadrivalent vaccine, and 29.4% of men (95% CI, 23.9–35.4, 75/255) from incident HRHPV covered by the nonavalent vaccine. Though there is high prevalence of anal HPV in men who have sex with men living with human immunodeficiency virus, there was also a high incidence of HRHPV vaccine types in the 2-year follow-up, indicating potential for prevention if these men were not previously infected with HPV vaccine types and were vaccinated at their baseline visit.
Oropharyngeal gonorrhoea infections among heterosexual women and heterosexual men with urogenital gonorrhoea attending a sexual health clinic in Melbourne, Australia
Publisher: Elsevier BV
Date: 12-2021
DOI: 10.1016/J.CMI.2021.03.033
Abstract: There is limited evidence about the transmission and prevalence of oropharyngeal gonorrhoea in heterosexuals. From August 2017, Melbourne Sexual Health Centre (MSHC) began testing for oropharyngeal gonorrhoea among heterosexuals with untreated urogenital gonorrhoea. This study aims to determine the positivity of oropharyngeal gonorrhoea among heterosexuals diagnosed with urogenital gonorrhoea at MSHC between August 2017 and May 2020. We included in iduals who had oropharyngeal gonorrhoea testing within 30 days of initial testing. We reported the number and proportion of oropharyngeal gonorrhoea positivity, stratified by gender and contact of gonorrhoea. The χ Of 617 in iduals with untreated urogenital gonorrhoea, 424 (68.7%) were tested for oropharyngeal gonorrhoea. Oropharyngeal gonorrhoea positivity was 38.9% (95%CI 34.2-43.7%, 165/424), and was higher in women than in men (115/252, 45.6% versus 50/172, 29.1%, p = 0.001). Furthermore, oropharyngeal gonorrhoea positivity was higher among in iduals who were contacts of gonorrhoea cases compared to those who were not (29/44, 65.9% versus 136/380, 35.8%, p < 0.001). There was also no significant difference between women who were sex workers and those who were not (30/78, 38.5% versus 85/174, 48.9%, p = 0.126). Our data suggest that oropharyngeal gonorrhoea infection is common among heterosexual women and heterosexual men with untreated urogenital gonorrhoea. Testing heterosexual women and heterosexual men for oropharyngeal gonorrhoea will identify a significant proportion with unrecognized oropharyngeal infections whose recommended treatment is different in some countries.
Drug and Alcohol Use with Condomless Anal Sex among Men Who Have Sex with Men in Melbourne, Australia: A Retrospective Data Analysis from 2011 to 2017
Publisher: Springer Science and Business Media LLC
Date: 10-11-2021
DOI: 10.1007/S10508-021-01966-1
Abstract: Rises in condomless anal sex among men who have sex with men (MSM) have been reported over the last decade but there is less certainty about the role that drugs, alcohol, play in this change. We examined the changes in drug and alcohol use among 22,255 MSM reporting condomless anal sex at Melbourne Sexual Health Centre in 2011-2017. There was a 7% annual increase in using drugs before and/or during condomless anal sex but a 3% annual reduction in condomless anal sex while drunk. MSM taking PrEP were more likely to report condomless anal sex with drug use (AOR: 1.21 95%CI: 1.07-1.37) and alcohol use (AOR: 1.29 95%CI: 1.14-1.46) compared with MSM not taking PrEP.
Sampling time for self-taking an oropharyngeal swab for gonorrhoea and chlamydia testing
Publisher: CSIRO Publishing
Date: 28-04-2022
DOI: 10.1071/SH22034
Abstract: Self-taking oropharyngeal swabs for sexually transmitted infections such as gonorrhoea and chlamydia has become more common during the COVID-19 pandemic to minimise the risk to healthcare workers. However, there have been no standardised guidelines on s ling time for taking an oropharyngeal swab for gonorrhoea and chlamydia testing. We recruited 215 participants at the Melbourne Sexual Health Centre, Australia, between November 2021 and January 2022. We asked participants to report the time they spent on self-taking the oropharyngeal swab. The median self-taking s ling time was 8 s (IQR = 5–12), and the time did not differ between oropharyngeal gonorrhoea positivity (P = 0.570) and oropharyngeal chlamydia positivity (P = 0.457).
HIV non-occupational post-exposure prophylaxis (nPEP) awareness and promotion among five key populations in China: A cross-sectional study
Publisher: Elsevier BV
Date: 02-2021
Oropharyngeal Gonorrhea in Absence of Urogenital Gonorrhea in Sexual Network of Male and Female Participants, Australia, 2018
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 07-2019
The HIV care cascade: a systematic review of data sources, methodology and comparability
Publisher: Wiley
Date: 2015
Preferences of men who have sex with men for performing anal self-examination for the detection of anal syphilis in Australia: A discrete choice experiment
Publisher: Elsevier BV
Date: 04-2022
A cross-sectional study of male and female kissing partners among men who have sex with men
Publisher: CSIRO Publishing
Date: 04-03-2022
DOI: 10.1071/SH21184
Abstract: Background Kissing may be a risk factor for gonorrhoea. Past studies have focused on male kissing partners among men who have sex with men (MSM). This study aimed to examine the kissing practices of MSM who kiss male and female partners. Methods We conducted a cross-sectional survey at the Melbourne Sexual Health Centre (MSHC) between March and April 2019. Men attending the MSHC, aged ≥16 years who reported any sexual contact with another man in the previous 12 months were invited to participate in the survey. Data about the number of kissing-only (kissing without sex), kissing-with-sex, and sex-only (having sex without kissing) partners in the previous 3 months were collected. Men were asked to report the number of male and female partners separately. Results There were 357 MSM included in the survey. Most men (97.2%, n = 347) had kissed or had sex with another man, whereas 16.0% (n = 57) had kissed or had sex with a female partner in the previous 3 months. Of the 57 men, 26.3% (n = 15) had only kissed a female partner without having sex. The mean number of male partners for kissing-only was 5.5 (s.d. = 6.6), kissing-with-sex was 5.0 (s.d. = 6.6) and sex-only was 3.9 (s.d. = 4.3). The mean number of female partners for kissing-only was 4.2 (s.d. = 6.9), kissing-with-sex was 3.8 (s.d. = 4.9) and sex-only was 3.2 (s.d. = 3.4). Conclusion MSM not only kiss men in the absence of sex, but also kiss women in the absence of sex. Gonorrhoea could be transmitted between MSM and women via kissing in the absence of sex.
Shifting Patterns of the HIV Epidemic in Southwest China: A Case Study Based on Sentinel Surveillance, 1995–2012
Publisher: Mary Ann Liebert Inc
Date: 06-2015
Abstract: The HIV epidemic is experiencing a rapid shift in transmission profile in China. This study aims to examine the changes in magnitude, transmission pattern, and trend of the HIV epidemic in a typical Southwest Chinese prefecture over the period of 1995-2012. HIV surveillance data from the web-based reporting system were analyzed during this period. We investigated the temporal trends in the changing characteristics of HIV transmission, the HIV disease burden in key affected populations, and assessed the impacts on HIV disease progression due to scale-up of antiretroviral treatment. A total of 3556 HIV/AIDS cases were reported in Yuxi prefecture, Yunnan, over the study period. The number of HIV tests conducted has dramatically increased from 1041 in 1995 to 247,859 in 2012, resulting in a substantial increase in HIV diagnoses from 11 cases to 327 cases over the same period. Since 2005, cumulatively 1250 eligible people living with HIV (PLHIV) have received combination antiretroviral therapy which reduced AIDS disease progression from 9.0% (95% CI: 6.7-11.4%) in 1995 to 0.1% (0-0.3%) in 2012 (ptrend=0.0002). The primary mode of HIV transmission has been shifted from injection sharing (71.9% diagnoses in 1995-2004) to unsafe sexual contacts (82.6% diagnoses in 2012). Yuxi prefecture is experiencing a concentrated but shifting HIV epidemic. Scale-up of HIV testing is essential to effective sentinel surveillance and enhancing early diagnosis and treatment in PLHIV.
Anorectal swabs as a marker of male-to-male sexual exposure in STI surveillance systems
Publisher: Cambridge University Press (CUP)
Date: 22-05-2017
DOI: 10.1017/S095026881700098X
Abstract: Identification of priority populations such as men who have sex with men (MSM) is important in surveillance systems to monitor trends of sexually transmitted infections (STIs). We explored using routinely collected non-behavioural data as a means to establish MSM status in surveillance by assessing anorectal swab as a marker of male-to-male sexual exposure. We used chlamydia testing data from a sexual health clinic, 2007–2012. Men reporting any male sexual partner(s) in the previous 12 months were considered MSM. The dataset was split into development and validation s les to develop a univariate predictive model and assess the model fit. The dataset included 30 358 in idual men and 48 554 episodes of STI testing 45% were among reported MSM and an anorectal swab was performed in 40% of testing episodes. Anorectal swabbing had good diagnostic performance as a marker for MSM status (sensitivity = 87%, specificity = 99%, positive predictive value = 98·6%, negative predictive value = 90·3%). The model showed good fit against the internal validation s le (area under the curve = 0·93). Anorectal swabs are a valid marker of MSM behaviour in surveillance data from sexual health clinics, and they are likely to be particularly useful for monitoring STI trends among MSM with higher risk behaviour.
Are wives of gay men becoming the next target of HIV infection in China?
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2013
Time to healthcare-seeking following the onset of STI-associated symptoms during two waves of the COVID-19 pandemic in Melbourne, Australia
Publisher: BMJ
Date: 12-08-2021
Epidemiology and prevention of sexually transmitted infections in men who have sex with men at risk of HIV
Publisher: Elsevier BV
Date: 06-2019
HIV and Syphilis Co-Infection Increasing among Men Who Have Sex with Men in China: A Systematic Review and Meta-Analysis
Publisher: Public Library of Science (PLoS)
Date: 15-08-2011
Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis
Publisher: Elsevier BV
Date: 08-2019
Timing of primary syphilis treatment and impact on the development of treponemal antibodies: a cross-sectional clinic-based study
Publisher: BMJ
Date: 29-03-2021
DOI: 10.1136/SEXTRANS-2020-054739
Abstract: Serology is negative in a proportion of primary syphilis cases where Treponema pallidum PCR testing is positive. We aimed to identify discordant, T. pallidum PCR-positive, serology-negative primary syphilis cases and any clinical or laboratory factors associated with failure to subsequently seroconvert. Serodiscordant primary syphilis cases that were T. pallidum PCR-positive and serology-negative (including rapid plasma reagin, T. pallidum particle agglutination, T. pallidum enzyme immunoassay or T. pallidum chemiluminescence assay) were identified from the Melbourne Sexual Health Centre electronic records between April 2011 and December 2019. Clinical and laboratory associations were examined. There were 814 primary syphilis cases in the study period and 38 (4.7%) were serodiscordant, 35 in men who have sex with men. Thirty-two had follow-up serology performed a median of 24 days later, of which 16 (50%) seroconverted, mostly (81%) within 6 weeks. Failure to seroconvert was significantly associated with treatment on day 1. Of the 12 cases treated on day 1, 10 (83%) failed to seroconvert compared with 6 of 20 (30%) among those who were treated after day 1. Earlier treatment of primary syphilis can prevent the development of serological markers. T. pallidum PCR can identify primary syphilis lesions before the development of serological markers and improve diagnosis of early primary syphilis lesions. Serology alone will miss a proportion of primary syphilis infections and should be repeated if a diagnosis of syphilis is being considered.
Chlamydia trachomatis transmission between the oropharynx, urethra and anorectum in men who have sex with men: a mathematical model
Publisher: Springer Science and Business Media LLC
Date: 17-11-2020
DOI: 10.1186/S12916-020-01796-3
Abstract: It has been presumed that Chlamydia trachomatis is transmitted between men only through anal or oral sex, but no mathematical models have tested this presumption. To test this presumption, we created 20 compartmental mathematical models of different sexual practices that included both oral and anal sex and calibrated these models to the observed rates of Chlamydia trachomatis infection at three anatomical sites from 4888 men who have sex with men (MSM) in Melbourne Sexual Health Centre during 2018–2019. A model that included only oral and anal sex could replicate the observed rates of single-site infection at the oropharynx, urethra and rectum alone, but could not replicate infection at more than one of these sites (multisite). However, if we included transmission from sexual practices that followed one another in the same sexual episode (e.g. saliva contamination of the penis from oral sex transmitting chlamydia to the rectum by anal sex), we significantly improved the calibration of multisite infection rates substantially. Our modelling study suggests that transmission routes other than just oral and anal sex are necessary to explain the high rate of Chlamydia trachomatis infection at more than one site.
Models of gonorrhoea transmission from the mouth and saliva
Publisher: Elsevier BV
Date: 10-2019
HIV and HCV prevalence among entrants to methadone maintenance treatment clinics in China: a systematic review and meta-analysis
Publisher: Springer Science and Business Media LLC
Date: 08-06-2012
Abstract: Methadone maintenance treatment (MMT) was implemented in China since 2004. It was initiated in 8 pilot clinics and subsequently expanded to 738 clinics by the end of 2011. Numerous in idual research studies have been conducted to estimate HIV and HCV prevalence among MMT clients but an overview of the epidemics in relations to MMT remains unclear. The aim of this study is to estimate the magnitude and changing trends of HIV, HCV and HIV-HCV co-infections among entry clients to MMT clinics in China during 2004-2010. Chinese and English databases of literature were searched for studies reporting HIV, HCV and co-infection prevalence among MMT clients in China from 2004 to 2010. The prevalence estimates were summarized through a systematic review and meta-analysis of published literatures. Ninety eligible articles were selected in this review (2 in English and 88 in Chinese). Nationally, pooled prevalence of HIV-HCV and HIV-HCV co-infection among MMT clients was 6.0% (95%CI: 4.7%-7.7%), 60.1% (95%CI: 52.8%-67.0%) and 4.6% (95%CI: 2.9%-7.2%), respectively. No significant temporal trend was found in pooled prevalence estimates. Study location is the major contributor of heterogeneities of both HIV and HCV prevalence among drug users in MMT. There was no significant temporal trend in HIV and HCV prevalence among clients in MMT during 2004–2010. Prevalence of HCV is markedly higher than prevalence of HIV among MMT clients. It is recommended that health educational programs in China promote the earlier initiation and wider coverage of MMT among injecting drug users (IDUs), especially HIV-infected IDUs.
HIV incidence and predictors of incident HIV among men who have sex with men attending a sexual health clinic in Melbourne, Australia
Publisher: Public Library of Science (PLoS)
Date: 24-05-2016
The Preferred Qualities of Human Immunodeficiency Virus Testing and Self-Testing Among Men Who Have Sex With Men: A Discrete Choice Experiment
Publisher: Elsevier BV
Date: 07-2020
Surface matching for high-accuracy registration of the lateral skull base
Publisher: Springer Science and Business Media LLC
Date: 03-05-2016
DOI: 10.1007/S11548-016-1394-3
Abstract: The accuracy achievable when utilizing image guidance depends to a large extent on the accuracy with which the patient can be registered to preoperative image data. This work proposes a method for the registration of the temporal bone based on surface matching and investigates the achievable accuracy of the technique. Fourteen human temporal bones were utilized for evaluation incisions were made, fiducial screws were implanted to act as a ground truth, and imaging was performed. The positions of the fiducials and surface of the mastoid were extracted from image data and reference positions defined at the round window and the mastoid surface. The surface of the bone was then digitized using a tracked pointer within the region exposed by the incisions and the physical and image point clouds registered, with the result compared to the fiducial-based registration. Results of one case were excluded due to a problem with the ground truth registration. In the remaining cases an accuracy of [Formula: see text] and [Formula: see text] mm was observed relative to the ground truth at the surface of the mastoid and round window, respectively. A technique for the registration of the temporal bone was proposed, based on surface matching after exposure of the mastoid surface, and evaluated on human temporal bone specimens. The results reveal that high-accuracy patient-to-image registration is possible without the use of fiducial screws.
Supernatural beliefs, religious affiliations, and HIV testing among recently arrived Asian-born men who have sex with men in Australia
Publisher: Informa UK Limited
Date: 23-02-2023
The rate of HIV testing is increasing among men who have sex with men in China
Publisher: Wiley
Date: 18-01-2012
DOI: 10.1111/J.1468-1293.2011.00974.X
Abstract: HIV infection is spreading relatively quickly among men who have sex with men (MSM) in China. Accurate knowledge of HIV status is of high importance for public health prevention. We conducted a systematic review of literature published in either English or Chinese to collate available HIV testing data among MSM in China. Linear regression and Spearman's rank correlation were used to study factors associated with HIV testing rates. Fifty-five eligible articles were identified in this review. The proportion of MSM who had ever been tested for HIV has significantly increased, from 10.8% in 2002 to 51.2% in 2009. In comparison, reported rates of HIV testing in the past 12 months have also significantly increased, from 11.0% in 2003 to 43.7% in 2009. Chinese MSM have relatively low HIV testing rates compared with MSM in other settings. It is important to continue to promote HIV testing among MSM in China.
Sexual activities and condom use among heterosexual men and women engaged in mixed-gender group sex events in Melbourne, Australia
Publisher: CSIRO Publishing
Date: 22-11-2022
DOI: 10.1071/SH22045
Abstract: Background Few studies investigate group sex among heterosexuals. The aim of this study was to provide an exploration of characteristics and practices among heterosexual men and women who engage in group sex. Method We conducted a cross-sectional survey between May 2019 and March 2020 among heterosexual men and women attending a sexual health clinic in Melbourne, Australia. Participants were asked whether they had participated in group sex (sex involving more than two participants) in the past 3 months, the size of the most recent event, sexual activities in which they engaged, and condom use. Results Of 3277 heterosexuals surveyed (1509 women and 1768 men), the mean age was 29.9 years (s.d. 8.8) and more than half (56.0%, n = 1834) were born outside Australia. One in 20 participants (5.4%) had engaged in group sex in the past 3 months with the number of events ranging 1–10 times. Kissing was the most common activity in group sex, and women were significantly more likely to kiss a same-sex partner than men. Overall, of 165 participants who engaged in vaginal sex, 57 (34.5%) reported always using condoms and changing condoms between consecutive partners. Of the 100 men and women who had condomless vaginal sex, 79 (79.0%) received or performed fellatio after condomless vaginal sex. Conclusion About two-thirds of heterosexuals who engaged in group sex neither used condoms nor changed condoms between partners in the most recent group sex event. Safe sex messages on changing condoms between partners and between sexual activities should be reinforced for sexually transmitted infections prevention.
Associations Between Methods of Meeting Sexual Partners and Sexual Practices Among Heterosexuals: Cross-sectional Study in Melbourne, Australia
Publisher: JMIR Publications Inc.
Date: 20-07-2021
DOI: 10.2196/26202
Abstract: The association between meeting partners on the web and sexual practices has been understudied in heterosexuals. This study aims to examine the associations between the methods of meeting partners and sexual practices and HIV and sexually transmitted infections (STIs) in heterosexuals. We conducted a survey among heterosexuals attending the Melbourne Sexual Health Centre in 2019. This survey asked about the methods through which the participants engaged in meeting their sexual partners, sexual practices, and intravenous drug use (IVDU) over the past 3 months. The participants’ HIV and STI (chlamydia, gonorrhea, and syphilis) status was obtained from clinical testing. Multivariable logistic regression was used to examine the association between each method of meeting and the participants’ sexual practices, IVDU, and STI status. A total of 698 participants (325 men and 373 women) were included in the study. Most of the participants reported using only one method to meet partners (222/325, 68.3% men 245/373, 65.7% women P=.05). The men met partners most commonly at social venues (eg, bar, pub, or party 126/325, 38.8%), whereas the women met partners most commonly through friends or family (178/373, 47.7%). Paying for sex was associated with men meeting partners at sex venues (adjusted odds ratio [AOR] 145.34, 95% CI 26.13-808.51) and on the internet (AOR 10.00, 95% CI 3.61-27.55). There was no association between IVDU and methods of meeting. Social venues were associated with condomless vaginal sex among men (AOR 3.31, 95% CI 1.94-5.71) and women (AOR 2.58, 95% CI 1.61-4.13) and testing positive for STI among men (AOR 3.04, 95% CI 1.24-7.48) and women (AOR 3.75, 95% CI 1.58-8.89). Heterosexuals who met partners at social venues had a more than threefold risk of testing positive for STIs, indicating that heterosexuals may benefit from health promotion c aigns that are delivered through a public setting.
Population Statistics Approach for Safety Assessment in Robotic Cochlear Implantation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2017
DOI: 10.1097/MAO.0000000000001357
Abstract: Descriptive statistics with respect to patient anatomy and image guidance accuracy can be used to assess the effectiveness of any system for minimally invasive cochlear implantation, on both an in idual patient and wider population level. Minimally invasive cochlear implantation involves the drilling of a tunnel from the surface of the mastoid to cochlea, with the trajectory passing through the facial recess. The facial recess anatomy constrains the drilling path and places prohibitive accuracy requirements on the used system. Existing single thresholds are insufficient for assessing the effectiveness of these systems. A statistical model of the anatomical situation encountered during minimally invasive drilling of the mastoid for cochlear implantation was developed. A literature review was performed to determine the statistical distribution of facial recess width these values were confirmed through facial recess measurements on computed tomography (CT) data. Based on the accuracy of a robotic system developed by the authors, the effect of variation of system accuracy, precision, and tunnel diameter examined with respect to the potential treatable portion of the population. A facial recess diameter of 2.54 ± 0.51 mm (n = 74) was determined from a review of existing literature subsequent measurements on CT data revealed a facial recess diameter of 2.54 ± 0.5 mm (n = 23). The developed model demonstrated the effects of varying accuracy on the treatable portion of the population. The presented model allows the assessment of the applicability of a system on a wider population scale beyond examining only the system's ability to reach an arbitrary threshold accuracy.
Genomic assessment of within-host population variation inNeisseria gonorrhoeae: Implications for gonorrhoea transmission
Publisher: Cold Spring Harbor Laboratory
Date: 31-08-2020
DOI: 10.1101/2020.08.24.20181230
Abstract: Mathematical modelling and genomic analyses are powerful methods for investigating the transmission dynamics of Neisseria gonorrhoeae , however, often make the implicit assumption that N. gonorrhoeae isolates at different anatomical sites within the same in idual are the same strain. In this study, two approaches were used to explore genetic ersity. First, we examined a collection of stored, clinical N. gonorrhoeae isolates sourced from multiple anatomical sites of single in iduals attending a sexual health clinic in Melbourne from 2011-2019. Second, we obtained multiple colony picks from primary clinical s les from in iduals attending a sexual health clinic in Melbourne from 2019-2020. Whole genome sequencing and a variety of bioinformatics approaches were used to determine both within-host and within-s le genetic ersity. Thirty-seven in iduals were identified that had cultured N. gonorrhoeae from two or more anatomical sites (urogenital, anorectal, or oropharyngeal), with a final dataset of 105 isolates. In 35/37 (94.6%) in iduals, infections were highly similar at the genetic level, with identical MLST and NG-MAST profiles. Pairwise comparisons of isolates within each in idual indicated that the maximum within-host pairwise SNP distance was 13 SNPs (median = 1, IQR: 0-3). Notably, four distinct multi-in idual phylogenetic clusters were identified, where the maximum pairwise SNP distance was 19 SNPs (median = 6, IQR = 2-11). Similarly, comparisons of isolates within each primary s le indicated that the maximum pairwise SNP distance was 8 SNPs (median = 2, IQR:1-3). This study suggests that in most cases of multi-site infection, the same strain of N. gonorrhoeae causes the infection at each anatomical site. However, WGS data alone cannot differentiate between the same infecting strain or (re)infections from the same transmission network. These data guide recommendations regarding optimal bioinformatic approaches to infer genetic relatedness of N. gonorrhoeae and will help inform future studies of gonorrhoea transmission and epidemiology. In most cases of multi-site infection, the same strain of N. gonorrhoeae causes infection at each anatomical site (urogenital, anorectal, and oropharyngeal) within an in idual. It is not possible, using genomics alone, to determine if an infection is from a single in idual or multiple in iduals within the same sexual network. Current literature reports an array of different bioinformatic methods for describing genetic ersity, highlighting that SNP thresholds are not directly transferable between studies.
Brief Report: Sexual Mixing Patterns by HIV Status and PrEP Use Among Men Who Have Sex With Men Partnerships in Melbourne, 2011–2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2020
Accessible health care is critical to the effective control of sexually transmitted infections
Publisher: CSIRO Publishing
Date: 2022
DOI: 10.1071/SH22042
Prevention of mother-to-child HIV transmission cascade in China: a systematic review and meta-analysis
Publisher: BMJ
Date: 02-05-2015
Trends and differences in sexual practices and sexually transmitted infections in men who have sex with men only (MSMO) and men who have sex with men and women (MSMW): a repeated cross-sectional study
Publisher: BMJ
Date: 11-2020
DOI: 10.1136/BMJOPEN-2020-037608
Abstract: In the 2010s, there has been an increase in sexually transmitted infections (STI) in men who have sex with men (MSM) in Australia, and since 2015 also in urban heterosexuals. Men who have sex with both men and women (MSMW) have characteristics that may differ from both men who have sex with men only (MSMO) and heterosexual men. We aimed to compare the sexual practices and the trends in HIV/STI positivity between MSMO and MSMW. Repeated cross-sectional study. A sexual health centre in Melbourne, Australia. MSM aged 18 years and above who attended the Melbourne Sexual Health Centre for the first time between 2011 and 2018. This includes 12 795 MSMO and 1979 MSMW. Demographic characterics, sexual practices and HIV/STI positivity. Compared with MSMW, MSMO were more likely to practice anal sex and to have condomless receptive anal sex with casual male partners, and less likely to have a current regular relationship. Over the 8-year period, there was an increase in condomless receptive anal sex with casual male partners for both groups (MSMO: from 46.2% to 63.3%, p trend .001 MSMW: from 41.3% to 57.9%, p trend =0.011). Syphilis positivity increased in MSMO (from 5.5% to 7.9%, p trend =0.012) and MSMW (from 0.9% to 6.4%, p trend =0.004) and HIV remained stable. Gonorrhoea increased among MSMO from 2011 to 2014 (from 6.7% to 9.6%, p trend =0.002), and remained stable from 2015 to 2018. MSMO had higher odds of testing positive for gonorrhoea (adjusted OR (aOR) 1.36, 95% CI 1.13 to 1.64), chlamydia (aOR 1.39, 95% CI 1.16 to 1.67), syphilis (aOR 1.74, 95% CI 1.37 to 2.22) and HIV (aOR 4.60, 95% CI 2.43 to 8.70) than MSMW. MSMW have overall lower condomless sex and lower HIV/STI positivity. In the last years, changes in sexual practices in MSM have affected both MSMW and MSMO leading to an increased STI risk.
Robotic middle ear access for cochlear implantation: first in man
Publisher: Cold Spring Harbor Laboratory
Date: 03-07-2019
DOI: 10.1101/19000711
Abstract: To demonstrate the feasibility of robotic middle ear access in a clinical setting, nine adult patients with severe-to-profound hearing loss indicated for cochlear implantation were included in this clinical trial. A keyhole access tunnel to the tympanic cavity and targeting the round window was planned based on preoperatively acquired computed tomography image data and robotically drilled to the level of the facial recess. Intraoperative imaging was performed to confirm sufficient distance of the drilling trajectory to relevant anatomy. Robotic drilling continued toward the round window. The cochlear access was manually created by the surgeon. Electrode arrays were inserted through the keyhole tunnel under microscopic supervision via a tympanomeatal flap. All patients were successfully implanted with a cochlear implant. In 9 of 9 patients the robotic drilling was planned and performed to the level of the facial recess. In 3 patients, the procedure was reverted to a conventional approach for safety reasons. No change in facial nerve function compared to baseline measurements was observed. Robotic keyhole access for cochlear implantation is feasible. Further improvements to workflow complexity, duration of surgery, and usability including safety assessments are required to enable wider adoption of the procedure.
Concordance of gonorrhoea of the rectum, pharynx and urethra in same-sex male partnerships attending a sexual health service in Melbourne, Australia
Publisher: Springer Science and Business Media LLC
Date: 27-02-2018
Reply to Kenyon.
Publisher: Oxford University Press (OUP)
Date: 16-10-2018
DOI: 10.1093/CID/CIX905
The Next Era of HIV in China: Rapidly Spreading Epidemics Among Men Who Have Sex With Men
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2010
The diagnostic accuracy of pooled testing from multiple individuals for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae: a systematic review
Publisher: Elsevier BV
Date: 05-2022
DOI: 10.1016/J.IJID.2022.03.009
Abstract: Molecular testing for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) is costly. Therefore, we appraised the evidence regarding pooling s les from multiple in iduals to test for CT/NG. In this systematic review, we searched 5 databases (2000-2021). Studies were included if they contained primary data describing pooled testing. We calculated the pooled sensitivities and specificities for CT and NG using a bivariate mixed-effects logistic regression model. We included 22 studies: most were conducted in high-income countries (81.8%, 18 of 22), among women (73.3%, 17 of 22), and pooled urine s les (63.6%, 14 of 22). Eighteen studies provided 25 estimates for the meta-analysis of diagnostic accuracy, with data from 6,913 pooled specimens. The pooled sensitivity for CT was 98.4% (95% confidence intervals [CI]: 96.8-99.2%, I Pooled testing from multiple in iduals for CT is highly sensitive and specific compared with in idual testing. This approach has the potential to reduce the cost of screening in populations for which single anatomic site screening is recommended.
Sexual health service adaptations to the coronavirus disease 2019 (COVID‐19) pandemic in Australia: a nationwide online survey
Publisher: Elsevier BV
Date: 12-2021
Behavioral Interventions Improve Condom Use and HIV Testing Uptake Among Female Sex Workers in China: A Systematic Review and Meta-Analysis
Publisher: Mary Ann Liebert Inc
Date: 08-2015
Abstract: Condomless commercial sex work is a common mode of HIV transmission in China. This study systematically reviews the impacts of behavioral interventions on condom use and HIV testing uptake among female sex workers (FSW) in China. Chinese and English language peer-reviewed articles published between January 2000 and December 2013 were searched in five electronic databases. Odds ratios (OR) were calculated by comparing the levels of improvements in condom use and HIV testing uptake by various intervention strategies. Study quality was assessed for included studies. This review followed the PRISMA guidelines and was registered in PROSPERO. One hundred and twenty-eight studies met inclusion criteria. Meta-analyses indicated that FSW in the post-intervention period were 2.3-5.0 times more likely to use condoms with male clients in their last sexual act and 2.3-3.4 times more likely to use condoms consistently in the last month than in the pre-intervention period. In particular, multiple session intervention were more effective in improving condom use among FSW with male clients (OR=5.6, [4.0-7.8]) than a single session intervention (OR=3.3, [2.8-3.8]). Behavioral interventions also improved past-12-month HIV testing uptake 4.6-fold (95% CI, 2.9-7.4). Comprehensive intervention programs were more effective (OR=8.1, [4.0-16.7]) in improving HIV testing uptake compared with health education only programs (OR=2.7, [1.6-4.5]). Longer intervention duration (>12 months) did not increase effectiveness in improving condom use or HIV testing rate among Chinese FSWs. Behavioral interventions are effective in improving condom use and HIV testing uptake among Chinese FSW. This review highlights both the potentials and limitations of condom promotion interventions targeting female sex workers.
Treponema pallidum detection in lesion and non-lesion sites in men who have sex with men with early syphilis: a prospective, cross-sectional study
Publisher: Elsevier BV
Date: 09-2021
Ability to access community-based needle-syringe programs and injecting behaviors among drug users: a cross-sectional study in Hunan Province, China
Publisher: Springer Science and Business Media LLC
Date: 2013
Global estimates for the lifetime cost of managing HIV
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 23-03-2021
Evidence for a new paradigm of gonorrhoea transmission: cross-sectional analysis of Neisseria gonorrhoeae infections by anatomical site in both partners in 60 male couples
Publisher: BMJ
Date: 17-04-2019
DOI: 10.1136/SEXTRANS-2018-053803
Abstract: Gonorrhoea transmission between men is currently thought to occur primarily to and from the urethra. Transmission without urethral involvement, from throat-to-throat and throat-to-anus, is considered to be uncommon. Using gonorrhoea results from male couples, we aimed to investigate the transmission dynamics of gonorrhoea. If current medical consensus is correct, then most throat and anal infections should be explained by the partner’s urethral infection. This is a cross-sectional analysis of gonorrhoea diagnosed by nucleic acid lification tests in both partners in male couples who attended Melbourne Sexual Health Centre together between March 2015 and June 2017. Isolates obtained from culture-positive infections underwent whole genome sequencing to assess phylogenetic relatedness between partners. In all 60 couples (120 men) at least one partner had gonorrhoea, and isolates had very high phylogenetic relatedness between partners. After excluding men with urethral gonorrhoea, among 32 men with anal gonorrhoea, 34% (95% CI 19% to 53 %) had a partner with throat gonorrhoea. After excluding couples where either man had urethral gonorrhoea, among 48 couples in which at least one man had throat gonorrhoea, in 23% (95% CI 12% to 37 %) of couples both men had throat gonorrhoea. The observed gonorrhoea positivity when urethral infection is absent supports a new paradigm of gonorrhoea transmission, where the throat is a major source of gonorrhoea transmission between men, through tongue kissing, oroanal sex and saliva use as anal lubricant. Public health messages may need to address the risk of saliva exposure during sex.
Intimacy during the COVID-19 pandemic: an online survey examining the impact of COVID-19 on the sexual practices and dating app usage of people living in Hong Kong
Publisher: CSIRO Publishing
Date: 23-08-2022
DOI: 10.1071/SH22058
Abstract: Background Little attention has been paid to understanding the impact of the coronavirus disease 2019 (COVID-19) pandemic on sexual practices and dating app usage among the Chinese population. To fill this gap, we examined the sexual practices and dating app usage of Hong Kong residents during the COVID-19 pandemic. Method An online survey was developed to collect data, and the participants were recruited via online social media. The respondents were asked to report on their sexual practices and dating app usage during the COVID-19 pandemic. Results In total, 249 participants met the inclusion criteria for the analysis. We found that more than 70% of the participants began masturbating more. Almost half of the participants reported decreases in various sexual activities with sexual partners, including vaginal, anal and oral sex. The vast majority of the study participants also reported a decline in sexual activities with casual partners, regular non-romantic partners and sex workers. Meanwhile, dating apps were used more frequently for chatting/texting, swapping photos, sexting and virtual dating. More than 50% of the participants reported less use of dating apps for face-to-face dates and sexual encounters. Conclusion It is evident that the COVID-19 pandemic and its corresponding public health measures impacted the sexual practices and dating app usage of Hong Kong residents.
Combinations of Sexual Activities During a Sex Episode with Recent Casual Male Partner Among Men Who Have Sex with Men: A Cross-Sectional Study
Publisher: Informa UK Limited
Date: 22-06-2023
Association between sexual mixing and genital warts in heterosexual men in Australia
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/SH16053
Abstract: Australian-born women aged ≤32 years were eligible for the free female human papillomavirus (HPV) vaccination program introduced in 2007. A total of 1165 heterosexual couples attending the Melbourne Sexual Health Centre between 2011 and 2014 were included in this analysis. Findings showed the odds of having penile warts was 0.52-fold lower among men who had a female partner aged ≤32 years compared with men who had a female partners aged years. This suggests men would have received herd protection from their female partners and hence they are at lower risk of acquiring genital warts.
Finger counting method is more accurate than age‐based weight estimation formulae in estimating the weight of Hong Kong children presenting to the emergency department
Publisher: Wiley
Date: 21-09-2016
Abstract: The aim of the present study was to evaluate the finger counting method and compare its performance with four commonly used age-based weight estimation formulae in children aged 1-9 years presenting to the ED in Hong Kong. A cross-sectional, observational study of children aged 1-9 years who presented to the ED of a tertiary referral hospital in Hong Kong over a 6 month period was conducted. Actual weight was compared with estimated weight using the finger counting method and four commonly used age-based weight estimation formulae. Bland-Altman analysis was performed to evaluate the degree of agreement in which the mean percentage difference (MPD) and 95% limits of agreement (LOA) were calculated. Root mean squared error (RMSE) and proportions of weight estimates within 10%, 15% and 20% of actual weight were determined. A total of 4178 children were included. The finger counting method was the most accurate method (MPD 0.1% 95% LOA -34.0% to 34.2%). The original Advanced Paediatric Life Support (APLS) formula (MPD -7.0% 95% LOA -38.4% to 24.3%) and the updated APLS formula (MPD -0.4% 95% LOA -38.5% to 37.8%) underestimated weight whereas the Luscombe formula (MPD 7.2% 95% LOA -31.8% to 46.2%) and the Best Guess formula (MPD 10.6% 95% LOA -27.3% to 48.4%) overestimated weight. The finger counting method had smallest RMSE of 4.06 kg and estimated the largest proportion of children within 10%, 15% and 20% of actual weight. The finger counting method outperforms the commonly used age-based weight estimation formulae in children aged 1-9 years presenting to the ED in Hong Kong.
Assortative sexual mixing patterns in male-female and male-male partnerships in Melbourne, Australia
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/SH16055
Abstract: Background: Assortative mixing patterns have become a new and important focus in HIV/sexually transmissible infection (STI) research in recent years. There are very limited data on sexual mixing patterns, particularly in an Australian population. Methods: Male–female and male–male partnerships attending the Melbourne Sexual Health Centre (MSHC) between 2011 and 2014 were included. Correlation of age between two in iduals within a partnership was examined by using Spearman’s rank correlation. The Newman’s assortativity coefficient was used as an aggregate quantitative measurement of sexual mixing for number of partners and condom use. Results: 1165 male–female and 610 male–male partnerships were included in the analysis. There was a strong positive correlation of age in both male–female (rho = 0.709 P 0.001) and male–male partnerships (rho = 0.553 P 0.001). The assortative mixing pattern for number of partners was similar in male–female (r = 0.255 95% CI: 0.221–0.289) and male–male partnerships (r = 0.264 95% CI: 0.218–0.309). There was a stronger assortative mixing pattern for condom use in male–male (r = 0.517, 95% CI: 0.465–0.569) compared with male–female (r = 0.382 95% CI: 0.353–0.412) partnerships. Conclusion: Male–female and male–male partnerships have a high assortativity mixing pattern for age, number of partners and condom use. The sexual mixing pattern is not purely assortative, and hence it may lead to increased HIV and STI transmission in certain risk groups.
Barriers and potential improvements for needle and syringe exchange programs (NSPs) in China: A qualitative study from perspectives of both health and public security sectors
Publisher: Public Library of Science (PLoS)
Date: 26-06-2015
Pregnancy, delivery mode, and infant feeding among HIV-infected women in China: a meta-analysis
Publisher: China Science Publishing & Media Ltd.
Date: 2014
Early sexual experiences of teenage heterosexual males in Australia: A cross-sectional survey
Publisher: BMJ
Date: 10-2017
DOI: 10.1136/BMJOPEN-2017-016779
Abstract: There are limited data on the patterns of early sexual behaviours among Australian teenage heterosexual boys. This study describes the nature and onset of early sexual experiences in this population through a cross-sectional survey. A cross-sectional survey between 2014 and 2015 Major sexual health clinics and community sources across Australia Heterosexual men aged 17–19 years There were 191 men in the study with a median age of 19.1 years. Median age at first oral sex was 16.4 years (IQR: 15.5–17.7) and 16.9 years (IQR: 16.0–18.0) for first vaginal sex. Most men had engaged in oral sex (89.5%) and vaginal sex (91.6%) in the previous 12 months with 32.6% reporting condom use at last vaginal sex. Of the total lifetime female partners for vaginal sex reported by men as a group (n=1187): 54.3% (n=645) were the same age as the man, 28.3% (n=336) were a year or more younger and 17.4% (n=206) were a year or more older. Prior anal sex with females was reported by 22% with 47% reporting condom use at last anal sex. Median age at first anal sex was 18.2 years (IQR: 17.3–18.8). Anal sex with a female was associated with having five or more lifetime female sexual partners for oral and vaginal sex. These data provide insights into the trajectory of sexual behaviours experienced by teenage heterosexual boys following sexual debut, findings which can inform programme promoting sexual health among teenage boys.
Web-Based Harm Reduction Intervention for Chemsex in Men Who Have Sex With Men: Randomized Controlled Trial
Publisher: JMIR Publications Inc.
Date: 05-01-2023
DOI: 10.2196/42902
Abstract: Men who have sex with men (MSM) who practice chemsex have a higher likelihood of engaging in risky sexual behaviors and higher rates of HIV infection and other sexually transmitted infections (STIs) than those who do not. This trial aimed to evaluate the effectiveness of a web-based intervention in reducing the sexual harms of chemsex among MSM. The study was a 2-arm, assessor-blinded, randomized, parallel-group trial with a 3-month follow-up period. The study was conducted in the year 2021 in Hong Kong. Underpinned by the theory of planned behaviors and a harm reduction approach, the intervention consisted of interactive components and knowledge-based information about chemsex. Participants in the control group received brief information and content about sexual violence. The primary outcome was self-efficacy in refusing risky sexual behaviors and chemsex, as measured by the Condom Self-Efficacy Scale (CSES), Self-Efficacy for Sexual Safety (SESS) instrument, and Drug Avoidance Self-Efficacy Scale (DASES). The secondary outcomes included intentions to have chemsex, actual engagement in chemsex, HIV and other STI testing, and condom use in the last 3 months. All outcomes were self-reported. An online structured questionnaire was used to collect data. In total, 316 MSM enrolled in the study. The intervention group demonstrated a significantly larger improvement in condom-use self-efficacy (as measured by CSES scores time-by-group interaction: β=4.52, 95% CI 2.03-7.02 P .001), self-efficacy for sexual safety (as measured by SESS scores time-by-group interaction: β=2.11, 95% CI 0.66-3.56 P=.004), and drug avoidance self-efficacy (as measured by DASES scores time-by-group interaction: β=6.98, 95% CI 1.75-12.22 P=.009). Regarding the secondary outcomes, participants in the intervention group demonstrated a significantly larger reduction in the likelihood of having engaged in chemsex in the last 3 months (time-by-group interaction: odds ratio [OR]=0.23, 95% CI 0.10-0.53 P=.001) and likelihood of having had the intention to engage in chemsex in the last 3 months (time-by-group interaction: OR=0.37, 95% CI 0.18-0.78 P=.009). Participants in the intervention group also showed a significantly larger increase in the likelihood of having undergone HIV testing in the last 3 months (time-by-group interaction: OR=3.08, 95% CI 1.72-5.54 P .001). This study suggests that a web-based intervention with a harm reduction approach can enhance the self-efficacy of MSM in refusing risky sexual behaviors and chemsex and improve the uptake of HIV testing. We also provide initial evidence that such interventions can reduce both the intention of MSM to engage in chemsex and their actual engagement in chemsex. ISRCTN Registry ISRCTN20134522 www.isrctn.com/ISRCTN20134522. RR2-10.1186/s12889-021-10742-8
Associations between oral sex practices and frequent mouthwash use in heterosexuals: A cross-sectional survey in Melbourne, Australia
Publisher: BMJ
Date: 2021
DOI: 10.1136/BMJOPEN-2020-041782
Abstract: This study aimed to determine the frequency of mouthwash use and its association to oral sex practice in heterosexuals. A cross-sectional study. Data obtained from a sexual health clinic in Victoria, Australia, between March 2019 and April 2019. Heterosexual men and women attending the sexual health clinic answered a survey using computer-assisted self-interview. Univariable and multivariable logistic regression were performed to examine the association between frequent mouthwash use (ie, daily or weekly mouthwash use) and oral sex practices (including tongue kissing, fellatio, cunnilingus and insertive rimming). There were 681 heterosexuals included in the analysis: 315 (46.3%) men and 366 (53.7%) women. Of participants, 302 (44.3%) used mouthwash frequently, 173 (25.4%) used mouthwash infrequently and 206 (30.2%) never used mouthwash. There was no significant difference in the proportion of frequent mouthwash users between men and women (46.4% of men vs 42.6% of women p=0.329). The proportion of frequent mouthwash users increased with increasing age groups (39.3% in ≤24 years, 45.2% in 25–34 years and 52.8% in ≥35 years or older p trend =0.039) with those aged ≥35 years having a 1.80 times (95% CI: 1.12 to 2.89) higher odds of being a frequent mouthwash user than those aged ≤24 years. There were no significant associations between frequent mouthwash users had sexually transmitted infection (STI) risk after adjusting for age and country of birth. Older heterosexuals are more likely to use mouthwash. Given the high proportion and associations of mouthwash use in heterosexuals, future investigations related to oral STIs in this group should include mouthwash use.
Herd protection from the female HPV vaccination programme – Authors' reply
Publisher: Elsevier BV
Date: 12-2016
Translating mouthwash use for gonorrhoea prevention into a public health campaign: identifying current knowledge and research gaps
Publisher: CSIRO Publishing
Date: 2019
DOI: 10.1071/SH18237
Abstract: The gonorrhoea rate among gay and bisexual men who have sex with men (MSM) has been increasing rapidly in many Western countries. Furthermore, gonorrhoea is becoming increasingly resistant to antibiotics and only limited options remain for treatment. Recent evidence suggests that the oropharynx may play an important role in gonorrhoea transmission. It is hypothesised that reducing the prevalence of oropharyngeal gonorrhoea will also reduce the population incidence of gonorrhoea. Mouthwash has been proposed as a novel non-antibiotic intervention to prevent oropharyngeal gonorrhoea hence, reducing the probability of antibiotic resistance developing. However, its efficacy is yet to be confirmed by a randomised controlled trial – the findings of which will be available in 2019. If the trial shows mouthwash is effective in preventing gonorrhoea, this finding could potentially be translated into a public health c aign to increase the mouthwash use in the MSM population. This article summarises the current evidence of the effectiveness of mouthwash against gonorrhoea and discusses the potential literature gaps before implementing the mouthwash intervention at a population level.
Use of doxycycline prophylaxis among gay and bisexual men in Melbourne
Publisher: Elsevier BV
Date: 09-2019
Trends in diagnosis of pelvic inflammatory disease in an Australian sexual health clinic, 2002-16: Before and after clinical audit feedback
Publisher: CSIRO Publishing
Date: 2019
DOI: 10.1071/SH18119
Prevalence of genital and oropharyngeal chlamydia and gonorrhoea among female sex workers in Melbourne, Australia, 2015–2017: need for oropharyngeal testing
Publisher: BMJ
Date: 21-05-2019
DOI: 10.1136/SEXTRANS-2018-053957
Abstract: The Victorian legislation requires sex workers to have quarterly screening for genital chlamydia and gonorrhoea, but screening for oropharyngeal infection is not mandatory in Victoria, Australia. In 2017, oropharyngeal screening for gonorrhoea and chlamydia was added as part of the routine quarterly screening for sex workers attending the Melbourne Sexual Health Centre (MSHC). The aim of this study was to examine the prevalence of oropharyngeal gonorrhoea and chlamydia among female sex workers (FSW). We included females who (1) self-identified as sex workers or were attended MSHC for a sex work certificate and (2) had tested for any STI or HIV, between March 2015 and December 2017. The prevalence of HIV, syphilis, chlamydia and gonorrhoea was calculated. There were 8538 FSW consultations among 2780 in iduals during the study period. There was a twofold increase in genital gonorrhoea (from 0.5% (95% CI 0.3% to 0.9%) to 1.1% (95% CI 0.8% to 1.5%) p trend =0.047) and a 1.5-fold increase in genital chlamydia (from 2.2% (95% CI 1.6% to 2.8%) to 3.2% (95% CI 2.6% to 3.8%) p trend =0.031) during the period. Overall, the prevalence of HIV (0.2% (95% CI 0.1% to 0.3%)) and syphilis (0.1% (95% CI 0.0% to 0.2%)) remained low and did not change over time. In 2017, the prevalence of oropharyngeal gonorrhoea was 2.0% (95% CI 1.6% to 2.6%) and oropharyngeal chlamydia was 2.1% (95% CI 1.6% to 2.7%). Among FSW who were tested positive for gonorrhoea and chlamydia, 55% (n=41) and 34% (n=45) only tested positive in the oropharynx but not genital for gonorrhoea and chlamydia, respectively. The prevalence of oropharyngeal gonorrhoea and chlamydia is similar to the prevalence at genital sites and is often independent of genital infection. It is important to test the oropharynx and genital site for chlamydia and gonorrhoea among FSW.
Chlamydia infection in individuals reporting contact with sexual partners with chlamydia: A cross-sectional study of sexual health clinic attendees
Publisher: BMJ
Date: 08-06-2015
DOI: 10.1136/SEXTRANS-2015-052068
Abstract: We aimed to ascertain the proportion of positive, and predictive factors of chlamydia infection among females, heterosexual males and men who have sex with men (MSM) presenting to a sexual health service reporting contact with a chlamydia infected sexual partner. A cross-sectional analysis of patients attending the Melbourne Sexual Health Centre from October 2010 to September 2013. Behavioural data obtained using computer assisted self-interview were analysed to determine factors predictive of chlamydia. Of the 491 female, 808 heterosexual male, and 268 MSM chlamydia contacts, the proportion diagnosed with chlamydia were 39.9% (95% CI 35.7% to 44.3%), 36.1% (95% CI 32.9% to 39.9%) and 23.5% (95% CI 18.8% to 29.0%), respectively. Female chlamydia contacts were more likely to have chlamydia if age <25 (adjusted OR (AOR) 1.86, 95% CI 1.12 to 3.10) or if they reported inconsistent condom use during vaginal sex with a regular male partner (AOR 2.5, 95% CI 1.12 to 6.14). Heterosexual male contacts were more likely to have chlamydia if age <25 (AOR 1.69, 95% CI 1.25 to 2.28) or if they had a regular female sexual partner (AOR 1.38, 95% CI 1.03 to 1.85). In MSM urethral chlamydia was diagnosed in 8.8%, rectal chlamydia in 20.2%, and 3.9% at both sites. MSM were more likely to have chlamydia if they had a regular male sexual partner (OR 2.12, 95% CI 1.18 to 3.81). This study of female, heterosexual male, and MSM presentations with self-reported chlamydia contact provides insight into the likelihood and predictive factors of infection. The data may inform policy and in idual clinical decision making regarding presumptive treatment of chlamydia contacts.
Cochlear base length as predictor for angular insertion depth in incomplete partition type 2 malformations
Publisher: Elsevier BV
Date: 08-2022
DOI: 10.1016/J.IJPORL.2022.111204
Abstract: The preoperative determination of suitable electrode array lengths for cochlear implantation in inner ear malformations is a matter of debate. The choice is usually based on in idual experience and the use of intraoperative probe electrodes. The purpose of this case series was to evaluate the applicability and precision of an angular insertion depth (AID) prediction method, based on a single measurement of the cochlear base length (CBL). We retrospectively measured the CBL in preoperative computed tomography (CT) images in 10 ears (8 patients) with incomplete partition type 2 malformation. With the known electrode length (linear insertion depth, LID) the AID at full insertion was retrospectively predicted for each ear with a heuristic equation derived from non-malformed cochleae. Using the intra- or post-implantation cone beam CT images, the actual AID was assessed and compared. The deviations of the predicted from the actual insertion angles were quantified (clinical prediction error) to assess the precision of this single-measure estimation. Electrode arrays with 15 mm (n = 3), 19 mm (n = 2), 24 mm (n = 3), and 26 mm (n = 2) length were implanted. Postoperative AIDs ranged from 211° to 625°. Clinical AID prediction errors from -64° to 62° were observed with a mean of 0° (SD of 44°). In two ears with partial insertion of the electrode, the predicted AID was overestimated. The probe electrode was intraoperatively used in 9/10 cases. The analyzed method provides good predictions of the AID based on LID and CBL. It does not account for incomplete insertions, which lead to an overestimation of the AID. The probe electrode is useful and well established in clinical practice. The investigated method could be used for patient-specific electrode length selection in future patients.
Saliva use as a lubricant for anal sex is a risk factor for rectal gonorrhoea among men who have sex with men, a new public health message
Publisher: BMJ
Date: 03-03-2016
DOI: 10.1136/SEXTRANS-2015-052502
Abstract: Apart from penile-anal intercourse, other anal sexual practices (rimming, fingering and saliva use as a lubricant for anal sex) are common among men who have sex with men (MSM). The aim of this study is to evaluate whether these anal sexual practices are risk factors for rectal gonorrhoea in MSM. A cross-sectional survey was conducted among MSM attending Melbourne Sexual Health Centre between 31 July 2014 and 30 June 2015. Rectal gonorrhoea cases were identified by culture. Among 1312 MSM, 4.3% (n=56) had rectal gonorrhoea. Other anal sexual practices were common among MSM: receptive rimming (70.5%), receptive fingering or penis dipping (84.3%) and using partner's saliva as a lubricant for anal sex (68.5%). Saliva as a lubricant (adjusted OR 2.17 95% CI 1.00 to 4.71) was significantly associated with rectal gonorrhoea after adjusting for potential confounding factors. Receptive rimming and fingering or penis dipping were not statistically associated with rectal gonorrhoea. The crude population-attributable fraction of rectal gonorrhoea associated with use of partner's saliva as a lubricant for anal sex was 48.9% (7.9% to 71.7%). Saliva use as a lubricant for anal sex is a common sexual practice in MSM, and it may play an important role in gonorrhoea transmission. Almost half of rectal gonorrhoea cases may be eliminated if MSM stopped using partner's saliva for anal sex.
A multicentre double-blind randomised controlled trial evaluating the efficacy of daily use of antibacterial mouthwash against oropharyngeal gonorrhoea among men who have sex with men: the OMEGA (Oral
Publisher: Springer Science and Business Media LLC
Date: 28-06-2017
Increasing proportion of herpes simplex virus type 1 among women and men diagnosed with first-episode anogenital herpes: a retrospective observational study over 14 years in Melbourne, Australia
Publisher: BMJ
Date: 15-12-2018
DOI: 10.1136/SEXTRANS-2018-053830
Abstract: Reports of rising herpes simplex virus type 1 (HSV-1) genital infections relative to HSV-2 have been published up to 2006 in Australia. These changes have been attributed to declining childhood immunity to HSV-1. We described the temporal trends of HSV-1 and HSV-2 up to 2017 in Melbourne, Australia, to determine if the earlier trend is continuing. We conducted a retrospective review of the medical records of 4517 patients who were diagnosed with first episode of anogenital HSV infection at the Melbourne Sexual Health Centre, Australia, between January 2004 and December 2017. HSV-1 and HSV-2 were calculated as a proportion of all first episode of anogenital HSV infections. The change in the proportions of HSV-1 and HSV-2 over time was assessed by a χ 2 trend test. Risk factors associated with HSV-1 were examined using a multivariable logistic regression model. The proportion of first episode of anogenital herpes due to HSV-1 increased significantly over time in women (from 45% to 61% p trend .001) and heterosexual men (from 38% to 41% p trend =0.01) but not in men who have sex with men (MSM) (p trend =0.21). After adjusting for condom use, partner number and age, the annual increase remained significant only in women (OR 1.08, 95% CI 1.03 to 1.13, p .001). In MSM, HSV-1 caused up to two-thirds of anogenital herpes in most years and HSV-1 was more likely to be diagnosed at an anal site than genital site (OR 1.69, 95% CI 1.23 to 2.32, p .001). Younger age ( years) was an independent risk factor for HSV-1 in all groups. The proportion of first-episode anogenital herpes due to HSV-1 has been rising in women since 2004. HSV-1 has become the leading cause of anogenital herpes in younger populations, women and MSM.
Factors associated with anorectal Chlamydia trachomatis or Neisseria gonorrhoeae test positivity in women: a systematic review and meta-analysis.
Publisher: BMJ
Date: 16-05-2019
DOI: 10.1136/SEXTRANS-2018-053950
Abstract: There has been considerable discussion about anorectal Chlamydia trachomatis (CT) in women, with some calling for anorectal CT screening, but little about anorectal Neisseria gonorrhoeae (NG). Given that urogenital NG is more strongly associated with pelvic inflammatory disease, this is an evidence gap. This systematic review and meta-analysis investigates the associations between anorectal CT in women and CT positivity at other sites (urogenital/oropharyngeal) and with anal intercourse, and compares these with anorectal NG within the same study populations. Electronic databases were searched for English-language studies published to October 2018 using the following terms: (“Chlamydia” OR “ Chlamydia trachomatis ”) AND ((“anal” OR “rect*” OR “anorect*”) OR (“extra?genital” OR “multi?site”)). Studies were included if anorectal NG data were available. Random-effects meta-analyses calculated pooled estimates heterogeneity was investigated using meta-regression. 25 studies were eligible. Anorectal CT positivity ranged from 0% to 17.5%, with a summary estimate of 8.0% (95% CI 7.0 to 9.1 I 2 =88.5%). Anorectal NG positivity ranged from 0% to 17.0%, with a summary estimate of 2.1% (95% CI 1.6 to 2.8 I 2 =92.7%). The association between urogenital and anorectal positivity was stronger for NG than CT (summary prevalence ratio (PR)=89.3 (95% CI 53.1 to 150.3 I 2 =80.1%), PR=32.2 (95% CI 25.6 to 40.7 I 2 =70.3%), respectively), and between oropharyngeal and anorectal positivity it was stronger for NG than CT (PR=34.8 (95% CI 10.2 to 118.2 I 2 =89.9%), PR=8.8 (95% CI 6.8 to 11.5 I 2 =58.1%), respectively). Anal intercourse was associated with anorectal NG (PR=4.3 95% CI 2.2 to 8.6 I 2 =0.0%) but not with anorectal CT (PR=1.0 95% CI 0.7 to 1.4 I 2 =0.0%). Anorectal CT is more common than anorectal NG, but anorectal NG is more strongly associated with anal intercourse, urogenital and oropharyngeal NG, suggesting that ongoing discussion about anorectal CT should also include NG. Longitudinal data are required to further understanding of the aetiology of anorectal STIs and assess whether anorectal screening is needed in women. CRD42df017080188.
HIV Testing With and Without a Clinical Consultation Among Men Who Have Sex With Men: A Randomized Controlled Trial
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2018
Azithromycin or Doxycycline for Asymptomatic Rectal Chlamydia trachomatis.
Publisher: Massachusetts Medical Society
Date: 24-06-2021
Comparing HIV Post-Exposure Prophylaxis, Testing, and New Diagnoses in Two Australian Cities with Different Lockdown Measures during the COVID-19 Pandemic
Publisher: MDPI AG
Date: 14-10-2021
Abstract: Australia introduced a national lockdown on 22 March 2020 in response to the COVID-19 pandemic. Melbourne, but not Sydney, had a second COVID-19 lockdown between July and October 2020. We compared the number of HIV post-exposure prophylaxis (PEP) prescriptions, HIV tests, and new HIV diagnoses during these lockdown periods. The three outcomes in 2020 were compared to 2019 using incidence rate ratio. There was a 37% and 46% reduction in PEP prescriptions in Melbourne and Sydney, respectively, with a larger reduction during lockdown (68% and 57% reductions in Melbourne’s first and second lockdown, 60% reduction in Sydney’s lockdown). There was a 41% and 32% reduction in HIV tests in Melbourne and Sydney, respectively, with a larger reduction during lockdown (57% and 61% reductions in Melbourne’s first and second lockdowns, 58% reduction in Sydney’s lockdown). There was a 44% and 47% reduction in new HIV diagnoses in Melbourne and Sydney, respectively, but no significant reductions during lockdown. The reduction in PEP prescriptions, HIV tests, and new HIV diagnoses during the lockdown periods could be due to the reduction in the number of sexual partners during that period. It could also result in more HIV transmission due to substantial reductions in HIV prevention measures during COVID-19 lockdowns.
Patterns of Condom Use Among Men Who Have Sex with Men in China: A Systematic Review and Meta-Analysis
Publisher: Springer Science and Business Media LLC
Date: 03-04-2011
DOI: 10.1007/S10461-011-9935-9
Abstract: HIV is rapidly spreading among men who have sex with men (MSM) in China. We estimate and compare rates of condom use among MSM in different regions of China through a systematic literature review. Meta-analyses were conducted over a final set of 66 studies to estimate national and regional condom use rates among MSM with different types of male sex partners. Country-wide, there has been a modest increase in reported condom use at last sex among MSM, from 56.1% (95% CI: 53.4-58.7%) in 2003-2005 to 61.6% (95% CI: 58.4-64.8%) in 2006-2008. Consistent condom use has also increased, from 32.5% (95% CI: 28.6-36.7%) in 2003-2005 to 36.3% (95% CI: 33.7-38.9%) in 2006-2008. Condom use was greatest and increasing among commercial sex partners, from 49.8 to 75.2% at last anal sex. Further condom promotion is still required to reduce the incidence of HIV infection among MSM in China.
Bridging of Neisseria gonorrhoeae lineages across sexual networks in the HIV pre-exposure prophylaxis era
Publisher: Springer Science and Business Media LLC
Date: 05-09-2019
DOI: 10.1038/S41467-019-12053-4
Abstract: Whole genome sequencing (WGS) has been used to investigate transmission of Neisseria gonorrhoeae , but to date, most studies have not combined genomic data with detailed information on sexual behaviour to define the extent of transmission across population risk groups (bridging). Here, through combined epidemiological and genomic analysis of 2,186 N. gonorrhoeae isolates from Australia, we show widespread transmission of N. gonorrhoeae within and between population groups. We describe distinct transmission clusters associated with men who have sex with men (MSM) and heterosexuals, and men who have sex with men and women (MSMW) are identified as a possible bridging population between these groups. Further, the study identifies transmission of N. gonorrhoeae between HIV-positive and HIV-negative in iduals receiving pre-exposure prophylaxis (PrEP). Our data highlight several groups that can be targeted for interventions aimed at improving gonorrhoea control, including returning travellers, sex workers, and PrEP users.
Ongoing decline in genital warts among young heterosexuals 7 years after the Australian human papillomavirus (HPV) vaccination programme
Publisher: BMJ
Date: 10-10-2015
DOI: 10.1136/SEXTRANS-2014-051813
Abstract: Australia has provided free quadrivalent human papillomavirus (HPV) vaccines to school girls since mid-2007 and a catch-up programme in the community to women aged up to 26 years in 2007-2009. We describe the temporal trend of genital warts in different populations in Melbourne. We analysed the proportion diagnosed with genital warts for all new patients attending Melbourne Sexual Health Centre from July 2004 to June 2014, stratified by different risk groups and age. Adjusted ORs were calculated to compare the annual trend in the proportion of patients with genital warts in different risk groups in the prevaccination period (before June 2007) and the vaccination period (after July 2007). The proportion with genital warts decreased in women aged <21 years, from 18.4% in 2004/2005 to 1.1% in 2013/2014 (p 32 years, from 4.0% to 8.5% (p=0.037). The odds per year for diagnosis of genital warts adjusted for number of sexual partners in the vaccination period were 0.55 (95% CI 0.47 to 0.65) and 0.63 (95% CI 0.54 to 0.74) in women and heterosexual men aged 32 years. A small annual decline in genital warts was observed in men who have sex with men (aOR=0.92 95% CI 0.88 to 0.97). Genital warts have now become rare in young Australian women and heterosexual men 7 years after the launch of the national HPV vaccination programme but in stark contrast, remain common in men who have sex with men.
Modelling the potential role of saliva use during masturbation in the transmission of
Publisher: CSIRO Publishing
Date: 17-12-2021
DOI: 10.1071/SH21138
Abstract: Background Neisseria gonorrhoeae can be cultured from saliva in men with pharyngeal gonorrhoea and could theoretically be transmitted from the pharynx to the urethra when saliva is used as a lubricant for masturbation. In this work, we proposed that saliva use during masturbation may be a potential transmission route of gonorrhoea. Methods We analysed the transmission of Neisseria gonorrhoeae at the oropharynx, urethra and anorectum with mathematical models among men who have sex with men using data from six different studies. Model 1 included transmission routes (oral sex, anal sex, rimming, kissing, and three sequential sex practices). In Model 2, we added saliva use during solo masturbation and mutual masturbation to model 1. Results Model 2 could replicate single site infection at the oropharynx, urethra and anorectum and multi-site infection across six different datasets. However, the calibration of Model 2 was not significantly different from Model 1 across four datasets. Model 2 generated an incidence of gonorrhoea from masturbation of between 5.2% (95% CI: 3.2–10.1) to 10.6% (95% CI: 5.8–17.3) across six data sets. Model 2 also estimated that about one in four cases of urethral gonorrhoea might arise from solo masturbation and mutual masturbation. Conclusions Our models raise the possibility that saliva use during masturbation may play a role in transmitting gonorrhoea. This is an important area to explore because it contributes to the knowledge base about gonorrhoea transmission.
HIV prevalence ratio of international migrants compared to their native-born counterparts: A systematic review and meta-analysis
Publisher: Elsevier BV
Date: 11-2022
Non-consensual condom removal, reported by patients at a sexual health clinic in Melbourne, Australia
Publisher: Public Library of Science (PLoS)
Date: 26-12-2018
Testing for HIV among men who have sex with men needs a paradigm shift in Australia, given the minimal increase between 2003 and 2013 in Melbourne, Australia
Publisher: CSIRO Publishing
Date: 2015
DOI: 10.1071/SH14167
Abstract: Background Increasing the frequency of HIV testing in men who have sex with men (MSM) will reduce the incidence of HIV. Trends in HIV testing among MSM in Melbourne, Australia over the last 11 years have been investigated. Methods: A retrospective study was conducted using electronic medical records of the first presentation of MSM who attended the Melbourne Sexual Health Centre between 2003 and 2013. Factors associated with HIV testing (year, demographic characteristics and sexual practices) were examined in multivariable logistic regression analyses. Jonckheere–Terpstra tests were used to examine the significance of trends in the mean time since the last HIV test. Results: Of 17 578 MSM seen 13 489 attended for the first time during the study period. The proportion of first attendances who had previously tested and reported a HIV test in the last 12 months increased from 43.6% in 2003 to 56.9% in 2013 (adjusted ptrend = 0.030), with a corresponding decrease in median time since the last HIV test from 19 months [interquartile range (IQR) 6–42] in 2003 to 10 months (IQR4–24) in 2013 (ptrend .001). The proportion of high-risk MSM (who reported unprotected anal intercourse and/or partners in 12 months) who reported an HIV test in the last 12 months was unchanged (ptrend = 0.242). Conclusions: Despite HIV testing becoming more frequent, the magnitude of change over the last decade is insufficient to substantially reduce HIV incidence. A paradigm shift is required to remove barriers to testing through strategies such as point-of-care rapid testing or access to testing without seeing a clinician.
Symptoms, Sites, and Significance ofMycoplasma genitaliumin Men Who Have Sex with Men
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 04-2019
HIV and STI Testing Preferences for Men Who Have Sex with Men in High-Income Countries: A Scoping Review
Publisher: MDPI AG
Date: 04-03-2022
Abstract: Background: Regular testing for HIV and other sexually transmitted infections (STI) is recommended at least annually for sexually active men who have sex with men (MSM) in most high-income countries. To encourage regular use of HIV and STI testing and treatment services for MSM, we reviewed the literature to summarise the attributes of an HIV/STI testing service that MSM prefer. Method: We conducted a scoping review, searching PubMed, EMBASE, PsycINFO and CINAHL in January 2020 for articles reporting primary data on the preferences of MSM (living in high-income countries) for HIV/STI testing services. Two reviewers independently screened titles and abstracts and any discrepancies were resolved by a third reviewer. We extracted data on the service attributes that MSM preferred and summarised these thematically using a socioecological framework. Results: In total, 1464 publications were identified, 220 full texts were read and 57 were included in the final analysis. We found 21 articles addressing ‘in idual’ attributes, 50 articles addressing ‘service’ attributes and 17 articles addressing ‘societal’ attributes. The key themes of preferences for HIV/STI testing services were: (1) the appeal of self-testing due to convenience and privacy (2) the need to provide a variety of testing options and (3) the influence of the testing experience, including confidentiality and privacy, tester characteristics and stigma. There were distinct patterns of preferences for subpopulations of MSM across studies, such as the preference of self-testing for young MSM, and of in-clinic testing for those who perceived themselves as high risk (i.e., with symptoms of STIs or exposed to a partner living with HIV). Conclusion: To make HIV/STI testing more accessible for MSM and encourage regular screening, it is important to address ‘in idual’, ‘service’ and ‘societal’ attributes, such as enhancing the convenience of testing through self-testing, and providing a service that men feel comfortable and safe accessing. Furthermore, services should accommodate the preferences of erse sub-populations within the MSM community.
What is the potential for bisexual men in China to act as a bridge of HIV transmission to the female population? Behavioural evidence from a systematic review and meta-analysis
Publisher: Springer Science and Business Media LLC
Date: 15-09-2011
Abstract: HIV prevalence among men who have sex with men (MSM) in China has rapidly increased in recent years. It is suggested that MSM could be a potential bridge of HIV transmission to the general female population. We investigated the bisexual behaviour of MSM in China through systematic review and meta-analysis. We conducted a systematic review and meta-analyses on published peer-reviewed Chinese and English literature during 2001-2010 according to the PRISMA guidelines. Marital status and sexual behavioural indicators of MSM were presented graphically using forest plots. The pooled effect rates with 95% confidence intervals were also calculated. Meta-regression analyses were performed to examine the factors associated with high heterogeneities across the studies. Forty-three eligible articles (11 in English and 32 in Chinese) were identified. Our results showed that 17.0% (95% CI: 15.1-19.1%) of MSM in China are currently married to a woman and 26.3% (95% CI: 23.6-29.1%) of MSM had female sexual partners in the last six months. The pooled estimates for condom use rate between MSM and female sex partners was 41.4% (95% CI: 35.5-47.5%) at the last sex act and 25.6% (95% CI: 23.0-28.4%) in the last six months. The consistent condom use rates with regular, non-commercial, casual and commercial female sex partners in the last six months were 23.3% (95% CI: 11.25-42.1%), 39.0% (95% CI: 28.8-50.3%) and 55.8% (95% CI: 41.4-69.4%), respectively. A substantial proportion of Chinese MSM is currently married or had sexual relations with a female in the past six months. In addition, low condom usage was common between married MSM and their wives, hence posing a higher risk of transmitting HIV. Harm-reduction programs targeting married MSM and their female partners are necessary to curb the further spread of HIV infection to the general female population.
Exploring the attitudes of men who have sex with men on anal self-examination for early detection of primary anorectal syphilis: a qualitative study
Publisher: Springer Science and Business Media LLC
Date: 20-09-2021
DOI: 10.1186/S12879-021-06686-4
Abstract: Studies show men who have sex with men (MSM) practising receptive anal sex are more likely to present with secondary syphilis, suggesting anorectal primary lesions are being missed. Regular anal self-examination might be able to detect anorectal syphilis lesions, hence potentially reducing transmission. This study aimed to explore the attitudes of MSM on performing anal self-examination to detect primary syphilis. In this qualitative study, 20 MSM over 18 years of age were purposively s led from a sexual health clinic to participate in semi-structured interviews. Interviews were recorded, transcribed verbatim and data analysed thematically. Four major themes and 12 sub-themes were generated from the study: (1) reasons for performing anal self-examination, (2) preferred educational resources for anal self-examination, (3) attitudes towards partner anal examination, and (4) acceptability of anal self-examination. Most participants had performed some form of anal self-examination in the past, and, just over half performed regularly for mostly health-related concerns. Most participants who infrequently or never performed anal self-examination were agreeable to perform regularly if it was recommended by health professionals with appropriate guidance. Participants preferred education on anal self-examination from health professionals and trusted online learning resources. Our study showed MSM were agreeable to anal self-examination however would like to receive education and training to gain more confidence in conducting anal self-examination as a screening tool. Further studies are required to explore the adherence and acceptability of anal self-examination for syphilis prior to studies examining efficacy. The study provides foundation for any future policy aiming at utilising anal self-examination as a screening tool for syphilis among MSM.
Treponema pallidum PCR screening at mucosal sites of asymptomatic men who have sex with men taking HIV pre-exposure prophylaxis
Publisher: American Society for Microbiology
Date: 17-10-2023
Awake Rhinology Surgery in Response to the COVID-19 Pandemic in Europe
Publisher: S. Karger AG
Date: 31-08-2021
DOI: 10.1159/000517155
Abstract: b i Background: /i /b European health-care systems are faced with a backlog of surgical procedures following the suspension of routine surgery during the COVID-19 crisis. Routine rhinology surgery under general anaesthetic (GA) is now faced with significant challenges which include limited theatre capacity, the negative ramifications of surgical prioritization, reduced patient throughput in secondary care, and additional personal protective equipment requirements. Delayed surgery in rhinology, particularly with regards to chronic rhinosinusitis, has previously been shown to have poorer surgical outcomes, a detrimental effect on quality of life and long-term negative health socio-economic effects. Awake rhinology surgery under local anaesthetic (LA) provides an ideal alternative to GA. It provides a means of operating on patients in a setting alternative to currently oversubscribed main theatres, by utilizing satellite facilities, while ensuring identical surgical outcomes for patients who may otherwise have been forced to wait a long time for their procedure. It also confers additional benefits in terms of shorter recovery time and hospital stay for patients. b i Objectives: /i /b We have developed a set of recommendations that are intended to help support clinicians and managers to better adopt LA rhinology protocols and minimize the risk to the patient and health-care professionals involved. b i Methodology: /i /b International roundtable forums were conducted and supplemented by in idual interviews. The international board consisted of 12 rhinologists experienced in awake rhinology surgery. Feedback was analysed and shared to develop a consensus of best practice. b i Recommendations: /i /b Local and national guidelines need to be adhered to with specific focus on patient and clinician safety. When performing awake rhinology procedures in the COVID-19 recovery process, consider implementing specific safety measures and workflow practices to safeguard patients and staff and minimize the risk of infection. b i Conclusion: /i /b Awake surgery potentially provides quicker access to routine rhinology surgery in the post-COVID-19 recovery phase, ensuring patients are treated in a timely matter, thereby avoiding higher downstream costs, and improving outcomes.
Predicting the Diagnosis of HIV and Sexually Transmitted Infections Among Men Who Have Sex with Men Using Different Machine Learning Approaches
Publisher: Elsevier BV
Date: 2020
DOI: 10.2139/SSRN.3550064
Evaluation of PrEP eligibility criteria using sexually transmissible infections as HIV risk markers at enrolment in PrEPX, a large Australian HIV pre-exposure prophylaxis trial
Publisher: Oxford University Press (OUP)
Date: 07-05-2018
DOI: 10.1093/CID/CIY370
High HIV Prevalence and Risk of Infection Among Rural-to-Urban Migrants in Various Migration Stages in China
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2013
Gonorrhoea gone wild: rising incidence of gonorrhoea and associated risk factors among gay and bisexual men attending Australian sexual health clinics
Publisher: CSIRO Publishing
Date: 2019
DOI: 10.1071/SH18097
Abstract: Background Gonorrhoea notifications continue to rise among gay and bisexual men in Australia and around the world. More information is needed on infection trends, accounting for testing and complimented by demographics and risk practices. Methods: A retrospective cohort analysis was undertaken using repeat gonorrhoea testing data among gay and bisexual men from 2010 to 2017, which was extracted from a network of 47 sexual health clinics across Australia. Poisson and Cox regression analyses were used to determine temporal trends in gonorrhoea incidence rates, as well as associated demographic and behavioural factors. Results: The present analysis included 46904 gay and bisexual men. Gonorrhoea incidence at any anatomical site increased from 14.1/100 person years (PY) in 2010 to 24.6/100 PY in 2017 (P& .001), with the greatest increase in infections of the pharynx (5.6-15.9/100 PY, P& .001) and rectum (6.6–14.8/100 PY, P& .001). After adjusting for symptomatic and contact-driven presentations, the strongest predictors of infection were having more than 20 sexual partners in a year (hazard ratio (HR)=1.9, 95% confidence interval (CI): 1.7–2.2), using injecting drugs (HR=1.7, 95%CI: 1.4–2.0), being HIV positive (HR=1.4, 95%CI: 1.2–1.6) and being aged less than 30 years old (HR=1.4, 95%CI: 1.2–1.6). Conclusions: Gonorrhoea has increased dramatically among gay and bisexual men in Australia. Enhanced prevention efforts, as well as more detailed, network-driven research are required to combat gonorrhoea among young men, those with HIV and those who use injecting drugs.
Efficacy and acceptability of ‘nudges’ aimed at promoting pre-exposure prophylaxis (PrEP) use: a survey of overseas born men who have sex with men
Publisher: CSIRO Publishing
Date: 23-02-2023
DOI: 10.1071/SH22113
Abstract: Background This study explores the potential for behavioural economics techniques called ‘nudges’ to encourage the use of HIV pre-exposure prophylaxis (PrEP) by overseas-born men who have sex with men (MSM) in Australia. We investigated the preferences of overseas-born MSM for different nudges and the effect of nudges on reported likelihood of seeking information about PrEP. Methods We conducted an online survey of overseas-born MSM, in which they were asked: (1) how likely they and a relevant friend would be to click on PrEP advertisements that used behavioural economics strategies and (2) what they most and least liked about each ad. We conducted ordered logistic regression of reported likelihood scores against participant age and sexual orientation, use of a model in an advertisement, use of statistics about PrEP, reference to the World Health Organization (WHO), rewards for seeking further information, and use of a call-to-action. Results Participants (n = 324) reported higher likelihoods of clicking on advertisements with images of people, statistics about PrEP, rewards for seeking further information, and calls-to-action. They reported lower likelihoods of clicking on advertisements referencing the WHO. They had negative emotional responses to sexualised humour, gambling metaphors, and the slogan ‘Live Fearlessly’. Conclusions Overseas-born MSM prefer public health messages that feature representative messengers and statistics about PrEP. These preferences are consistent with previous data on descriptive norms (i.e. statistics about the number of peers doing the desired behaviour) and gain-framed information (i.e. focusing on what can be gained from an intervention).
The Experience of Using Dating Applications for Sexual Hook-Ups: A Qualitative Exploration among HIV-Negative Men Who Have Sex With Men in Hong Kong
Publisher: Informa UK Limited
Date: 03-03-2021
New thinking on gonorrhoea control in MSM: are antiseptic mouthwashes the answer?
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2018
Universal lymphogranuloma venereum (LGV) testing of rectal chlamydia in men who have sex with men and detection of asymptomatic LGV
Publisher: BMJ
Date: 25-02-2022
DOI: 10.1136/SEXTRANS-2021-055368
Abstract: Lymphogranuloma venereum (LGV) is caused by Chlamydia trachomatis serovars L1-L3. This study determined the positivity for LGV testing before and after introduction of universal LGV testing of positive rectal Chlamydia trachomatis s les in men who have sex with men (MSM). From March 2015 to February 2018, MSM with rectal C. trachomatis were not routinely tested for LGV at the Melbourne Sexual Health Centre unless they had HIV or symptoms of proctitis. From February 2018, universal testing for LGV of all positive rectal C. trachomatis specimens in men over the age of 25 years, regardless of symptoms was undertaken. LGV positivity was defined as the detection of LGV-associated C. trachomatis serovars. There were 3429 and 4020 MSM who tested positive for rectal chlamydia in the selective and universal LGV-testing periods, respectively. Of the total 3027 assessable specimens in both periods, 97 (3.2% 95% CI 2.6% to 3.9%) specimens tested positive for LGV. LGV positivity in the selective testing period was higher than in the universal testing period (6.6% (33/502) vs 2.5% (64/2525), p .001). The proportion of LGV cases that were asymptomatic increased from 15.2% (5/33) in the selective testing period to 34.4% (22/64) in the universal testing period (p=0.045). Of the 70 symptomatic LGV cases symptoms included rectal discharge (71.4%, n=45) and rectal pain (60.0%, n=42). Universal LGV testing of all positive rectal chlamydia s les in MSM compared with selective testing led to the detection of asymptomatic rectal LGV, which constituted 34% of rectal LGV cases.
Perceptions and experiences of sexual violence among Chinese men who have sex with men in Hong Kong
Publisher: Wiley
Date: 31-07-2022
DOI: 10.1111/JAN.15391
Abstract: This study aimed to understand the perceptions and experiences of sexual violence among Chinese men who have sex with men (MSM) in Hong Kong. The study adopted a qualitative descriptive design with thematic analysis. Thirty‐one Chinese MSM were recruited in Hong Kong from May to June 2019 using purposive s ling. In idual semi‐structured interviews were conducted with the participants. The interview data were transcribed verbatim from the recordings and analysed using Braun and Clarke's thematic analysis approach. Four themes were identified: (1) different forms of sexual violence, from physical to virtual (2) inner struggles with fears and worry (3) low awareness and perceived risk of sexual violence – ‘it has nothing to do with me’ and (4) dilemma towards sexual violence prevention. The study provided qualitative evidence regarding the experiences and perceptions of sexual violence among Chinese MSM in Hong Kong. Physical and image‐based forms of sexual violence were identified, which led the participants to experience psychological distress, fear of contracting human immunodeficiency virus/other sexually transmitted infections, notoriety within the gay community, and discrimination and stigmatization within their family and workplace. To reduce the risk of sexual violence, some participants were cautious about the venue in which they engaged in sex and the habit of sharing sexually explicit photos with others. However, some participants had low awareness and perceived risk of sexual violence. This study was the first to fill the research gap on sexual violence issues among Chinese MSM using dating apps in Hong Kong. The qualitative findings enhanced the scholarly understanding of Chinese MSM's perceptions and experiences of sexual violence. The study findings can help nursing staff and other healthcare professionals to develop tailored primary, secondary and tertiary sexual violence prevention programmes for MSM or beyond.
Human papillomavirus in young women with Chlamydia trachomatis infection 7 years after the Australian human papillomavirus vaccination programme: A cross-sectional study
Publisher: Elsevier BV
Date: 11-2015
Is it the end of mouthwash as an intervention for gonorrhoea?
Publisher: Elsevier BV
Date: 06-2021
Saliva use in sex
Publisher: SAGE Publications
Date: 23-08-2018
Abstract: Smartphone dating applications have become a primary source for men who have sex with men (MSM) to meet sexual partners. It has been found that MSM who used smartphone dating applications are at higher risk of gonorrhoea, but the reasons remain unknown. This study aimed to investigate whether MSM who met their partners via smartphone dating applications are more likely to engage in sexual practices such as rimming (oro-anal sex), and use of partner’s saliva as a lubricant, that are associated with the risk of gonorrhoea. A cross-sectional study was conducted among 1672 MSM attending the Melbourne Sexual Health Centre, Australia, between 31 July 2014 and 30 June 2015. Multivariate logistic regression was conducted to examine the associations between sources of meeting partners and the two aforementioned sexual practices. MSM who used smartphone dating applications were 1.78 (95% CI: 1.38–2.28) times more likely to get rimmed, and 1.63 (95% CI: 1.27–2.09) times more likely to use partner’s saliva as a lubricant during anal sex, compared to other sources, after adjusting for age and other sources for meeting partners. These practices are highly associated with gonorrhoea.
Oropharyngeal and Genital Gonorrhea Infections Among Women and Heterosexual Men Reporting Sexual Contact With Partners With Gonorrhea: Implication for Oropharyngeal Testing of Heterosexual Gonorrhea C
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-09-2019
DOI: 10.1097/OLQ.0000000000001068
Abstract: There have been very limited studies of oropharyngeal gonorrhea in heterosexuals. Routine screening of oropharyngeal gonorrhea is not recommended in heterosexual contacts of gonorrhea. This study aimed to examine oropharyngeal gonorrhea positivity among heterosexuals reporting contact with a partner with gonorrhea. At the Melbourne Sexual Health Centre (MSHC), all heterosexual in iduals reporting contact with sexual partners with gonorrhea are tested for genital gonorrhea. In May 2017, MSHC also included screening for oropharyngeal gonorrhea in heterosexual contacts of gonorrhea. All contacts of gonorrhea among women and heterosexual men between May 2017 and November 2018 were reviewed. Site-specific gonorrhea positivity was also calculated. One hundred ninety-one gonorrhea contacts (102 heterosexual men and 89 women) were reviewed. The median age was 28 (interquartile range, 24–33) years. The gonorrhea positivity in males was significantly higher at the oropharynx compared with urethra (18% 95% confidence interval [CI], 11% to 26% vs 2% 95% CI, 0% to 7% P 0.001) and higher at the oropharynx compared with cervicovaginal site in women (46% 95% CI, 35% to 57% vs 36% 95% CI, 26% to 47% P = 0.056). Of the 100 men who did not have genital gonorrhea, 17 (18% 95% CI, 10% to 26%) tested positive at the oropharynx. Of the 55 women who did not have genital gonorrhea, 21 (24% 95% CI, 15% to 34%) tested positive at the oropharynx. Infection at both the oropharynx and genital sites was not associated with sex worker status in women. Overall, 89% and 40% of gonorrhea in heterosexual men and women were only in the oropharynx, respectively. Oropharyngeal gonorrhea testing among heterosexual contacts of gonorrhea may be indicated given a substantial proportion of gonorrhea contacts are only infected at this site.
Socio-cultural influences on the transmission of HIV among gay men in rural China
Publisher: Informa UK Limited
Date: 21-02-2014
DOI: 10.1080/13691058.2014.883643
Abstract: Bisexual behaviours are relatively common among men who have sex with men in China. This pilot study aims to reveal the complex processes through which such men manage their sexuality, family responsibilities and sexual behaviours in a rural Chinese setting. A total of 15 men who have sex with men were recruited by purposive s ling. Face-to-face in-depth interviews were conducted to explore participants' views about their sexual experiences and practices. The Chinese traditional moral code, family values and gender roles that form the crucial components of Confucianism were reflected in the participants' efforts to maintain familial and social harmony through a compromised form of sexual partnership. Most study participants demonstrated a mixed experience of social stigma, sexual naiveté and ignorance of HIV and sexually transmitted infections (STIs). Under cultural and family pressure, men who have sex with men entered heterosexual marriages with the intention of maintaining a balance between their collectivist (familial) obligations and their in idualistic (same-sex sexual) desires. However, the opaque nature of their concurrent sexual relationships may endanger their personal health and accelerate HIV and STI transmission. Reducing the stigma and social prejudice associated with male same-sex sexual relations is essential for any culturally sensitive HIV-prevention programme to succeed in rural China.
HIV Non-Occupational Postexposure Prophylaxis (nPEP) Awareness, Usage, Willingness, and Promotion in China: A Cross-Sectional Study Among Five Key Populations
Publisher: Elsevier BV
Date: 2020
DOI: 10.2139/SSRN.3588537
Pooling Pharyngeal, Anorectal, and Urogenital Samples for Screening Asymptomatic Men Who Have Sex with Men for Chlamydia trachomatis and Neisseria gonorrhoeae
Publisher: American Society for Microbiology
Date: 23-04-2020
DOI: 10.1128/JCM.01969-19
Abstract: Screening for Chlamydia trachomatis and Neisseria gonorrhoeae at the pharyngeal, urogenital, and anorectal sites is recommended for men who have sex with men (MSM). Combining the three in idual-site s les into a single pooled s le could result in significant cost savings, provided there is no significant sensitivity reduction. The aim of this study was to examine the sensitivity of pooled s les for detecting chlamydia and gonorrhea in asymptomatic MSM using a nucleic acid lification test.
Changing from Clinician-Collected to Self-Collected Throat Swabs for Oropharyngeal Gonorrhea and Chlamydia Screening among Men Who Have Sex with Men
Publisher: American Society for Microbiology
Date: 24-08-2020
DOI: 10.1128/JCM.01215-20
Abstract: The coronavirus disease 2019 (COVID-19) pandemic has led many clinics to move from clinician-collected to self-collected oropharyngeal swabs for the detection of sexually transmitted infections (STIs). Before this change, however, self-collection was used primarily for genital and anorectal infections, with only limited studies on the performance of self-collection of oropharyngeal swabs for oropharyngeal STI detection. The Melbourne Sexual Health Centre (MSHC) changed from clinician-collected to self-collected oropharyngeal swabs for oropharyngeal gonorrhea and chlamydia screening on 16 March 2020 in order to reduce health care worker risk during the COVID-19 pandemic.
Detection of human papillomavirus in urine among heterosexual men in relation to location of genital warts and circumcision status
Publisher: BMJ
Date: 02-09-2017
DOI: 10.1136/SEXTRANS-2016-053031
Abstract: Human papillomavirus (HPV) surveillance is important to monitor the effectiveness of national HPV vaccination programmes. Positivity of HPV in urine in men varies with different s ling methods. We aimed to determine the positivity for detection of HPV-6/11 in urine s les among men in relation to the position of genital warts and circumcision status. We analysed stored chlamydia-positive urine specimens in young heterosexual men aged less than 25 years attending Melbourne Sexual Health Centre, Australia, between 2004 and 2015, for HPV genotypes. Positivity of HPV-6/11 and high-risk genotypes were stratified according to the position of genital warts and circumcision status. Positivity of HPV-6/11 was calculated using diagnosis of warts as the gold standard. Warts were classified as proximal penile warts from suprapubic area to midshaft of penis, and distal penile warts from distal shaft of penis to meatus. Of the 934 specimens, 253 (27.1%) men were positive for any HPV and 82 men (8.8%) had genital warts. The ORs of HPV-6/11 detection in urine were 4.63 (95% CI: 1.68 to 12.78) and 40.20 (95% CI: 19.78 to 81.70) times higher among men who had proximal penile warts and distal penile warts, respectively, compared with men who did not have genital warts. Circumcised men were less likely to have high-risk HPV (OR 0.31 95% CI: 0.14 to 0.65) than uncircumcised men. Uncircumcised men were more likely to have distal penile warts than circumcised men (OR 8.22 95% CI: 1.34 to 337.46). Positivity of HPV-6/11 in urine increases greatly in men with distal penile warts. Circumcised men are less likely to have distal penile warts, any HPV or high-risk HPV detected. Urine is likely to be an alternative s ling method for HPV-6/11 surveillance programme in men in countries with low circumcision rates.
Disparities in characteristics in accessing public Australian sexual health services between Medicare‐eligible and Medicare‐ineligible men who have sex with men
Publisher: Elsevier BV
Date: 10-2020
Anal and oral detection ofTreponema pallidumin men who have sex with men with early syphilis infection
Publisher: BMJ
Date: 26-05-2022
DOI: 10.1136/SEXTRANS-2021-055370
Abstract: We aimed to characterise patterns of anal and oral detection of Treponema pallidum among men who have sex with men (MSM) with early syphilis. 200 MSM with serologically confirmed primary, secondary and early latent syphilis were tested with T. pallidum polA PCR using an anal canal swab, oral rinse, plus swabs from any anal and oral lesions in a prospective, cross-sectional study. Anal and oral T. pallidum cycle threshold values were compared between subsets of men and according to rapid plasma reagin (RPR) titre. Of 200 men with early syphilis, 45 and 48 had anal and oral T. pallidum detected, respectively. Cycle threshold values were lower with anal compared with oral T. pallidum whether lesions were present or not. Among 27 and 42 men with anal and oral T. pallidum detected, respectively, and no anal or oral primary lesion, frequency of detection increased with increasing RPR titre, with 95% (25/27) and 98% (41/42) of shedding from respective sites occurring with RPR titres ≥1:16. 6.5% (13/200) of men with syphilis had concurrent detection of T. pallidum from both anal and oral sites: 9/13 with secondary syphilis, 7/9 of whom had anal lesions with a median duration of 30 days (range 7–180 days). These data suggest T. pallidum load at the anus is higher than at the oral cavity and that a subset of men with secondary syphilis and prolonged anal lesions may be relatively infectious. Earlier detection and treatment of syphilis, when RPR titres are lower than 1:16, could potentially reduce infectiousness from anal and oral sites.
The role of saliva in gonorrhoea and chlamydia transmission to extragenital sites among men who have sex with men: new insights into transmission
Publisher: Wiley
Date: 08-2019
DOI: 10.1002/JIA2.25354
A comparison of cotton-tipped and nylon flocked swabs for culture of Neisseria gonorrhoeae from oropharyngeal samples
Publisher: Elsevier BV
Date: 11-2021
DOI: 10.1016/J.DIAGMICROBIO.2021.115455
Abstract: Our aim was to determine if there was a difference in culture positivity for oropharyngeal gonorrhoea when s ling using a nylon-flocked versus cotton-tipped swab. We collected FLOQSwabs and cotton-tipped swabs from in iduals aged ≥ 18 years who had untreated oropharyngeal gonorrhoea detected by NAAT between November 2019-June 2020.Of 78 participants, 32 (41.0%) were culture-positive for N. gonorrhoeae from either swab. Of these 32, 29 (90.6%, 95%CI: 75.0%-98.0%) were positive on both swabs, one (3.1%, 95%CI: 0.0%-16.2%) tested positive on FLOQSwab only and two (6.2%, 95%CI: 0.1%-20.8%) tested positive on cotton-tipped swabs only. There was moderate agreement between the swabs in the amount of bacterial growth (Cohen's Kappa (k)=0.745 95%CI: 0.622-0.868, p<0.001). Our results showed that the proportion of positive results was comparable using the FLOQSwabs versus the cotton-tipped swabs for oropharyngeal gonorrhoea culture.
Modelling the Contribution that Different Sexual Practices Involving the Oropharynx and Saliva Have on <i>Neisseria gonorrhoeae</i> Infections at Multiple Anatomical Sites in Men Who Have
Publisher: Elsevier BV
Date: 2020
DOI: 10.2139/SSRN.3578740
Anal human papillomavirus infections in young unvaccinated men who have sex with men attending a sexual health clinic for HPV vaccination in Melbourne, Australia
Publisher: Elsevier BV
Date: 10-2019
DOI: 10.1016/J.VACCINE.2019.08.066
Abstract: The Victorian Government introduced a time-limited quadrivalent human papillomavirus (HPV) vaccination catch-up program targeting gay and bisexual men who have sex with men (MSM) aged up to 26 years in 2017. As of 2017, men aged ≥20 years were not eligible for the school-based HPV vaccination program. This study examined the prevalence of anal HPV among 496 MSM aged 20-26 years before they received the first dose of the HPV vaccine at the Melbourne Sexual Health Centre, Australia. More than half (56.5%) had any high-risk HPV genotypes detected in the anus. Almost half (43.1%) had at least one quadrivalent HPV vaccine-preventable genotype (6, 11, 16 or 18) and one-fifth (21.0%) had HPV 16 detected in the anus. These findings suggest that a targeted catch-up HPV vaccination program for MSM is still beneficial to protect against high-risk HPV genotypes associated with anal cancer, as well as low-risk HPV genotypes.
HIV and Sexually Transmissible Infections among Money Boys in China: A Data Synthesis and Meta-Analysis
Publisher: Public Library of Science (PLoS)
Date: 29-11-2012
Accuracy of Self-reported Human Papillomavirus Vaccination Status Among Gay and Bisexual Adolescent Males: Cross-sectional Study
Publisher: JMIR Publications Inc.
Date: 06-12-2021
DOI: 10.2196/32407
Abstract: Men who have sex with men are a risk group for anal human papillomavirus (HPV) and anal cancer. Australia introduced a universal school-based HPV vaccination program in 2013. Self-reported HPV vaccination status has been widely used in clinical and research settings, but its accuracy is understudied. We aimed to examine the accuracy of self-reported HPV vaccination status among gay and bisexual adolescent males. We included 192 gay and bisexual males aged 16-20 years from the Human Papillomavirus in Young People Epidemiological Research 2 (HYPER2) study in Melbourne, Australia. All participants had been eligible for the universal school-based HPV vaccination program implemented in 2013 and were asked to self-report their HPV vaccination status. Written informed consent was obtained to verify their HPV vaccination status using records at the National HPV Vaccination Program Register and the Australian Immunisation Register. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value of self-reported HPV vaccination status. The median age of the 192 males was 19 (IQR 18-20) years. There were 128 males (67%) who had HPV vaccination records documented on either registry. Self-reported HPV vaccination had a sensitivity of 47.7% (95% CI 38.8%-56.7% 61/128), a specificity of 85.9% (95% CI 75.0%-93.4% 55/64), a positive predictive value of 87.1% (95% CI 77.0%-93.9% 61/70), and a negative predictive value of 45.1% (95% CI 36.1%-54.3% 55/122). Self-reported HPV vaccination status among Australian gay and bisexual adolescent males underestimates actual vaccination and may be inaccurate for clinical and research purposes.
Brief Report: Group Sex Among Men Who Have Sex With Men in the Era of PrEP: A Cross-Sectional Study
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2021
Methadone maintenance treatment programme reduces criminal activity and improves social well-being of drug users in China: a systematic review and meta-analysis
Publisher: BMJ
Date: 08-01-2015
Accessing first doses of mpox vaccine made available in Victoria, Australia
Publisher: Elsevier BV
Date: 02-2023
Mother-to-child transmission rate of HIV and use of drugs to prevent the transmission in China: a systematic review
Publisher: China Science Publishing & Media Ltd.
Date: 2014
Incidence and duration of incident oropharyngeal gonorrhoea and chlamydia infections among men who have sex with men: prospective cohort study
Publisher: BMJ
Date: 18-11-2021
DOI: 10.1136/SEXTRANS-2020-054764
Abstract: This prospective cohort study aimed to determine the natural history and incidence of oropharyngeal gonorrhoea and chlamydia among a cohort of men who have sex with men (MSM) over a 12-week period, and to examine risk factors associated with incident oropharyngeal infections. MSM either aged ≥18 years and had a diagnosis of oropharyngeal gonorrhoea by nucleic acid lification test (NAAT) in the past 3 months or aged 18–35 years who were HIV-negative taking pre-exposure prophylaxis (PrEP) were eligible for this study. Enrolled men were followed up for 12 weeks. Oropharyngeal swabs were collected at week 0 (baseline) and week 12 (end of study). Between these time points, weekly saliva specimens and the number of tongue kissing, penile–oral and insertive rimming partners were collected by post. Oropharyngeal swabs and saliva specimens were tested by NAAT for Neisseria gonorrhoeae and Chlamydia trachomatis . Poisson regression was performed to examine the risk factors (weekly number of partners) associated with incident oropharyngeal gonorrhoea. A total of 100 MSM were recruited. The incidence of oropharyngeal gonorrhoea and chlamydia was 62 (95% CI 37 to 105) and 9 (95% CI 2 to 35)/100 person-years, respectively. The median duration of incident oropharyngeal infection with gonorrhoea was 28 days (IQR=21–36, n=7). The incidence rate ratio (IRR) for oropharyngeal gonorrhoea increased with an increased number of kissing partners (IRR=1.08 95% CI 1.03 to 1.12) an increased number of penile-oral sex partners (IRR=1.07, 95% CI 1.01 to 1.14) but not with an increased number of insertive rimming partners (IRR=1.11, 95% CI 0.96 to 1.29) or other demographic factors. The IRR and duration of incident oropharyngeal chlamydia were not calculated due to the small number of cases (n=2). MSM have a high incidence of oropharyngeal gonorrhoea and the median duration of infection was less than 3 months.
Pharyngeal gonorrhoea
Publisher: Public Library of Science (PLoS)
Date: 19-12-2016
A qualitative evaluation of a Nudgeathon event for the co-design of sexual health campaign images targeting overseas-born men who have sex with men
Publisher: CSIRO Publishing
Date: 23-03-2023
DOI: 10.1071/SH22125
Abstract: Background Additional approaches to HIV prevention and management, such as Nudgeathons, are required to increase access to HIV pre-exposure prophylaxis (PrEP) among overseas-born men who have sex with men (MSM). Methods In September 2021, we conducted a 4-h online Nudgeathon, wherein four teams co-designed behaviourally informed adverts to improve PrEP access and uptake for overseas-born MSM. After the Nudgeathon, eight of 17 invited Nudgeathon attendees were interviewed about their experience. We conducted a qualitative content analysis of interview data to highlight participants’ experiences of the co-design process. Results We identified three major themes: (1) what worked well (2) group dynamics and (3) improvement and future directions. The Nudgeathon about PrEP was a positive learning experience, with valuable contributions and overall satisfaction with the end-products. The online format was perceived as less costly than if the Nudgeathon was hosted in person, and suitable for participants from different geographical regions. In-person Nudgeathons with international attendees would require costs for flights, accommodation, function room hire and catering. Within groups, sharing personal experiences essential to co-designing concepts. However, less information on how to create nudges and more information before the Nudgeathon was preferred. Conclusion Our evaluation finds that Nudgeathons are fast and efficient in developing potential solutions to complex issues related to HIV prevention.
Human papillomavirus vaccine uptake among young gay and bisexual men who have sex with men with a time-limited targeted vaccination programme through sexual health clinics in Melbourne in 2017
Publisher: BMJ
Date: 08-11-2018
DOI: 10.1136/SEXTRANS-2018-053619
Abstract: In mid-2017, the Victorian Government funded a free time-limited human papillomavirus (HPV) vaccination catch-up programme for gay and bisexual men who have sex with men (MSM) aged up to 26 years through sexual health clinics or other immunisation centres. We aimed to examine the uptake of the HPV vaccine among young MSM attending the Melbourne Sexual Health Centre (MSHC). MSM aged ≤26 attending MSHC between 27 April 2017 and 31 December 2017 were included in the analysis. HPV vaccine uptake was calculated based on the first consultation of each patient during the period. Multivariable logistic regression was performed to examine the association between vaccine uptake and patient factors. There were 2108 MSM aged ≤26 who attended MSHC over the study period, with 7.6% (n=161) reporting previous HPV vaccination. Of the 1947 eligible men, 1134 (58.2%, 95% CI 56.0% to 60.4%) were offered the vaccine by the clinicians, and 830 men received it on the day. The vaccine coverage among all eligible MSM was 42.6% (95% CI 40.4% to 44.9% 830 of 1947) and among MSM who were offered the vaccine by the clinicians was 73.2% (95% CI 70.5% to 75.8% 830 of 1134). Men with a history of genital warts (adjusted OR (aOR)=3.11, 95%CI 1.39 to 6.99) and those who had male partners in the last 12 months (aOR=1.38, 95% CI 1.04 to 1.85) were more likely to receive the HPV vaccine on the day. 304 men declined the vaccine most men did not specify the reason (31.3%, n=95), while 27.3% (n=83) needed time to think. Although vaccine uptake was 73.2% among those offered, the actual coverage of those eligible remained unsatisfactory (42.6%) in a sexual health clinic. This highlights a clinic-based targeted MSM programme may not reach sufficiently high vaccine coverage to provide MSM with the same vaccine benefits as heterosexuals.
Human bony labyrinth dataset: Co-registered CT and micro-CT images, surface models and anatomical landmarks
Publisher: Elsevier BV
Date: 12-2019
The acceptability and usability of two
HIV
self‐test kits among men who have sex with men: a randomised crossover trial
Publisher: Wiley
Date: 12-07-2022
DOI: 10.5694/MJA2.51641
Abstract: To compare the usability and acceptability of oral fluid- and blood-based HIV self-test kits among men who have sex with men in Australia. Randomised crossover trial. Gay, bisexual, and other men aged 18 years or older who have sex with men, who attended two metropolitan sexual health clinics in Sydney and Melbourne, 7 January - 10 December 2019. Ease of use of HIV self-test kits preferred HIV self-test type difficulties encountered during HIV self-testing. 170 men were recruited (median age, 34 years interquartile range, 29-43 years) 144 identified as gay (85%), 96 were born outside Australia (57%). Participants were more likely to report the oral fluid HIV self-test was easy to use than the blood-based self-test (oral fluid, 99% blood, 86% odds ratio [OR], 3.0 95% confidence interval [CI], 1.4-6.6). The oral fluid test was preferred by 98 participants (58% 95% CI, 50-65%), the blood-based test by 69 (41% 95% CI, 33-48%). Difficulties with the oral fluid test kit identified by observing nurses included problems placing the buffer solution into the stand (40 of 170 participants, 24%) and not swabbing both gums (23 of 169, 14%) difficulties with the blood-based test kit included problems filling the device test channel (69 of 170, 41%) and squeezing the finger firmly enough to generate a blood drop (42 of 170, 25%). No participant received an invalid result with the oral fluid self-test two of 162 participants (1%) received invalid results with the blood self-test. After adjusting for age, education level, and ethnic background, characteristics associated with higher odds of using HIV self-testing in the future were overseas birth (adjusted OR, 3.07 95% CI, 1.42-6.64), and self-evaluated ease of use and confidence in using the kits. It is important to provide options for obtaining both oral fluid- and blood-based HIV self-tests. The usability and acceptability of both kits were high, but the ease of use and perceived accuracy influenced test kit preference.
Sustained high prevalence of viral hepatitis and sexually transmissible infections among female sex workers in China: A systematic review and meta-analysis
Publisher: Springer Science and Business Media LLC
Date: 12-2016
Early presentation of symptomatic individuals is critical in controlling sexually transmissible infections
Publisher: CSIRO Publishing
Date: 2015
DOI: 10.1071/SH15036
Abstract: Two papers in this issue by Williams et al. and Scott et al. describe the sexual risks and health-seeking behaviour of young Indigenous Australians. Their sexual risks and health-seeking behaviours are similar to the general Australian population, yet their risk of past sexually transmissible infections (STIs) is higher. These findings are consistent with previous findings and suggest that access to health care, and not sexual risk, remain critical to STI control in remote Indigenous communities.
Inhibitory Activity of Antibacterial Mouthwashes and Antiseptic Substances against Neisseria gonorrhoeae
Publisher: American Society for Microbiology
Date: 21-06-2022
DOI: 10.1128/AAC.00042-22
Abstract: Improved treatment and prevention strategies, such as antimicrobial mouthwashes, may be important for addressing the public health threat of antimicrobial-resistant Neisseria gonorrhoeae . Here, we describe the activity of seven common antibacterial mouthwashes and antiseptics against N. gonorrhoeae isolates, incorporating the use of a human saliva test matrix.
Estimating HIV incidence among female partners of bisexual men in China
Publisher: Elsevier BV
Date: 05-2012
DOI: 10.1016/J.IJID.2012.01.012
Abstract: HIV prevalence among men who have sex with men (MSM) in China is rapidly increasing. The majority of Chinese MSM engage in bisexual behaviors and their female partners may be at high risk of HIV infection. Through a comprehensive literature review and the utilization of a mathematical optimization approach, this study infers quantitative distributions of sexual behavioral practices between Chinese MSM and their female partners over the past decade, and consequently estimates the trends in HIV incidence rates among female partners of Chinese MSM. The average Chinese MSM had approximately 0.89 (95% confidence interval (CI) 0.68-1.23) female sexual partners, with a mean number of total penetrative acts with the female partners of 0.57 (95% CI 0.52-0.62), in the past 6 months. Condom usage increased slightly from 23.57% (95% CI 14.20-32.93%) in 2002 to 27.33% (95% CI 19.88-34.78%) in 2010. Thus, the substantially increasing HIV prevalence among MSM has led to an increase in HIV incidence among partners of bisexual MSM of approximately 5.3-fold, from 0.18 per 1000 person-years in 2002 to 0.88 per 1000 person-years in 2010. Bisexual Chinese MSM may be a bridge group to the general female population for HIV transmission. There has been a substantial HIV incidence increase among their female partners.
Population-level effects of human papillomavirus vaccination programs on infections with nonvaccine genotypes
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 10-2016
Abstract: We analyzed human papillomavirus (HPV) prevalences during prevaccination and postvaccination periods to consider possible changes in nonvaccine HPV genotypes after introduction of vaccines that confer protection against 2 high-risk types, HPV16 and HPV18. Our meta-analysis included 9 studies with data for 13,886 girls and women ≤19 years of age and 23,340 women 20-24 years of age. We found evidence of cross-protection for HPV31 among the younger age group after vaccine introduction but little evidence for reductions of HPV33 and HPV45. For the group this same age group, we also found slight increases in 2 nonvaccine high-risk HPV types (HPV39 and HPV52) and in 2 possible high-risk types (HPV53 and HPV73). However, results between age groups and vaccines used were inconsistent, and the increases had possible alternative explanations consequently, these data provided no clear evidence for type replacement. Continued monitoring of these HPV genotypes is important.
Prevalence of Mycoplasma genitalium by anatomical site in men who have sex with men: a systematic review and meta-analysis
Publisher: BMJ
Date: 27-04-2020
DOI: 10.1136/SEXTRANS-2019-054310
Abstract: To systematically review and appraise published data, to determine the prevalence of Mycoplasma genitalium (MG) in men who have sex with men (MSM) tested at each anatomical site, that is, at the urethra, rectum and/or pharynx. Systematic review and meta-analysis. Ovid Medline, PubMed, Embase were searched for articles from 1st January 1981 (the year MG was first identified) to 1st June 2018. Studies were eligible for inclusion if they reported MG prevalence in MSM tested at the urethra, rectum and/or pharynx, in at least 50 MSM, using nucleic acid lification testing. Data were extracted by anatomical site, symptom and HIV status. Summary estimates (95% CIs) were calculated using random-effects meta-analysis. Subgroup analyses were performed to assess heterogeneity between studies. Forty-six studies met inclusion criteria, with 34 reporting estimates of MG prevalence at the urethra (13 753 s les), 25 at the rectum (8629 s les) and 7 at the pharynx (1871 s les). MG prevalence was 5.0% (95% CI 3.5 to 6.8 I 2 =94.0) at the urethra 6.2% (95% CI 4.6 to 8.1 I 2 =88.1) at the rectum and 1.0% (95% CI 0.0 to 5.1 I 2 =96.0) at the pharynx. The prevalence of MG was significantly higher at urethral and rectal sites in symptomatic versus asymptomatic MSM (7.1% vs 2.2%, p .001 and 16.1% vs 7.5%, p=0.039, respectively). MG prevalence at the urethra was significantly higher in HIV-positive compared with HIV-negative MSM (7.0% vs 3.4%, p=0.006). MG was common in MSM, particularly at urethral and rectal sites (5% to 6%). MG was more commonly detected in symptomatic men at both sites, and more common in HIV-positive men at the urethra. MG was uncommonly detected in the pharynx. Site-specific estimates are similar to those for chlamydia and will be helpful in informing testing practices in MSM. CRD42017058326.
Qualitative exploration of HIV-related sexual behaviours and multiple partnerships among Chinese men who have sex with men living in a rural area of Yunnan Province, China
Publisher: CSIRO Publishing
Date: 2013
DOI: 10.1071/SH13097
Abstract: BackgroundThe HIV epidemic has been spreading rapidly among men who have sex with men (MSM) in China. The present study explored the pattern of HIV-related high-risk sexual practices among MSM in a rural Chinese setting. Methods: Data were collected by semistructured in-depth interviews conducted among 15 MSM in Yuxi Prefecture, Yunnan Province, China. Fifteen respondents were recruited through a local non-governmental organisation via purposive s ling. Thematic analysis was used. Results: Technological changes, risk behaviours, social stigma and high migration rates have played a significant role in the spread of HIV among MSM in rural China. The Internet has become the primary channel for soliciting casual sex partners in the MSM community. Bisexuality and having concurrent and multiple sexual partners were common among rural MSM. A large number of sexual partners and low condom use in all MSM partnership types were noted. Due to Chinese cultural traditions and social stigma, Chinese rural MSM were reluctant to disclose their homosexuality. Rural-to-urban migrant MSM were often engaged in the commercial sex trade. Conclusions: Rural MSM is a distinctive and complex population with multiple identities in China. Concurrent multiple sexual partnerships, high mobility and low disclosure rate are the major challenges for HIV prevention and intervention programs in MSM.
Seasonal variation in gonorrhoea incidence among men who have sex with men
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/SH16122
Abstract: Background After reviewing urethral gonorrhoea cases among men who have sex with men (MSM) at the South Australia Specialist Sexual Health (SASSH) in Adelaide, Australia, we noticed peaks of gonorrhoea among MSM occurred predominantly in the first quarter of the year (January–March). The aim of this study was to formally test this hypothesis against data from a similar period at three sexual health services, one each in Adelaide, Melbourne and Sydney. Methods: This study was a retrospective analysis of computerised records at the three Australian sexual health services. Potential risk factors for urethral gonorrhoea among MSM were also reviewed at the SASSH. Results: More peaks of gonorrhoea cases were observed in the first quarter of the year in Adelaide and Sydney and in the second and fourth quarter in Melbourne. Factors independently associated with urethral gonorrhoea at the SASSH were being a young MSM, especially those aged 25–29 (odds ratio (OR) 2.66, 95% confidence interval (CI): 2.00–3.54), having more than one sexual partner (OR 1.71, 95% CI: 1.43–2.04), having had sex interstate and overseas (OR 1.52, 95% CI: 1.06–2.17), and presenting in the first quarter (OR 1.30, 95% CI: 1.10–1.55). Conclusion: Our data suggest that gonorrhoea among MSM occurs in a seasonal pattern, particularly late summer into early autumn. This has implications for the provision of health services over the year and for the timing of health promotion activities.
Time from HIV infection to virological suppression
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 13-11-2017
Associations Between Methods of Meeting Sexual Partners and Sexual Practices Among Heterosexuals: Cross-sectional Study in Melbourne, Australia (Preprint)
Publisher: JMIR Publications Inc.
Date: 02-12-2020
Abstract: he association between meeting partners on the web and sexual practices has been understudied in heterosexuals. his study aims to examine the associations between the methods of meeting partners and sexual practices and HIV and sexually transmitted infections (STIs) in heterosexuals. e conducted a survey among heterosexuals attending the Melbourne Sexual Health Centre in 2019. This survey asked about the methods through which the participants engaged in meeting their sexual partners, sexual practices, and intravenous drug use (IVDU) over the past 3 months. The participants’ HIV and STI (chlamydia, gonorrhea, and syphilis) status was obtained from clinical testing. Multivariable logistic regression was used to examine the association between each method of meeting and the participants’ sexual practices, IVDU, and STI status. total of 698 participants (325 men and 373 women) were included in the study. Most of the participants reported using only one method to meet partners (222/325, 68.3% men 245/373, 65.7% women i P /i =.05). The men met partners most commonly at social venues (eg, bar, pub, or party 126/325, 38.8%), whereas the women met partners most commonly through friends or family (178/373, 47.7%). Paying for sex was associated with men meeting partners at sex venues (adjusted odds ratio [AOR] 145.34, 95% CI 26.13-808.51) and on the internet (AOR 10.00, 95% CI 3.61-27.55). There was no association between IVDU and methods of meeting. Social venues were associated with condomless vaginal sex among men (AOR 3.31, 95% CI 1.94-5.71) and women (AOR 2.58, 95% CI 1.61-4.13) and testing positive for STI among men (AOR 3.04, 95% CI 1.24-7.48) and women (AOR 3.75, 95% CI 1.58-8.89). eterosexuals who met partners at social venues had a more than threefold risk of testing positive for STIs, indicating that heterosexuals may benefit from health promotion c aigns that are delivered through a public setting.
Reflex Detection of Ciprofloxacin Resistance in Neisseria gonorrhoeae by Use of the SpeeDx ResistancePlus GC Assay
Publisher: American Society for Microbiology
Date: 20-04-2021
DOI: 10.1128/JCM.00089-21
Abstract: Resistance-guided therapy (RGT) for gonorrhoea may reduce unnecessary use of broad-spectrum antibiotics. When reflexed from the Aptima Combo 2 assay, the ResistancePlus GC assay demonstrated 94.8% sensitivity and 100.0% specificity for Neisseria gonorrhoeae detection.
Endoscopic Cholesteatoma Surgery
Publisher: MyJove Corporation
Date: 19-01-2022
DOI: 10.3791/63315
Abstract: Implementation of endoscopes in cholesteatoma surgery resulted in considerable changes in the management of cholesteatoma in the last two decades. Compared to the microscopic approach with an excellent but straight-line view and limited illumination, the introduction of endoscopes provides a wide-angled panoramic view. Moreover, angled lenses allow the surgeon to visualize the middle ear and its hidden recesses through a transcanal, minimally-invasive approach. The endoscope enables the surgeon to remove limited cholesteatoma of the middle ear and its recesses using an exclusive endoscopic technique by taking advantage of these benefits. This reduces the rate of residual disease and sparing external incisions and excessive temporal bone drilling as in a transmastoid approach. Since transcanal endoscopic access is mainly a one-handed technique, it implies the need for specific procedures and technical refinements. This article describes a step-by-step guide as a surgical manual for endoscopic removal of epitympanic cholesteatoma. Different techniques for cholesteatoma dissection and bone removal for epitympanectomy, including curettage and powered instruments such as drills and ultrasonic devices with their outcomes, are discussed. This may offer ear surgeons insight into technical refinements and the latest technological developments and open the horizon for different techniques.
Kissing while high on ecstasy: lessons from a gay dance party attendee
Publisher: BMJ
Date: 20-02-2018
Sexually Transmitted Infections among Heterosexual Male Clients of Female Sex Workers in China: A Systematic Review and Meta-Analysis
Publisher: Public Library of Science (PLoS)
Date: 12-08-2013
Patterns of sexual behaviour and sexual healthcare needs among transgender individuals in Melbourne, Australia, 2011-2014
Publisher: BMJ
Date: 29-09-2018
DOI: 10.1136/SEXTRANS-2016-052710
Abstract: Literature surrounding the healthcare needs of transgender in iduals is limited in Australia. This study aimed to investigate the demographic characteristics, risk behaviours and HIV/STI positivity among male-to-female (MTF) and female-to-male (FTM) transgender in iduals attending Melbourne Sexual Health Centre (MSHC), Australia, between 2011 and 2014. A retrospective cohort analysis for 133 transgender in iduals was conducted based on the first visit of in iduals to MSHC during the study period. Demographic characteristics, sexual behaviours and HIV/STI positivity were examined. The majority of transgender in iduals were single or never married (74% n=99). Almost half of the in iduals (47% n=62) had ever engaged in sex work during their lifetime. The median number of male sexual partners (MSP) reported in the last 3 months was 1 (IQR: 1–2) and with female sexual partners (FSP) was 2 (IQR: 1–4). For those who reported having sexual partners in the previous 3 months, always using condoms with MSP was 31% (n=22), and that with FSP was 18% (n=2). HIV/STI positivity during the study period was 7% (n=8) for chlamydia, 5% (n=6) for gonorrhoea, 5% (n=5) for syphilis and 1% (n=1) for HIV. Hormone use for reassignment was reported by 63% (n=90) of in iduals and reassignment surgery was reported by 27% (n=29+6=35). Transgender in iduals in this study were found to be a erse group, with a history of sex work being a common feature. These findings indicate that transgender in iduals' sexual healthcare needs differ substantially from those in other countries, including the US and Canada. Attention to differences in MTF and FTM transgender persons must be considered in healthcare settings in Australia.
Sexual mixing patterns among male–female partnerships in Melbourne, Australia
Publisher: CSIRO Publishing
Date: 08-03-2022
DOI: 10.1071/SH21161
Abstract: Background In iduals who have both opposite- and same-sex partners have the potential to pass sexually transmitted infections (STIs) between high- and low-risk populations. Our aim was to examine assortative sexual mixing in terms of same-sex activity among male–female partnerships. Methods This was a retrospective repeated cross-sectional study of male–female partnerships attending the Melbourne Sexual Health Centre (MSHC) from 2015 to 2019. Sex of sexual partners was collected via computer-assisted self-interview. We calculated the proportion of partnerships where at least one in idual reported same-sex partners in the previous 12 months and the degree of assortativity by bisexuality. Results A total of 2112 male–female partnerships (i.e. 4224 in iduals) were included, with a median age of 27 years (IQR 23–31). Overall, 89.3% (1885/2112) of male–female partnerships did not report any other same-sex partners however, in 9.5% (201/2112) of partnerships, same-sex partners were reported by one in idual and in 1.2% (26/2112) of partnerships, both in iduals reported same-sex partners. Bisexuality appeared to be slightly assortative in male–female partnerships (r = 0.163, 95% CI: 0.150–0.176 P 0.001). Conclusion One in 10 in iduals in male–female partnerships had at least one same-sex partner within the previous 12 months. In iduals were minorly selective by bisexuality, suggesting the patterns of bisexual mixing in male–female partners are more variable and this may have a significant impact on STI transmission in heterosexual populations.
Testing for HIV/STIs in China: Challenges, Opportunities, and Innovations
Publisher: Hindawi Limited
Date: 2017
DOI: 10.1155/2017/2545840
Neisseria gonorrhoeaeDNA bacterial load in men with symptomatic and asymptomatic gonococcal urethritis
Publisher: BMJ
Date: 02-2017
DOI: 10.1136/SEXTRANS-2016-052950
Abstract: Previous studies have quantified bacterial loads of Consecutive men diagnosed with urethral gonorrhoea by Aptima Combo 2 testing of urine at the Melbourne Sexual Health Centre between March and July 2016 were eligible for the study: symptomatic men with purulent urethral discharge and asymptomatic men with no urethral symptoms. The gonococcal bacterial load in both groups was measured by urethral swab using a standardised collection method and real-time quantitative PCR targeting the Twenty men were recruited into the study: 16 had purulent urethral discharge and 4 had asymptomatic urethral gonorrhoea. The median gonococcal bacterial load was significantly higher among symptomatic men (3.7×10 Gonococcal loads in men with urethral discharge were higher than loads seen with asymptomatic urethral gonorrhoea and loads seen in asymptomatic pharyngeal and rectal gonorrhoea infections in previous studies.
Outcomes of Resistance-guided Sequential Treatment of Mycoplasma genitalium Infections
Publisher: Oxford University Press (OUP)
Date: 05-06-2019
DOI: 10.1093/CID/CIY477
Comparison of the patterns of chlamydia and gonorrhoea at the oropharynx, anorectum and urethra among men who have sex with men
Publisher: BMJ
Date: 12-01-2021
DOI: 10.1136/SEXTRANS-2020-054632
Abstract: Chlamydia and gonorrhoea are common sexually transmitted infections that infect the oropharynx, anorectum and urethra in men who have sex with men (MSM). This study aimed to examine the pattern of infection at more than one site (multisite) for chlamydia and gonorrhoea among MSM. This was a retrospective study of MSM attending the Melbourne Sexual Health Centre for the first time between 2018 and 2019. We included MSM aged ≥16 years who had tested for Neisseria gonorrhoeae and Chlamydia trachomatis at all three sites (oropharynx, anorectum and urethra). We compared infections that occurred at a single site (termed single-site infection) and those that occurred at more than one site (termed multisite infections). Of the 3938 men who were tested for chlamydia and gonorrhoea, 498/3938 men (12.6%, 95% CI 11.5% to 13.6%) had chlamydia at any site, of whom 400/498 (80.3%, 95% CI 78.9% to 81.2%) had single-site chlamydia infection, and 98/498 (19.7%, 95% CI 16.2% to 23.1%) had multisite infections. A similar proportion of men had gonorrhoea at any site (447/3938, 11.4%, 95% CI 10.3% to 12.2%), but among these 447 men, single-site infection was less common (256/447, 57.3%, 95% CI 52.6% to 61.7%, p .001) and multisite infection (191/447, 42.7%, 95% CI 38.2% to 47.3%, p .001) was more common than chlamydia. There were also marked differences by anatomical site. Urethral infection commonly occurred as single sites (75/122, 61.5%, 95% CI 52.8% to 70.1%) for chlamydia but uncommonly occurred for gonorrhoea (12/100, 12.0%, 95% CI 5.6% to 18.3%, p .001). In contrast, anorectal infection uncommonly occurred as multisite infection for chlamydia (98/394, 24.9%, 95% CI 20.6% to 29.1%) but was common (184/309, 59.5%, 95% CI 54.0% to 64.9%, p .001) for gonorrhoea. The markedly different pattern of site-specific infection for chlamydia and gonorrhoea infections among the same MSM suggests significant differences in the transmissibility between anatomical sites and the duration of each infection at each site.
HIV, Sexually Transmitted Infections and Sexual Practices Among Male Sex Workers Attending a Sexual Health Clinic in Melbourne, Australia: 2010 to 2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-09-2020
DOI: 10.1097/OLQ.0000000000001283
Abstract: There are limited data on HIV/sexually transmitted infection (STI) positivity and sexual practices among male sex workers (MSWs) both globally and particularly in Australia. This study aimed to explore demographic characteristics, sexual practices, and HIV/STI positivity among MSWs attending a sexual health clinic in Melbourne. We analyzed computerized medical records of all first-visit consultations with men 18 years or older who self-identified as current sex workers and attended the Melbourne Sexual Health Centre (MSHC) between 2010 and 2018. Demographic data, sexual behavior data, and laboratory results for HIV, syphilis, chlamydia, and gonorrhea were collected as part of routine clinical care at Melbourne Sexual Health Centre. Of the 190 MSWs included in the analysis, the median age was 28 years (interquartile range, 23–30 years), 30.4% (52/171) reported having condomless penile-anal sex with their clients, and 59.6% (102/171) reported having condomless penile-oral sex with their clients since their last STI screening. Most (85.6%) MSWs had noncommercial sex partners, including 56.5% with male partners only, 30.6% with female partners only, and 12.9% with both. Approximately half of MSWs used condoms consistently with noncommercial sex partners (regardless of partner gender). The positivity for incident HIV was 1.7% (95% confidence interval [CI], 0.0%–5.0%), that for syphilis was 6.1% (95% CI, 2.6%–10.5%), that for chlamydia was 9.6% (95% CI, 5.6%–14.9%), and that for gonorrhea was 10.8% (95% CI, 4.4%–20.9%). Male sex workers who exclusively had sex with women had a lower any HIV/STI positivity (0%) compared with MSW who had sex with men (15.7% P = 0.013). Male sex workers fall into 2 groups: those who had male clients and/or noncommercial partners who have a relatively high HIV/STI positivity and those who only had female partners or clients whose HIV/STI positivity is low. Both have a high proportion of condomless sex with clients and noncommercial sex partners. Strategies to increase condom use during sex work are needed.
A cross-sectional survey on the health status and the health-related quality of life of the elderly after flood disaster in Bazhong city, Sichuan, China
Publisher: Springer Science and Business Media LLC
Date: 19-02-2015
Meningococcal vaccine uptake among men who have sex with men in response to an invasive meningococcal C disease outbreak in Melbourne, Australia
Publisher: BMJ
Date: 09-01-2020
DOI: 10.1136/SEXTRANS-2019-054318
Abstract: In 2017, there was an outbreak of invasive meningococcal disease (IMD) serogroup C among men who have sex with men (MSM) in Victoria, Australia. A government-funded free meningococcal (MenACWY) vaccination programme targeting all MSM living in Victoria was launched between December 2017 and December 2018. The aim of this study was to examine the vaccine uptake among MSM attending a sexual health clinic in Melbourne. This was a retrospective clinical audit of MSM attending the Melbourne Sexual Health Centre (MSHC) during the vaccination programme. We calculated the proportion of MSM who received the meningococcal vaccine on their first visit and at any time during the programme. We performed univariable and multivariable logistic regression to identify the factors associated with the vaccine uptake on the first visit. Of the 10 370 MSM who attended MSHC, 55.5% received the vaccine on their first visit and 67.4% at any time during the programme. MSM had higher odds of receiving the vaccine on the first visit if they were aged 16–25 years (adjusted OR (aOR) 1.21 95% CI 1.08 to 1.35) or 26–35 years (aOR 1.17 95% CI 1.07 to 1.29) in comparison with MSM older than 35 years were HIV-negative and not on pre-exposure prophylaxis (aOR 1.80 95% CI 1.56 to 2.09) had more than four male partners in the last 12 months (aOR 1.16 95% CI 1.06 to 1.27) had male partners only (aOR 2.24 95% CI 1.96 to 2.55) or were born overseas (aOR 1.11 95% CI 1.03 to 1.21). Two-thirds of the MSM attending a sexual health clinic received at least one dose of meningococcal vaccine. The vaccination programme coincided temporally with a dramatic reduction in the incidence of IMD. Vaccination should be further promoted among MSM and men who have sex with both men and women.
Cost-effectiveness of artificial intelligence-assisted liquid-based cytology testing for cervical cancer screening in China
Publisher: Elsevier BV
Date: 05-2023
Global Estimates for the Lifetime Cost of Managing HIV: A Systematic Review
Publisher: Elsevier BV
Date: 2020
DOI: 10.2139/SSRN.3719079
Doxycycline and Sitafloxacin Combination Therapy for Treating Highly Resistant Mycoplasma genitalium
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 08-2020
Changing the Use of HIV Pre-exposure Prophylaxis Among Men Who Have Sex With Men During the COVID-19 Pandemic in Melbourne, Australia
Publisher: Oxford University Press (OUP)
Date: 07-2020
DOI: 10.1093/OFID/OFAA275
Abstract: We surveyed 204 men who have sex with men (MSM) who were pre-exposure prophylaxis (PrEP) users. One in 4 daily PrEP users stopped taking PrEP during the COVID-19 pandemic, and 5% switched to on-demand PrEP. Most men reduced PrEP use because they stopped having casual sex and reduced the number of casual partners during the COVID-19 pandemic.
A Comparison of the Performance of Different Age-Based Paediatric Weight Estimation Formulae in Hong Kong Children
Publisher: SAGE Publications
Date: 2016
DOI: 10.1177/102490791602300101
Abstract: To evaluate the performance of five existing age-based weight estimation formulae - the original and updated Advanced Paediatric Life Support (APLS) formulae, Luscombe formula, Best Guess formula, Chinese Age Weight Rule (CAWR) - as well as a new two-part weight estimation formula, the Chinese Age Weight Rule-3 (CAWR-3), in Hong Kong children presenting to the emergency department (ED). Data based on children aged 1-12 who presented to the ED of a tertiary referral centre in Hong Kong over a six-month period. Actual weight was compared against estimated weight from the weight estimation formulae. Level of agreement was assessed by Bland-Altman analysis using mean percentage difference (MPD) and 95% limits of agreement (LOA). Root mean squared error (RMSE) and proportions of weight estimates within 10%, 15% and 20% of actual weight were calculated. A total of 4600 children were included. The CAWR-3 outperformed the five existing weight estimation formulae. The CAWR-3 had the least MPD in age 4-12 (MPD +3.2%), as well as the second least MPD in age 1-12 (MPD -0.7%). The CAWR-3 had narrowest 95% LOA in age 1-3 (95% LOA -32.6% to 21.9%) and the second narrowest 95% LOA in age 1-12 (95% LOA -37.5% to 36.1%). The CAWR-3 had the smallest RMSE of 6.33 kg in age 4-12 and the smallest RMSE of 4.90 kg in age 1-12. Furthermore, the CAWR-3 had the highest proportion of weight estimates within 10%, 15% and 20% of actual weight. The CAWR-3 outperforms the five existing age-based weight estimation formulae in Hong Kong children presenting to the emergency department.
Pattern of HIV testing and multiple sexual partnerships among men who have sex with men in China
Publisher: Springer Science and Business Media LLC
Date: 16-11-2013
Abstract: Men who have sex with men (MSM) are a hidden but emerging population susceptible to HIV infection against a background of rapidly increasing HIV prevalence in China. Low HIV testing levels and multiple partnerships among MSM are two major contributing factors to HIV transmission. We conducted a cross-sectional survey among 447 Chinese MSM in Changsha and Tianjin cities from November to December 2011 using an anonymous questionnaire. We aim to investigate (1) the trend of HIV testing rates among Chinese MSM during 2009 to 2011 and (2) the patterns of multiple sexual relationships with male, female and commercial partners. The self-reported past-12-months HIV testing level among Chinese MSM increased from 16.6% in 2009 to 46.3% in 2010 and 58.6% in 2011 (χ 2 = 173.49, p 0.001). Compared with men who have tested for HIV, the never-tested MSM were generally younger, never married, students, and more likely to have unprotected anal intercourse with non-commercial male partners. Furthermore, 21.3% (56/263) MSM reported having multiple regular male and female sexual partnerships and 6.2% (16/257) reported having commercial male partners in the past six months. However, in iduals who were never-tested for HIV are consistently less likely to engage in multiple sexual relationships. HIV testing rates have increased substantially among Chinese MSM in the period 2009–2011, although significant barriers to testing remain. Multiple sexual partnerships, and especially bisexual behaviours, are common among Chinese MSM.
Fuckbuddy partnerships among men who have sex with men – a marker of sexually transmitted infection risk
Publisher: SAGE Publications
Date: 06-07-2017
Abstract: ‘Fuckbuddies’ are a type of regular sexual partner with whom men have ongoing sexual contact, generally in the absence of romantic attachment. We surveyed 989 men who have sex with men (MSM) at the Melbourne Sexual Health Centre, Australia, with the aim of determining the frequency of ‘fuckbuddy’ partnerships among sexual health clinic attendees and assessing their sexual risk. The majority (60%) of 1139 regular partnerships were described as ‘fuckbuddies’. Most MSM (63%) with a ‘fuckbuddy’ had multiple ‘fuckbuddies’. MSM with ‘fuckbuddies’ were more likely to also have casual sexual partners (odds ratio [OR] 5.7 95% confidence interval 3.6–8.9) and had more casual sexual partners (median of 4 versus 1, p 0.001) and more rectal chlamydia (12.4% versus 5.7% adjusted OR 2.3 p 0.05) than MSM without ‘fuckbuddies’, and this risk persisted after adjusting for total numbers of sexual partners. Our findings suggest that patients with ‘fuckbuddies’ are at particular risk of sexually transmitted infections. We argue that clinicians should specifically ask about ‘fuckbuddy’ partnerships as part of their risk assessment during patient interviews, as these patients may benefit from HIV prevention strategies such as pre-exposure prophylaxis (PrEP).
Love during lockdown: findings from an online survey examining the impact of COVID-19 on the sexual practices of people living in Australia
Publisher: Cold Spring Harbor Laboratory
Date: 12-08-2020
DOI: 10.1101/2020.08.10.20171348
Abstract: Australia recorded its first case of COVID-19 in late January 2020. On 22 nd March 2020, amid increasing daily case numbers, the Australian Government implemented lockdown restrictions to help ‘flatten the curve’. Our study aimed to understand the impact of lockdown restrictions on sexual and reproductive health. Here we focus on sexual practices. An online survey was open from the 23 rd April 2020 to the 11 th May 2020. Participants were recruited online via social media and other networks and were asked to report on their sexual practices in 2019 and during lockdown. Logistic regression was used to calculate the difference (including 95% confidence intervals) in the proportion of sex practices between time periods. Of the 1187 who commenced the survey, 965 (81.3%) completed it. Overall 70% were female and 66.3% were aged 18 to 29 years. Most (53.5%) reported less sex during lockdown than in 2019. Compared with 2019, participants were more likely to report sex with a spouse (35.3% vs 41.7% difference=6.4% 95%CI: 3.6, 9.2) and less likely to report sex with a girl/boyfriend (45.1% vs 41.8% diff=-3.3% 95%CI: -7.0, -0.4) or with casual hook-up (31.4% vs 7.8% 95%CI:-26.9, -19.8). Solo sex activities increased, 14.6% (123/840) reported using sex toys more often and 26.0% (218/838) reported masturbating more often. Dating app use decreased during lockdown compared with 2019 (42.1% vs 27.3% difference= -14.8% 95%CI: -17.6, -11.9). Using dating apps for chatting/texting (89.8% vs 94.5% diff=4.7% 95%CI:1.0, 8.5) and for setting up virtual dates (2.6% vs 17.2% diff=14.6% 95%CI:10.1, 19.2) increased during lockdown. Although significant declines in sexual activity during lockdown were reported, people did not completely stop engaging in sexual activities during the pandemic, highlighting the importance of ensuring availability of normal sexual and reproductive health services during global emergencies. Sexual activity declined among our participants during the COVID-19 lockdown restrictions in Australia, with more than half reporting having less sex than in 2019 Sexual practices also changed during lockdown, with more people reporting solo sex activities like masturbating alone or using a sex toy. Use of dating apps also declined among our participants. Of those still using apps, we saw increased use for chatting/texting and setting up virtual dates.
Only recent sexual partners contribute to oropharyngeal gonorrhoea positivity
Publisher: CSIRO Publishing
Date: 2018
DOI: 10.1071/SH17196
Abstract: Background Mathematical models have demonstrated that the majority of gonococcal transmission is from oropharynx to oropharynx (i.e. kissing) among men who have sex with men (MSM). The aim of this study is to investigate the association between the number of partners within specific time periods and gonorrhoea and chlamydia positivity. Methods: This was a retrospective data analysis of MSM attending the Melbourne Sexual Health Centre between 2007 and 2016. Univariable and multivariable logistic regression analyses, with generalised estimating equations (GEE), were performed to determine if the number of partners within specified time periods was associated with site-specific gonorrhoea and chlamydia positivity. Results: There were 45933 consultations which included 15197 MSM. Oropharyngeal gonorrhoea positivity was associated with the number of partners in the past 3 months, but not the number of partners 4–12 months ago men who had ≥6 partners in the past 3 months had significantly higher odds of acquiring oropharyngeal gonorrhoea (aOR 1.93 95% CI 1.61–2.31), but this was not the case for men who had ≥6 partners 4–12 months ago. Anorectal gonorrhoea and chlamydia and urethral chlamydia were associated with the number of partners in both time periods after adjusting for age and condom use. Conclusions: The association of oropharyngeal gonorrhoea with the number of recent partners, but not partners from an earlier period, unlike anorectal gonorrhoea and anorectal and urethral chlamydia, could be explained by a shorter duration of oropharyngeal gonococcal infection. Annual screening for gonorrhoea may be insufficient to materially reduce oropharyngeal prevalence.
Human Papillomavirus Prevalence in Unvaccinated Heterosexual Men After a National Female Vaccination Program
Publisher: Oxford University Press (OUP)
Date: 03-11-2017
Abstract: In Australia, high uptake of the quadrivalent human papillomavirus (4vHPV) vaccine has led to reductions in the prevalence of human papillomavirus (HPV) genotypes 6, 11, 16, and 18 in women and girls aged ≤25 years. We evaluated the impact of the program impact on HPV prevalence in unvaccinated male subjects. Sexually active heterosexual male subjects aged 16-35 years were recruited in 2014-2016. Participants provided a self-collected penile swab s le for HPV genotyping (Roche Linear Array) and completed a demographic and risk factor questionnaire. The prevalence of 4vHPV genotypes among 511 unvaccinated male subjects was significantly lower in those aged ≤25 than in those aged >25 years: 3.1% (95% confidence interval, 1.5%-5.7%) versus 13.7% (8.9%-20.1%), respectively (P < .001) adjusted prevalence ratio, 0.22 (.09-.51 P 25 years (P = .76) adjusted prevalence ratio, 0.98, (.57-1.37 P = .58). A 78% lower prevalence of 4vHPV genotypes was observed among younger male subjects. These data suggest that unvaccinated men may have benefited from herd protection as much as women from a female-only HPV vaccination program with high coverage.
Mpox knowledge, vaccination and intention to reduce sexual risk practices among men who have sex with men and transgender people in response to the 2022 mpox outbreak: a cross-sectional study in Victoria, Australia
Publisher: CSIRO Publishing
Date: 10-07-2023
DOI: 10.1071/SH23075
The Microscopic Transcanal Approach in Stapes Surgery Revisited
Publisher: MyJove Corporation
Date: 16-02-2022
DOI: 10.3791/63011
Abstract: The microscopic transcanal (aka transmeatal) surgical approach was first described in the 60s, offering a minimally invasive means of reaching the external auditory canal, the middle ear, and epitympanon. Such an approach avoids a retroauricular or endaural skin incision however, working through a narrow space needs angled microsurgical instruments and specific training in otologic surgery. The transcanal approach restricts the working space however, it offers a binocular microscopic vision into the middle ear without extended skin incisions and thus, reducing post-operative pain and bleeding. In addition, this minimally invasive approach avoids scar tissue complications, hypoesthesia of the auricle, and potential protrusion of the pinna. Despite its numerous advantages, this method is still not routinely performed by otologic surgeons. Since this minimally invasive technique is more challenging, there is a need for extensive training in order for it to be widely adopted by otologic surgeons. This article provides step-by-step surgical instructions for stapes surgery and reports possible indications, pitfalls, and limitations using this microscopic transcanal technique.
Infectious syphilis in women and heterosexual men in major Australian cities: sentinel surveillance data, 2011–2019
Publisher: Wiley
Date: 28-02-2023
DOI: 10.5694/MJA2.51864
Abstract: To examine changes in the positive infectious syphilis test rate among women and heterosexual men in major Australian cities, and rate differences by social, biomedical, and behavioural determinants of health. Analysis of data extracted from de‐identified patient records from 34 sexual health clinics participating in the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance of Sexually Transmissible Infections and Blood Borne Viruses (ACCESS). First tests during calendar year for women and heterosexual men aged 15 years or more in major cities who attended ACCESS sexual health clinics during 2011–2019. Positive infectious syphilis test rate change in annual positive test rate. 180 of 52 221 tested women (0.34%) and 239 of 36 341 heterosexual men (0.66%) were diagnosed with infectious syphilis. The positive test rate for women was 1.8 (95% confidence interval [CI], 0.9–3.2) per 1000 tests in 2011, 3.0 (95% CI, 2.0–4.2) per 1000 tests in 2019 (change per year: rate ratio [RR], 1.12 95% CI, 1.01–1.25) for heterosexual men it was 6.1 (95% CI, 3.8–9.2) per 1000 tests in 2011 and 7.6 (95% CI, 5.6–10) per 1000 tests in 2019 (RR, 1.10 95% CI, 1.03–1.17). In multivariable analyses, the positive test rate was higher for women (adjusted RR [aRR], 1.85 95% CI, 1.34–2.55) and heterosexual men (aRR, 2.39 95% CI, 1.53–3.74) in areas of greatest socio‐economic disadvantage than for those in areas of least socio‐economic disadvantage. It was also higher for Indigenous women (aRR, 2.39 95% CI, 1.22–4.70) and for women who reported recent injection drug use (aRR, 4.87 95% CI, 2.18–10.9) than for other women it was lower for bisexual than heterosexual women (aRR, 0.48 95% CI, 0.29–0.81) and for women who reported recent sex work (aRR, 0.35 95% CI, 0.29–0.44). The positive test rate was higher for heterosexual men aged 40–49 years (aRR, 2.11 95% CI, 1.42–3.12) or more than 50 years (aRR, 2.36 95% CI, 1.53–3.65) than for those aged 15–29 years. The positive test rate among both urban women and heterosexual men tested was higher in 2019 than in 2011. People who attend reproductive health or alcohol and drug services should be routinely screened for syphilis.
Immunity to hepatitis A among men who have sex with men attending a large sexual health clinic in Melbourne, Australia, 2012–2018
Publisher: BMJ
Date: 13-03-2020
DOI: 10.1136/SEXTRANS-2019-054327
Abstract: Outbreaks of hepatitis A are being reported more commonly among men who have sex with men (MSM) globally. Australia has also reported a sharp increase in the number of cases of hepatitis A in 2017. This study aimed to determine the level of immunity to hepatitis A among MSM attending a large urban sexual health clinic in Victoria in the lead up to recent outbreak. This was a retrospective audit of serological testing data from first-time MSM attendees at Melbourne Sexual Health Centre (MSHC) in Australia from 1 January 2012 to 31 December 2018. We determined the proportion of MSM who were tested and who had serological detection of hepatitis A IgG, stratified by age and calendar year. We used univariable and multivariable logistic regression to investigate factors associated with testing for and detection of hepatitis A IgG. There were 16 609 first-time MSM attendees at MSHC over the 7-year period, of which 9718 (59%, 95% CI 58% to 60%) were tested for hepatitis A IgG. There was a 2% annual increase in the proportion of men tested (from 60% in 2012 to 69% in 2018 OR=1.02, 95% CI 1.00 to 1.03, p=0.025). Men born outside of Australia/New Zealand, and younger men years had higher odds of being tested. Of those tested, 44% (n=4304, 95% CI 43% to 45%) had hepatitis A IgG detected at their first visit, with no change over time (OR=1.01, 95% CI 0.99 to 1.03, p=0.210). Detection of hepatitis A IgG was associated with being aged 30 years or older (adjusted OR=2.06, 95% CI 1.89 to 2.24, p .001) or being born overseas versus Australia/New Zealand (AOR=1.21, 95% CI 1.11 to 1.31, p .001). Hepatitis A immunity among MSM remains below the estimated 70% required to prevent outbreaks. Measures including increased testing and higher vaccination coverage are needed to prevent outbreaks and to limit the number of cases and deaths.
Is SMS text or email more effective for recruitment into sexual health research?
Publisher: BMJ
Date: 11-04-2022
Prevalence of human papillomavirus in teenage heterosexual males following the implementation of female and male school-based vaccination in Australia: 2014–2017
Publisher: Elsevier BV
Date: 10-2019
DOI: 10.1016/J.VACCINE.2019.09.052
Abstract: Australia introduced a school-based human papillomavirus (HPV) vaccination program for females aged 12-13 years in 2007, with a three-year catch-up to age 26 and for boys aged 12-13 from 2013, with a two-year catch-up to age 15. This study aimed to compare the prevalence of penile HPV between teenage heterosexual males in cohorts eligible or non-eligible for the school-based male vaccination program. Between 2014 and 2017, sexually active heterosexual males aged 17-19 were recruited from sexual health centres and community sources across Australia. Males provided a self-collected penile swab for 37 HPV genotypes using Roche Linear Array and completed a questionnaire. We calculated adjusted prevalence ratios (aPR) of HPV between males in two periods: 2014-2015 (preceding implementation of school-based male vaccination) and 2016-2017 (eligible for school-based male vaccination). Self-reported vaccine doses were confirmed with doses reported to the National HPV Vaccination Program Register. Overall, 152 males were recruited in 2014-2015 and 146 in 2016-2017. Numbers of female sex partners and condom use did not differ between the two periods. The prevalence of quadrivalent vaccine-preventable [4vHPV] genotypes (6/11/16/18) was low in both periods (2.6% [2014-15] versus 0.7% [2016-17] p = 0.371 aPR 0.28 [95% CI: 0.03-2.62]). Compared with men in 2014-2015, men in 2016-2017 had a lower prevalence of any of the 37 HPV genotypes tested (21.7% versus 11.6% aPR 0.62 [95% CI: 0.36-1.07]) and any of the 13 high-risk genotypes tested (15.8% versus 7.5% aPR 0.59 [95% CI: 0.30-1.19]). Prevalence of low-risk HPV genotypes did not differ between the two periods. Of the males recruited in 2016-2017, 55% had received ≥1 vaccine dose. The prevalence of 4vHPV genotypes among teenage heterosexual males in both cohorts was low, presumably due to herd protection from the female-only vaccination program. Further studies are required to determine the impact of universal HPV vaccination on HPV prevalence in males.
Are Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum Associated With Specific Genital Symptoms and Clinical Signs in Nonpregnant Women?
Publisher: Oxford University Press (OUP)
Date: 27-01-2021
DOI: 10.1093/CID/CIAB061
Abstract: There is limited evidence supporting an association between Mycoplasma hominis, Ureaplasma urealyticum, and Ureaplasma parvum with symptoms or disease in nonpregnant women. However, testing and reporting of these organisms frequently occurs, in part due to their inclusion in multiplex-PCR assays for sexually transmitted infection (STI) detection. We investigated if M. hominis, U. urealyticum, and U. parvum were associated with symptoms and/or signs in nonpregnant women attending a sexual health service. Eligible women attending the Melbourne Sexual Health Centre completed a questionnaire regarding sexual practices and symptoms. Symptomatic women underwent examination. Women were assessed for bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC), and tested for M. hominis, U. urealyticum, and U. parvum, and 4 nonviral STIs using a commercial multiplex-PCR. 1272 women were analyzed. After adjusting for STIs and VVC, M. hominis was associated with abnormal vaginal discharge (aOR = 2.70, 95%CI:1.92–3.79), vaginal malodor (aOR = 4.27, 95%CI:3.08–5.91), vaginal pH & 4.5 (aOR = 4.27, 95%CI:3.22–5.66), and presence of clue cells (aOR = 8.08, 95%CI:5.68–11.48). Ureaplasma spp. were not associated with symptoms/signs. Bacterial vaginosis was strongly associated with M. hominis (aOR = 8.01, 95%CI:5.99–10.71), but was not associated with either Ureaplasma spp. In stratified analyses, M. hominis was associated with self-reported vaginal malodor and clinician-recorded vaginal discharge in women with BV, but not with symptoms/signs in women without BV. Only M. hominis was associated with symptoms/signs, and these were manifestations of BV. Importantly, M. hominis was not associated with symptoms/signs in women without BV. These findings do not support routine testing for M. hominis, U. urealyticum, and U. parvum in nonpregnant women.
Increased Detection of Pharyngeal and Rectal Gonorrhea in Men Who Have Sex With Men After Transition From Culture To Nucleic Acid Amplification Testing
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2017
Correlation between monkeypox viral load and infectious virus in clinical specimens
Publisher: Elsevier BV
Date: 04-2023
Are genital examinations necessary for STI screening for female sex workers? An audit of decriminalized and regulated sex workers in Melbourne, Australia
Publisher: Public Library of Science (PLoS)
Date: 16-04-2020
Characteristics of recently arrived Asian men who have sex with men diagnosed with HIV through sexual health services in Melbourne and Sydney
Publisher: Elsevier BV
Date: 10-2019
Abstract: Asian men who have sex with men (MSM) who have recently arrived in Australia are an emergent risk group for HIV however, little is known about how they compare to Australian MSM diagnosed with HIV. This study compared the characteristics of these two groups. A retrospective, cross-sectional study of MSM diagnosed with HIV between January 2014 and October 2017 in Melbourne and Sydney public sexual health clinics. Asian MSM were those who had arrived in Australia within 4 years of diagnosis. Among 111 Asian men, 75% spoke a language other than English, 88% did not have Medicare and 61% were international students. Compared with Australian men (n=209), Asian men reported fewer male sexual partners within 12 months (median 4 versus 10, p<0.001), were less likely to have tested for HIV previously (71% versus 89%, p<0.001) and had a lower median CD4 count (326 versus 520, p<0.001). Among Asian men, HIV subtype CRF01-AE was more common (55% versus 16%, p<0.001) and subtype B less common (29% versus 73%, p<0.001). Asian MSM diagnosed with HIV reported lower risk and had more advanced HIV. Implications for public health: HIV testing and preventative interventions supporting international students are required.
Assessing disparity in the distribution of HIV and sexually transmitted infections in Australia: a retrospective cross-sectional study using Gini coefficients
Publisher: BMJ
Date: 08-2023
DOI: 10.1136/BMJPH-2023-000012
Abstract: The risk of HIV and sexually transmitted infections (STIs) varies substantially across population groups in Australia. We examined this disparity in HIV/STI distribution using Gini coefficients, where scores closer to one indicate greater disparity. We used demographic and sexual behaviour data from the Melbourne Sexual Health Centre, between 2015 and 2018. We examined 88 642 HIV consultations, 92 291 syphilis consultations, 97 473 gonorrhoea consultations and 115 845 chlamydia consultations. We applied a machine learning-based risk assessment tool, MySTIRisk, to determine the risk scores. Based on in iduals’ risk scores and HIV/STIs diagnoses, we calculated the Gini coefficients for these infections for different subgroups. Overall, Gini coefficients were highest for syphilis (0.60, 95% CI 0.57 to 0.64) followed by HIV (0.57, 95% CI 0.52 to 0.62), gonorrhoea (0.38, 95% CI 0.36 to 0.42) and chlamydia (0.31, 95% CI 0.28 to 0.35). Gay, bisexual and other men who have sex with men (GBMSM) had lower Gini coefficients compared with heterosexual men or women HIV (0.54 vs 0.94 vs 0.96), syphilis (0.50 vs 0.86 vs 0.93), gonorrhoea (0.24 vs 0.57 vs 0.57) and chlamydia (0.23 vs 0.42 vs 0.40), respectively. The Gini coefficient was lower among 25–34 years than in other age groups for HIV (0.66 vs 0.83–0.90) and gonorrhoea (0.38 vs 0.43–0.47). For syphilis, the oldest age group (≥45 years) had a lower Gini coefficient than 18–24 years (0.61 vs 0.70). Our study demonstrated that HIV/STIs are more evenly distributed among GBMSM, suggesting widely disseminated interventions for GBMSM communities. In contrast, interventions for heterosexual men and women should be more targeted at in iduals with higher risk scores.
Gonorrhoea notifications and nucleic acid amplification testing in a very low-prevalence Australian female population
Publisher: AMPCo
Date: 30-03-2015
DOI: 10.5694/MJA14.00780
Abstract: To examine whether the rapid increase of gonorrhoea notifications in Victoria, Australia, identified by nucleic acid lification test (NAAT) is supported by similar changes in diagnoses by culture, which has higher specificity, and to determine the proportion of tests positive among women tested. Retrospective analysis of Medicare reporting of dual NAATs in Victoria, Victorian Department of Health gonorrhoea notifications, and gonorrhoea culture data at the Melbourne Sexual Health Centre (MSHC), among women, 2008 to 2013. Gonorrhoea notifications and testing methods. Gonorrhoea cases identified by NAAT increased from 98 to 343 cases over the study period. Notifications by culture alone decreased from 19 to five cases. The proportion of NAATs positive for gonorrhoea in Victoria was low (0.2%-0.3%) and did not change over time (P for trend, 0.66). Similarly, the proportion of women tested at the MSHC for gonorrhoea who tested positive (0.4%-0.6%) did not change over time (P for trend, 0.70). Of untreated women who had a positive NAAT result for gonorrhoea and were referred to the MSHC, 10/25 were confirmed by culture. The positivity of gonorrhoea in women identified by culture remains stable over time. Using NAAT for gonorrhoea screening in low-prevalence populations will result in many false positives. Positive NAAT results among low-risk women should be regarded as doubtful, and confirmatory cultures should be performed.
Prevalence of human papillomavirus in young men who have sex with men after the implementation of gender-neutral HPV vaccination: a repeated cross-sectional study
Publisher: Elsevier BV
Date: 10-2021
Routine CD4 cell count monitoring seldom contributes to clinical decision-making on antiretroviral therapy in virologically suppressed HIV-infected patients
Publisher: Wiley
Date: 18-09-2015
DOI: 10.1111/HIV.12198
Abstract: In Australia, CD4 cell count is monitored approximately every 6 months in HIV-infected patients during antiretroviral therapy (ART). The aim of this study was to determine if routine CD4 monitoring contributed to decisions on changes to ART, and to estimate how reduced CD4 monitoring could contribute to cost savings in Australia. We conducted a retrospective cohort analysis investigating all HIV-infected patients who attended the Melbourne Sexual Health Centre (MSHC) in Australia from 1 April 2011 to 1 October 2013. We reviewed the electronic medical records of all patients who changed or stopped antiretroviral regimens during this time period to determine whether CD4 cell count could have contributed to this clinical decision. Among 1004 patients with HIV infection on ART, none [95% confidence interval (CI) 0-2.3%] of the 162 clinical decisions to change or stop treatment were influenced by CD4 cell counts. Reducing the current biannual CD4 monitoring strategy to annually could potentially save ∼AU$ 1.5 million (US$ 1.4 million) each year in Australia [i.e. ∼AU$ 74 700 (US$ 67 700) could be saved per 1000 HIV-infected patients during ART]. Routine CD4 monitoring in HIV-infected patients during ART could be reduced from biannually to annually, as it rarely influences clinical decisions in patients' management. Not only could this avoid patients being unnecessarily anxious about normal fluctuations in their CD4 counts but it would also result in cost savings.
Nonclassical Pathogens as Causative Agents of Proctitis in Men who Have Sex With Men
Publisher: Oxford University Press (OUP)
Date: 19-03-2021
DOI: 10.1093/OFID/OFAB137
Abstract: This study aimed to identify enteric and sexually acquired rectal pathogens, other than chlamydia and gonorrhea, associated with symptomatic proctitis in men who have sex with men (MSM). Anorectal swab s les were obtained from MSM presenting with rectal symptoms and a clinical diagnosis of proctitis at the Melbourne Sexual Health Centre between January 2017 and March 2019. S les that tested positive for Neisseria gonorrhoeae and Chlamydia trachomatis were excluded. As a comparison group, anorectal s les were also obtained from MSM not reporting symptoms of proctitis between November 2018 and February 2019. S les from both groups were tested for 15 viral, bacterial, and protozoal enteric pathogens using polymerase chain reaction. Anorectal s les from 499 men with symptomatic proctitis and 506 asymptomatic men were analyzed. Age, HIV status, and pre-exposure prophylaxis (PrEP) use did not differ between men with proctitis and asymptomatic men. Treponema pallidum was more common in men with proctitis (risk difference [RD], 3.6% 95% CI, 2.0%–5.2%). Most men with anorectal T. pallidum presented with painful anal primary infections. Shigella spp. was more common among men with proctitis compared with asymptomatic men (RD, 1.8% 95% CI, 0.1%–3.5%). Most men with Shigella did not report diarrhea. Mycoplasma genitalium was more common in men with proctitis (RD, 4.3% 95% CI, 1.1%–7.5%). Herpes simplex virus (HSV)–1 (RD, 10.1% 95% CI, 6.8%–13.3%) and HSV-2 (RD, 7.2% 95% CI, 4.5%–10.0%) were more common with proctitis. Testing for T. pallidum, Shigella, and HSV should be considered in MSM presenting with symptomatic proctitis. These data provide support for M. genitalium as a significant cause of proctitis. A comprehensive diagnostic evaluation is required for MSM with proctitis.
Treatment efficacy for pharyngeal Neisseria gonorrhoeae: a systematic review and meta-analysis of randomized controlled trials
Publisher: Oxford University Press (OUP)
Date: 03-08-2020
DOI: 10.1093/JAC/DKAA300
Abstract: Rising gonorrhoea rates require highly effective treatments to reduce transmission and prevent development of antimicrobial resistance. Currently the most effective treatments for pharyngeal gonorrhoea remain unclear. This review aimed to estimate treatment efficacy for pharyngeal gonorrhoea. Online bibliographic databases were searched for the period 1 January 2000 to 17 September 2019 for treatments of gonorrhoea. All randomized controlled trials (RCTs) with data on pharyngeal gonorrhoea among participants aged 15 years or above, published in English, were included. Meta-analyses (random effects) were used to estimate the treatment efficacy, defined as microbiological cure, among currently recommended monotherapies and dual therapies, previously recommended but no longer used regimens and emerging drugs under evaluation. Side effects were also summarized. The study protocol was registered on PROSPERO (CRD42020149278). There were nine studies that included 452 participants studying 19 treatment regimens. The overall treatment efficacy for pharyngeal gonorrhoea was 98.1% (95% CI: 93.8%–100% I2 = 57.3% P & 0.01). Efficacy was similar for single (97.1% 95% CI: 90.8%–100.0% I2 = 15.6% P = 0.29) and dual therapies (98.0% 95% CI: 91.4%–100% I2 = 79.1% P & 0.01). Regimens containing azithromycin 2 g or ceftriaxone were similarly efficacious. The summary efficacy estimate for emerging drugs was 88.8% (95% CI: 76.9%–97.5% I2 = 11.2% P = 0.34). Small s le sizes in each trial was a major limitation. Regimens containing ceftriaxone or azithromycin 2 g, alone or as part of dual therapies are the most efficacious for pharyngeal gonorrhoea. Further pharyngeal-specific RCTs with adequate s le sizes are needed.
Detection of Neisseria gonorrhoeae in the pharynx and saliva
Publisher: BMJ
Date: 30-11-2016
DOI: 10.1136/SEXTRANS-2015-052399
Abstract: This study aimed to determine the proportion of untreated pharyngeal swabs or saliva s les positive by culture or nucleic acid lification tests (NAATs) for Neisseria gonorrhoeae up to 14 days after an initial culture-positive pharyngeal swab. Men who have sex with men who tested positive for pharyngeal gonorrhoea at Melbourne Sexual Health Centre (MSHC) and returned to MSHC for treatment within 14 days between 13 October 2014 and 25 March 2015 were included in this study. Pharyngeal swabs and saliva s les were collected for culture and NAAT. Of 33 initially culture-positive pharyngeal swabs, 32 saliva s les and 31 pharyngeal swabs were positive by NAAT and 14 pharyngeal and 6 saliva s les were positive by culture within 14 days. There was a significant decline in the proportion of repeated pharyngeal culture s les positive by culture over time (p<0.001). The rapid decline suggests pharyngeal gonorrhoea is short-lived, and the finding of gonorrhoea commonly in the saliva implicates this body fluid in its transmission without direct throat inoculation.
Culture obtained from urethral swab of asymptomatic men who screen positive for Neisseria gonorrhoeae by urine nucleic acid amplification testing
Publisher: BMJ
Date: 02-2021
DOI: 10.1136/SEXTRANS-2020-054690
Abstract: In a previous study of men attending Melbourne Sexual Health Centre who had Neisseria gonorrhoeae detected by urine Aptima Combo 2 (AC2) testing, 11% were asymptomatic. This study aimed to determine whether N. gonorrhoeae can be cultured from asymptomatic men screening positive for N. gonorrhoeae by nucleic acid lification testing (NAAT) of urine. Between 1 July 2017 and 31 March 2019, all men attending Melbourne Sexual Health Centre were tested for N. gonorrhoeae by AC2 testing of urine whether urethral symptoms were reported or not. NAAT-positive men were recalled and a urethral swab performed for gonococcal culture using modified Thayer-Martin media with determination of minimum inhibitory concentrations (MICs) by agar dilution. There were 1001 cases (860 in iduals) positive for N. gonorrhoeae by urine AC2: 892 (89%) reported urethral symptoms 109 (11%) did not. Twenty-five asymptomatic cases were excluded because of antibiotic use at or following screening. Of the remaining 84 asymptomatic men, 41 (49%) had a urethral swab performed a median of 5 days after screening. Twenty-one men had urethral discharge at the return visit, 11 of whom reported the discharge at the return visit. Of the 41 men who were swabbed, 31 (76% 95% CI 60% to 88%) were culture positive for N. gonorrhoeae . Among the 21 men who subsequently developed discharge, 19 (90% 95% CI 70% to 99%) were culture positive. Among the 20 men who remained asymptomatic, 12 (60% 95% CI 36% to 81%) were culture positive. MIC profiles were obtained from all isolates. Gonorrhoea was isolated in most but not all asymptomatic men screening positive for N. gonorrhoeae by urine NAAT. Clinicians should consider performing urethral culture in such men to ensure optimal surveillance for antimicrobial resistance. Isolation of N. gonorrhoeae by culture in men without discharge indicates these are true infections with viable organisms.
Developing and testing of an interactive internet-based intervention to reduce sexual harm of sexualised drug use (‘chemsex’) among men who have sex with men in Hong Kong: a study protocol for a rando
Publisher: Springer Science and Business Media LLC
Date: 13-04-2021
DOI: 10.1186/S12889-021-10742-8
Abstract: Sexualised drug use, known as ‘chemsex’ or ‘chemfun,’ is the practice of intentionally using illicit drugs before or during sexual activates to enhance sexual arousal and pleasure. International and local data have both suggested that chemsex is common among men who have sex with men (MSM). Chemsex is generally seen with the engagement of risky sexual activities and therefore poses a threat regarding the potentially increased spread of human immunodeficiency virus and other sexually transmitted infections. However, little work has been done on the primary prevention of chemsex among MSM. Therefore, the aim of this study is to develop and evaluate an interactive internet-based intervention in reducing the sexual harms of chemsex among MSM in Hong Kong, A two-armed, randomised, parallel-group trial with a three-month follow-up period will be conducted. 250 MSM aged 18 years or the above will be recruited through local non-governmental organisations, social media and by snowballing in Hong Kong. Participants will be randomly allocated into either the intervention ( n = 125) or control group ( n = 125). The interactive internet-based intervention will be developed based on the theory of planned behaviours. Participants in the control group will receive a web-based intervention without any sexual health information and without any interactive components. The primary outcomes will be self-efficacy in refusing risky sexual behaviours and chemsex, as measured by the Drug Avoidance Self-Efficacy Scale, the Self-Efficacy for Sexual Safety and the Condom Self-Efficacy Scale. Subjects in both groups will be evaluated at baseline and 3 months after baseline. To the best of our knowledge, this will be the first interactive internet-based intervention to specifically target chemsex among MSM. This project can help in the development and testing of culturally relevant health promotion programmes that reduce chemsex among MSM. Using an online delivery mode, the intervention is capable of reaching a large population of targets at a relatively low cost and thus has the potential to reduce the public health burden of chemsex and other risky sexual behaviours among MSM in a cost-effective manner. International standard randomized controlled trial number (ISRCTN) registry: ISRCTN20134522 registered on 17 March 2021.
Oral, Vaginal and Anal Sexual Practices among Heterosexual Males and Females Attending a Sexual Health Clinic: A Cross-Sectional Survey in Melbourne, Australia
Publisher: MDPI AG
Date: 12-2021
Abstract: Sex practices among heterosexuals are not well studied. We aimed to explore sexual practices among heterosexuals attending a sexual health clinic. This cross-sectional survey was conducted at Melbourne Sexual Health Centre between March and April 2019. Data were collected on kissing, oral sex (fellatio or cunnilingus), vaginal sex, anal sex and rimming in the previous 3 months. Univariable and multivariable logistic regression analyses were performed to examine the associations between engaging in anal sex and other sex practices. There were 709 participants (333 men 376 women) who were eligible and completed the survey (response rate was 24.6%). In the past 3 months, most participants had had vaginal sex (n = 677 95.5%), with a mean of 3.0 (standard deviation (SD): 3.9) vaginal sex partners, and half reported engaging in condomless vaginal sex in the past 3 months (n = 358 50.1%). A total of 135 (19.0%) participants had had anal sex, with a mean of 1.3 (SD: 1.0) anal sex partners, with 63.5% (n = 94) engaging in any condomless anal sex in the past 3 months. Most participants (n = 637, 89.8%) had received oral sex in the past 3 months this proportion did not differ by age group or gender. Women (n = 351, 93.4%) were more likely to perform oral sex than men (n = 275 82.6% men) (p 0.001) and to have received rimming (26.6% women vs. 12.6% men p 0.001). Men were more likely to have performed rimming (25.5% men vs. 9.3% women p 0.001). After adjusting for age, number of partners and sexual practice, anal sex was associated with being ≥35 years (adjusted odds ratio (aOR): 2.3 95% CI: 1.2–4.2), receiving rimming (aOR: 3.8 95% CI: 2.4–6.0) and performing rimming (aOR: 2.8 95% CI: 1.8–4.6). Rimming and anal sex are practiced by one-fifth or more of heterosexuals. Older heterosexuals were more likely to engage in anal sex and to perform rimming. Future research should consider the benefits of testing extragenital sites where appropriate.
Gardnerella vaginalis Clade Distribution Is Associated With Behavioral Practices and Nugent Score in Women Who Have Sex With Women
Publisher: Oxford University Press (OUP)
Date: 23-09-2020
Abstract: Gardnerella vaginalis is detected in women with and without bacterial vaginosis (BV). Identification of 4 G. vaginalis clades raised the possibility that pathogenic and commensal clades exist. We investigated the association of behavioral practices and Nugent Score with G. vaginalis clade distribution in women who have sex with women (WSW). Longitudinal self-collected vaginal specimens were analyzed using established G. vaginalis species-specific and clade-typing polymerase chain reaction assays. Logistic regression assessed factors associated with detection of G. vaginalis clades, and multinomial regression assessed factors associated with number of clades. Clades 1, 2, and 3 and multiclade communities ( clades) were associated with Nugent-BV. Clade 1 (odds ratio [OR], 3.36 95% confidence interval [CI], 1.65–6.84) and multiclade communities (relative risk ratio [RRR], 9.51 95% CI, 4.36–20.73) were also associated with Lactobacillus-deficient vaginal microbiota. Clade 4 was neither associated with Nugent-BV nor Lactobacillus-deficient microbiota (OR, 1.49 95% CI, 0.67–3.33). Specific clades were associated with differing behavioral practices. Clade 1 was associated with increasing number of recent sexual partners and smoking, whereas clade 2 was associated with penile-vaginal sex and sharing of sex toys with female partners. Our results suggest that G. vaginalis clades have varying levels of pathogenicity in WSW, with acquisition occurring through sexual activity. These findings suggest that partner treatment may be an appropriate strategy to improve BV cure.
The Urethral Microbiota of Men with and without Idiopathic Urethritis
Publisher: American Society for Microbiology
Date: 26-10-2022
Abstract: Nongonococcal urethritis (NGU) is the commonest genital tract syndrome in men and is nearly universally presumptively treated with an antibiotic. Common causes of NGU include Chlamydia trachomatis and Mycoplasma genitalium , but in more than 50% of cases, an infectious cause is not identified.
Factors associated with self-reported unprotected anal intercourse among men who have sex with men in Changsha city of Hunan province, China
Publisher: Informa UK Limited
Date: 14-08-2015
DOI: 10.1080/09540121.2015.1058892
Abstract: Men who have sex with men (MSM) in China are highly susceptible to HIV infection and HIV prevalence among Chinese MSM is rapidly increasing in recent years. Unprotected anal intercourse (UAI) is a major contributing factor of HIV transmission. This study aims to identify factors associated with UAI among MSM in Changsha city, China. A cross-sectional survey was conducted among 642 MSM in Changsha city from July 2009 to June 2011 via a venue-based s ling method. Data on socio-demographic characteristics, sexual behaviours and utilisation of HIV/AIDS services were collected to determine the associates of UAI in MSM. Among the 642 MSM, 184 (28.7%) reported having UAI with male partners at the last sexual episode. UAI was associated with the venues where MSM met other MSM, and having unprotected sex with female partners at last the sexual episode and in the past six months. In addition, UAI was significant associated with not being exposed to HIV interventions, including free condom, lubricant, HIV testing and counselling, and peer education. MSM who have UAI practice are more likely to have unprotected sex with female hence, potentially bridging HIV to the general female population. Specific harm-reduction programmes are shown to have significant impacts in reducing UAI and should be scaled up among MSM in China.
What do young people in high-income countries want from STI testing services? A systematic review
Publisher: BMJ
Date: 30-06-2021
DOI: 10.1136/SEXTRANS-2021-055044
Abstract: There are upward trends of STI rates among young people in most high-income countries. We reviewed the literature to provide a summary of information to support health services with the aim of increasing testing of STIs among young people living in high-income countries. We conducted a systematic review (Prospero: CRD42020179720) using PubMed, Embase, PsychINFO and CINAHL. The search was performed on 10 January 2020 for studies between January 2000 and 10 January 2020. Two reviewers independently screened articles, and any discrepancies were resolved by a third reviewer. Studies were included if they were performed in high-income countries and contained data on both young people ( years) and STI testing preferences. Data regarding the characteristics of STI testing services that young people preferred was extracted. We categorised these characteristics using the framework of a social-ecological model. We identified 1440 studies, and 63 studies were included in the final review. We found 32 studies that addressed in idual factors, 62 studies that addressed service factors and 17 studies that addressed societal factors. At an in idual level, we identified eight attributes including the need for improved sexual health education. At a service level, 14 attributes were identified including preferences from different subgroups of young people (such as sexual and ethnic minorities) for the types of services. At a societal level, we identified two attributes including the need to address stigma associated with STIs. We provide an overview of the growing body of literature capturing the preferences of young people for STI testing services. To optimise the uptake of STI testing among young people, factors from all socioecological levels should be considered. In addition, understanding and accounting for distinct preferences from subgroups of young people could increase demand for STI testing services for those at greatest need.
Intra-Anal Imiquimod Cream against Human Papillomavirus Infection in Men Who Have Sex with Men Living with HIV: A Single-Arm, Open-Label Pilot Study
Publisher: MDPI AG
Date: 28-09-2021
DOI: 10.3390/JCM10194477
Abstract: Men who have sex with men (MSM) living with HIV have a high prevalence and incidence of anal high-risk human papillomavirus (hrHPV) and anal cancer. We conducted an open-label, single-arm pilot study to examine the tolerability of imiquimod cream among MSM aged ≥18 years, living with HIV, who tested positive for anal hrHPV at Melbourne Sexual Health Centre between April 2018 and June 2020. We instructed men to apply 6.25 mg imiquimod intra-anally and peri-anally 3 doses per week for 16 weeks (period 1) and then one dose per week for a further 48 weeks (period 2). Twenty-seven MSM enrolled in period 1 and 24 (86%) applied at least 50% of doses. All men reported adverse events (AEs), including 39.5% grade 1, 39.5% grade 2, and 21% grade 3 AEs on at least one occasion. Eighteen MSM (67%) temporarily stopped using imiquimod during period 1, most commonly due to local AEs (n = 11) such as irritation and itching. Eighteen MSM continued in period 2 and all applied at least 50% of doses with no treatment-limiting AEs reported. Imiquimod 3 doses per week caused local AEs in most men and was not well tolerated. In contrast, once-a-week application was well tolerated over 48-weeks with no treatment-limiting AEs.
Group sex events among female sex workers in Melbourne, Australia.
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/SH20136
Abstract: Background Group sex is associated with increased risk of HIV and sexually transmissible infections (STIs), but there is limited data on group sex among female sex workers (FSW). Understanding current group sex practices among FSW may assist with understanding and addressing the rise in STIs observed among Australian FSW in the 2010s. The aim of this study was to examine the proportion of FSWs who had engaged in group sex. Methods: A cross-sectional survey was conducted among FSWs attending the Melbourne Sexual Health Centre, Australia, between March and April 2019. Females aged ≥18 years who self-reported as a sex worker were invited to participate in the survey asking whether they had had group sex in the past 3 months. Group sex was defined as sex that involved two or more sexual partners. Results: Of the 51 FSWs who completed the survey, the median age was 29 years (IQR 24–34). Almost half (49% n = 25) reported having group sex in the past 3 months, with a median number of group sex events of two (IQR 1–4). Australian-born FSW were more likely to report group sex than overseas-born FSW (76% vs 42% P = 0.02). Age, number of paid clients and injecting drug use were not associated with group sex. Conclusion: The present study findings show that group sex is common among FSW and should be included in peer sexual health education and interventions among FSW.
Cochlear Implant Insertion Depth Prediction: A Temporal Bone Accuracy Study
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2018
Bridging of Neisseria Gonorrhoeae across Diverse Sexual Networks in the HIV Pre-Exposure Prophylaxis (PrEP) Era: A Clinical and Molecular Epidemiological Study
Publisher: Elsevier BV
Date: 2019
DOI: 10.2139/SSRN.3326641
Factors associated with group sex in heterosexual males and females attending a sexual health clinic in Melbourne, Australia: a cross-sectional survey
Publisher: CSIRO Publishing
Date: 16-03-2022
DOI: 10.1071/SH21224
Abstract: Background There have been limited studies of group sex among heterosexual in iduals. This study aimed to explore the factors associated with group sex among heterosexual males and females to improve risk assessment guidelines and inform sexually transmitted infection (STI) screening requirements. Methods A cross-sectional survey was conducted among heterosexual males and females aged ≥16 years attending the Melbourne Sexual Health Centre between March and April 2019. The survey asked about group sex participation, methods used to meet sexual partners, number of casual and/or regular partners, and injection drug use (IDU) in the previous 3 months. HIV and STI (chlamydia, gonorrhoea, syphilis) diagnoses were extracted. A multivariable logistic regression was conducted to identify the factors associated with group sex participation. Results A total of 698 participants (325 males, 373 females) were included and 4.7% (33/698) had participated in group sex in the previous 3 months. The proportion who participated in group sex increased with age (2.1% in 16–24 years, 5.5% in 25–34 years, 7.8% in ≥35 years, ptrend = 0.010). Meeting partners at sex venues (e.g. brothels) was associated with the highest odds of participating in group sex (aOR = 5.74, 95% CI: 1.20–27.44), followed by dating apps (aOR = 2.99, 95% CI: 1.36–6.58), friends/family (aOR = 2.99, 95% CI: 1.34–6.69) and social venues (e.g. bar) (aOR = 2.73, 95% CI: 1.18–6.30). Group sex was strongly associated with STI positivity (aOR = 6.24, 95% CI: 2.41–16.13). There was no association between group sex and sex, casual and/or regular partners, HIV positivity or IDU. Conclusion Heterosexual in iduals participating in group sex had a six-fold risk of testing positive for STIs. Including group sex in a sexual history is useful to determine STI risk and inform testing practices. Safe sex messages on group sex that are delivered through multiple methods (e.g. at sex venues, social venues and dating apps simultaneously) would be beneficial.
“Moving from one environment to another, it doesn’t automatically change everything”. Exploring the transnational experience of Asian-born gay and bisexual men who have sex with men newly arrived in A
Publisher: Public Library of Science (PLoS)
Date: 20-11-2020
DOI: 10.1371/JOURNAL.PONE.0242788
Abstract: Asian-born gay, bisexual and other men who have sex with men (gbMSM) who are newly arrived in Australia are at a higher risk of acquiring HIV than Australian-born gbMSM. We used a social constructionist framework to explore HIV knowledge and prevention strategies used by newly-arrived Asian-born gbMSM. Twenty four Asian-born gbMSM, aged 20–34 years, attending Melbourne Sexual Health Centre, who arrived in Australia in the preceding five years, participated in semi-structured, face-to-face interviews. Interviews were recorded, transcribed verbatim and analysed thematically. Participants described hiding their sexual identities in their country of origin, particularly from family members, due to fear of judgement and discrimination resulting from exposure to sexual identity and HIV related stigma in their countries of origin, although some were open to friends. Despite feeling more sexual freedom and acceptance in Australia, many were still not forthcoming with their sexual identity due to internalised feelings of stigma and shame. Exposure to stigma in their country of origin led many to report anxiety around HIV testing in Australia due to a fear of testing positive. Some described experiencing racism and lack of acceptance in the gay community in Australia, particularly on dating apps. Fear of discrimination and judgement about their sexual identity can have a significant impact on Asian-born gbMSM living in Australia, particularly in terms of social connectedness. Additionally, HIV-related stigma can contribute to anxieties around HIV testing. Our data highlights the potential discrimination Asian-born gbMSM face in Australia, which has implications for social connectedness, particularly with regard to LGBTQI communities and HIV testing practices. Future studies should determine effective strategies to reduce sexual identity and HIV-related stigma in newly-arrived Asian-born gbMSM.
Improved rapid diagnostic tests to detect syphilis and yaws: a systematic review and meta-analysis
Publisher: BMJ
Date: 30-09-2022
DOI: 10.1136/SEXTRANS-2022-055546
Abstract: Current rapid tests for syphilis and yaws can detect treponemal and non-treponemal antibodies. We aimed to critically appraise the literature for rapid diagnostic tests (RDTs) which can better distinguish an active infection of syphilis or yaws. We conducted a systematic review and meta-analysis, searching five databases between January 2010 and October 2021 (with an update in July 2022). A generalised linear mixed model was used to conduct a bivariate meta-analysis for the pooled sensitivity and specificity. Heterogeneity was assessed using the I 2 statistic. We used the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) to assess the risk of bias and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) to evaluate the certainty of evidence. We included 17 studies for meta-analyses. For syphilis, the pooled sensitivity and specificity of the treponemal component were 0.93 (95% CI: 0.86 to 0.97) and 0.98 (95% CI: 0.96 to 0.99), respectively. For the non-treponemal component, the pooled sensitivity and specificity were 0.90 (95% CI: 0.82 to 0.95) and 0.97 (95% CI: 0.92 to 0.99), respectively. For yaws, the pooled sensitivity and specificity of the treponemal component were 0.86 (95% CI: 0.66 to 0.95) and 0.97 (95% CI: 0.94 to 0.99), respectively. For the non-treponemal component, the pooled sensitivity and specificity were 0.80 (95% CI: 0.55 to 0.93) and 0.96 (95% CI: 0.92 to 0.98), respectively. RDTs that can differentiate between active and previously treated infections could optimise management by providing same-day treatment and reducing unnecessary treatment. CRD42021279587.
A Machine-Learning-Based Risk-Prediction Tool for HIV and Sexually Transmitted Infections Acquisition over the Next 12 Months
Publisher: MDPI AG
Date: 25-03-2022
DOI: 10.3390/JCM11071818
Abstract: Background: More than one million people acquire sexually transmitted infections (STIs) every day globally. It is possible that predicting an in idual’s future risk of HIV/STIs could contribute to behaviour change or improve testing. We developed a series of machine learning models and a subsequent risk-prediction tool for predicting the risk of HIV/STIs over the next 12 months. Methods: Our data included in iduals who were re-tested at the clinic for HIV (65,043 consultations), syphilis (56,889 consultations), gonorrhoea (60,598 consultations), and chlamydia (63,529 consultations) after initial consultations at the largest public sexual health centre in Melbourne from 2 March 2015 to 31 December 2019. We used the receiver operating characteristic (AUC) curve to evaluate the model’s performance. The HIV/STI risk-prediction tool was delivered via a web application. Results: Our risk-prediction tool had an acceptable performance on the testing datasets for predicting HIV (AUC = 0.72), syphilis (AUC = 0.75), gonorrhoea (AUC = 0.73), and chlamydia (AUC = 0.67) acquisition. Conclusions: Using machine learning techniques, our risk-prediction tool has acceptable reliability in predicting HIV/STI acquisition over the next 12 months. This tool may be used on clinic websites or digital health platforms to form part of an intervention tool to increase testing or reduce future HIV/STI risk.
Provision of HIV test results by telephone is both safe and efficient for men who have sex with men
Publisher: SAGE Publications
Date: 10-07-2017
Abstract: The aim of this study was to assess the impact of delivering HIV test results by telephone on HIV testing and subsequent risk behaviour of men, as well as saving on clinic consultation time. It was conducted at the Melbourne Sexual Health Centre, the main public sexual health clinic servicing Victoria, Australia. In 2013, a policy change was introduced so men could obtain their HIV test result via telephone. We compared the proportion of men testing for HIV and receiving results in the 24 months before (2011–2012) and the 24 months after (2013–2014) the policy change. There was a modest increase in the proportion of men having a HIV test of 3.2% ( p 0.001) after the policy change. The provision of HIV results by telephone more than halved the number of men re-attending (74.4% vs. 33.1%) which freed up 516 hours of clinic time and had no adverse outcome on subsequent risk behaviour, nor changed the proportion of men who obtained their HIV results ( p = 0.058), or the period of time between testing and obtaining results for HIV-negative ( p = 0.007) and HIV-positive results ( p = 0.198). Telephone notification of HIV test results is a useful option given the potential beneficial effects shown.
Risk Behaviours among Female Sex Workers in China: A Systematic Review and Data Synthesis
Publisher: Public Library of Science (PLoS)
Date: 27-03-2015
Clinical Presentation of Incident Syphilis Among Men Who Have Sex with Men Taking HIV Pre-Exposure Prophylaxis in Melbourne, Australia
Publisher: Oxford University Press (OUP)
Date: 02-2021
DOI: 10.1093/CID/CIAB052
Abstract: Current international guidelines on human immunodeficieny virus (HIV) Pre-Exposure Prophylaxis (PrEP) recommend serological screening for syphilis at routine 3-monthly PrEP appointments. The aim of our study was to describe the pattern of clinical presentation of syphilis among men who have sex with men (MSM) taking PrEP. We were interested in whether syphilis is detected through screening at scheduled3-monthly PrEP clinic appointments or whether primary or secondary syphilis presented at unscheduled interval visits. This was a retrospective study of MSM attending the PrEP clinic at the Melbourne Sexual Health Centre between February 2016 and March 2019. Serological screening for syphilis was routinely undertaken at 3-monthly PrEP clinic appointments. Diagnoses of early syphilis were identified from PrEP clinic visits and from interim walk-in STI clinic attendances. There were 69 cases of early syphilis among 61 MSM taking PrEP during the study period. There were 24 (35%) primary, 16 (23%) secondary, and 29 (42%) early latent infections. The incidence of early syphilis was 8.6 per 100 person-years. A substantial proportion of primary (58%) and secondary (44%) syphilis diagnoses were made at interim STI clinic attendances, between PrEP appointments. Syphilis screening at routine 3-monthly PrEP visits alone fails to detect a proportion of primary and secondary syphilis infections and may be insufficient in preventing onward transmission. Education of MSM taking PrEP regarding the risk of syphilis and symptom recognition is necessary together with access to syphilis testing between PrEP visits.
Quadrivalent vaccine-targeted human papillomavirus genotypes in heterosexual men after the Australian female human papillomavirus vaccination programme
Publisher: Elsevier BV
Date: 2017
Accuracy of Self-reported Human Papillomavirus Vaccination Status Among Gay and Bisexual Adolescent Males: Cross-sectional Study (Preprint)
Publisher: JMIR Publications Inc.
Date: 26-07-2021
Abstract: en who have sex with men are a risk group for anal human papillomavirus (HPV) and anal cancer. Australia introduced a universal school-based HPV vaccination program in 2013. Self-reported HPV vaccination status has been widely used in clinical and research settings, but its accuracy is understudied. e aimed to examine the accuracy of self-reported HPV vaccination status among gay and bisexual adolescent males. e included 192 gay and bisexual males aged 16-20 years from the Human Papillomavirus in Young People Epidemiological Research 2 (HYPER2) study in Melbourne, Australia. All participants had been eligible for the universal school-based HPV vaccination program implemented in 2013 and were asked to self-report their HPV vaccination status. Written informed consent was obtained to verify their HPV vaccination status using records at the National HPV Vaccination Program Register and the Australian Immunisation Register. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value of self-reported HPV vaccination status. he median age of the 192 males was 19 (IQR 18-20) years. There were 128 males (67%) who had HPV vaccination records documented on either registry. Self-reported HPV vaccination had a sensitivity of 47.7% (95% CI 38.8%-56.7% 61/128), a specificity of 85.9% (95% CI 75.0%-93.4% 55/64), a positive predictive value of 87.1% (95% CI 77.0%-93.9% 61/70), and a negative predictive value of 45.1% (95% CI 36.1%-54.3% 55/122). elf-reported HPV vaccination status among Australian gay and bisexual adolescent males underestimates actual vaccination and may be inaccurate for clinical and research purposes.
Systematic Review and Meta-Analysis of Doxycycline Efficacy for Rectal Lymphogranuloma Venereum in Men Who Have Sex with Men
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 10-2016
Abstract: Rectal lymphogranuloma venereum (LGV) has reemerged as a sexually transmitted infection among men who have sex with men (MSM), particularly those who are HIV-positive. We undertook a systematic review and meta-analysis to determine the efficacy of doxycycline (100 mg 2×/d for 21 days) for rectal LGV in MSM. Nine studies were included: 4 prospective, 4 retrospective, and 1 combined retrospective and prospective. In total, 282 MSM with rectal LGV were included in the studies. All studies reported using nucleic acid lification tests to assess microbial cure. Most patients (>80%) had symptomatic rectal infection. The fixed-effects pooled efficacy for doxycycline was 98.5% (95% CI 96.3%-100%, I (2) = 0% p = 0.993). Doxycycline at 100 mg twice daily for 21 days demonstrated a high microbial cure rate. These data support doxycycline at this dosage and duration as first-line therapy for rectal LGV in MSM.
Age pattern of sexual activities with the most recent partner among men who have sex with men in Melbourne, Australia: a cross-sectional study
Publisher: BMJ
Date: 31-08-2020
DOI: 10.1136/BMJSRH-2020-200720
Abstract: Sexual behavioural studies among men who have sex with men (MSM) are predominantly focused on penile-anal intercourse. Other non-anal sexual activities are under-studied. This study aimed to examine the age pattern of a range of sexual activities among MSM with the most recent male sex partner. We conducted a survey among MSM attending the Melbourne Sexual Health Centre in 2017. This survey asked about nine different sexual activities with their most recent regular and casual partner. A Chi-square trend test was used to examine the age patterns of each sexual activity. A total of 1596 men answered the survey and their median age was 30 (IQR 25–37) years. With casual partners, kissing was the most common activity (92.4%), followed by performing penile-oral sex (86.0%) and receiving penile-oral sex (83.9%). The least common activity was insertive rimming (38.1%). Young men were more likely to engage in kissing (p trend .001), receptive rimming (p trend =0.004) and receptive penile-anal sex (p trend .001) but they were less likely to have insertive penile-anal sex compared with older MSM. With regular partners, the most common activity was kissing (97.4%), followed by touching penises (90.0%) and performing penile-oral sex (88.3%). Age was not associated with most types of sexual activity with regular partners except mutual masturbation and receptive penile-anal sex. Younger men were more likely to masturbate mutually (p trend =0.028) and engage in receptive penile-anal sex (p trend =0.011). The pattern of sexual activities shows age-related differences with casual partners but less so with regular partners in MSM.
Chlamydia Infection Between Men and Women: A Cross-Sectional Study of Heterosexual Partnerships
Publisher: Oxford University Press (OUP)
Date: 2017
DOI: 10.1093/OFID/OFX160
Abstract: Studies of sexual partnerships can further our understanding of the sexual transmission of chlamydia, which is important for informing public health interventions and clinical management. The aim of this study was to ascertain among heterosexual dyads the proportion concordantly infected with chlamydia and factors associated with infection between partners. This study was conducted at the Melbourne Sexual Health Centre between January 2006 and March 2015. Heterosexual partners attending the clinic on the same day were identified prospectively. Dyads where 1 or both in iduals were diagnosed with chlamydia by a test performed on the day of joint attendance or within the prior 30 days were included. Testing was by strand displacement assay. Men and women with genital symptoms underwent clinical examination. Of 233 females with chlamydia, 76% (n = 178) of their male partners tested positive. Of the chlamydia-positive females with cervicitis, 91% of males were chlamydia positive. Male infection was less likely if their partner had taken azithromycin or doxycycline within 30 days (7% vs 25% P = .039). Of 235 males with chlamydia, 77% (n = 178) of their female partners tested positive. No associations were found between male symptoms, signs, or recent antibiotic use and a positive chlamydia result in female partners. Sixty-one percent of the dyads were concordantly infected with chlamydia. These results underscore the high likelihood of heterosexual partners of men and women with chlamydia being infected and the importance that partners are tested and managed appropriately for chlamydia.
Risk factors for urethral gonorrhoea infection among heterosexual males in Melbourne, Australia
Publisher: CSIRO Publishing
Date: 2019
DOI: 10.1071/SH19027
Abstract: Background Since 2014 there has been an increase in gonorrhoea among heterosexuals in Australia. Sex with a partner from a country with high gonorrhoea prevalence has been identified as a risk factor for gonorrhoea in heterosexual females, but risk factors for heterosexual males remain unclear. This study determined risk factors for gonorrhoea among heterosexual males. Methods: Retrospective analysis was performed among heterosexual males attending Melbourne Sexual Health Centre (MSHC) between 1 January 2007 and 31 December 2017. Countries for overseas sexual partners were stratified as high-prevalence countries (HPC) or low-prevalence countries (LPC) based on the incidence of gonorrhoea. Results: The annual gonorrhoea positivity increased from 0.72% in 2007 to 1.33% in 2017 (Ptrend & .001). Males attending MSHC as a contact of gonorrhoea had the highest odds of testing positive (adjusted odds ratio (aOR) 7.46 95% confidence interval (CI) 4.46–12.49), followed by males identifying as Aboriginal and Torres Strait Islander (aOR 2.57 95% CI 1.30–5.09), males who had injected drugs in the past 12 months (aOR 2.44 95% CI 1.39–4.30) and males who had sex with a female from an HPC (aOR 2.18 95% CI 1.77–2.68). Males aged ≥35 were at higher risk than those aged ≤24 years (aOR 1.44 95% CI 1.14–1.82). Gonorrhoea positivity increased among males who had sex with females from an LPC (from 0.60% to 1.33% Ptrend = 0.004) but remained the same over time among males who had sex with females from an HPC (2.14% Ptrend = 0.143). Conclusions: There was an 80% increase in urethral gonorrhoea among heterosexual males between 2007 and 2017. Having sex with a female from an HPC is a significant risk factor for gonorrhoea. Gonorrhoea positivity among men having sex with a female from an HPC did not change over time, suggesting this risk factor has become less important.
Predictors and incidence of sexually transmitted Hepatitis C virus infection in HIV positive men who have sex with men
Publisher: Springer Science and Business Media LLC
Date: 02-03-2017
Incident HIV infection has fallen rapidly in men who have sex with men in Melbourne, Australia (2013–2017) but not in the newly-arrived Asian-born
Publisher: Springer Science and Business Media LLC
Date: 20-08-2018
Prevalence, awareness, treatment and control of high blood pressure among Chinese rural population in Haimen, Jiangsu
Publisher: Springer Science and Business Media LLC
Date: 22-10-2015
DOI: 10.1038/JHH.2015.107
Abstract: Nowadays, high blood pressure (HBP) is one of the most common chronic diseases in China. This survey aims to assess HBP prevalence, and related disease awareness, treatment and control among rural population in Haimen, Jiangsu province, China. A total of 7538 rural residents, aged over 18 years, from four randomly selected villages in Haimen, were selected to participate in the blood pressure examination in September 2010, the male-to-female ratio of participants was 1:1.57. In all, 2034 patients were diagnosed with HBP. The total crude prevalence of HBP was 26.98%, the overall standardized prevalence of HBP was 24.38%. Both male and female prevalence rates demonstrate ascending trend with age. Awareness, treatment and control rates among all patients were 68.34%, 61.46% and 27.43% respectively, whereas the corresponding rates in young group (18-44 years) were lower (50.94%, 35.85%, 24.53%). Improving treatment coverage and efficacy should be the focus of HBP prevention in rural areas in China.
Sampling technique and detection rates of oropharyngeal and anorectal gonorrhoea using nucleic acid amplification tests in men who have sex with men
Publisher: BMJ
Date: 13-11-2018
DOI: 10.1136/SEXTRANS-2017-053339
Abstract: The objective of this study was to examine the associations between clinicians’ self-reported s ling technique and the detection rate of gonorrhoea at the oropharynx and anorectum using a highly sensitive nucleic acid lification test (NAAT). We analysed oropharyngeal and anorectal gonorrhoea swab results among men who have sex with men attending the Melbourne Sexual Health Centre (MSHC) between March 2015 and December 2016. Swabs were tested by NAAT using the Aptima Combo 2 transcription-mediated lification assay due to its high sensitivity. Clinicians at MSHC were invited to complete a questionnaire on s ling techniques in November 2016. Univariable generalised estimating equations (GEE) logistic regressions were performed to determine the association between gonorrhoea detection rates and clinicians’ s ling technique. Patients’ epidemiological risk factors were included in the multivariable GEE logistic model. A total of 2605 oropharyngeal gonorrhoea and 2392 anorectal gonorrhoea swab results were analysed. There was no significant difference in the detection rates of gonorrhoea between the 23 clinicians at the oropharynx (range 3.6%–16.9%, median 8.2%, P=0.302) or and anorectum (range 2.4%–17.3%, median 10.5%, P=0.177). Variations in clinicians’ self-reported s ling technique were not associated with oropharyngeal or anorectal gonorrhoea detection rates after adjusting for patients’ epidemiological risk factors. This study shows that differences in clinicians’ self-reported s ling technique did not result in measurable differences in the detection rate for oropharyngeal or anorectal gonorrhoea when using NAAT.
Noninvasive Registration Strategies and Advanced Image Guidance Technology for Submillimeter Surgical Navigation Accuracy in the Lateral Skull Base
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2018
The Impact of Mouthwash on the Oropharyngeal Microbiota of Men Who Have Sex with Men: a Substudy of the OMEGA Trial
Publisher: American Society for Microbiology
Date: 23-02-2022
DOI: 10.1128/SPECTRUM.01757-21
Abstract: Given the role of the oral microbiota in human health, it is important to understand if and how external factors influence its composition. Mouthwash use is common in some populations, and the use of antiseptic mouthwash has been proposed as an alternative intervention to prevent gonorrhea transmission.
Increased syphilis testing and detection of late latent syphilis among women after switching from risk-based to opt-out testing strategy in an urban Australian sexual health clinic: a retrospective ob
Publisher: Elsevier BV
Date: 08-2023
Kissing may be an important and neglected risk factor for oropharyngeal gonorrhoea: a cross-sectional study in men who have sex with men
Publisher: BMJ
Date: 09-05-2019
DOI: 10.1136/SEXTRANS-2018-053896
Abstract: A mathematical model suggested that a significant proportion of oropharyngeal gonorrhoea cases are acquired via oropharynx-to-oropharynx transmission (ie, tongue-kissing), but to date, no empirical study has investigated this. This study aimed to examine the association between kissing and oropharyngeal gonorrhoea among gay and bisexual men who have sex with men (MSM). MSM attending a public sexual health centre in Melbourne, Australia, between March 2016 and February 2017 were invited to participate in a brief survey that collected data on their number of male partners in the last 3 months, in three distinct categories: kissing-only (ie, no sex including no oral and/or anal sex), sex-only (ie, any sex without kissing), and kissing-with-sex (ie, kissing with any sex). Univariable and multivariable logistic regression analyses were performed to examine associations between oropharyngeal gonorrhoea positivity by nucleic acid lification tests and the three distinct partner categories. A total of 3677 men completed the survey and were tested for oropharyngeal gonorrhoea. Their median age was 30 (IQR 25–37) and 6.2% (n=229) had oropharyngeal gonorrhoea. Men had a mean number of 4.3 kissing-only, 1.4 sex-only, and 5.0 kissing-with-sex partners in the last 3 months. Kissing-only and kissing-with-sex were associated with oropharyngeal gonorrhoea, but sex-only was not. The adjusted odds for having oropharyngeal gonorrhoea were 1.46-fold (95% CI 1.04 to 2.06) for men with ≥4 kissing-only partners and 1.81-fold (95% CI 1.17 to 2.79) for men with ≥4 kissing-with-sex partners. These data suggest that kissing may be associated with transmission of oropharyngeal gonorrhoea in MSM, irrespective of whether sex also occurs.
Sex with a transgender or gender diverse person among patients attending a sexual health centre in Melbourne, Australia
Publisher: BMJ
Date: 27-06-2019
DOI: 10.1136/SEXTRANS-2018-053653
Abstract: All males and females attending the Melbourne Sexual Health Centre (MSHC) from August 2017 were asked whether they had had sex with a transgender or gender erse (TGD) person using computer-assisted self-interviewing (CASI). We aimed to verify the self-reported responses via chart review. The secondary aim of this study was to identify whether having sex with a TGD person was associated with STI risk. This was a retrospective chart analysis of patients visiting MSHC between August and December 2017. Chart review was performed to verify the self-reported responses. Multivariable logistic regression was performed to examine the association between having sex with a TGD person and patients’ characteristics and STI risk. Of the 10 100 male and female consultations, the proportion who reported having sex with a TGD person was 111 (1.0%) and was higher among males (1.3%) than females (0.6%) (p=0.001). After chart review, we could verify 66.9% of the responses, more for males (75.2%) than females (45.2%) (p .001). Of the 6822 males, men aged ≥35 years (adjusted OR=2.2 95% CI 1.1 to 4.1) were more likely to have sex with a TGD person compared with men aged ≤24 years, after adjusting for confounding factors. Sex with a TGD person was not associated with sexual orientation in males. Of the 3278 females, gay and bisexual females had 13.7-fold (95% CI 5.1 to 37.0) higher odds of having sex with a TGD person than heterosexual females. There was no association between chlamydia positivity and sex with a TGD person in both males and females. When a question on TGD partners is asked as part of routine sexual history using CASI, the majority of responses could be verified. TGD partners were most commonly reported among males. These findings underscore the value of asking patients about sex with TGD partners.
Love during lockdown: findings from an online survey examining the impact of COVID-19 on the sexual health of people living in Australia
Publisher: BMJ
Date: 17-11-2020
DOI: 10.1136/SEXTRANS-2020-054688
Abstract: Australia recorded its first case of COVID-19 in late January 2020. On 22P March 2020, amid increasing daily case numbers, the Australian Government implemented lockdown restrictions to help ‘flatten the curve’. Our study aimed to understand the impact of lockdown restrictions on sexual and reproductive health. Here we focus on sexual practices. An online survey was open from the 23PP April 2020 to 11P May 2020. Participants were recruited online via social media and other networks and were asked to report on their sexual practices in 2019 and during lockdown. Logistic regression was used to calculate the difference (diff) (including 95% CIs) in the proportion of sex practices between time periods. Of the 1187 who commenced the survey, 965 (81.3%) completed it. Overall, 70% were female and 66.3% were aged 18–29 years. Most (53.5%) reported less sex during lockdown than in 2019. Compared with 2019, participants were more likely to report sex with a spouse (35.3% vs 41.7% diff=6.4% 95% CI 3.6 to 9.2) and less likely to report sex with a girl/boyfriend (45.1% vs 41.8% diff=−3.3% 95% CI −7.0 to -0.4) or with casual hook-up (31.4% vs 7.8% 95% CI −26.9 to -19.8). Solo sex activities increased 14.6% (123/840) reported using sex toys more often and 26.0% (218/838) reported masturbating more often. Dating app use decreased during lockdown compared with 2019 (42.1% vs 27.3% diff= −14.8% 95% CI −17.6 to -11.9). Using dating apps for chatting/texting (89.8% vs 94.5% diff=4.7% 95% CI 1.0 to 8.5) and for setting up virtual dates (2.6% vs 17.2% diff=14.6% 95% CI 10.1 to 19.2) increased during lockdown. Although significant declines in sexual activity during lockdown were reported, people did not completely stop engaging in sexual activities, highlighting the importance of ensuring availability of normal sexual and reproductive health services during global emergencies.
Modelling the contribution that different sexual practices involving the oropharynx and saliva have onNeisseria gonorrhoeaeinfections at multiple anatomical sites in men who have sex with men
Publisher: BMJ
Date: 18-11-2020
DOI: 10.1136/SEXTRANS-2020-054565
Abstract: The spectrum of sexual practices that transmit Neisseria gonorrhoeae in men who have sex with men (MSM) is controversial. No studies have modelled potential Neisseria gonorrhoeae transmission when one sexual practice follows another in the same sexual encounter (‘sequential sexual practices’). Our aim was to test what sequential practices were necessary to replicate the high proportion of MSM who have more than one anatomical site infected with gonorrhoea (‘multisite infection’). To test our aim, we developed eight compartmental models. We first used a baseline model (model 1) that included no sequential sexual practices. We then added three possible sequential transmission routes to model 1: (1) oral sex followed by anal sex (or vice versa) (model 2) (2) using saliva as a lubricant for penile–anal sex (model 3) and (3) oral sex followed by oral–anal sex (rimming) or vice versa (model 4). The next four models (models 5–8) used combinations of the three transmission routes. The baseline model could only replicate infection at the single anatomical site and underestimated multisite infection. When we added the three transmission routes to the baseline model, oral sex, followed by anal sex or vice versa, could replicate the prevalence of multisite infection. The other two transmission routes alone or together could not replicate multisite infection without the inclusion of oral sex followed by anal sex or vice versa. Our gonorrhoea model suggests sexual practices that involve oral followed by anal sex (or vice versa) may be important for explaining the high proportion of multisite infection.
Doxycycline post-exposure prophylaxis: let the debate begin
Publisher: Elsevier BV
Date: 03-2018
Methadone Maintenance Treatment Participant Retention and Behavioural Effectiveness in China: A Systematic Review and Meta-Analysis
Publisher: Public Library of Science (PLoS)
Date: 26-07-2013
Neisseria gonorrhoeae Transmission Among Men Who Have Sex With Men: An Anatomical Site-Specific Mathematical Model Evaluating the Potential Preventive Impact of Mouthwash
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2017
Human papillomavirus vaccine coverage in male-male partnerships attending a sexual health clinic in Melbourne, Australia
Publisher: Informa UK Limited
Date: 17-06-2022
Robotic middle ear access for cochlear implantation: First in man
Publisher: Public Library of Science (PLoS)
Date: 02-08-2019
Describing the Chinese HIV Surveillance System and the Influences of Political Structures and Social Stigma
Publisher: Bentham Science Publishers Ltd.
Date: 07-09-2012
DOI: 10.2174/1874613601206010163
Abstract: China’s public health surveillance system for HIV was established in late 1980s and has evolved significantly during the past three decades. With the gradually changing mode of HIV transmission from sharing of intravenous injecting equipment to sexual exposure and the rapid spread of HIV infection among Chinese homosexual men in recent years, an efficient and comprehensive population-level surveillance system for describing epidemics trends and risk behaviours associated with HIV acquisition are essential for effective public health interventions for HIV. The current review describes the overall strength of the Chinese HIV surveillance system and its structural weaknesses from a political and social perspective. The HIV surveillance system in China has undergone substantial rev ing leading to a comprehensive, timely and efficient reporting system. However, large data gaps and lack of quality control and sharing of information obstruct the full performance of the system. This is largely due to fragmented authoritarianism brought about by the underlying political structure. Social stigma and discrimination in health institutes are also key barriers for further improvements of HIV diagnosis and surveillance in China.
Self-Reported Use of Mouthwash and Pharyngeal Gonorrhoea Detection by Nucleic Acid Amplification Test
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2017
Was an epidemic of gonorrhoea among heterosexuals attending an Adelaide sexual health services associated with variations in sex work policing policy?
Publisher: BMJ
Date: 13-11-2016
DOI: 10.1136/SEXTRANS-2014-051918
Abstract: A review of historical trends in gonococcal diagnoses made at the Adelaide Sexual Health Clinic (ASHC), South Australia, identified a substantial rise in diagnoses among heterosexuals between 2006 and 2010. Sex work is illegal in South Australia, regulated in Victoria and legal in New South Wales. This and other factors that could have influenced the epidemic were explored in this analysis. Retrospective analyses of gonorrhoea diagnoses made by sexual health services between 1990 and 2012 in three Australian state capitals, Melbourne (Victoria) and Sydney (New South Wales) were undertaken. At the ASHC the proportion of gonorrhoea diagnoses was higher between 2006 and 2010 among heterosexual men (5.34% vs 0.84%, p<0.001), non-sex worker women (0.64% vs 0.28%, p<0.001) and female sex workers (FSWs) (1.75% vs 0.24%, p<0.001) compared with other years. This relationship was not seen at the Melbourne Sexual Health Clinic and corresponding data from the Sydney Sexual Health Centre showed that FSWs were less likely to have gonorrhoea between 2006 and 2010 than the other groups (p=0.746, p=0.522, p=0.024, respectively). At ASHC FSWs were significantly more likely to be diagnosed between 2006 and 2010 (OR 2.8, 95% CI 1.48 to 5.27, p=0.002). Charges against sex workers peaked in 2007/2008. A substantial, self-limiting rise in diagnoses of heterosexual gonorrhoea was seen in Adelaide FSWs between 2006 and 2010. Removing barriers to condom use is vital to the prevention of HIV and STI transmission.
A comparative, retrospective analysis of HIV testing among gay, bisexual and other men who have sex with men in Melbourne, Australia
Publisher: Elsevier BV
Date: 10-2019
Abstract: PRONTO!, a peer-led rapid HIV-testing service in Melbourne, Australia, opened to improve HIV testing among gay and bisexual men (GBM). We compared client characteristics and return testing among GBM testing at PRONTO! with GBM testing at Melbourne Sexual Health Centre (MSHC). All GBM attending PRONTO! and MSHC for HIV testing between August 2013 and April 2016 were included. We describe the number of tests, percentage of clients who returned during follow-up, the mean number of tests and median time between tests at the two services. At PRONTO!, 33% of 3,102 GBM and at MSHC 50% of 9,836 GBM returned for a further HIV test at least once. The mean number of tests per client was 1.7 and 2.5 at PRONTO! and MSHC (p<0.01), respectively. A majority of clients at both services reported behaviours that would recommend up to quarterly testing, however, the median time between tests was 20.0 and 17.0 weeks at PRONTO! and MSHC (p<0.01), respectively. A greater proportion of clients returned and returned frequently at MSHC compared to PRONTO!, however, at both services HIV testing frequency was suboptimal. Implications for public health: Novel HIV testing services should provide convenient and comprehensive sexual health services.
Evaluation of the Implementation of a New Nurse-Led Express test-And-Go Human Immunodeficiency Virus/Sexually Transmitted Infection Testing Service for Men Who Have Sex with Men at a Sexual Health Center in Melbourne, Australia
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2018
DOI: 10.1097/OLQ.0000000000000777
Abstract: In August 2015, a nurse-led express human immunodeficiency virus (HIV)/sexually transmitted infection (STI) testing service “Test-And-Go” (TAG) for asymptomatic men who have sex with men (MSM) was implemented in a large public sexual health center in Melbourne, Australia. We aimed to compare the clients' characteristics between the TAG and routine walk-in service among asymptomatic MSM. This study was conducted at the Melbourne Sexual Health Centre, Australia, between August 5, 2015, and June 1, 2016. General estimating equation logistic regression models were constructed to examine the association between the use of TAG service and clients' demographic characteristics, sexual behaviors, and HIV/STI positivity. Clients' consultation and waiting times for both services were calculated. Of the 3520 consultations, 784 (22.3%) were TAG services and 2736 (77.7%) were routine walk-in services for asymptomatic MSM. Asymptomatic MSM were more likely to use the TAG service if they were born in Australia (adjusted odds ratio, 1.29 95% confidence interval, 1.07–1.56), and had more than 6 male partners in the last 12 months (adjusted odds ratio, 1.13 95% confidence interval, 1.08–1.58). Age, HIV status, condomless anal sex and HIV/STI positivity did not differ between the two services. The TAG service had a shorter median waiting time (8.4 minutes vs 52.9 minutes p 0.001) and consultation time (8.9 minutes vs 17.6 minutes p 0.001) than the routine walk-in service. Although country of birth and sexual behaviors differed between clients attending the 2 services, there were no differences in HIV and STI positivity. Importantly, the TAG service required less waiting and consultation time and hence created additional clinic capacity at the general clinic to see clients who are at higher risk.
Web-Based Risk Prediction Tool for an Individual's Risk of HIV and Sexually Transmitted Infections Using Machine Learning Algorithms: Development and External Validation Study
Publisher: JMIR Publications Inc.
Date: 25-08-2022
DOI: 10.2196/37850
Abstract: HIV and sexually transmitted infections (STIs) are major global public health concerns. Over 1 million curable STIs occur every day among people aged 15 years to 49 years worldwide. Insufficient testing or screening substantially impedes the elimination of HIV and STI transmission. The aim of our study was to develop an HIV and STI risk prediction tool using machine learning algorithms. We used clinic consultations that tested for HIV and STIs at the Melbourne Sexual Health Centre between March 2, 2015, and December 31, 2018, as the development data set (training and testing data set). We also used 2 external validation data sets, including data from 2019 as external “validation data 1” and data from January 2020 and January 2021 as external “validation data 2.” We developed 34 machine learning models to assess the risk of acquiring HIV, syphilis, gonorrhea, and chlamydia. We created an online tool to generate an in idual’s risk of HIV or an STI. The important predictors for HIV and STI risk were gender, age, men who reported having sex with men, number of casual sexual partners, and condom use. Our machine learning–based risk prediction tool, named MySTIRisk, performed at an acceptable or excellent level on testing data sets (area under the curve [AUC] for HIV=0.78 AUC for syphilis=0.84 AUC for gonorrhea=0.78 AUC for chlamydia=0.70) and had stable performance on both external validation data from 2019 (AUC for HIV=0.79 AUC for syphilis=0.85 AUC for gonorrhea=0.81 AUC for chlamydia=0.69) and data from 2020-2021 (AUC for HIV=0.71 AUC for syphilis=0.84 AUC for gonorrhea=0.79 AUC for chlamydia=0.69). Our web-based risk prediction tool could accurately predict the risk of HIV and STIs for clinic attendees using simple self-reported questions. MySTIRisk could serve as an HIV and STI screening tool on clinic websites or digital health platforms to encourage in iduals at risk of HIV or an STI to be tested or start HIV pre-exposure prophylaxis. The public can use this tool to assess their risk and then decide if they would attend a clinic for testing. Clinicians or public health workers can use this tool to identify high-risk in iduals for further interventions.
Sexual practices of female sex workers in Melbourne, Australia: An anonymous cross-sectional questionnaire study in 2017-18
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/SH19037
Abstract: Background Sexually transmissible infections (STIs) are rising among female sex workers (FSW) in Australia. The rise might be explained by changes in sexual practices however, there is limited behavioural data available. This study aimed to explore the current sexual practices among FSW in Melbourne. Methods: This cross-sectional study was conducted among FSW at Melbourne Sexual Health Centre between September 2017 and March 2018. Participants were asked about current sexual practices with male clients in an average working week. The frequency and proportion of each sexual practice was calculated. Results: There were 180 questionnaires included in the analysis. The median age of the FSW was 28 years (interquartile range [IQR]: 25–34). Most FSW (80.6%) worked in brothels. In an average working week, FSW had a median of 10 (IQR: 7–20) male clients. The most common sexual practices included: vaginal sex (98.3%), fellatio (97.2%), cunnilingus (92.2%) and tongue-kissing (83.7%). FSW had a median number of 10 (IQR: 6–18) vaginal, 10 (IQR: 5–18) fellatio, 7 (IQR: 2–10) cunnilingus and 6 (IQR: 2–10) tongue-kissing clients. Consistent condom use with all clients was highest for vaginal sex (97.1%), followed by anal sex (92.3%), then fellatio (78.9%). Only 3.1% used dental dams consistently for cunnilingus. Conclusion: Consistent condom use with all clients was high among FSWs, especially for vaginal and anal sex. However, one-fifth of FSW had condomless fellatio during an average working week. Tongue-kissing was more common than previously published. Peer-led sexual health education on safe sex practice for FSW is of high importance.
Utility of risk-based chlamydia testing in primary care: analysis of retrospective surveillance data among women in Melbourne, Australia
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/SH16202
Abstract: Background Chlamydia (Chlamydia trachomatis) continues to be a public health challenge in Australia, with some contention as to the best screening approach. In the present study we examined chlamydia testing, positivity and sexual behaviour among women with the aim of informing targeted testing among women aged ≥30 years. Methods: A longitudinal analysis was conducted on retrospective surveillance data collected among women attending general practice, family planning and sexual health clinics participating in sentinel surveillance in Melbourne, Australia. Women were aged ≥16 years and underwent urogenital testing for C. trachomatis (chlamydia) at participating clinics between 2007 and 2014. Chlamydia incidence was calculated as positive chlamydia tests over person-years (PY) among women and reported by 5-year age groups. A Cox regression model examined correlates of a positive chlamydia test among women aged ≥30 years. Results: In all, 36 770 women contributed 46 432 PY and 52 395 chlamydia tests, of which 2895 were positive. The overall chlamydia incidence rate was 6.2 per 100 PY (95% confidence interval (CI) 6.0–6.5). Chlamydia incidence declined with age, plateauing to per 100 PY among women aged ≥30 years. Among women aged ≥30 years, being born in North-East Asia (adjusted hazard ratio (aHR) 2.9 95% CI 1.9–4.5) and reporting multiple partners (aHR 2.5 95% CI 1.8–3.5) in the past 12 months were associated with a positive chlamydia test. Conclusions: Chlamydia control remains challenging in Australia and optimising testing in primary care is a key priority. The results of the present study suggest that, at least among women aged ≥30 years, chlamydia testing should be risk-based and informed by appropriate sexual history taking.
Risk of Subsequent HIV Infection Following Sexually Transmissible Infections Among Men Who Have Sex With Men
Publisher: Oxford University Press (OUP)
Date: 23-08-2019
DOI: 10.1093/OFID/OFZ376
Abstract: HIV and bacterial sexually transmissible infection (STI) notifications among men who have sex with men (MSM) have increased in Australia and many other countries. The relationship between HIV infection and other STIs has been demonstrated previously. However, the relationship between the cumulative history of STIs and subsequent HIV infection remains largely unexplored and limits our understanding of the mechanisms underpinning the elevated HIV risk. Data from HIV-negative MSM who attended high–HIV caseload primary care clinics in Melbourne, Australia, from 2007 to 2014 with 2 or more HIV and STI tests were included. Controlling for sexual behaviors self-reported at clinic visits, discrete time survival analyses using generalized linear modeling estimated the effect of an STI at the prior test event and the cumulative history of STIs (none, 1, 2, or more [repeated]) on risk of HIV infection. A total of 8941 MSM met the study criteria 227 (2.5%) were diagnosed with HIV over the follow-up period. Adjusting for sexual behaviors, a cumulative history of repeated rectal gonorrhea infections (adjusted hazard ratio [aHR], 6.27 95% confidence interval [CI], 2.68–14.50) and a single rectal gonorrhea infection (aHR, 2.09 95% CI, 1.15–3.79) were associated with increased HIV infection risk. Repeated and single rectal gonorrhea infections were independently associated with increased HIV infection risk. These findings suggest that MSM with any history of rectal gonorrhea, particularly repeat rectal gonorrhea, represent a group for whom preventive interventions for HIV should be emphasized.
The accuracy of image-based safety analysis for robotic cochlear implantation
Publisher: Springer Science and Business Media LLC
Date: 02-08-2018
DOI: 10.1007/S11548-018-1834-3
Abstract: To evaluate the accuracy and reliability of image-based safety analysis for robotic cochlear implantation (RCI) in an ex vivo assessment. The accuracy was evaluated in a study on 23 human temporal bones. For image analysis, a computer-assisted safety analysis based on intraoperative cone beam computed tomography was implemented. The method automatically segments the drill tunnel and predicts the distance between the tunnel and the facial nerve. In addition, the drilling error at the target is predicted. The predicted distances were compared with the actually drilled distances measured in postoperative high-resolution micro-computed tomography scans. The automatic method was compared to accuracies associated with a manual analysis of the image data. The presented computerized image-based analysis enabled the proximity of the facial nerve to the drill trajectory to be predicted with an accuracy of 0.22 ± 0.15 mm and drilling error at the target to be predicted with an accuracy of 0.11 mm ± 0.08 during N = 19 RCI procedures. The manual assessment of facial nerve proximity was performed with an accuracy of 0.34 ± 0.20 mm by a trained clinical expert. The assessment of intraoperative CT-based imaging presents multiple benefits over alternative safety mechanisms including early detection and applicability even in cases of malformation of the mastoid. This work presents a computer-assisted approach to image analysis that enables procedure safety measurements to be reliably performed with superior accuracy to other proposed safety methodologies, at a safe distance from the facial nerve. Its application must, however, be considered in relation to associated costs (time, cost, irradiation) and the dependence of the measure on a reliable preoperative segmentation.
Rural-to-urban migrants are at high risk of sexually transmitted and viral hepatitis infections in China: a systematic review and meta-analysis
Publisher: Springer Science and Business Media LLC
Date: 08-09-2014
HIV non-occupational postexposure prophylaxis (nPEP) usage among five key populations in China
Publisher: BMJ
Date: 04-01-2021
DOI: 10.1136/SEXTRANS-2020-054791
Abstract: To examine the feasibility of non-occupational postexposure prophylaxis (nPEP) as a national strategy for HIV prevention in China, we investigated nPEP usage and related sociodemographic and behavioural factors among five key populations at high risk of contracting HIV. We conducted a cross-sectional study among five key populations from November 2018 to September 2019 in China using convenience s ling to recruit participants aged ≥18 years, self-reporting HIV status as either negative or unknown and providing written informed consent. Univariable and multivariable logistic regression models were fitted. Our analysis included data from 2022 participants with a mean age of 35 years (SD=11.62). Only 57 (2.82%) participants had ever used nPEP. Sociodemographic and behavioural factors related to nPEP usage included populations (p .0001), age (p .05), education (p .05), nPEP knowledge (p .01), receiving conventional HIV prevention services (p .05) and HIV testing (p .05). A significant percentage (26%) of nPEP users used nPEP medication more than once. Challenges and concerns, such as multiple use of nPEP and syndemic conditions, were emerging. Key populations in China had low nPEP usage rates. Female sex workers, people who use drugs, older and illiterate in iduals with poor nPEP knowledge, not using HIV prevention services or never tested for HIV should be emphasised. Implementing nPEP services would be an important way to access high-risk in iduals for intensive and tailored HIV prevention and intervention. Challenges of providing nPEP services and future study foci are highlighted.
Antiseptic mouthwash against pharyngeal Neisseria gonorrhoeae:A randomised controlled trial and an in vitro study
Publisher: BMJ
Date: 20-12-2017
DOI: 10.1136/SEXTRANS-2016-052753
Abstract: Gonorrhoea is increasing among men who have sex with men (MSM). We aimed to determine whether Listerine, a commercial mouthwash product, has an inhibitory effect against In vitro: a suspension of ∼10 In vitro: Listerine mouthwashes at dilutions of up to 1:4 for 1 min resulted in significant reduction of total This data suggest Listerine, significantly reduces the amount of ACTRN12615000716561.
Understanding the duration of tongue kissing among female sex workers for potential oropharyngeal-oropharyngeal gonorrhoea transmission.
Publisher: BMJ
Date: 06-05-2022
Prevalence of HIV and syphilis infections among long-distance truck drivers in China: a data synthesis and meta-analysis
Publisher: Elsevier BV
Date: 2013
DOI: 10.1016/J.IJID.2012.07.018
Abstract: By 2009, 46 national sentinel surveillance sites had been established for long-distance truck drivers (LDTDs) in China, but the overall disease burden of HIV and syphilis among LDTDs has remained unclear. This study aimed to summarize the prevalence levels of these infections from available published peer-reviewed studies through a comprehensive systematic review and meta-analysis. Forty-six eligible articles were selected in this review. The pooled prevalence estimates of HIV and syphilis among Chinese LDTDs during 1995-2010 were 0.19% (95% confidence interval (CI) 0.15-0.24%) and 0.86% (95% CI 0.70-1.06%), respectively, corresponding to a 3.33 (95% CI 2.40-4.62) and 1.65 (95% CI 1.35-2.03) times higher risk of infection among LDTDs than the general Chinese population. However, these infection risks were much lower than those of LDTDs in other developing country settings and at-risk groups in China. Current surveillance resources have been disproportionately focused on LDTDs and should be erted to other at-risk groups.
Clinical and laboratory aspects of condylomata lata lesions of syphilis
Publisher: BMJ
Date: 22-06-2022
DOI: 10.1136/SEXTRANS-2021-055385
Abstract: Condylomata lata are a less common but distinctive syphilitic lesion. Variable theories as to their nature and origin exist. The aim of this study was to determine the clinical and laboratory characteristics of condylomata lata by determining (1): the most closely aligned stage of syphilis, based on the rapid plasma reagin (RPR) titre (2) symptom duration and (3) Treponema pallidum PCR cycle threshold (C T ) values, as an indicator of organism load. This was a retrospective study of patients with T. pallidum PCR-positive condylomata lata lesions, attending a clinic in Melbourne, Australia, between 2011 and 2021. Syphilis serology was undertaken and RPR titres compared between condylomata lata, primary and secondary syphilis cases. 51 cases with T. pallidum PCR-positive condylomata lata were included. 41 cases were in men, 40 of whom were men who have sex with men (MSM), and 10 in women. Twelve of 51 (24%) cases were in HIV-positive MSM. Thirty-three of 51 (65%) had other mucocutaneous signs of secondary syphilis 18 (35%) had no other signs of secondary syphilis. The median RPR titre among the 51 condylomata lata cases was 1:128, compared with the median RPR titre of primary syphilis (1:4) and of secondary syphilis (1:128). The median duration of lesions was 24 (IQR 10–60) days, with no significant difference between those with and without other signs of secondary syphilis (p=0.75). Median C T values for condylomata lata (C T =31) and primary syphilis (C T =31) were significantly lower than for other secondary syphilis lesion types (C T =33), indicating higher T. pallidum loads for condylomata lata and primary lesions compared with other secondary syphilis lesion types. These findings support condylomata lata as lesions that occur during the secondary stage of syphilis and which are likely to be highly infectious.
Seasonal variations in kissing and sexual activities among men who have sex with men in Melbourne, Australia: implications for seasonal sexually transmissible infection preventions and interventions
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/SH19046
Abstract: Background Previous studies have shown that there is a peak in sexually transmissible infection (STI) cases and sexual activities around summer, but there has been no study examining whether kissing also follows a similar seasonal pattern. The aim of this study was to examine the seasonal patterns of kissing and sex partners among gay, bisexual and other men who have sex with men (MSM). Methods: A short cross-sectional study was conducted among MSM attending the Melbourne Sexual Health Centre between March 2016 and February 2017. Participants were asked to report the number of kissing-only, sex-only and kissing-with-sex male partners in the last 3 months. The mean number of male partners was calculated and stratified by Australia’s seasons. The seasonal trend in the number of partners was assessed by negative binomial regression models. Results: In total, 4391 MSM were included in the analysis. The number of kissing-only and sex-only partners increased significantly from autumn to summer among MSM in Melbourne (Ptrend & .001). MSM reported the highest number of male partners for kissing-only (mean: 4.91 95% confidence intervals (CI): 4.78–5.04) and sex-only (mean: 1.91 95% CI: 1.83–1.99) around summer compared with other seasons. However, the number of kissing-with-sex partners remained stable across seasons. Conclusions: The study data suggest that there is a peak in kissing-only and sex-only partners among MSM around summer and holiday seasons.
Trichomoniasis among men presenting to a sexual health clinic in Melbourne, Australia.
Publisher: CSIRO Publishing
Date: 14-02-2022
DOI: 10.1071/SH21240
Abstract: Background This study aimed to examine the positivity of urethral Trichomonas vaginalis in men attending an urban sexual health clinic in Melbourne, Australia. Methods We conducted a retrospective analysis of men who were tested for T. vaginalis using nucleic acid lification test at the Melbourne Sexual Health Centre between August 2018 and May 2021, and calculated the positivity. Results Of the 893 men who were tested for T. vaginalis, 12 (1.3% 95% CI 0.7–2.3) tested positive for T. vaginalis. The positivity of T. vaginalis among men who reported sexual contact with a female partner with T. vaginalis was significantly higher than men who were not contacts (18.6% [8/43] vs 0.5% [4/850], P 0.001). Conclusions The positivity of T. vaginalis was low at our clinic. The high positivity among contacts highlights the importance of partner notification, testing and management.
Weight Change When Initiating, Switching to, and Discontinuing Integrase Strand Transfer Inhibitors in People Living with HIV
Publisher: Mary Ann Liebert Inc
Date: 03-2023
Neurosyphilis‐related hospital admissions, Australia, 2007–20
Publisher: Wiley
Date: 22-12-2022
DOI: 10.5694/MJA2.51830
Co-circulation of Multidrug-resistant Shigella among Men Who Have Sex with Men in Australia
Publisher: Oxford University Press (OUP)
Date: 07-01-2019
DOI: 10.1093/CID/CIZ005
Abstract: In urban Australia, the burden of shigellosis is either in returning travelers from shigellosis-endemic regions or in men who have sex with men (MSM). Here, we combine genomic data with comprehensive epidemiological data on sexual exposure and travel to describe the spread of multidrug-resistant Shigella lineages. A population-level study of all cultured Shigella isolates in the state of Victoria, Australia, was undertaken from 1 January 2016 through 31 March 2018. Antimicrobial susceptibility testing, whole-genome sequencing, and bioinformatic analyses of 545 Shigella isolates were performed at the Microbiological Diagnostic Unit Public Health Laboratory. Risk factor data on travel and sexual exposure were collected through enhanced surveillance forms or by interviews. Rates of antimicrobial resistance were high, with 17.6% (95/541) and 50.6% (274/541) resistance to ciprofloxacin and azithromycin, respectively. There were strong associations between antimicrobial resistance, phylogeny, and epidemiology. Specifically, 2 major MSM-associated lineages were identified: a Shigellasonnei lineage (n = 159) and a Shigella flexneri 2a lineage (n = 105). Of concern, 147/159 (92.4%) of isolates within the S. sonnei MSM-associated lineage harbored mutations associated with reduced susceptibility to recommended oral antimicrobials: namely, azithromycin, trimethoprim-sulfamethoxazole, and ciprofloxacin. Long-read sequencing demonstrated global dissemination of multidrug-resistant plasmids across Shigella species and lineages, but predominantly associated with MSM isolates. Our contemporary data highlight the ongoing public health threat posed by resistant Shigella, both in Australia and globally. Urgent multidisciplinary public health measures are required to interrupt transmission and prevent infection.
Getting to the Bottom of It: Sexual Positioning and Stage of Syphilis at Diagnosis, and Implications for Syphilis Screening
Publisher: Oxford University Press (OUP)
Date: 02-08-2019
DOI: 10.1093/CID/CIZ802
Abstract: Syphilis control among men who have sex with men (MSM) would be improved if we could increase the proportion of cases who present for treatment at the primary stage rather than at a later stage, as this would reduce their duration of infectivity. We hypothesized that MSM who practiced receptive anal intercourse were more likely to present with secondary syphilis, compared to MSM who did not practice receptive anal intercourse. In this retrospective analysis of MSM diagnosed with primary or secondary syphilis at Melbourne Sexual Health Centre between 2008 and 2017, we analyzed associations between the stage of syphilis (primary vs secondary) and behavioral data collected by computer-assisted self-interviews. There were 559 MSM diagnosed with primary (n = 338) or secondary (n = 221) syphilis. Of these, 134 (24%) men reported not practicing receptive anal sex. In multivariable logistic regression analysis, MSM were more likely to present with secondary rather than primary syphilis if they reported practicing receptive anal intercourse (adjusted odds ratio 3.90 P & .001) after adjusting for age, human immunodeficiency virus status, and condom use. MSM with primary syphilis who did not practice receptive anal intercourse almost always (92%) had their primary syphilis lesion on their penis. The finding that MSM who practiced receptive anal intercourse more commonly presented with secondary syphilis—and hence, had undetected syphilis during the primary stage—implies that anorectal syphilis chancres are less noticeable than penile chancres. These men may need additional strategies to improve early detection of anorectal chancres, to reduce their duration of infectivity and, hence, reduce onward transmission. Men who practiced receptive anal intercourse (AI) were more likely to present with secondary syphilis, compared to men who exclusively practiced insertive AI. Hence, men who practice receptive AI may need additional strategies to detect anal chancres, to reduce transmission.
Clinical Characteristics of Anorectal Mycoplasma genitalium Infection and Microbial Cure in Men Who Have Sex With Men
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2018
DOI: 10.1097/OLQ.0000000000000793
Abstract: We report clinical characteristics of proctitis caused solely by Mycoplasma genitalium (MG) compared with chlamydia and gonococcus. We determined the proportions cured with first-line (azithromycin) and second-line antimicrobials (moxifloxacin, pristinamycin). A total of 166 patients attending Melbourne Sexual Health Centre from 2012 to 2016 with symptoms of proctitis were tested for MG, Chlamydia trachomatis , and Neisseria gonorrhoeae . Demographic characteristics, sexual behaviors, clinical symptoms, and signs were recorded. Multinomial multivariable logistic regression was used to test for significant differences in symptoms and signs for the pathogens detected. Seventeen percent of men had MG (95% confidence interval, 12–24), 21% had chlamydia (15–27), and 40% had gonococcal monoinfection (32–48), whereas 22% had MG coinfection (16–29). Relative to men with MG monoinfection, those with chlamydial monoinfection reported more anal pain (adjusted prevalence odds ratio (aPOR), 4.68 [1.41–14.19]), whereas men with gonococcal monoinfection reported more anal pain (aPOR, 6.75 [2.21–20.55]) and tenesmus (aPOR, 15.44 [1.62–146.90]), but less anal itch (aPOR, 0.32 [0.11–0.93]). The microbiological cure for MG using azithromycin was low at 35% (22–50), whereas moxifloxacin subsequently cured 92% (64–100) and pristinamycin cured 79% (54–94) of infections. M. genitalium was almost as common as chlamydia in men presenting to a sexual health center with symptoms of proctitis. Men with anorectal MG monoinfection were less likely to have symptoms and signs compared with those with chlamydia or gonococcus monoinfection. Cure for men with symptomatic anorectal MG by azithromycin was low. We suggest routine testing for MG in cases of proctitis, with test of cure after treatment being essential.
HIV prevalence in China: integration of surveillance data and a systematic review
Publisher: Elsevier BV
Date: 11-2013
Assortative sexual mixing among heterosexuals in Australia
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/SH15246
Abstract: The aim was to investigate the assortative sexual mixing by country of birth among heterosexuals in Australia. An analysis of 1060 heterosexual couples who attended the Melbourne Sexual Health Centre between 2011 and 2014 was conducted. Of the 1060 couples, 27% (n = 281) were both Australian-born men and women, and 42% (n = 445) were both overseas-born. Of the 171 couples with women aged ≤21 years, 41% (n = 70) were both born in Australia and 33% (n = 56) were both born overseas. A strong assortative mixing pattern by country of birth was observed among all 1060 couples (r = 0.361 95% CI: 0.320–0.403), and among 171 couples with women aged ≤21 years (r = 0.481 95% CI: 0.379–0.584).
Prevalence of mutations associated with resistance to macrolides and fluoroquinolones in Mycoplasma genitalium: a systematic review and meta-analysis
Publisher: Elsevier BV
Date: 11-2020
Should Female Partners of Men With Non-Gonococcal Urethritis, Negative for Chlamydia trachomatis and Mycoplasma genitalium, Be Informed and Treated? Clinical Outcomes From a Partner Study of Heterosex
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2017
Increasing trends of syphilis among men who have sex with men in high income countries
Publisher: CSIRO Publishing
Date: 2015
DOI: 10.1071/SH14153
Abstract: Background The epidemiology of syphilis, and therefore the population most impacted, differs between countries. Many developed countries have reported an increase in syphilis notifications among men who have sex with men (MSM) over the past decade. Methods: The rates of syphilis notifications between 2000 and 2013 in the 31 countries categorised by the Organisation for Economic Co-operation and Development (OECD) as high income were investigated. Data was taken primarily from published national surveillance reports, and a male-to-female ratio substantially greater than two in syphilis notifications was taken as a proxy for the infection being disproportionately diagnosed in MSM. Results: Data was available for 27 high-income countries. The male-to-female ratio exceeded two in all but four countries. This ratio significantly increased across all geographical areas over time. Globally, the male-to-female ratio in these countries increased from 4.1 in 2000 to 7.9 in 2013 (P = 0.001). Furthermore, the proportion of male cases reported as being among MSM increased over time from 26.8% to 55.0% between 2000 and 2013 (P 0.001). Conclusion: These data show that in countries with high income, there is a near universal finding of increasing rates of syphilis in MSM. It is therefore clear that no country has identified an effective method to control syphilis in this population.
Domestic HPV vaccine price and economic returns for cervical cancer prevention in China: a cost-effectiveness analysis
Publisher: Elsevier BV
Date: 10-2020
Ratio of anogenital warts between different anatomical sites in homosexual and heterosexual individuals in Australia, 2002-2013: Implications for susceptibility of different anatomical sites to genital warts
Publisher: Cambridge University Press (CUP)
Date: 19-08-2015
DOI: 10.1017/S0950268814002118
Abstract: There is little known regarding the transmissibility of human papillomavirus (HPV) between different sites in men who have sex with men (MSM) and heterosexual in iduals. We conducted a retrospective analysis investigating all new patients attending the Melbourne Sexual Health Centre in Australia between 2002 and 2013. We describe the prevalence and ratio of the first episode of anogenital warts in MSM and heterosexual males and females. The proportion of new MSM clients with anal and penile warts was 4·0% (362/8978) and 1·6% (141/8978), respectively which gave an anal-to-penile wart ratio of 1:2·6. About 13·7% (1656/12112) of heterosexual males had penile warts and 10·0% (1121/11166) of females had vulval warts, which yielded a penile-to-vulval wart ratio of 1:0·7. Penile–anal transmission has a higher ratio than penile–vulval transmission, suggesting that the anal epithelium may be more susceptible to HPV infection than the vulval epithelium in females these ratios are important in modelling the control of HPV in MSM.
Clinical presentation of asymptomatic and symptomatic heterosexual men who tested positive for urethral gonorrhoea at a sexual health clinic in Melbourne, Australia
Publisher: Springer Science and Business Media LLC
Date: 08-07-2020
DOI: 10.1186/S12879-020-05197-Y
Abstract: Asymptomatic screening for gonorrhoea in heterosexual men is currently not recommended in many countries including Australia, given the prevalence is relatively low in the heterosexual population. We aimed to determine the proportion of urethral gonorrhoea cases among heterosexual men attending a sexual health clinic that was asymptomatic and symptomatic, the time since last sexual contact to the onset of symptoms and the time to clinic presentation following the onset of symptoms. This was a cross-sectional study that included heterosexual men aged 16 years or above attending the Melbourne Sexual Health Centre (MSHC) in Australia between August 2017 and August 2018. Gonorrhoea cases were diagnosed by nucleic acid lification testing (NAAT) and/or culture. Descriptive analyses were conducted for all gonorrhoea cases including demographic characteristics, recent sexual practices, reported urethral symptoms and duration, sexual contact with a person diagnosed with gonorrhoea, investigations performed and laboratory results. There were 116 confirmed cases of urethral gonorrhoea in heterosexual men over the study period of which 6.0% (95% CI: 2.7–12.1%) were asymptomatic. Typical urethral discharge was present in 80.2% (95% CI: 71.9–86.5%) of men. The mean time between last sexual contact and the onset of symptoms was 7.0 days, and between the onset of symptoms to presentation to the clinic was 5.6 days. A small proportion of heterosexual men with urethral gonorrhoea do not have any symptoms. Heterosexual men with urethral symptoms usually seek for healthcare within a week, prompting rapid healthcare-seeking behaviour.
A Prospective, Open-Label Pilot Study of Concurrent Male Partner Treatment for Bacterial Vaginosis
Publisher: American Society for Microbiology
Date: 26-10-2021
Abstract: Recurrence of BV following standard treatment is unacceptably high. Posttreatment recurrence is distressing for women, and it imposes a considerable burden on the health care system.
Emerging sexual and reproductive health in Australia and New Zealand: gaps, challenges and solutions.
Publisher: CSIRO Publishing
Date: 2023
DOI: 10.1071/SH23156
Postexposure prophylaxis during COVID-19 lockdown in Melbourne, Australia
Publisher: Elsevier BV
Date: 08-2020
Human Papillomavirus Antibody Levels Following Vaccination or Natural Infection Among Young Men Who Have Sex With Men
Publisher: Oxford University Press (OUP)
Date: 31-12-2021
DOI: 10.1093/CID/CIAB1052
Abstract: Australia introduced a school-based gender-neutral human papillomavirus (HPV) vaccination program for girls and boys aged 12–13 years in 2013. We examined HPV type–specific antibody levels in unvaccinated young men who have sex with men (MSM) with natural infection and compared these with levels in those vaccinated against HPV. Serum specimens at baseline were collected from MSM aged 16–20 years in the HYPER1 (Human Papillomavirus in Young People Epidemiological Research) and HYPER2 studies, conducted in 2010–2013 and 2017–2019, respectively. Merck’s 4-plex HPV competitive Luminex Immunoassay was used to quantify HPV6-, HPV11-, HPV16-, and HPV18-specific antibodies. We compared antibody levels for each HPV genotype between unvaccinated men (HYPER1) and vaccinated men (HYPER2) using the Mann-Whitney U test. There were 200 unvaccinated men and 127 vaccinated men included in the analysis. Median antibody levels among vaccinated men were significantly higher than levels among unvaccinated men for HPV6 (223 milli-Merck units per milliliter [mMU/mL] vs 48 mMU/mL, P & .0001), HPV11 (163 mMU/mL vs 21 mMU/mL, P & .0001), HPV16 (888 mMU/mL vs 72 mMU/mL, P & .0001), and HPV18 (161 mMU/mL vs 20 mMU/mL, P & .0001). Antibody levels did not change over time for up to 66 months for all 4 genotypes among vaccinated men. Among young MSM vaccinated with the quadrivalent HPV vaccine, antibody levels for HPV6, HPV11, HPV16, and HPV18 were significantly higher than those in unvaccinated MSM following natural infection. Antibody levels following vaccination appeared to remain stable over time. NCT01422356 for HYPER1 and NCT03000933 for HYPER2.
Duration of gargling and rinsing among frequent mouthwash users: a cross-sectional study.
Publisher: BMJ
Date: 09-2020
DOI: 10.1136/BMJOPEN-2020-040754
Abstract: To examine the rinsing and gargling mouthwash practices among frequent mouthwash users to determine if there are differences in use between gender, sexual orientation and sex work status. Cross-sectional study. Data obtained from patients attending a sexual health centre located in Melbourne, Australia. 200 frequent mouthwash users (four or more times per week), 50 for each of the following patient groups: men who have sex with men (MSM), female sex workers (FSW), females who are not sex workers and men who have sex with women only (MSW). Participants were observed and audio recorded using mouthwash. Descriptive analyses were conducted to calculate the median age, time rinsing and gargling, amount of mouthwash used and proportion of participants who rinsed, gargled or both, as determined from the audio files. Kruskal-Wallis H test and χ 2 test were used to examine differences between the patient groups. Median age was 28 years (IQR: 24–33). During the study, most (n=127 63.5%) rinsed and gargled, but 70 (35.0%) rinsed only and three (1.5%) gargled only. Median time rinsing was 13.5 s (IQR: 8.5–22.0 s), gargling was 4.0 s (IQR: 2.5–6.0 s) and the median total duration was 17.0 s (IQR: 11.5–25.8 s). Median duration of mouthwash did not differ significantly between the groups (females not sex workers: 18.8 s (IQR: 12.5–24.5 s) FSW: 14.0 s (9.0–22.0 s) MSM: 22.3 s (13.0–26.5 s) MSW: 15.8 s (12.0–25.0 s) p=0.070) but males used mouthwash longer than females (median 20.3 s compared with 15.5 s p=0.034). The median volume of mouthwash used was 20 mL (IQR: 15–27 mL). And most (n=198 99.0%) did not dilute mouthwash with water. Over a quarter of frequent users do not gargle mouthwash at all (35%) and used it for a substantially shorter period of time than it was used in the randomised trial (1 min) where it was shown to be effective at inhibiting Neisseria gonorrhoeae growth. Our findings suggest that many frequent mouthwash users do not follow the manufacturer instructions for using mouthwash and may not use mouthwash in a way that was shown to reduce the growth of oropharyngeal gonorrhoea.
Summer heat
Publisher: BMJ
Date: 06-11-2016
DOI: 10.1136/SEXTRANS-2015-052225
Abstract: To date, no study has correlated seasonal differences in sexual behaviour with the seasonal differences in sexually transmitted infections (STIs) and no seasonal study of STIs has been conducted in the southern hemisphere. Our study aimed to describe seasonal differences in sexual behaviour and correlate this with seasonal differences in STI diagnoses in Melbourne, Australia. This was a cross-sectional study of in iduals attending the Melbourne Sexual Health Centre over a 9-year period from 2006 to 2014. We conducted separate analyses for men who have sex with men (MSM) and men who have sex with women (MSW), and women. Seasonal patterns of sexual behaviour and STI positivity were examined within each group. All groups reported a higher number of partners over the preceding three months for consultations in summer compared with winter (MSM mean 5.48 vs 5.03 MSW mean 2.46 vs 2.31 women mean 1.83 vs 1.72). Urethral gonorrhoea diagnoses among MSM were higher in summer compared with winter (OR 1.23, 95% CI 1.04 to 1.46). Similarly, non-gonococcal urethritis (NGU) diagnoses among MSW were the highest in summer (OR 1.11, 95% CI 1.03 to 1.20), but there was no seasonal difference in NGU diagnoses when we adjusted for partner numbers. In women, pelvic inflammatory disease (PID) diagnoses peaked in autumn, when rates were higher than in winter (OR 1.30, 95% CI 1.09 to 1.55). Our results describe a peak in sexual partner number and STI diagnoses during consultations in summer in men and a rise in PID in autumn in women.
A second peak in genital warts in later life suggests that behavioural factors explain a second peak in human papillomavirus prevalence in older women
Publisher: CSIRO Publishing
Date: 2015
DOI: 10.1071/SH15097
Abstract: An age-based pattern of human papillomavirus (HPV) was observed among unvaccinated women in Australia, with a second peak occurring when women were in their early 50s. A similar age-based pattern for genital warts was also observed among unvaccinated Australian women, with the first peak (8.4%) occurring at age 15–20 years, which then declined gradually to 4.8% when women were aged 41–45 years this then increased to 5.4% when women were aged 46–50 years. This data suggests that behavioural factors may explain the changes in HPV occurrence.
Routledge Handbook of Global Public Health in Asia
Publisher: Routledge
Date: 16-04-2014
Resistance-guided antimicrobial therapy using doxycycline-moxifloxacin and doxycycline-2.5g azithromycin for the treatment of Mycoplasma genitalium infection: efficacy and tolerability
Publisher: Oxford University Press (OUP)
Date: 20-10-2019
DOI: 10.1093/CID/CIZ1031
Abstract: Macrolide resistance in Mycoplasma genitalium (MG) exceeds 50% in many regions, and quinolone resistance is increasing. We recently reported that resistance-guided therapy (RGT) using doxycycline followed by sitafloxacin or 2.5 g azithromycin cured 92% and 95% of macrolide-resistant and macrolide-susceptible infections, respectively. We present data on RGT using doxycycline–moxifloxacin, the regimen recommended in international guidelines, and extend data on the efficacy of doxycycline–2.5 g azithromycin and de novo macrolide resistance. Patients attending Melbourne Sexual Health Centre between 2017 and 2018 with sexually transmitted infection syndromes were treated with doxycycline for 7 days and recalled if MG-positive. Macrolide-susceptible cases received 2.5 g azithromycin (1 g, then 500 mg daily for 3 days), and resistant cases moxifloxacin (400 mg daily, 7 days). Test of cure was recommended 14–28 days post-antimicrobials. There were 383 patients (81 females/106 heterosexual males/196 men who have sex with men) included. Microbial cure following doxycycline–azithromycin was 95.4% (95% confidence interval [CI], 89.7–98.0) and doxycycline–moxifloxacin was 92.0% (95% CI, 88.1–94.6). De novo macrolide resistance was detected in 4.6% of cases. Combining doxycycline–azithromycin data with our prior RGT study (n = 186) yielded a pooled cure of 95.7% (95% CI, 91.6–97.8). ParC mutations were present in 22% of macrolide-resistant cases. These findings support the inclusion of moxifloxacin in resistance-guided strategies and extend the evidence for 2.5 g azithromycin and presumptive use of doxycycline. These data provide an evidence base for current UK, Australian, and European guidelines for the treatment of MG.
High prevalence of rectal gonorrhoea among men reporting contact with men with gonorrhoea: Implications for epidemiological treatment
Publisher: Springer Science and Business Media LLC
Date: 14-07-2015
Use of pristinamycin for Macrolide-Resistant mycoplasma genitalium infection
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 02-2018
Treating male partners of women with bacterial vaginosis (StepUp): a protocol for a randomised controlled trial to assess the clinical effectiveness of male partner treatment for reducing the risk of BV recurrence.
Publisher: Springer Science and Business Media LLC
Date: 11-11-2020
DOI: 10.1186/S12879-020-05563-W
Abstract: Bacterial vaginosis (BV) is estimated to affect 1 in 3 women globally and is associated with obstetric and gynaecological sequelae. Current recommended therapies have good short-term efficacy but 1 in 2 women experience BV recurrence within 6 months of treatment. Evidence of male carriage of BV-organisms suggests that male partners may be reinfecting women with BV-associated bacteria (henceforth referred to as BV-organisms) and impacting on the efficacy of treatment approaches solely directed to women. This trial aims to determine the effect of concurrent male partner treatment for preventing BV recurrence compared to current standard of care. StepUp is an open-label, multicentre, parallel group randomised controlled trial for women diagnosed with BV and their male partner. Women with clinical-BV defined using current gold standard diagnosis methods (≥3 Amsel criteria and Nugent score (NS) = 4–10) and with a regular male partner will be assessed for eligibility, and couples will then be consented. All women will be prescribed oral metronidazole 400 mg twice daily (BID) for 7 days, or if contraindicated, a 7-day regimen of topical vaginal 2% clindamycin. Couples will be randomised 1:1 to either current standard of care (female treatment only), or female treatment and concurrent male partner treatment (7 days of combined antibiotics - oral metronidazole tablets 400 mg BID and 2% clindamycin cream applied topically to the glans penis and upper shaft [under the foreskin if uncircumcised] BID). Couples will be followed for up to 12 weeks to assess BV status in women, and assess the adherence, tolerability and acceptability of male partner treatment. The primary outcome is BV recurrence defined as ≥3 Amsel criteria and NS = 4–10 within 12 weeks of enrolment. The estimated s le size is 342 couples, to detect a 40% reduction in BV recurrence rates from 40% in the control group to 24% in the intervention group within 12 weeks. Current treatments directed solely to women result in unacceptably high rates of BV recurrence. If proven to be effective the findings from this trial will directly inform the development of new treatment strategies to impact on BV recurrence. The trial was prospectively registered on 12 February 2019 on the Australian and New Zealand Clinical Trial Registry (ACTRN12619000196145, Universal Trial Number: U1111–1228-0106, www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376883& isReview=true ).
Men Who have Sex with Men in China have Relatively Low Numbers of Sexual Partners
Publisher: MDPI AG
Date: 23-06-2011
DOI: 10.4081/IDR.2011.E10
Abstract: HIV prevalence is increasing rapidly among men who have sex with men (MSM) in China and potentially associated with the number of male sexual partners that each man has on average. This study estimates the distribution of the number of male sexual partners among Chinese MSM through a comprehensive review of English and Chinese published literature. The overall median number of male sexual partners of Chinese MSM in the past 6 months China was estimated to be 1.5 (95% CI, 1.1-1.9) and 3.8 (95% CI 1.5-6.9) sexual partners in the past 6-month and 12-month periods respectively. An estimated 31% of sexual partners of MSM in China are regular partners, 54% are casual partners, and 16% are commercial partners. The reported numbers of sexual partners has not changed over time during the past decade. The numbers of male sexual partners reported by Chinese MSM is consistently lower than other settings and may not be sufficient to explain the recent rapid increase in HIV prevalence.
Asymptomatic and symptomatic urethral gonorrhoea in men who have sex with men attending a sexual health service
Publisher: Elsevier BV
Date: 08-2017
DOI: 10.1016/J.CMI.2017.02.020
Abstract: Guidelines regarding whether men who have sex with men (MSM) without symptoms of urethritis should be screened for urethral gonorrhoea differ between countries. We examined the rate of asymptomatic urethral gonorrhoea in MSM using sensitive nucleic acid lification testing. This study was conducted on consecutive MSM attending the Melbourne Sexual Health Centre between July 2015 and May 2016 for sexually transmitted infections screening. Gonorrhoea testing with the Aptima Combo 2 (AC2) assay was performed on all urine specimens obtained from MSM, whether symptoms of urethritis were present or not. Men were classified as having: typical discharge if they reported symptoms suggesting purulent discharge other symptoms if they reported other symptoms of urethritis and no symptoms if they reported no urethral symptoms. During the study period, there were 7941 clinic visits by 5947 in idual MSM with 7090 urine specimens obtained from 5497 in idual MSM tested with the AC2 assay. Urethral gonorrhoea was detected in 242 urine specimens from 228 in idual MSM. The majority (189/242, 78%, 95% CI 73-83) reported typical discharge, 27/242 (11%, 95% CI 8-16) reported other urethral symptoms, and 26/242 (11%, 95% CI 7-15) reported no symptoms on the day of presentation and testing. Among men with urethral gonorrhoea, the proportions with concurrent pharyngeal or rectal gonorrhoea were 32% (134/210) and 64% (74/235), respectively. The mean interval between last reported sexual contact and onset of typical urethral discharge, where present, was 3.9 days. The findings from our study lend support to guidelines that recommend screening asymptomatic MSM for urethral gonorrhoea.
Hepatitis A vaccine uptake among men who have sex with men from a time-limited vaccination programme in Melbourne in 2018
Publisher: BMJ
Date: 25-07-2019
DOI: 10.1136/SEXTRANS-2019-054132
Abstract: In 2017, an outbreak of hepatitis A among gay, bisexual and other men who have sex with men (MSM) was reported in Victoria, Australia. In 2018, the Victorian government implemented a free hepatitis A vaccination programme targeting all Victorian MSM. This study aimed to determine hepatitis A vaccine uptake among MSM in a sexual health clinic in Melbourne. All MSM attending the Melbourne Sexual Health Centre (MSHC) in 2018 were included. Chart review was performed to determine the proportion of men vaccinated for at least one dose of hepatitis A and to examine why men did not receive the vaccine. Multivariable logistic regression was performed to examine the factors associated with vaccine uptake. Vaccine uptake was defined as receipt of at least one dose of hepatitis A vaccine. Of the 9582 MSM who attended MSHC in 2018, 61.3% (95% CI 60.3% to 62.2%) self-reported already being immune to hepatitis A. Of the 3713 remaining eligible men, 62.7% (95% CI 61.1% to 64.2%) received at least one dose of the hepatitis A vaccine on the day of attendance. Compared with MSM not living with HIV and not taking pre-exposure prophylaxis (PrEP), MSM taking PrEP (adjusted OR 1.28 95% CI 1.01 to 1.62) were more likely to receive the vaccine. 1386 men (37.3%) did not receive the vaccine and 55.4% were not offered the vaccine by their treating clinician. 300 men (21.6%) were identified as non-immune after serological testing but did not return for vaccination. By the end of 2018, 85.5% of MSHC attendees (8196/9582) were immune to hepatitis A. The critical vaccination threshold for hepatitis A has been estimated at %. Continuation of the targeted hepatitis A vaccination programme will improve immunity among the MSM population to prevent ongoing transmission and the likelihood of future outbreaks.
Disparities and Risks of Sexually Transmissible Infections among Men Who Have Sex with Men in China: A Meta-Analysis and Data Synthesis
Publisher: Public Library of Science (PLoS)
Date: 24-02-2014
Human papillomavirus vaccination in men who have sex with men – what will be required by 2020 for the same dramatic changes seen in heterosexuals
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/SH16067
Abstract: This paper addresses the issue of whether men who have sex with men (MSM) will share the spectacular reductions in human papillomavirus (HPV) infection and its associated neoplasia that we are currently witnessing in heterosexuals. The reproductive rate for HPV infection in heterosexuals is not well established, but 70% vaccination coverage in women has resulted in a fall of more than 90% in genital warts and HPV types 16/18 in young women and 80% fall in young men indicating that the critical vaccination threshold has been exceeded for this group. Published data on the three elements of the reproductive rate for HPV infection (i.e. transmission probability per sexual partnership, rate of partner change and duration of infectiousness) suggest they are higher in MSM than heterosexuals. This indicates that the reproductive rate for HPV will be higher in MSM and hence the critical vaccination threshold will also be higher. But while vaccinating 70% of girls protect 70% of sexual partnerships in heterosexuals, vaccinating 70% of boys protect more than 70% of partnerships in MSM. Only 9% (30% by 30%) of sexual partnerships in MSM are not protected with 70% coverage. Therefore vaccinating 70% of boys will protect 91% of sexual partnerships in MSM. However the efficacy of the HPV vaccine is much lower when sexually active MSM are vaccinated rather than boys. We argue that if MSM are to have the same benefit from the HPV vaccine that heterosexuals had, boys and not adult MSM will need to be vaccinated.
Predicting the diagnosis of HIV and sexually transmitted infections among men who have sex with men using machine learning approaches.
Publisher: Elsevier BV
Date: 2020
Whole-genome sequencing reveals transmission of gonococcal antibiotic resistance among men who have sex with men: An observational study
Publisher: BMJ
Date: 15-12-2018
DOI: 10.1136/SEXTRANS-2017-053287
Abstract: Drug-resistant Neisseria gonorrhoeae are now a global public health threat. Direct transmission of antibiotic-resistant gonococci between in iduals has been proposed as a driver for the increased transmission of resistance, but direct evidence of such transmission is limited. Whole-genome sequencing (WGS) has superior resolution to investigate outbreaks and disease transmission compared with traditional molecular typing methods such as multilocus sequence typing (MLST) and N. gonorrhoeae multiantigen sequence (NG-MAST). We therefore aimed to systematically investigate the transmission of N. gonorrhoeae between men in sexual partnerships using WGS to compare isolates and their resistance to antibiotics at a genome level. 458 couples from a large prospective cohort of men who have sex with men (MSM) tested for gonorrhoea together between 2005 and 2014 were included, and WGS was conducted on all isolates from couples where both men were culture-positive for N. gonorrhoeae . Resistance-determining sequences were identified from genome assemblies, and comparison of isolates between and within in iduals was performed by pairwise single nucleotide polymorphism and pangenome comparisons, and in silico predictions of NG-MAST and MLST. For 33 of 34 (97% 95% CI 85% to 100%) couples where both partners were positive for gonorrhoea, the resistance-determining genes and mutations were identical in isolates from each partner (94 isolates in total). Resistance determinants in isolates from 23 of 23 (100% 95% CI 86% to 100%) men with multisite infections were also identical within an in idual. These partner and within-host isolates were indistinguishable by NG-MAST, MLST and whole genomic comparisons. These data support the transmission of antibiotic-resistant strains between sexual partners as a key driver of resistance rates in gonorrhoea among MSM. This improved understanding of the transmission dynamics of N. gonorrhoeae between sexual partners will inform treatment and prevention guidelines.
Distributions and trends in sexual behaviors and HIV incidence among men who have sex with men in China
Publisher: Springer Science and Business Media LLC
Date: 24-07-2012
An open-label, parallel-group, randomised controlled trial of antiseptic mouthwash versus antibiotics for oropharyngeal gonorrhoea treatment (OMEGA2)
Publisher: Springer Science and Business Media LLC
Date: 09-11-2020
DOI: 10.1038/S41598-020-76184-1
Abstract: New treatments for oropharyngeal gonorrhoea are required to address rising antimicrobial resistance. We aimed to examine the efficacy of a 14-day course of mouthwash twice daily compared to standard treatment (antibiotic) for the treatment of oropharyngeal gonorrhoea. The OMEGA2 trial was a parallel-group and open-labelled randomised controlled trial among men with untreated oropharyngeal gonorrhoea that was conducted between September 2018 and February 2020 at Melbourne Sexual Health Centre in Australia. Men were randomised to the intervention (rinsing, gargling and spraying mouthwash twice daily for 14 days) or control (standard treatment) arm and followed for 28 days. Participants in both arms were advised to abstain from sex and kissing with anyone for 14 days after enrolment. Oropharyngeal swabs were collected at baseline, Day 14 and Day 28 and tested for Neisseria gonorrhoeae by nucleic acid lification test (NAAT) and culture. The primary outcome was the detection of oropharyngeal N. gonorrhoeae by NAAT at Day 14 after treatment. This trial was registered on the Australian and New Zealand Clinical Trials Registry (ACTRN12618001380280). This trial stopped early due to a high failure rate in the mouthwash arm. Twelve men were randomly assigned to either mouthwash (n = 6) or standard treatment (n = 6). Of the 11 men who returned at Day 14, the cure rate for oropharyngeal gonorrhoea in the mouthwash arm was 20% (95% CI 1–72% 1/5) and in the standard treatment arm was 100% (95% CI 54–100% 6/6). A 14-day course of mouthwash failed to cure a high proportion of oropharyngeal gonorrhoea cases.
Duration of syphilis symptoms at presentations in men who have sex with men in Australia
Publisher: Cambridge University Press (CUP)
Date: 06-2016
DOI: 10.1017/S0950268815001168
Abstract: The rapid rise in syphilis cases has prompted a number of public health c aigns to assist men who have sex with men (MSM) recognize and present early with symptoms. This study aimed to investigate the temporal trend of the duration of self-report symptoms and titre of rapid plasma reagin (RPR) in MSM with infectious syphilis. Seven hundred and sixty-one syphilis cases in MSM diagnosed at the Melbourne Sexual Health Centre (MSHC) from 2007–2013 were reviewed. Median duration of symptoms and RPR titres in each year were calculated. The median durations of symptoms with primary and secondary syphilis were 9 [interquartile range (IQR) 6–14] days and 14 (IQR 7–30) days, respectively. The overall median titre of RPR in secondary syphilis (median 128, IQR 64–256) was higher than in primary syphilis (median 4, IQR 1–32) and in early latent syphilis (median 32, IQR 4–64). The median duration of symptoms for primary syphilis, secondary syphilis and titre of RPR level did not change over time. Public health c aigns were not associated with a significant shorter time from onset of symptoms to treatment. Alternative strategies such as more frequent testing of MSM should be promoted to control the syphilis epidemic in Australia.
Mycoplasma genitalium Infection in Adults Reporting Sexual Contact with Infected Partners, Australia, 2008–2016
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 11-2017
Oro-anal sexual practice among female sex workers in Melbourne: implication for extragenital gonorrhoea and chlamydia transmission
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/SH19219
Abstract: Background The prevalence of sexually transmissible infections has been low among female sex workers (FSWs) in Melbourne, Australia. However, the prevalence of gonorrhoea and chlamydia, especially at extragenital sites, has increased since the mid-2010s. Oro-anal sex (i.e. rimming) has been identified as a risk factor for extragenital gonorrhoea and chlamydia. However, rimming has rarely been studied among the FSW population. The aim of this study was to examine the proportion of FSWs who had had rimming with their male clients. Methods: A cross-sectional survey among FSWs attending the Melbourne Sexual Health Centre in Australia in March 2018 was conducted. All females aged ≥18 years and self-reported as a sex worker were eligible. The survey included questions related to the number of insertive and receptive rimming partners with their male clients in an average working week. Results: Forty-five FSWs completed the survey five (11.1% 95% CI: 3.7–24.1%) FSWs had had insertive rimming and 19 (42.2% 95% CI: 27.7–57.8%) had had receptive rimming with their male clients in an average working week. The median number of insertive rimming partners was two (interquartile range (IQR) 1–5) and the median number of receptive rimming partners was one (IQR 1–3). Conclusion: Insertive rimming is more commonly practiced than receptive rimming among FSWs with their male clients in an average working week.
Risk practices in the era of smartphone apps for meeting partners: A cross-sectional study among men who have sex with men in Melbourne, Australia
Publisher: Mary Ann Liebert Inc
Date: 04-2016
A cross-sectional study of HIV and STIs among male sex workers attending Australian sexual health clinics
Publisher: BMJ
Date: 02-09-2016
DOI: 10.1136/SEXTRANS-2016-052578
Abstract: Although sex work is frequently characterised as a practice with high risk for HIV and other STIs, little is known about the epidemiology of these infections among men who sell sex in Australia. This study reports the prevalence of chlamydia, gonorrhoea, infectious syphilis and HIV among men who have sex with men attending Australian publicly funded sexual health clinics and compares prevalence between sex workers and non-sex workers. From 2011 to 2014, de-identified patient data were extracted from 40 sexual health clinics in four Australian jurisdictions. The χ In total, 27 469 gay, bisexual and other men who have sex with men attended participating clinics 443 (1.6%) reported sex work. At first consultation, 18% of sex workers and 17% of non-sex workers were diagnosed with HIV or an STI (p=0.4): 13% of sex workers were newly diagnosed with chlamydia, 15% with gonorrhoea, 0.5% with infectious syphilis and 0.6% with HIV. After controlling for demographic and behavioural factors, sex work was not independently associated with an HIV or STI diagnosis. These findings provide estimates of HIV and STI prevalence among men who sell sex in Australia and they challenge assumptions of sex work as inherently risky to the sexual health of gay bisexual and other men who have sex with men.
High-Risk Sexual Activities and Condom Use Patterns During Group Sex Among Men Who Have Sex With Men in Melbourne, Australia
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-08-2023
DOI: 10.1097/QAI.0000000000003211
Abstract: Few studies have examined the types of sexual activities and condom use during group sex among men who have sex with men (MSM). This study aimed to examine sexual activities and condom use during group sex. A cross-sectional survey among MSM attending a sexual health clinic in Melbourne, Australia, between May 2019 and March 2020. Participants were asked whether they had engaged in group sex (sex involving more than 2 participants) within the past 3 months, the number of people involved, the sexual activities they engaged in, and their condom use during the most recent group sex. More than a quarter (26.8%, 287 of 1071) had engaged in group sex in the past 3 months, and the median number of people involved was 3 (interquartile range 3–4), including the participant. Fellatio was the most common activity in group sex (94.4%, 271 of 287), followed by kissing (85.7%, 246 of 287) and anal sex (79.8%, 229 of 287). The proportion of men who always used condoms and changed condoms between partners was 27.0% (48 of 178) for insertive and 32.3% (52 of 161) for receptive anal sex. Compared with men not taking pre-exposure prophylaxis (PrEP), men living with HIV (adjusted odds ratio [aOR]: 2.35 95% confidence interval [CI]: 1.20 to 4.59) and men taking PrEP (aOR: 3.07 95% CI: 2.21 to 4.26) had higher odds of engaging in group sex after adjusting for confounders. Two-thirds of MSM either did not use condoms or did not change condoms between partners during group sex, which may increase sexually transmitted infection transmission between partners.
Incorporating digital anorectal examinations for anal cancer screening into routine HIV care for men who have sex with men living with HIV : a prospective cohort study
Publisher: Wiley
Date: 12-2018
DOI: 10.1002/JIA2.25192
Frequent transmission of gonorrhea in men who have sex with men
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 2017
Trends and associated factors in HIV testing among heterosexual men and women in Melbourne, Australia, 2011–2020
Publisher: CSIRO Publishing
Date: 20-07-2023
DOI: 10.1071/SH22195
Associations between oral sex practices and frequent mouthwash use in men who have sex with men: implications for gonorrhoea prevention.
Publisher: CSIRO Publishing
Date: 2018
DOI: 10.1071/SH18131
Abstract: Background Rates of gonorrhoea continue to rise among men who have sex with men (MSM) in Australia and worldwide. Recently, it has been proposed that oropharyngeal gonorrhoea may play a role in its onward transmission and that mouthwash use may be an effective intervention for gonorrhoea prevention and control. The objective of this study was to determine the association between specific oral sex practices and frequency of mouthwash use. Methods: A questionnaire-based study was conducted among MSM attending the Melbourne Sexual Health Centre in Australia from March to September 2015. Logistic regression was performed to examine the association between frequent mouthwash use (i.e. daily or weekly mouthwash use) and four oral sex practices (tongue kissing, receptive fellatio with or without ejaculation, and insertive rimming) among MSM. Results: Of the 918 MSM included in the final analysis, 490 men (53.4%) were frequent mouthwash users. Participants aged 24–34 years were 2.13-fold (95% CI 1.52–2.98) and those ≥35 years were 2.64-fold (95% CI 1.83–3.83) more likely to use mouthwash frequently than those aged ≤24 years. The most common oral sex practice was tongue kissing (n=874 95.2%), followed by receptive fellatio without ejaculation (n=839 91.4%), receptive fellatio with ejaculation (n=610 66.5%), then insertive rimming (n=356 38.8%). No significant association was found between frequent mouthwash use and tongue kissing, receptive fellatio with or without ejaculation, or insertive rimming with regular or casual male partners in the previous 3 months. Conclusions: Younger MSM are less likely to use mouthwash. There is no association between engaging in oral sex practices and frequent mouthwash use among MSM.
Impact load mitigation of meta-panels with single local resonator
Publisher: Elsevier BV
Date: 08-2022
HIV Disease Burden and Related Risk Behaviours Among Men Who Have Sex with Men in Yuxi Prefecture, Yunnan Province, China: 2010−2011
Publisher: Springer Science and Business Media LLC
Date: 09-09-2012
DOI: 10.1007/S10461-012-0300-4
Abstract: The HIV epidemic is rapidly increasing among men who have sex with men (MSM) in China. Data on the disease burden and risk behaviours of MSM related to HIV transmission are needed to inform education and prevention programs. We conducted two cross-sectional surveys among MSM in Yuxi Prefecture in Yunnan Province, China, during 2010-2011. Men were recruited by snowball (participant referrals) and nomination s ling methods at gay-oriented venues and hotspots. Participants were asked to complete a 20-min anonymous questionnaire. Blood s les were collected to determine HIV status and the BED capture enzyme immunoassay was used to estimate the incidence rate. A total of 288 MSM participated in this study across the two surveys. The two-year overall HIV prevalence was 10.7 % and the estimated incidence rate was 5.4 per 100 person-years (95 % CI 1.1-9.6). A reported 37.2 % of MSM were married to a female and 35.1 % had sex with a female in the past 6 months. Condom use with male partners (81.4-93.0 %) and female partners (56.3-77.4 %) at the last penetrative act significantly increased between the survey conducted in 2010 and the survey in 2011. HIV prevalence is high among Chinese MSM in Yunnan. Common bisexual behaviours and low consistent condom use with female partners suggest a potential spread of HIV from MSM to females.
Epidemics of STIs; ask why
Publisher: BMJ
Date: 20-07-2016
Increased Syphilis Testing of Men Who Have Sex With Men: Greater Detection of Asymptomatic Early Syphilis and Relative Reduction in Secondary Syphilis
Publisher: Oxford University Press (OUP)
Date: 13-04-2017
DOI: 10.1093/CID/CIX326
Abstract: Syphilis rates have increased markedly among men who have sex with men (MSM) internationally. We examined trends in syphilis testing and detection of early syphilis among MSM in Australia. Serial cross-sectional analyses on syphilis testing and diagnoses among MSM attending a national sentinel network of 46 clinics in Australia between 2007 and 2014. 359313 clinic visits were included. The proportion of MSM serologically tested for syphilis annually increased in HIV-negative (48% to 91% Ptrend < .0001) and HIV-positive MSM (42% to 77% Ptrend < .0001). The mean number of tests per man per year increased from 1.3 to 1.6 in HIV-negative MSM (Ptrend < .0001) and from 1.6 to 2.3 in HIV-positive MSM (Ptrend < .0001). 2799 and 1032 syphilis cases were detected in HIV-negative and HIV-positive MSM, respectively. Among HIV-negative MSM, the proportion of infections that were early latent increased from 27% to 44% (Ptrend < .0001), while the proportion that were secondary decreased from 24% to 19% (Ptrend = .030). Among HIV-positive MSM, early latent infections increased from 23% to 45% (Ptrend < .0001), while secondary infections decreased from 45% to 26% (Ptrend = .0003). Among HIV-positive MSM, decreasing secondary syphilis correlated with increasing testing coverage (r = -0.87 P = .005) or frequency (r = -0.93 P = .001). Increases in syphilis screening were associated with increased detection of asymptomatic infectious syphilis and relative falls in secondary syphilis for both HIV-positive and HIV-negative MSM nationally, suggesting interruption of syphilis progression.
The influence of sexual activity on the vaginal microbiota and Gardnerella vaginalis clade diversity in young women
Publisher: Public Library of Science (PLoS)
Date: 24-02-2017
The clinical indications for testing women for Mycoplasma genitalium
Publisher: BMJ
Date: 07-2021
DOI: 10.1136/SEXTRANS-2020-054818
Abstract: While the contribution of Mycoplasma genitalium (MG) to symptoms in men is well described, less is known about its association with common genital symptoms in women. We aimed to determine the prevalence of MG and macrolide resistance, and its association with common genital symptoms in women attending a sexual health service, to inform indications for testing and clinical practice. We undertook a cross-sectional study of symptomatic and asymptomatic women attending Melbourne Sexual Health Centre (MSHC), between April 2017 and April 2019. Women were tested for MG and macrolide resistance, Chlamydia trachomatis (CT), Neisseria gonorrhoeae , Trichomonas vaginalis , bacterial vaginosis and vulvovaginal candidiasis. Women completed a questionnaire on symptoms, and symptomatic women underwent examination. The prevalence of MG (and macrolide resistance) and other genital infections was calculated with 95% CIs, and associations between these outcomes and specific genital symptoms were examined using logistic regression. Of 1318 women, 83 (6%, 95% CI: 5% to 8%) had MG, of which 39 (48%, 95% CI: 36% to 59%) had macrolide-resistant MG 103 (8%, 95% CI: 6% to 9%) women had CT. MG prevalence was similar in asymptomatic (10 of 195 5%) and symptomatic (73 of 1108 7%) women, p=0.506. MG was associated with mucopurulent cervicitis on examination (adjusted OR=4.38, 95% CI: 1.69 to 11.33, p=0.002), but was not associated with other specific genital symptoms or signs. MG was as common as CT among women attending MSHC. MG was not associated with genital symptoms, but like CT, was significantly associated with cervicitis. These data provide evidence that routine testing for MG in women with common genital symptoms is not indicated. The presence of macrolide resistance in 48% of women supports use of resistance-guided therapy.
Sexually Transmitted Infection Diagnoses and Access to a Sexual Health Service Before and After the National Lockdown for COVID-19 in Melbourne, Australia
Publisher: Oxford University Press (OUP)
Date: 02-11-2020
DOI: 10.1093/OFID/OFAA536
Abstract: We aimed to examine the impact of lockdown on sexually transmitted infection (STI) diagnoses and access to a public sexual health service during the coronavirus disease 2019 (COVID-19) pandemic in Melbourne, Australia. The operating hours of Melbourne Sexual Health Centre (MSHC) remained the same during the lockdown. We examined the number of consultations and STIs at MSHC between January and June 2020 and stratified the data into prelockdown (February 3 to March 22), lockdown (March 23 to May 10), and postlockdown (May 11 to June 28), with 7 weeks in each period. Incidence rate ratios (IRRs) and their 95% confidence intervals (CI) were estimated using Poisson regression models. The total number of consultations dropped from 7818 in prelockdown to 4652 during lockdown (IRR, 0.60 95% CI, 0.57–0.62) but increased to 5347 in the postlockdown period (IRR, 1.15 95% CI, 1.11–1.20). There was a 68% reduction in asymptomatic screening during lockdown (IRR, 0.32 95% CI, 0.30–0.35), but it gradually increased during the postlockdown period (IRR, 1.59 95% CI, 1.46–1.74). Conditions with milder symptoms showed a marked reduction, including nongonococcal urethritis (IRR, 0.60 95% CI, 0.51–0.72) and candidiasis (IRR, 0.61 95% CI, 0.49–0.76), during lockdown compared with prelockdown. STIs with more marked symptoms did not change significantly, including pelvic inflammatory disease (IRR, 0.95 95% CI, 0.61–1.47) and infectious syphilis (IRR, 1.14 95% CI, 0.73–1.77). There was no significant change in STI diagnoses during postlockdown compared with lockdown. The public appeared to be prioritizing their attendance for sexual health services based on the urgency of their clinical conditions. This suggests that the effectiveness of clinical services in detecting, treating, and preventing onward transmission of important symptomatic conditions is being mainly preserved despite large falls in absolute numbers of attendees.
Targeted human papillomavirus vaccination for young men who have sex with men in Australia yields significant population benefits and is cost-effective
Publisher: Elsevier BV
Date: 09-2017
DOI: 10.1016/J.VACCINE.2017.07.078
Abstract: We investigated the effectiveness and cost-effectiveness of a targeted human papillomavirus (HPV) vaccination program for young (15-26) men who have sex with men (MSM). We developed a compartmental model to project HPV epidemic trajectories in MSM for three vaccination scenarios: a boys program, a targeted program for young MSM only and the combination of the two over 2017-2036. We assessed the gain in quality-adjusted-life-years (QALY) in 190,000 Australian MSM. A targeted program for young MSM only that achieved 20% coverage per year, without a boys program, will prevent 49,283 (31,253-71,500) cases of anogenital warts, 191 (88-319) person-years living with anal cancer through 2017-2036 but will only stablise anal cancer incidence. In contrast, a boys program will prevent 82,056 (52,100-117,164) cases of anogenital warts, 447 (204-725) person-years living with anal cancers through 2017-2036 and see major declines in anal cancer. This can reduce 90% low- and high-risk HPV in young MSM by 2024 and 2032, respectively, but will require vaccinating ≥84% of boys. Adding a targeted program for young MSM to an existing boys program would prevent an additional 14,912 (8479-21,803) anogenital wart and 91 (42-152) person-years living with anal cancer. In combination with a boys' program, a catch-up program for young MSM will cost an additional $AUD 6788 ($4628-11,989) per QALY gained, but delaying its implementation reduced its cost-effectiveness. A boys program that achieved coverage of about 84% will result in a 90% reduction in HPV. A targeted program for young MSM is cost-effective if timely implemented.
Incidence of renal Fanconi syndrome in patients taking antiretroviral therapy including tenofovir disoproxil fumarate
Publisher: SAGE Publications
Date: 08-2018
Abstract: The objective of this study was to determine the incidence and predictors of Fanconi Syndrome (FS) in a cohort of patients taking tenofovir disoproxil fumarate (TDF). Clinical records and laboratory investigations from patients receiving TDF between 2002 and 2016 were extracted. FS was defined as normoglycaemic glycosuria and proteinuria and at least one other marker of renal dysfunction. Regression analysis was performed with time to development of FS and the following covariates: ritonavir co-administration, age, gender, co-morbidities (hypertension, hyperlipidaemia, diabetes, viral hepatitis), CD4 cell count nadir and baseline eGFR. One thousand and forty-four patients received TDF without ritonavir and 398 patients with ritonavir. Thirteen cases of FS were identified with a mean duration of exposure of 55 months. The incidence of FS was 1.09/1000PY (0.54–1.63) of TDF exposure (without ritonavir) and 5.50/1000PY (3.66–7.33) of TDF-ritonavir co-administration (p=0.0057). The adjusted hazards ratio for ritonavir co-administration was 4.71 (1.37–16.14, p=0.014). Known risk factors for chronic kidney disease were not associated with development of FS. Ritonavir co-administration, but not other factors, is associated with a greater risk of FS. FS developed late. Known risk factors for chronic kidney disease and length of treatment are not useful for identifying patients most at risk of developing FS in patients taking TDF.
Trends in HIV Transmission According to Differences in Numbers of Sexual Partnerships Among Men Who Have Sex with Men in China
Publisher: Springer New York
Date: 2013
Associations between Anorectal Chlamydia and Oroanal Sex or Saliva Use as a Lubricant for Anal Sex
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2018
DOI: 10.1097/OLQ.0000000000000800
Abstract: Receptive condomless anal sex is a known risk factor for anorectal chlamydia, but it remains unclear whether oroanal sex practices also contribute. We aimed to determine whether oroanal sex (“rimming”), fingering, or the use of saliva as anal lubricant are risk factors for anorectal chlamydia among men who have sex with men (MSM). This cross-sectional study was conducted at Melbourne Sexual Health Centre from July 2014 to June 2015. Routinely collected computer-assisted self-interview data included demographics, number of sexual partners, and condom use. We added questions on receptive rimming, receptive fingering or penis “dipping,” and the use of a partner's saliva as anal lubricant. A total of 1691 MSM completed the questionnaire and tested for anorectal chlamydia. In univariable analyses, anorectal chlamydia was associated with using a partner's saliva as lubricant (odds ratio [OR] 1.97, 95% confidence interval [CI] 1.26–3.09), receptive rimming (OR 1.59 95% CI 1.04–2.45), and receptive fingering or dipping (OR 1.90 95% CI 1.06–3.43). In multivariable analysis, anorectal chlamydia was not associated with these sexual practices, after adjusting for number of sexual partners, HIV status, known contact with chlamydia, and condom use. However, collinearity between sexual practices likely obscured associations with anorectal chlamydia, and further analyses suggested weak associations between these sexual practices and anorectal chlamydia. The use of a partner's saliva during receptive anal sex practices such as rimming, fingering, or penis dipping were weak risk factor for anorectal chlamydia in MSM. This contrasts with our previously reported findings that the use of saliva as anal lubricant is more strongly associated with anorectal gonorrhea.
Clinical factors associated with syphilis concordance in men in sexual partnerships: A cross-sectional couples study
Publisher: BMJ
Date: 30-11-2018
DOI: 10.1136/SEXTRANS-2017-053297
Abstract: Syphilis infections continue to increase among men who have sex with men (MSM) in many countries, with rates often higher among HIV-positive MSM. There is limited understanding of the risk and determinants of syphilis transmission between men. We aimed to examine the concordance of early syphilis infection between male sexual partners and clinical factors associated with transmission. Men attending Melbourne Sexual Health Centre with their male partners, where at least one was diagnosed with early syphilis, were identified from linkage of partner records between March 2011 and April 2016. Early latent syphilis was defined as a new asymptomatic syphilis presentation of less than 2 years’ duration. Associations between concordance and potential risk factors were examined using Fisher’s exact test. Among 43 couples (86 men) identified, there were 13 couples (26 men) where both were diagnosed with early syphilis, representing a concordance rate of 30.2% (95% CI 17.2% to 46.1%). Among the 13 concordant couples, 5 men had primary syphilis (4 penile, 1 anal), 11 secondary syphilis (8 generalised rash, 3 penile, 2 anal, 1 oral lesion) and 10 early latent infections. Concordance was higher among couples where at least one partner had secondary syphilis compared with couples where neither partner had secondary syphilis (53% (9/17) vs 15% (4/26), P=0.016). Furthermore, concordance was higher among couples where one was HIV positive compared with couples where both were HIV negative (62% (5/8) vs 23% (8/35), P=0.042). There was an overall concordance rate of 30%. Higher concordance rates for early syphilis infection between male sexual partners were associated with HIV and secondary syphilis.
A systematic review and meta-analysis of the prevalence, trends, and geographical distribution of HIV among Chinese female sex workers (2000–2011): implications for preventing sexually transmitted HIV
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.IJID.2015.08.014
Abstract: The aim of this meta-analysis was to investigate temporal and geographical trends in the HIV epidemic among female sex workers (FSWs) recruited from various venues in China. Chinese and English peer-reviewed articles published between January 2000 and February 2013 were systematically searched. Standard meta-analysis methods were used to calculate the pooled HIV prevalence, in accordance with the PRISMA guidelines. The national HIV prevalence among FSWs declined from 0.74% (95% confidence interval (CI) 0.37-1.49%) in 2000-2002 to 0.40% (95% CI 0.31-0.53%) in 2009-2011. All Chinese regions demonstrated significant declines in HIV prevalence, apart from the East and South Central regions, in which the epidemics stabilized at low/moderate levels. Despite a significant decline from 1.92% (95% CI 0.86-4.24%) to 0.87% (95% CI 0.65-1.18%) during 2000-2011, Southwest China still bore the greatest HIV disease burden. Nationwide, FSWs recruited from detention centres had the highest HIV prevalence (0.92%, 95% CI 0.46-1.88%), followed by voluntary counselling and testing sites (0.80%, 95% CI 0.46-1.67%) and entertainment venues (0.61%, 95% CI 0.47-0.79%). The prevalences among FSWs in high-, middle-, and low-tier entertainment venues were 0.59% (95% CI 0.32-1.45%), 0.92% (95% CI 0.50-1.77%), and 1.10% (95% CI 0.71-2.16%), respectively. High- and middle-tier FSWs had a significantly lower risk of HIV infection than lower-tier FSWs (high/low: odds ratio (OR) 0.48, 95% CI 0.40-0.59 middle/low: OR 0.49, 95% CI 0.37-0.66). The HIV epidemic has shown a gradual declining or stabilizing trend among Chinese FSWs. Intervention efforts should be erted to high-risk subgroups of FSWs, such as drug-using and low-tier FSWs.
Risk factors associated with HIV/HCV infection among entrants in methadone maintenance treatment clinics in China: A systematic review and meta-analysis
Publisher: Elsevier BV
Date: 12-2012
DOI: 10.1016/J.DRUGALCDEP.2012.05.028
Abstract: Methadone maintenance treatment (MMT) has rapidly expanded in China, from 8 pilot sites to 696 clinics covering 27 provinces, during 2004-2010. This study evaluates the demographic characteristics and drug use behaviors associated with Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV) infections among MMT entrants through a systematic review and meta-analysis of published literature. Thirty-nine eligible articles (1 in English and 38 in Chinese) were selected for this review. We extracted the relevant indicator information from all eligible studies and performed meta-analyses, by stratifying according to sex of the participants, age groups and drug use behaviors. Five provinces (i.e., Yunnan, Guizhou, Sichuan, Guangxi and Xinjiang) with the population size of HIV-infected drug users greater than 10,000 were defined as high transmission areas (HTAs) for HIV infection whereas the remaining twenty-six Chinese provinces were considered as low transmission areas (LTAs). The odds of being infected by HIV among male drug users were significantly higher than for females in high transmission areas (OR=1.49, 95% CI: 1.11-1.99, k=9), while the opposite results were observed in low transmission areas (OR=0.46, 0.27-0.79, k=11). In comparison, no significant differences in risk behaviors were found between sexes in HTAs and LTAs. Younger age was not associated with risk of HIV infection, but was associated with higher risk of HCV infection ( 40 years, k=17). Risk of HIV infection was higher among injectors than non-injectors (OR=4.29, 2.70-6.79, k=14) and for those who inject, there was greater risk among sharers than non-sharers (OR=2.47, 1.44-4.23, k=4). Similar patterns were also observed in HCV infection (injectors: OR=10.82, 7.60-15.40 sharers: OR=3.41, 2.56-4.54, k=7). Characteristics of MMT entrants positive for HIV or HCV in China vary by disease types, geographical region, sex, age, and injecting behavior. These factors need to be considered in targeted interventions for MMT participants, such as age-specific health education and psychological treatment, antiretroviral therapy and needle-syringe exchange programs.
Clinical presentation of asymptomatic and symptomatic women who tested positive for genital gonorrhoea at a sexual health service in Melbourne, Australia
Publisher: Cambridge University Press (CUP)
Date: 2020
DOI: 10.1017/S0950268820002265
Abstract: Gonorrhoea cases in women have been rising in Australia in the 2010s but the cause of the increase is not well understood. This cross-sectional study aimed to describe the characteristics of genital gonorrhoea infection in women attending the Melbourne Sexual Health Centre, Australia. Gonorrhoea cases were diagnosed by nucleic acid lification test (NAAT) and/or culture. Genitourinary specimens were obtained in 12 869 clinic visits in women aged 16 years or above between August 2017 and August 2018. Genital gonorrhoea was detected in 142 (1.1%) of the visits. Almost half of the cases were asymptomatic, 47.9% [95% confidence interval (CI) 39.8–56.1%] yellow, green or pus-like vaginal discharge was present in 11.3% (95% CI 7.0–17.6%) and other genital symptoms in 40.8% (95% CI 33.1–49.1%) of the cases. The mean time between last sexual contact and onset of symptoms was 7.3 days and between the onset of symptoms to presentation to the clinic was 12.1 days. Half of the cases of genital gonorrhoea among women are asymptomatic and these cases would have been missed by testing of only symptomatic women. Further epidemiological and behavioural research is required to understand the temporal changes in sexual practices among women in Australia.
Age, ethnic and travel-related disparities in kissing and sexual practices among heterosexual men in Melbourne, Australia
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/SH19230
Abstract: Background The kissing practices of heterosexual men are not well understood, despite the potential of kissing to be a significant risk factor for gonorrhoea transmission. This study aimed to explore kissing and sex practices among heterosexual men. Methods: A cross-sectional survey among heterosexual men attending the Melbourne Sexual Health Centre in 2016–2017 was conducted. Men were asked to report their number of kissing-only (in the absence of sex), sex-only (in the absence of kissing) and kissing-with-sex partners in the last 3 months. The mean number of each partner type was calculated, and multivariable negative binomial regression was used to investigate associations between the number of different types of partners and demographic characteristics. Results: Of the 2351 heterosexual men, men reported a mean of 2.98 kissing-only, 0.54 sex-only and 2.64 kissing-with-sex partners in the last 3 months. Younger men had a mean higher number of kissing-only partners than older men (4.52 partners among men aged ≤24 years compared with 1.75 partners among men ≥35 years, P & 0.001). Men born in Europe had the most kissing-only partners (mean: 5.16 partners) and men born in Asia had the fewest kissing-only partners (mean: 1.61 partners). Men recently arrived in Australia, including travellers from overseas, had significantly more kissing-only partners (adjusted incidence rate ratio (aIRR): 1.53 95% CI: 1.31–1.80) than local men. Conclusions: This study provides novel data about kissing practices of heterosexual men. Studies assessing oropharyngeal gonorrhoea should include measurements of kissing until studies can clarify its contribution to transmission risk.
Characteristics of adenovirus urethritis among heterosexual men and men who have sex with men
Publisher: BMJ
Date: 16-11-2016
DOI: 10.1136/SEXTRANS-2015-052243
Abstract: The aim of this study was to characterise the clinical features of adenovirus urethritis in men and to compare the frequency of these between heterosexual men and men who have sex with men (MSM). This was a review of the clinical and laboratory information from men diagnosed with PCR-confirmed adenovirus urethritis at the Melbourne Sexual Health Centre between January 2006 and April 2014. 102 adenovirus urethritis cases were reported, among which 61 were heterosexual men and 41 MSM. Eighty-nine per cent (n=91) had signs of meatitis or conjunctivitis: 51% had meatitis only 32% meatitis together with conjunctivitis and 6% with conjunctivitis only. The distribution of symptoms and signs was similar among heterosexual men and MSM (p values >0.1). Adenovirus was the sole pathogen found in 93% of cases, excluding gonorrhoea, chlamydia, Mycoplasma genitalium and herpes simplex virus. Only 37% had ≥5 polymorphs per high-power field from a urethral smear. Where s les were still available for adenoviral sequencing (n=20), all were subgroup D. The clinical features of adenovirus urethritis in men can be distinctive and aid diagnosis, distinguishing it from other treatable causes of male urethritis.
Could antiseptic mouthwash inhibit pharyngeal Neisseria gonorrhoeae ? Further research is required
Publisher: BMJ
Date: 21-08-2017
Testing commercial sex workers for sexually transmitted infections in Victoria, Australia: An evaluation of the impact of reducing the frequency of testing
Publisher: Public Library of Science (PLoS)
Date: 21-07-2014
Reduction in Domestic HPV Vaccine Price Enables Good Economic Returns for Cervical Cancer Prevention in China: A Cost-Effectiveness Analysis
Publisher: Elsevier BV
Date: 2019
DOI: 10.2139/SSRN.3487751
Factors associated with declining to report the number of sexual partners using computer-assisted self-interviewing
Publisher: CSIRO Publishing
Date: 2018
DOI: 10.1071/SH18024
Abstract: Background The number of sexual partners is one of the most important risk factors for sexually transmissible infections (STIs), including HIV. The aim of the present study was to examine the association between declining to report the number of partners using computer-assisted self-interviewing (CASI) and HIV or STI positivity at a public sexual health centre in Melbourne, Australia, in 2016. Methods: In iduals were categorised into three risk populations: women, men who have sex with women only (MSW) and men who have sex with men (MSM). Logistic regression analysis was used to examine the association between declining to report the number of sexual partners in the past 12 months and HIV or STI positivity for women and MSW, with generalised estimating equations (GEE) used for estimation in MSM to address repeated-measures within in iduals. Results: In all, 18085 in iduals (5579 women, 6013 MSW, 6493 MSM) were included in the final analysis. There was no association between chlamydia positivity and declining to respond among women and MSW. MSM who declined to respond were more likely to be chlamydia positive (adjusted odds ratio1.21 95% confidence interval (CI) 1.01–1.43). Known HIV-positive MSM and MSM newly diagnosed with HIV had 3.31-fold (95% CI 2.48–4.42) and 2.82-fold (95% CI 1.84–4.32) greater odds respectively of declining to respond compared with HIV-negative MSM. Gonorrhoea and syphilis positivity in MSM were not associated with declining to respond. Conclusions: There was no association between declining to report the number of partners and chlamydia positivity among women and MSW. However, MSM who declined to report the number of partners were slightly more likely to have chlamydia and substantially more likely to be HIV positive.
Performing Intracochlear Electrocochleography During Cochlear Implantation
Publisher: MyJove Corporation
Date: 08-03-2022
DOI: 10.3791/63153
Abstract: Electrocochleography (ECochG) measures inner ear potentials generated in response to acoustic stimulation of the ear. These potentials reflect the residual function of the cochlea. In cochlear implant candidates with residual hearing, the implant electrode can directly measure ECochG responses during the implantation process. Various authors have described the ability to monitor the inner ear function by continuous ECochG measurements during the surgery. The measurement of ECochG signals during surgery is not trivial. There are no interpretable signals in up to 20% of cases. For a successful recording, a standardized procedure is recommended to achieve the highest measurement reliability and avoid possible pitfalls. Therefore, seamless collaboration between the CI surgeon and CI technician is key. This video consists of an overview of the system setup and a stepwise procedure of performing intracochlear ECochG measurements during CI surgery. It shows the surgeon's and the CI technician's roles in the process, and how a smooth collaboration between the two is made possible.
Role of saliva use during masturbation in the transmission of Chlamydia trachomatis in men who have sex with men
Publisher: Cambridge University Press (CUP)
Date: 2021
DOI: 10.1017/S0950268821001941
Abstract: Masturbation is a common sexual practice in men, and saliva is often used as a lubricant during masturbation by men who have sex with men. However, the role of saliva use during masturbation in the transmission of chlamydia is still unclear. We developed population-level, susceptible-infected-susceptible compartmental models to explore the role of saliva use during masturbation on the transmission of chlamydia at multiple anatomical sites. In this study, we simulated both solo masturbation and mutual masturbation. Our baseline model did not include masturbation but included transmission routes (anal sex, oral-penile sex, rimming, kissing and sequential sexual practices) we have previously validated (model 1). We added masturbation to model 1 to develop the second model (model 2). We calibrated the model to five clinical datasets separately to assess the effects of masturbation on the prevalence of site-specific infection. The inclusion of masturbation (model 2) significantly worsened the ability of the models to replicate the prevalence of C. trachomatis . Using model 2 and the five data sets, we estimated that saliva use during masturbation was responsible for between 3.9% [95% confidence interval (CI) 2.0–6.8] and 6.2% (95% CI 3.8–10.5) of incident chlamydia cases at all sites. Our models suggest that saliva use during masturbation is unlikely to play a major role in chlamydia transmission between men, and even if it does have a role, about one in seven cases of urethral chlamydia might arise from masturbation.
Nudgeathons to control HIV: designing strategies using behavioural economics
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2020
Trends in gonorrhoea positivity by nucleic acid amplification test versus culture among Australian heterosexual men with a low prevalence of gonorrhoea, 2007-2014
Publisher: BMJ
Date: 17-02-2016
DOI: 10.1136/SEXTRANS-2015-052246
Abstract: Testing for gonorrhoea with nucleic acid lification tests (NAATs) is not recommended in low-prevalence populations as it results in high numbers of false positive results. The aim of this study was to examine temporal trends of gonorrhoea positivity by NAAT and culture in heterosexual men in Victoria, Australia following recent increases in gonorrhoea notifications. Three data sources between 2007 and 2014 were used in this study: notification data from the Victorian Department of Health, Medicare testing numbers of single chlamydia and dual NAATs performed, and electronic records on heterosexual men attending Melbourne Sexual Health Centre (MSHC). Notifications of gonorrhoea by NAAT (with/without culture) in heterosexual men in Victoria rose threefold from 74 in 2007 to 238 in 2014, while the number of dual NAATs ordered over the same period underwent a fivefold increase from 14 061 to 71 860. The overall proportion of NAATs that were positive for gonorrhoea in Victoria was low and fell from 0.53% in 2007 to 0.33% in 2014 (P These data suggest that gonorrhoea prevalence in heterosexual men is low and stable, despite annual increases in notifications. Guidelines in most countries recommend restricting testing to groups or populations with prevalence over 1%, symptomatic in iduals or those at increased epidemiological risk. These data indicate gonorrhoea testing should not automatically accompany chlamydia screening in low-risk heterosexual men.
Concordance of chlamydia infections of the rectum and urethra in same-sex male partnerships
Publisher: Springer Science and Business Media LLC
Date: 05-01-2017
The safe use of dating applications among men who have sex with men: a study protocol for a randomised controlled trial to evaluate an interactive web-based intervention to reduce risky sexual behavio
Publisher: Springer Science and Business Media LLC
Date: 27-05-2020
DOI: 10.1186/S12889-020-08914-Z
Abstract: Notably, both international and local studies have found a high prevalence of sexually transmitted infections (STIs) and risky sexual behaviours, such as condomless anal sex, substance misuse in conjunction with sex (‘chemsex’) and group sex, among men who have sex with men (MSM) dating application (app) users. Although the use of dating apps is an emerging sexual risk factor, little effort has been expended on the promotion of safe sex and good sexual health among the users of those apps. Therefore, the aim of the proposed study is to develop and evaluate the effectiveness of an interactive web-based intervention in improving the sexual health of MSM dating app users in Hong Kong. A two-armed randomised controlled trial will be conducted. Chinese MSM dating app users will be recruited and randomly allocated into either the intervention ( n = 200) or control group ( n = 200). Subjects in the intervention group will receive the web-based intervention containing interactive content that (1) encourages a positive attitude towards consistent condom use and HIV/STI testing and negative attitude towards chemsex and group sex (2) positions condom use and regular HIV/STI testing as normative and (3) targets improved perceived self-efficacy concerning condom use and negotiation and HIV/STI testing. The control group will receive only web-based information without sexual health components. Subjects in both groups will be evaluated at baseline and three and 6 months after baseline. The primary outcome will be the frequency of condomless anal sex in the past 3 months. The proposed study will aid development of culturally relevant health promotion programmes aimed at minimising the potential harm of dating app use and promoting the sexual health of MSM dating app users. The web-based intervention, if found successful, will have important clinical and policy implications, as it can be adopted by the government and non-governmental organisations targeting MSM. Moreover, the proposed intervention can reach many MSM at relatively low cost, and thus has the potential to check the burgeoning HIV/STI epidemic among MSM in Hong Kong in a cost-effective manner. International standard randomized controlled trial number (ISRCTN) registry: ISRCTN16681863 registered on 28 April 2020.
Is differential access to prevention distorting HIV epidemiology in Australia?
Publisher: Elsevier BV
Date: 08-2019
Human Immunodeficiency Virus Prevalence Is Increasing Among Men Who Have Sex With Men in China: Findings From a Review and Meta-Analysis
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2011
Increasing the reliability of real-time electrocochleography during cochlear implantation: a standardized guideline
Publisher: Springer Science and Business Media LLC
Date: 20-01-2022
DOI: 10.1007/S00405-021-07204-7
Abstract: Electrocochleography (ECochG) measures electrical potentials generated by the inner ear in response to acoustic stimulation. Real-time (rt) recordings are increasingly used during cochlear implant (CI) surgeries to monitor the inner ear function. However, the performance of rt-ECochG is a delicate measurement procedure involving several pitfalls, which lead to inaccurate or invalid signal recordings in up to 20%. In order to use the technique routinely in CI candidates, an improvement in measurement reliability must be achieved. In our prospective study, we systematically investigated potential pitfalls and error sources during rt-ECochG recordings. We performed experiments (i) on a head and torso simulator, (ii) on a whole-head cadaver specimen, (iii) as well as in vivo during rt-ECochG recordings in CI recipients. After analyzing experiments i-iii, a standardized measurement procedure was developed. We followed this guideline in 10 CI recipients to test the measurement reliability. Besides improper installation, surgical and patient-specific factors influenced the measured signal. In particular, the unattenuated presentation of the acoustic stimulus was of importance. We summarized our findings in a standardized guideline. Following this guideline, we measured successful intraoperative ECochG recordings in 9/10 patients. Our error analysis improved the understanding of successful rt-ECochG measurements. When following our proposed guideline, we achieved more reliable intraoperative ECochG recordings.
Treatment Outcomes for Rectal Lymphogranuloma Venereum in Men Who Have Sex with Men Using Doxycycline, Azithromycin, or Both: A Review of Clinical Cases
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2017
Robotic cochlear implantation: surgical procedure and first clinical experience
Publisher: Informa UK Limited
Date: 02-2017
DOI: 10.1080/00016489.2017.1278573
Abstract: A system for robotic cochlear implantation (rCI) has been developed and a corresponding surgical workflow has been described. The clinical feasibility was demonstrated through the conduction of a safe and effective rCI procedure. To define a clinical workflow for rCI and demonstrate its feasibility, safety, and effectiveness within a clinical setting. A clinical workflow for use of a previously described image guided surgical robot system for rCI was developed. Based on pre-operative images, a safe drilling tunnel targeting the round window was planned and drilled by the robotic system. Intra-operatively the drill path was assessed using imaging and sensor-based data to confirm the proximity of the facial nerve. Electrode array insertion was manually achieved under microscope visualization. Electrode array placement, structure preservation, and the accuracy of the drilling and of the safety mechanisms were assessed on post-operative CT images. Robotic drilling was conducted with an accuracy of 0.2 mm and safety mechanisms predicted proximity of the nerves to within 0.1 mm. The approach resulted in a minimal mastoidectomy and minimal incisions. Manual electrode array insertion was successfully performed through the robotically drilled tunnel. The procedure was performed without complications, and all surrounding structures were preserved.
Decline in new HIV diagnoses among MSM in Melbourne
Publisher: Elsevier BV
Date: 09-2018
Neisseria gonorrhoeae bacterial DNA load in the pharynges and saliva of men who have sex with men
Publisher: American Society for Microbiology
Date: 10-2016
DOI: 10.1128/JCM.01186-16
Abstract: Neisseria gonorrhoeae can be cultured in the saliva of in iduals with pharyngeal gonorrhea. The aim of this study was to quantify the gonococcal bacterial DNA loads in the pharynges and saliva among men who have sex with men (MSM) with untreated pharyngeal gonorrhea. Untreated MSM who tested positive for pharyngeal gonorrhea by culture and returned for antibiotic treatment within 14 days at the Melbourne Sexual Health Centre between October 2014 and March 2015 were eligible for this study. The gonococcal bacterial DNA load was measured using real-time quantitative PCR. The median gonococcal bacterial DNA loads in the pharynges and saliva were calculated and compared to culture positivity using the Mann-Whitney U test. A total of 33 men were included in this study. The median gonococcal bacterial DNA load did not differ between the pharynges in men who were culture positive (2.5 × 10 5 copies/swab) and culture negative (2.9 × 10 4 copies/swab) ( P = 0.166) and the saliva (culture positive, 2.2 × 10 5 copies/ml culture negative, 2.7 × 10 5 copies/ml) ( P = 0.499). The bacterial DNA load in the pharynges ( P = 0.695) and saliva ( P = 0.969) did not differ between who men returned for treatment within 7 days and those who returned 8 to 14 days later. Substantial gonococcal bacterial DNA loads were detected in both saliva and pharynges among MSM with pharyngeal gonorrhea. These findings suggest that gonorrhea can be transmitted via sexual practices involving exposure to saliva, such as oroanal practices (rimming) and saliva use as a lubricant for anal sex.
Paying for Sex Among Males and Females: A Cross-Sectional Survey in Melbourne, Australia
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2021
DOI: 10.1097/OLQ.0000000000001307
Abstract: Most research focuses on in idual selling sex but very few on paying for sex. This study aimed to determine the proportion of males and females who paid for sex and associated factors. We conducted a short survey at the Melbourne Sexual Health Centre between March and April 2019, which included a question on whether they had paid for sex in the past 3 months. The proportion of in iduals who had paid for sex was calculated by sex and sexual orientation. Univariable and multivariable logistic regression models were conducted to identify in idual's factors (e.g., demographics, sexual orientation, and HIV/sexually transmitted infection [STI] positivity) associated with paying for sex in the past 3 months. The proportion who reported paying for sex in the past 3 months was 12.2% (42/345) among heterosexual males, followed by 6.4% (23/357) among men who have sex with men (MSM) and 0.2% (1/430) among females. HIV status, preexposure prophylaxis use, and sexual orientation were not associated with paying for sex among MSM. No MSM living with HIV reported paying for sex in the past 3 months. There was a significant association between paying for sex and gonorrhea (odds ratio, 2.84 95% confidence interval, 1.05–7.71 P = 0.041) but not HIV, syphilis, and chlamydia among MSM. HIV/STI was not associated with paying for sex among heterosexual males. Paying for sex was more commonly reported among heterosexual males, followed by MSM. Females were very unlikely to pay for sex. There was a limited association between HIV/STI diagnosis and paying for sex among males.
Time from HIV diagnosis to commencement of antiretroviral therapy as an indicator to supplement the HIV cascade
Publisher: Public Library of Science (PLoS)
Date: 16-05-2017
Freehand Stereotactic Image-Guidance Tailored to Neurotologic Surgery
Publisher: Frontiers Media SA
Date: 07-10-2021
DOI: 10.3389/FSURG.2021.742112
Abstract: Hypothesis: The use of freehand stereotactic image-guidance with a target registration error (TRE) of μ TRE + 3σ TRE & 0.5 mm for navigating surgical instruments during neurotologic surgery is safe and useful. Background: Neurotologic microsurgery requires work at the limits of human visual and tactile capabilities. Anatomy localization comes at the expense of invasiveness caused by exposing structures and using them as orientation landmarks. In the absence of more-precise and less-invasive anatomy localization alternatives, surgery poses considerable risks of iatrogenic injury and sub-optimal treatment. There exists an unmet clinical need for an accurate, precise, and minimally-invasive means for anatomy localization and instrument navigation during neurotologic surgery. Freehand stereotactic image-guidance constitutes a solution to this. While the technology is routinely used in medical fields such as neurosurgery and rhinology, to date, it is not used for neurotologic surgery due to insufficient accuracy of clinically available systems. Materials and Methods: A freehand stereotactic image-guidance system tailored to the needs of neurotologic surgery–most importantly sub-half-millimeter accuracy–was developed. Its TRE was assessed preclinically using a task-specific phantom. A pilot clinical trial targeting N = 20 study participants was conducted (ClinicalTrials.gov ID: NCT03852329) to validate the accuracy and usefulness of the developed system. Clinically, objective assessment of the TRE is impossible because establishing a sufficiently accurate ground-truth is impossible. A method was used to validate accuracy and usefulness based on intersubjectivity assessment of surgeon ratings of corresponding image-pairs from the microscope/endoscope and the image-guidance system. Results: During the preclinical accuracy assessment the TRE was measured as 0.120 ± 0.05 mm (max: 0.27 mm, μ TRE + 3σ TRE = 0.27 mm, N = 310). Due to the COVID-19 pandemic, the study was terminated early after N = 3 participants. During an endoscopic cholesteatoma removal, a microscopic facial nerve schwannoma removal, and a microscopic revision cochlear implantation, N = 75 accuracy and usefulness ratings were collected from five surgeons each grading 15 image-pairs. On a scale from 1 (worst rating) to 5 (best rating), the median (interquartile range) accuracy and usefulness ratings were assessed as 5 (4–5) and 4 (4–5) respectively. Conclusion: Navigating surgery in the tympanomastoid compartment and potentially in the lateral skull base with sufficiently accurate freehand stereotactic image-guidance (μ TRE + 3σ TRE & 0.5 mm) is feasible, safe, and useful. Clinical Trial Registration: www.ClinicalTrials.gov , identifier: NCT03852329.
Sites in the oropharynx reached by different methods of using mouthwash: clinical implication for oropharyngeal gonorrhoea prevention.
Publisher: BMJ
Date: 18-10-2020
DOI: 10.1136/SEXTRANS-2019-054158
Abstract: Oropharyngeal gonorrhoea is increasing among men who have sex with men and is commonly found in the tonsils and at the posterior pharyngeal wall. To address this rise, investigators are currently trialling mouthwash to prevent oropharyngeal gonorrhoea. We aimed to determine which parts of the oropharynx were reached by different methods of mouthwash use (oral rinse, oral gargle and oral spray). Twenty staff at Melbourne Sexual Health Centre participated in the study from March to May 2018. Participants were asked to use mouthwash mixed with food dye, by three application methods on three separate days: oral rinse (15 s and 60 s), oral gargle (15 s and 60 s) and oral spray (10 and 20 times). Photographs were taken after using each method. Three authors assessed the photographs of seven anatomical areas (tongue base, soft palate, uvula, anterior tonsillar pillar, posterior tonsillar pillar, tonsil, posterior pharyngeal wall) independently and scored the dye coverage from 0% to 100%. Scores were then averaged. The mean coverage at the sites ranged from 2 to 100. At the posterior pharyngeal wall, spraying 10 times had the highest mean coverage (29%) and was higher than a 15 s rinse (2%, p=0.001) or a 15 s gargle (8%, p=0.016). At the tonsils, there was no difference in mean coverage between spray and gargle at any dosage, but spraying 20 times had a higher mean coverage than a 15 s rinse (42% vs 12%, p=0.012). Overall, spray is more effective at reaching the tonsils and posterior pharyngeal wall compared with rinse and gargle. If mouthwash is effective in preventing oropharyngeal gonorrhoea, application methods that have greater coverage may be more efficacious.
Effects of multiple types of stigma on the probability of HIV disclosure to sex partners: a systematic review
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/SH16089
Abstract: Previous review studies explored factors related to the process of HIV disclosure. However, none of these review studies specifically focused on the effects of stigma on HIV disclosure to sex partners. A comprehensive systematic review of empirical studies on the effects of stigma on HIV disclosure to sex partners was conducted until December 2014. Twenty-seven articles published in English-language journals were selected, and study characteristics and findings were evaluated. Inconsistent findings in the assessment of impacts of stigma on HIV disclosure to sex partners were documented. Three underlying plausible reasons were identified, and these included: (1) different types of stigma may have different effects on HIV disclosure to sex partners (2) studies used different measurement strategies and (3) varied personal backgrounds and health factors that can mitigate, facilitate or moderate the effect of stigma on HIV disclosure to sex partners. Studies with precise definition measurements of specific types of stigma used them appropriately in a matching context to provide more consistent research results. This review identifies the need for further investigation into how the HIV disclosure process is shaped by particular types of stigma, types of sex partners and demographic characteristics of people living with HIV/AIDS.
Agreement of and discussion with clients about Undetectable equals Untransmissible among general practitioners in Australia: a cross-sectional survey
Publisher: CSIRO Publishing
Date: 29-05-2023
DOI: 10.1071/SH23051
Abstract: Background The message of undetectable HIV viral load equals untransmissible (U=U) is important to reduce HIV stigma. We examined Australian general practitioner (GP)s’ agreement of and discussion with clients about U=U. Methods We conducted an online survey through GP networks from April to October 2022. All GPs working within Australia were eligible. Univariable and multivariable logistic regression analyses were performed to identify factors associated with: (1) agreement of U=U and (2) discussing U=U with clients. Results Of 703 surveys, 407 were included in the final analysis. Mean age was 39.7 years (s.d.: 8.4). Most GPs (74.2%, n = 302) agreed with U=U, but only 33.9% (n = 138) had ever discussed U=U with clients. Key barriers to discussing U=U were lack of relevant client presentations (48.7%), lack of understanding about U=U (39.9%), and difficulty identifying those who would benefit from U=U (6.6%). Agreement with U=U was associated with greater odds of discussing U=U (adjusted odds ratio (AOR) 4.75, 95% confidence interval (CI): 2.33–9.68), younger age (AOR 0.96 per additional year of age, 95%CI: 0.94–0.99), and extra training in sexual health (AOR 1.96, 95%CI: 1.11–3.45). Discussing U=U was associated with younger age (AOR 0.97, 95%CI: 0.94–1.00), extra training with sexual health (AOR 1.93, 95%CI: 1.17–3.17), and negatively associated with working in a metropolitan or suburban area (AOR 0.45, 95%CI: 0.24–0.86). Conclusion Most GPs agreed with U=U, but most had not discussed U=U with their clients. Concerningly, one in four GPs were neutral or disagreed with U=U, suggesting that further qualitative research to understand this finding, and implementation research to promote U=U among Australian GPs, is urgently needed.
Access to HIV Antiretroviral Therapy among People Living with HIV in Melbourne during the COVID-19 Pandemic
Publisher: MDPI AG
Date: 03-12-2021
Abstract: The social measures taken to control the COVID-19 pandemic can potentially disrupt the management of HIV. The objective of this study was to examine the impact of the Australian COVID-19 lockdown restrictions on access to antiretroviral therapy (ART) for people living with HIV in Melbourne. Using data from the Melbourne Sexual Health Centre (MSHC), we assessed the changes in rates of ART postal delivery, controlled viral load, and ART dispensing from 2018 to 2020. The percentage of ART delivered by postage from the MSHC pharmacy was calculated weekly. The percentage of people living with HIV with a controlled viral load (≤200 copies/mL) was calculated monthly. We calculated a yearly Medication Possession Ratio (MPR). The average percentage of HIV ART dispensed through postage for the years 2018, 2019, and 2020 was 3.7% (371/10,023), 3.6% (380/10,685), and 14% (1478/10,765), respectively (Ptrend 0.0001). Of the 3115 people living with HIV, the average MPR for 2018, 2019, and 2020 was 1.05, 1.06, and 1.14, respectively (Ptrend = 0.28). The average percentage of people with an HIV viral load of copies/mL for the years 2018, 2019, and 2020 was 97.6% (2271/2327), 98.0% (2390/2438), and 99.2% (2048/2064), respectively (Ptrend 0.0001). This study found that the proportion of controlled viral load and access to ART of people living with HIV in Melbourne was largely unaffected by the COVID-19 lockdown restrictions. This suggests that some of the services provided by the MSHC during the pandemic, such as HIV ART postal delivery, may assist long-term HIV management.
Risk factors for oropharyngeal gonorrhoea in men who have sex with men: An age-matched case-control study
Publisher: BMJ
Date: 22-01-2018
DOI: 10.1136/SEXTRANS-2017-053381
Abstract: Oropharyngeal gonorrhoea is common among men who have sex with men (MSM). We aimed to clarify which oral sex practices were independent risk factors for oropharyngeal gonorrhoea: tongue kissing, receptive oro-penile sex (fellatio) or insertive oro-anal sex (rimming), and whether daily use of mouthwash and recent antibiotic use was protective. In 2015, we conducted an age-matched case–control study of MSM who attended the Melbourne Sexual Health Centre. Cases had tested positive for oropharyngeal gonorrhoea by nucleic acid lification testing, and controls had tested negative. Questionnaire items included tongue kissing, oral sex practices, condom use, recent antibiotic use, mouthwash use and alcohol consumption. We identified 177 cases, age matched to 354 controls. In univariable analyses, cases were 1.90 times (95% CI 1.13 to 3.20) more likely than controls to have had casual sexual partners (CSP) in the preceding 3 months, were 2.17 times (95% CI 1.31 to 3.59) more likely to have kissed CSP and were 2.04 times (95% CI 1.26 to 3.30) more likely to have had receptive oro-penile sex with CSP. Oropharyngeal gonorrhoea was not associated with insertive oro-anal sex or mouthwash use. The number of CSP for tongue kissing and receptive oral sex and total CSP were highly correlated, and in multivariable analysis neither kissing nor receptive oro-penile sex was significantly associated with having oropharyngeal gonorrhoea, after adjusting for total number of CSP. The finding that oropharyngeal gonorrhoea was associated with a higher number of sexual partners but not specific sexual practices highlights the need for further research in the area of gonorrhoea transmission to define the probability of transmission from specific sex acts.
Characteristics, sexual practices and sexually transmissible infections diagnoses of men who have sex with men and use non-occupational HIV post-exposure prophylaxis in Victoria, Australia
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/SH16092
Abstract: Background Non-occupational post-exposure prophylaxis (NPEP) is available to people with a potential risk for HIV exposure within the preceding 72 h. We sought to determine if men who have sex with men (MSM) and receive NPEP had a significantly different risk profile (before the preceding 72 h) from MSM not receiving NPEP. If this is the case, NPEP consultations may act as a cue for also discussing pre-exposure prophylaxis. Methods: We conducted a retrospective analysis to compare the demographic characteristics, sexual practices and clinical diagnoses of MSM who were NPEP users and those who were non-NPEP users attending Melbourne Sexual Health Centre from January 2008 to December 2014. Univariate and multivariate logistic regression models were used to examine the association between NPEP use and risk practices. Generalised estimating equations were used to adjust for within-in idual correlations related to multiple visits of the same in idual. Results: Of the 40 395 MSM consultations included in the study, 1776 consultations (4%) were related to NPEP prescription. NPEP prescribing was associated with ever having injected drugs (adjusted odds ratio (AOR) 1.8, 95% confidence interval (CI): 1.4–2.3), sex with males only (AOR 1.9, 95% CI: 1.6–2.3), more than three male partners in the past 3 months (AOR 1.5, 95% CI: 1.4–1.7) and inconsistent condom use with these partners within the past 3 months (AOR 2.1, 95% CI: 1.9–2.4). Sex workers (AOR 0.6, 95% CI: 0.3–0.9), and men reporting sex overseas within the past 12 months (AOR 0.7, 95% CI: 0.6–0.8) were less likely to receive NPEP. MSM who used NPEP were more likely to test positive for any sexually transmissible infection (AOR 1.2, 95% CI: 1.0–1.4). Conclusions: MSM receiving NPEP generally had a higher risk profile than MSM not requesting NPEP, indicating that NPEP was used by MSM at higher risk for HIV. Therefore, consultations for NPEP may be an opportune time for also discussing pre-exposure prophylaxis for HIV.
Access to sexual health services after the rapid roll out of the launch of pre-exposure prophylaxis for HIV in Melbourne, Australia
Publisher: CSIRO Publishing
Date: 2018
DOI: 10.1071/SH17182
Abstract: Background On 26 July 2016, Victoria began a large study of HIV pre-exposure prophylaxis, called PrEPX, that involved the creation of around 2600 appointments over 3 months across multiple sites in Melbourne, Australia. At this time, the Melbourne Sexual Health Centre (MSHC) appeared to have a larger demand on its services. The aim of the present study was to determine whether this apparent increase in demand was substantially different from other demand fluctuations. Methods: Patients presenting to the MSHC from 2014 to 2016 were reviewed. Demographic characteristics, sexual risks and sexually transmitted infection diagnoses were extracted from the clinical database. Results: There were 115522 walk-in presentations for care and a rise in presentations in the week following the launch of the PrEPX study, but at least six similar peaks occurred that year. The peak coinciding with the launch of PrEPX was only apparent for men who have sex with men. There was a substantial increase in the proportion of patients who could not be seen (i.e. triaged out), from 10% in the week before PrEPX to 22.2% in the second week after, but this was primarily due to staff absences. At the time of the PrEPX study, data were collected on the duration of symptoms for common conditions and found no significant (P& .29) change in the average duration of symptoms compared with that seen before the PrEPX launch. Conclusions: The increase in the number of medical consultations required for the PrEPX study did not result in excessive demand for public sexual health services.
HIV Prevalence Trends, Risky Behaviours, and Governmental and Community Responses to the Epidemic among Men Who Have Sex with Men in China
Publisher: Hindawi Limited
Date: 2014
DOI: 10.1155/2014/607261
Abstract: Purpose of Review. Numerous studies reported the rapid spread of HIV/AIDS epidemic among men who have sex with men (MSM) in China. This paper aims to investigate the overall epidemic trend and associated high-risk behaviours among Chinese MSM and to explore the governmental and community responses to the epidemic. Recent Findings. HIV prevalence among Chinese MSM increased rapidly in all Chinese regions in the past decade and disproportionally affected the Southwest China. In addition to the high-risk homosexual behaviours, overlapping bisexual, commercial, and drug use behaviours are commonly observed among Chinese MSM. The Chinese government has significantly expanded the surveillance efforts among MSM over the past decade. Community responses against HIV have been substantially strengthened with the support of international aid. However, lack of enabling legal and financial environment undermines the role of community-based organisations (CBOs) in HIV surveillance and prevention. Conclusion. HIV continues to spread rapidly among MSM in China. The hidden nature of MSM and the overlapping homosexual, bisexual, and commercial behaviours remain a challenge for HIV prevention among MSM. Strong collaboration between the government and CBOs and innovative intervention approaches are essential for effective HIV surveillance and prevention among MSM in China.
Antiseptic mouthwash for gonorrhoea prevention (OMEGA): a randomised, double-blind, parallel-group, multicentre trial
Publisher: Elsevier BV
Date: 05-2021
Willingness to change behaviours to reduce the risk of pharyngeal gonorrhoea transmission and acquisition in men who have sex with men: A cross-sectional survey
Publisher: BMJ
Date: 04-07-2017
DOI: 10.1136/SEXTRANS-2017-053148
Abstract: The aim of this study was to examine the willingness of men who have sex with men (MSM) to change their behaviours to potentially reduce the risk of pharyngeal gonorrhoea transmission and acquisition. A cross-sectional questionnaire-based study was conducted among MSM attending the Melbourne Sexual Health Centre, Australia, between March and September 2015. Participants were asked how likely they would change their behaviours to reduce the risk of pharyngeal gonorrhoea. Six different potential preventive interventions were asked: (1) stop tongue kissing (2) stop having receptive oral sex (3) stop performing rimming (4) stop using saliva as a lubricant during anal sex (5) use of condoms during oral sex and (6) use of alcohol-containing mouthwash daily. Of the 926 MSM who completed the questionnaire, 65.4% (95% CI 62.3% to 68.5%) expressed they were likely to use mouthwash daily to reduce the risk of pharyngeal gonorrhoea, 63.0% (95% CI 59.8% to 66.1%) would stop using saliva as a lubricant, and 49.5% (95% CI 46.2% to 52.7%) would stop rimming. In contrast, 77.6% (95% CI 74.8% to 80.3%) of MSM expressed they were unlikely to stop tongue kissing. MSM who were younger and had less male partners expressed they were unlikely to use mouthwash daily as an intervention to reduce risk of pharyngeal gonorrhoea acquisition. The practices MSM are willing to change to reduce the risk of pharyngeal gonorrhoea transmission and acquisition vary greatly however, the majority of men are likely to use mouthwash daily to reduce the risk of pharyngeal gonorrhoea.
Gonorrhoea: tackling the global epidemic in the era of rising antimicrobial resistance
Publisher: CSIRO Publishing
Date: 2019
DOI: 10.1071/SH19121
Abstract: This Special Issue of Sexual Health aims to collate the latest evidence base focussed on understanding the current epidemic and transmission of gonorrhoea, choice of treatment, molecular epidemiology application, concerns about antimicrobial resistance and alternative prevention and control for gonorrhoea.
Sensitivity of HIV rapid tests compared with fourth-generation enzyme immunoassays or HIV RNA tests
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 31-07-2016
Modelling the multiple anatomical site transmission of Mycoplasma genitalium among men who have sex with men in Australia
Publisher: Springer Science and Business Media LLC
Date: 27-05-2021
DOI: 10.1038/S41598-021-90627-3
Abstract: Mycoplasma genitalium ( M. genitalium ) is a recently recognised and important sexually transmitted infection among men who have sex with men (MSM). The role of oral sex, rimming, and kissing on M. genitalium transmission in MSM is unclear. We created four deterministic susceptible-infectious-susceptible epidemic models to examine the role that different sexual behaviours play in transmitting M. genitalium at the oropharynx, urethra anorectum among men who have sex with men in Australia. Our results suggest that oral and anal sex without other sexual practices (model 1) replicate well single site infection at the oropharynx, urethra and anorectum and also multi-site infection. If kissing or rimming are added to model 1 (i.e., model 2–4) no substantial improvements in the calibration of the models occur. Model 1 estimates that 3.4% of infections occur at the oropharynx, 34.8% at the urethra and 61.8% at the anorectum. Model 1 also estimates that the proportion of incident M. genitalium transmitted by anal sex was 82.4%, and by oral sex was about 17.6%. Our findings could provide an enhanced understanding of M. genitalium transmission in MSM, thus providing insights into what sexual practices contribute most to transmission.
In-Vitro Study of Speed and Alignment Angle in Cochlear Implant Electrode Array Insertions
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 2022
Changes in the Syphilis Rapid Plasma Reagin Titer Between Diagnosis and Treatment
Publisher: Oxford University Press (OUP)
Date: 26-10-2022
DOI: 10.1093/CID/CIAC843
Abstract: We compared the rapid plasma reagin (RPR) titer on the day of initial presentation with that on the day of syphilis treatment to inform clinical practice as to whether a repeated RPR test should be recommended. We undertook a retrospective study between 1 March 2011 and 31 December 2020 at the Melbourne Sexual Health Centre in Australia among in iduals who underwent syphilis serology on the day of initial presentation and the day of treatment, if the latter were within 14 days after initial presentation. We calculated the percentage of in iduals with a ≥4-fold change in RPR titer, stratified by the time between initial presentation and treatment and by syphilis stage. Among the 766 included syphilis cases, the median duration between initial presentation and treatment was 6 days (interquartile range, 5–7 days). Of these cases, 14.8% (n = 113) had a ≥4-fold increase or decrease during this interval. The number of cases with a ≥4-fold increase or decrease in RPR titer increased with increasing time between initial presentation and treatment, from 5.7% (n = 6) 1–3 days after initial presentation to 26.2% (n = 27) at 10–14 days (Ptrend & .001). There was no significant difference in the number of cases with a ≥4-fold increase or decrease in RPR titer between syphilis stages (P = .66). Our data support the recommendation of repeating the RPR titer if the day of initial presentation and the day of treatment are different, even when treatment is within a few days after initial presentation.
Substantial increases in chlamydia and gonorrhea positivity unexplained by changes in individual-level sexual behaviors among men who have sex with men in an australian sexual health service from 2007 to 2013
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2015
Patterns of Sexual Practices, Sexually Transmitted Infections and Other Genital Infections in Women Who Have Sex with Women Only (WSWO), Women Who Have Sex with Men Only (WSMO) and Women Who Have Sex
Publisher: Springer Science and Business Media LLC
Date: 07-2022
DOI: 10.1007/S10508-022-02311-W
Abstract: Despite rises in sexually transmitted infection (STI) notifications among Australian women in the last decade, limited STI surveillance data exist specifically for women who have sex with women. This study aimed to compare differences in sexual practices and positivity for STIs and other genital infections among women who have sex with men only (WSMO), women who have sex with women only (WSWO), and women who have sex with men and women (WSMW), and whether these changed over time. In this retrospective repeated cross-sectional study, women attending the Melbourne Sexual Health Centre for the first time between 2011 and 2019 were categorized as “WSMW,” “WSWO,” or “WSMO” according to self-reported sexual practices in the previous 12 months. Demographic information, sexual practices, and positivity for STIs and other genital infections were compared between the three groups and over time. A total of 36,147 women (2618 WSMW, 534 WSWO, and 32,995 WSMO) were included. WSMW reported more sexual partners (median = 6 IQR = 4–10) than WSMO (median = 3 IQR = 2–5) and WSWO (median = 2 IQR = 1–4) ( p .001). A higher proportion of WSMW always used condoms with casual male partners compared to WSMO (20.4% vs 15.9% p .001). The proportion of women who always used condoms with casual male partners decreased over time in WSMO, (19.9% in 2011 to 15.2% in 2019, p trend .001) but not in WSMW. Bacterial vaginosis was more common in WSWO (14.8%) than in WSMW (11.8%) and WSMO (7.7%) ( p .001). Chlamydia was more common in WSMO (9.3%) than in WSMW (6.6%) and WSWO (1.2%) ( p .001). Syphilis was more common in WSMO (1.0%) than in WSMW (0.3%) and WSWO (0.0%) ( p = .004). Over time, chlamydia positivity in WSWO increased (from 0.0% to 2.7%, p trend = .014), and syphilis positivity in WSMW increased (from 0.0% to 0.7%, p trend = .028) however, positivity of these STIs did not change in other groups. Sexual practices and positivity for STIs and other genital infections differed according to the sex of women’s partners in the previous 12 months. Knowledge of these differences is important to account for future changes in STI trends that may occur in these subpopulations.
Improving Access to Sexual Health Services in General Practice Using a Hub-and-Spoke Model: A Mixed-Methods Evaluation
Publisher: MDPI AG
Date: 25-03-2022
Abstract: Improving access to sexual health services is critical in light of rising sexually transmitted infections (STIs). We evaluated a hub-and-spoke model for improving access to sexual health services in three general practices in Victoria, Australia. The primary outcome was the impact on HIV and STI (chlamydia, gonorrhoea, syphilis) testing. Segmented linear regression analysis was conducted to examine the trends in the total HIV/STI tests pre- (from January 2019 to June 2020) and post-implementation (from July 2020 to July 2021). We evaluated the feasibility and acceptability of integrating this model into the general practices using semi-structured in idual interviews. There was a statistically significant rise in testing for HIV and STIs in all general practices: post-implementation, there was an increase of an average of 11.2 chlamydia tests per month (p = 0.026), 10.5 gonorrhoea tests per month (p = 0.001), 4.3 syphilis tests per month (p = 0.010), and 5.6 HIV tests per month (p = 0.010). Participants reported increases in knowledge level and confidence in offering STI testing and managing a greater variety of sexual health cases. This study demonstrates the feasibility of implementing a hub-and-spoke model to enable GPs to deliver sexual health care with support from a sexual health specialist service.
Reflections on public health challenges of the HIV epidemic among men who have sex with men in China
Publisher: Routledge
Date: 2014
Drug use and the influence on kissing among men who have sex with men in Melbourne, Australia
Publisher: SAGE Publications
Date: 02-12-2019
Abstract: The use of drugs is not uncommon among gay, bisexual and other men who have sex with men (MSM). Kissing has been recently identified as a risk factor for gonorrhoea. This study aimed to examine the proportion of MSM who used drugs and how specific drugs influence the likelihood of kissing. We conducted a cross-sectional survey among MSM attending the Melbourne Sexual Health Centre between March 2016 and February 2017. Participants reported their use of eleven specific drugs in the last three months and whether they felt the drug influenced them to kiss someone. Four thousand, three hundred and ninety-one MSM were included in the analysis 63.1% ( n = 2772) used at least one drug in the last three months and 36.6% ( n = 1605) used ≥2 drugs. Poppers (44.8%), marijuana (30.8%) and ecstasy (19.1%) were the three most common drugs used among MSM in the last three months. 80.4% of ecstasy users and 74.3% of gammahydroxybutyrate users reported the drug made them much more likely to kiss someone. The majority of MSM reported that the use of heroin (63.6%) and Viagra/Cialis (60.7%) did not influence their kissing behaviour. Drug use is common among sexually active MSM in Melbourne. Most reported the use of ecstasy would increase their likelihood of kissing someone.
Rate of repeat diagnoses in men who have sex with men for Chlamydia trachomatis and Neisseria gonorrhoeae: A retrospective cohort study
Publisher: CSIRO Publishing
Date: 2015
DOI: 10.1071/SH14234
Abstract: Background Sexually transmissible infections (STIs) have increased rapidly among men who have sex with men (MSM). One of the most effective strategies to control STIs is partner notification. Inadequate partner notification may be associated with high rates of repeat diagnoses with STIs. The aim of this study is to estimate and compare the rate of chlamydia and gonorrhoea infection following primary infection to the overall clinic rate. Methods: A retrospective cohort analysis of MSM attending the Melbourne Sexual Health Clinic was conducted. For both infections, the overall incidence and that following diagnosis and treatment was calculated. Results: Of the 13053 MSM, the incidence of diagnoses for chlamydia and gonorrhoea was 8.5 (95% CI: 8.2–8.9) and 6.2 (95% CI: 5.9–6.5) per 100 person-years, respectively. Seventy per cent of chlamydia and 64% of gonorrhoea cases were retested at 10–365 days after diagnosis and treatment. Following diagnosis and treatment of chlamydia, the rate ratio in these in iduals in the first quarter was 16- and 8-fold higher for chlamydia and gonorrhoea, respectively, compared with the background incidence of diagnoses. Similarly, following diagnosis and treatment of gonorrhoea, the rate ratio in these in iduals in the first quarter was 18- and 10-fold higher for gonorrhoea and chlamydia, respectively. Conclusions: These data suggest that approximately half of MSM who test positive for chlamydia or gonorrhoea within 90 days after an initial infection represent contact with either a previous sexual partner or member of the same sexual network, the remainder representing the particularly high STI risk for these MSM.
Risk Factors for Asymptomatic Enteric Pathogen Detection Among Men Who Have Sex With Men
Publisher: Oxford University Press (OUP)
Date: 11-07-2019
DOI: 10.1093/OFID/OFZ326
Abstract: Improved knowledge of factors that promote outbreaks of enteric pathogens among men who have sex with men (MSM) could enable targeted public health interventions. We detected enteric pathogens in 57 of 519 (11%) asymptomatic MSM, and we found that enteric pathogen detection was associated with both oroanal sex (rimming) and group sex.
HIV notification rate: a more accurate and useful indicator to measure the HIV epidemic
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2015
Understanding HIV in China
Publisher: BMJ
Date: 16-06-2011
Human papillomavirus vaccination and sexual practices among men who have sex with men in Melbourne, Australia: a cross-sectional study
Publisher: SAGE Publications
Date: 17-02-2020
Abstract: The aim of this study was to explore the factors associated with self-reported receipt of human papillomavirus (HPV) vaccine among men who have sex with men (MSM). MSM aged 16–40 years attending the Melbourne Sexual Health Centre, Australia, for their first visit in 2016 were included in the analysis. Multivariable logistic regression analyses were performed to examine the association between self-reported HPV vaccination and sexual practices: one examining the sexual practices. A total of 1332 MSM with a mean age of 27.6 (standard error [SE] = 0.1) were included in the analysis. The mean number of reported male partners in the last 3 and 12 months was 4.0 (SE = 0.1) and 8.9 (SE = 0.4), respectively. Six percent ( n = 81) of MSM reported receiving the HPV vaccine. There was no significant association between sexual practices (the number of partners or condomless anal sex) and self-reported HPV vaccine receipt after adjusting for confounding factors such as human immunodeficiency virus (HIV) status and pre-exposure prophylaxis (PrEP). HIV-negative MSM taking PrEP were three times more likely to be vaccinated against HPV compared with HIV-negative MSM not taking PrEP in both multivariable analyses. Our findings suggest that there is no association between HPV vaccination and sexual risk practices in MSM.
How is cervical cancer screening discussed with clients at a sexual health clinic in Melbourne, Australia?
Publisher: CSIRO Publishing
Date: 30-06-2022
DOI: 10.1071/SH22093
Abstract: We conducted a survey among 40 clinicians working at the Melbourne Sexual Health Centre in November 2021. We asked clinicians how they discussed cervical screening with their clients. All clinicians used the term ‘Cervical Screening Test (CST)’ when discussing cervical cancer screening with clients. However, 19 clinicians (48%) also used the term ‘Pap smear’, particularly among older women as they were more familiar with Pap smear than CST. Twenty-five (63%) clinicians believed that clients did not understand the difference between Pap smears and CST. Further education is required to improve the understanding between the terminologies.
Related Organisations
Inselspital Bern Universitätsklinik Für Hals- Nasen- Und Ohrenkrankheiten Kopf- Und Halschirurgie
Location: Switzerland
Related Funding Activities
No related grants have been discovered for Eric P.F. Chow.