ORCID Profile
0000-0002-6643-5678
Current Organisations
Alfred Health
,
Monash University
,
University of Melbourne
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Medical Biotechnology | Sociology not elsewhere classified | Medical Biotechnology Diagnostics (incl. Biosensors) | Pharmacology and Pharmaceutical Sciences not elsewhere classified |
Human Diagnostics | Human Pharmaceutical Treatments (e.g. Antibiotics) | Expanding Knowledge in Technology
Publisher: American Society for Microbiology
Date: 03-2011
DOI: 10.1128/JCM.02328-10
Abstract: Established in-house quantitative PCR (qPCR) assays to detect the Mycoplasma genitalium adhesion protein (MgPa) and the 16S rRNA gene were found to be comparable for screening purposes, with a kappa value of 0.97 (95% confidence interval [CI], 0.94 to 1.01) and no difference in bacterial load quantified ( P = 0.4399).
Publisher: Public Library of Science (PLoS)
Date: 11-09-2013
Publisher: Wiley
Date: 2015
Publisher: Springer Science and Business Media LLC
Date: 06-01-2017
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.
Publisher: Oxford University Press (OUP)
Date: 2011
DOI: 10.1111/J.1743-6109.2010.01967.X
Abstract: Previous studies have examined sex workers' attitudes to work but not their levels of job satisfaction compared with other occupations. The job satisfaction levels and standards of living of sex workers in licensed brothels in Victoria were compared with Australian women. Responses to a questionnaire that included questions about sex work and their "most likely alternative job." Survey data was compared with identical questions from the Households, Income and Labour Dynamics in Australia Survey. A structured survey was undertaken with sex workers in Victoria attending a a sexual health service. Of the 112 sex workers who agreed to participate in the study, 85 (76%) completed the survey. The median years women had been working as sex workers was three (range 0.1-18). The main reasons women started sex work was because "they needed the money" (69%), were attracted to the flexible hours (44%) or had a particular goal in mind (43%). The two biggest concerns women had about sex work were their safety (65%) and the risk of sexually transmitted infections (65%). When compared with the median job satisfaction scores of Australian women working in sex workers' "most likely alternative jobs," 50% of sex workers reported a higher median satisfaction score for sex work in relation to hours worked, 47% in relation to flexibility, 43% in relation to total pay, 26% in relation to job security, 19% in relation to the work itself, and 25% in relation to overall job satisfaction. Women reported that they primarily do sex work for financial gain although a significant minority prefer it to other work they would be likely to do. These results should be interpreted in the context that the presence of personality disorders that are common among sex workers were not measured in this study.
Publisher: CSIRO Publishing
Date: 10-07-2023
DOI: 10.1071/SH23075
Publisher: CSIRO Publishing
Date: 2004
DOI: 10.1071/SH04035
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.
Publisher: SAGE Publications
Date: 02-2009
Abstract: The aim of this study is to compare risk factors in new clients attending the walk-in triage-based day clinic (WITS) to those attending a telephone-triage appointment-based evening clinic of a sexual health service. The method involves an audit of computerized medical records of new clients attending between July 2002 and December 2007. There were 37,833 new clients of which 37,223 (98.4%) attended WITS and 610 (1.6%) attended the evening clinic. WITS clients were significantly older (31% vs. 30%, P 0.041), more likely to be male (58% vs. 43%, P 0.001), sex workers (6% vs. 3%, P 0.001), not employed (34% vs. 10%, P 0.001), diagnosed with gonorrhoea (1.7% vs. 0.7%, P 0.041), herpes (4% vs. 2%, P 0.000), non-specific urethritis (6% vs. 2%, P 0.000) and less likely asymptomatic (35.1% vs. 53.4%, P 0.001). Men attending WITS had significantly more female partners in the 12 months (3.9 vs. 3.0, P 0.001), but other risks were similar in both clinics. A telephone-triage appointment-based evening clinic is important for asymptomatic high-risk in iduals.
Publisher: BMJ
Date: 2012
Publisher: Springer Science and Business Media LLC
Date: 09-03-2011
Publisher: American Society for Microbiology
Date: 11-2015
DOI: 10.1128/JCM.01647-15
Abstract: We examined the factors influencing gonorrhea detection at the pharynx. One hundred men infected with Neisseria gonorrhoeae were swabbed from the tonsils and posterior oropharynx. N. gonorrhoeae was reisolated from the tonsils and posterior oropharynx in 62% and 52%, respectively ( P = 0.041). Culture positivity was greater with higher gonococcal DNA loads at the tonsils ( P = 0.001) and oropharynx ( P 0.001). N. gonorrhoeae can be cultured from the tonsils and posterior oropharynx with greater isolation rates where gonococcal loads are higher.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2017
Publisher: BMJ
Date: 12-11-2009
Abstract: This study aimed to ascertain the attitudes of men who have sex with men (MSM) to the human papillomavirus (HPV) vaccine and to determine the age at which MSM would be willing to ask for the HPV vaccine in relation to their age of sexual debut. Of 205 MSM attending the Melbourne Sexual Health Centre between December 2007 and January 2008, 200 (98% median age 27 years) completed the study questionnaire. Only 30% were aware that there was a vaccine available for protection against infection with certain HPV types. When informed of the increased risk of anal cancer among MSM, 47% of MSM indicated that they would be willing to pay $A450 for the vaccine course. A total of 93% indicated that they would be willing to disclose that they were MSM to a health professional in order to obtain the vaccine for free, but not until a median age of 20 years: 2 years after the median age of sexual debut (18 years) and after a median of 15 sexual partners. If the HPV vaccine is targeted to MSM, the challenge will be for MSM to be vaccinated before they acquire HPV infection.
Publisher: SAGE Publications
Date: 2009
Abstract: The objective of this study was to determine the duration between onset of symptoms of early symptomatic syphilis and diagnosis among men who have sex with men (MSM). A review of cases of primary and secondary syphilis among MSM presented to the Melbourne Sexual Health Centre between January 2003 and August 2007. The mean age of the 123 MSM included was 37 years. Fifty-two percent ( n = 64) presented with primary syphilis and 48% ( n = 59) with secondary syphilis. Twenty-five percent were HIV-positive. The median rapid plasma reagin titre was 1:32. Of the 34 men referred by general practitioners, referring practitioners did not consider the diagnosis of syphilis in 10 cases of primary syphilis and 20 cases of secondary syphilis. For primary and secondary cases combined, the median duration between onset of symptoms and diagnosis, and onset of symptoms and treatment, was 15 (3–56) and 20 (1–57) days, respectively. The respective durations for secondary syphilis (17 and 23 days) was longer than for primary syphilis (13 and 15 days) ( P 0.05). The mean number of sex partners reported for the prior three months was 8.8 (range 1–15). If early detection and treatment of syphilis is to be optimized in order to improve syphilis control, greater awareness of its symptoms and signs of syphilis need to be promoted among both health-care providers and affected communities.
Publisher: Oxford University Press (OUP)
Date: 27-11-2014
Abstract: A community-based study of women who have sex with women (WSW) was performed to determine the burden of bacterial vaginosis (BV), and behavioral factors influencing the vaginal microbiota of women and their female sexual partners (FSPs), as measured by Nugent score (NS). In a cross-sectional study of 18-55-year-old WSW recruited nationally, participants completed questionnaires and self-collected vaginal swab s les weekly on 3 occasions. BV was defined as an NS of 7-10. Factors associated with BV, stability of NS category, and concordance of these categories in co-enrolled couples were examined with multivariable logistic regression analysis. A total of 458 participants were recruited 192 were co-enrolled with their FSP (96 couples). BV was detected in 125 women (27% 95% confidence interval [CI], 23%-32%). BV was associated with ≥4 lifetime FSPs (adjusted odds ratio [AOR], 1.9 95% CI, 1.2-3.1), an FSP with BV symptoms (AOR, 2.9 1.0-8.2) and smoking, with ≥30 cigarettes per week showing greatest odds (AOR, 2.7 1.5-5.0). Of 428 women returning ≥2 swab s les, 375 (88%) had a stable NS category across all s les, predominantly reflecting normal flora. Co-enrolled WSW were less likely to have BV (31% vs 23% P = .07), and the majority (70%) were concordant for NS category (κ = 0.47 P ≤ .01), with most concordant for normal flora. Concordant NS category was associated with a relationship of >6 months (AOR, 4.7 95% CI, 1.4-16.4) and frequent sexual contact (more than once per month AOR, 2.7 1.0-7.1). BV is associated with key behaviors and smoking practices in WSW, but longer-duration, sexually active WSW partnerships support a stable favorable vaginal microbiota.
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.
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.
Publisher: Elsevier BV
Date: 05-2012
DOI: 10.1016/J.VACCINE.2012.03.024
Abstract: Epidemics of hepatitis A among men who have sex with men (MSM) have decreased significantly in recent years although the level of immunity that is required to prevent epidemics has not been studied. Our aim was to determine the level of immunity to hepatitis A among MSM. This was a retrospective study conducted using notifications of Hepatitis A in Victoria from 1991 to 2010, serological testing for hepatitis A among MSM attending Melbourne Sexual Health Centre (MSHC), and vaccination records among MSM attending MSHC. Hepatitis A notifications declined from 370 to 47 and the male to female ratio declined from 4.2 to 0.9 in Victoria between 1991 to 2010. Between 2002 and 2011, there were 12,064 in iduals MSM seen at MSHC of whom 3055 (25%) were tested for hepatitis A antibodies and 1180 (39%) had antibodies. The proportion of MSM who were tested for hepatitis A rose significantly over time (P<0.01), but the proportion of these with hepatitis A antibodies did not (P=0.28). Hepatitis A antibodies were more common in MSM over 30 (54%) compared to those 30 or less (32%), (Crude Odds Ratio 2.5 (95% confidence interval 2.1-2.9)) and were uncommon in MSM under 20 (19%). Vaccination against hepatitis A was recorded in 49% of 660 clinical files of MSM who attended the centre between 2003 and 2011 and did not change over time (P=0.42) but was significantly more common in those over 30 years of age (P<0.005). Hepatitis A is rare in MSM in Victoria where levels of immunity are about 40-50%. As outbreaks have occurred when levels of immunity were around 30%, maintaining vaccination levels over 40-50% is important if outbreaks are to be prevented. The lower levels of immunity in younger MSM create the potential for outbreaks in this sub-group.
Publisher: BMJ
Date: 04-10-2011
DOI: 10.1136/SEXTRANS-2011-050234
Abstract: Australia provided free quadrivalent human papillomavirus vaccines to 12-18-year-old girls and women aged ≤26 years from mid-2007 until the end of 2009. After this time, only girls aged 12-13 years had access to free vaccines. Before and after the study, of the proportion of new patients attending Melbourne Sexual Health Centre from mid-2004 to mid-2011, diagnosed with genital warts (GW) by risk group. From July 2004 to June 2011, 52 454 new patients were seen at Melbourne Sexual Health Centre and 5021 (9.6%, 95% CI 9.3% to 9.8%) were diagnosed with GW. From July 2004 to June 2007, the proportions with GW either increased or did not change in all groups. Comparing the two 12-month periods of 2007/2008 and 2010/2011, GW declined in women under 21 years from 18.6% to 1.9% and in heterosexual men under 21 years from 22.9% to 2.9%. The ORs per year for diagnosis of GW adjusted for number of sexual partners from July 2007 until June 2011 in women and heterosexual men <21 years were 0.44 (95% CI 0.32 to 0.58) and 0.42 (95% CI 0.31 to 0.60), respectively. There was no significant change in GW in women ≥30 years (OR 0.97, 95% CI 0.84 to 1.12), heterosexual men ≥30 years (OR 0.97, 95% CI 0.89 to 1.06) or in homosexual men (OR 0.95, 95% CI 0.85 to 1.07). The dramatic decline and near disappearance of GW in women and men under 21 years of age, 4 years after commencing this programme, suggest that the basic reproductive rate has fallen below one.
Publisher: Elsevier BV
Date: 03-2016
DOI: 10.1016/J.CMI.2015.11.016
Abstract: This study examined the contribution of Mycoplasma genitalium to sexually acquired infectious proctitis in men who have sex with men (MSM). MSM with symptomatic proctitis between May 2012 and August 2013 were tested for rectal sexually transmitted infections including chlamydia, gonorrhoea, herpes simplex virus (HSV) and M. genitalium. The load of rectal M. genitalium in men with symptomatic proctitis was compared with a separate group of men who had rectal M. genitalium but no symptoms of proctitis. Among 154 MSM with proctitis, rectal M. genitalium was detected in 18 men (12%, 95% CI 6.9-17.1) and was significantly more common among human immunodeficiency virus (HIV) -positive men (21%, 95% CI 9.5-32.6) than HIV-negative men (8%, 95% CI 2.9-13.1 prevalence ratio 3.2, 95% CI 1.2-8.8). Among HIV-positive men the detection of M. genitalium was comparable to that for chlamydia (21%, 95% CI 9.5-32.5), gonorrhoea (25%, 95% CI 16.2-41.8) and HSV (19%, 95% CI 7.9-30.1). Rectal M. genitalium load was significantly higher among the 18 men with symptomatic M. genitalium-associated proctitis than among a separate group of 18 men with asymptomatic rectal M. genitalium infection (60 000 copies of organism/swab versus 10 744 copies of organism/swab, p 0.023). Comprehensive testing for rectal pathogens in MSM with proctitis should include testing for M. genitalium.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2018
Publisher: Oxford University Press (OUP)
Date: 16-12-2015
DOI: 10.1093/CID/CIU1130
Abstract: Female same-sex partnerships provide a unique opportunity to study the pathogenesis and transmissibility of bacterial vaginosis (BV) because it can be diagnosed in both members of the partnership. We conducted a nationwide community-enrolled cohort study of women who have sex with women, including women coenrolled with their regular female sexual partner (FSP), to investigate the BV incidence rate and factors associated with incident BV. Women who have sex with women, without prevalent BV in a cross-sectional study, were enrolled in a 24-month cohort study involving 3-monthly questionnaires and self-collected vaginal swabs that were scored by the Nugent method. We assessed the BV incidence rate per 100 woman-years (WY) and used univariate and multivariable Cox regression analysis to establish factors associated with BV acquisition. Two hundred ninety-eight participants were enrolled in the cohort 122 were coenrolled with their regular FSP. There were 51 incident cases of BV (rate, 9.75/100 WY 95% confidence interval [CI], 7.41-12.83). Incident BV was associated with exposure to a new sexual partner (adjusted hazard ratio [AHR], 2.51 95% CI, 1.30-4.82), a partner with BV symptoms (AHR, 3.99 95% CI, 1.39-11.45), receptive oral sex (AHR, 3.52 95% CI, 1.41-8.79), and onset of BV symptoms (AHR, 2.80 95% CI, 1.39-5.61). Women coenrolled with their BV-negative partner had a greatly reduced risk of incident BV (AHR, 0.26 95% CI, .11-.61), and high concordance of Nugent category (74%), which was predominantly normal vaginal flora throughout follow-up. These data highlight the strong influence of sexual relationships and behaviors on BV acquisition and the vaginal microbiota. They provide epidemiological evidence to support exchange of vaginal bacterial species between women and the concept that BV is sexually transmitted.
Publisher: Public Library of Science (PLoS)
Date: 02-01-2018
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.
Publisher: Public Library of Science (PLoS)
Date: 17-07-2014
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.
Publisher: SAGE Publications
Date: 11-2010
Abstract: The proportion of clinically important diagnoses in a low-risk, asymptomatic population who use a computer-assisted self-interview (CASI) to assess risk was needed to determine optimal health service delivery. Medical records were retrospectively analysed between July 2008 and June 2009 for risk characteristics and diagnoses. A total of 7733 new patients completed a CASI, of whom 1060 were asymptomatic heterosexuals. From this low-risk group, 26 diagnoses were made on the day of presentation, including 22 cases of genital warts (2.08% [95% confidence interval (CI) 1.22–2.93]), three cases of genital herpes (0.28% [95% CI 0.055–0.82]) and one case of unintended pregnancy (0.094% [95% CI 0.0061–0.52]). Additionally, there were 54 cases of chlamydia detected (5.09% [95% CI 3.77–6.42]). As chlamydia is effectively diagnosed and managed from self-collected s les, patient review is not always required. This study provides evidence for an express testing service for chlamydia to streamline the screening of low-risk, asymptomatic heterosexual patients as identified by CASI without the need to for a traditional face-to-face consultation.
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.
Publisher: Public Library of Science (PLoS)
Date: 16-12-2015
Publisher: Oxford University Press (OUP)
Date: 12-2009
DOI: 10.1086/648092
Abstract: We have undertaken a cross-sectional study that investigates the association between bacterial vaginosis (BV) and sexual practices in sexually experienced and inexperienced women. Participants were 17-21-year-old females who attend Melbourne University, Australia. Study kits that contained an information and consent form, questionnaire, swab, and slide were distributed. Information regarding demographic characteristics and a broad range of sexual practices were collected. Gram-stained, self-collected vaginal smears were scored with the Nugent method. Associations between BV and behaviors were examined by univariate and multivariate analysis. BV was diagnosed in 25 (4.7%) of 528 women (95% confidence interval [CI], 3.1%-6.9%). Importantly, BV was not detected in women (n = 83) without a history of coital or noncoital sexual contact (0% 95% CI, 0%-4.3%). BV was detected in 3 (3.8%) of 78 women (95% CI, 0.8%-10.8%) with noncoital sexual experience only and in 22 (6.0%) of 367 women (95% CI, 3.8%-8.9%) who reported penile-vaginal sex. BV was associated with a history of any genital contact with a sexual partner (P=.02). BV was strongly associated with >3 penile-vaginal sex partners in the prior year (adjusted odds ratio, 7.1 95% CI, 2.7-18.4) by multivariable analysis. This study shows a strong association between BV and penile-vaginal sex with multiple partners but found no BV in sexually inexperienced women, once a history of noncoital sexual practices was elicited. Our findings indicate that BV is not present in truly sexually inexperienced women.
Publisher: BMJ
Date: 26-09-2014
DOI: 10.1136/SEXTRANS-2013-051103
Abstract: We quantified the proportion of cases and risk of primary syphilis (PS), urethral chlamydia (UCT) and urethral gonorrhoea (UGC) attributable to sexual practices other than anal sex. In this cross-sectional study, electronic records for men who have sex with men (MSM) who attended the Melbourne Sexual Health Centre between July 2002 (for PS) or January 2006 (for UCT and UGC) and October 2012, inclusive, were examined. There were 37 533 eligible consultations 2374 (6%) of these reported no anal sex. There were 204 PS diagnoses, 673 UCT diagnoses, and 618 UGC diagnoses 12 (6%), 16 (2%) and 44 (7%) cases, respectively, occurred in consultations where no anal sex was reported in the previous 3 months (PS, UGC) or twelve months (UCT). Among MSM reporting no anal sex, PS was diagnosed in 0.5 cases/100 consultations, UCT was diagnosed in 1.5 cases/100 tests for UCT and UGC was diagnosed in 14 cases/100 tests for UGC. UCT was significantly more common in MSM reporting anal sex (OR 2.18, 95% CI 1.32 to 3.59, p=0.002), but PS (OR 1.07 95% CI 0.6 to 1.93, p=0.82) and UGC (OR 1.28 95% CI 0.92 to 1.79. p=0.14) were not. For MSM reporting anal sex, condom use was protective for all three infections (all p≤0.03). Our findings suggest that UCT uncommonly occurs from sexual practices other than anal sex however, these practices contribute significantly to PS and UGC. Successful programmes to control PS and UGC will need strategies, such as frequent testing, in addition to promoting condom use.
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.
Publisher: Public Library of Science (PLoS)
Date: 24-03-2016
Publisher: Public Library of Science (PLoS)
Date: 04-04-2013
Publisher: Springer Science and Business Media LLC
Date: 12-2016
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.
Publisher: Springer Science and Business Media LLC
Date: 29-07-2015
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.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2016
Publisher: Elsevier BV
Date: 2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2011
Publisher: Public Library of Science (PLoS)
Date: 17-04-2013
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.
Publisher: Springer Science and Business Media LLC
Date: 02-03-2017
Publisher: Elsevier BV
Date: 2015
Publisher: Elsevier BV
Date: 09-2014
Publisher: Public Library of Science (PLoS)
Date: 24-05-2016
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.
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.
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.
Publisher: Oxford University Press (OUP)
Date: 22-07-2016
Publisher: Public Library of Science (PLoS)
Date: 27-09-2013
Publisher: Elsevier BV
Date: 02-2017
DOI: 10.1016/J.MIMET.2016.12.024
Abstract: We investigated the utility of quantitative PCR assays for diagnosis of bacterial vaginosis and found that while the best model utilized bacterial copy number adjusted for total bacterial load (sensitivity=98%, specificity=93%, AUC=0.95[95%CI=0.93,0.97]), adjusting for total bacterial or human cell load did not consistently increase the diagnostic performance of the assays.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2013
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2017
Publisher: Oxford University Press (OUP)
Date: 29-01-2014
DOI: 10.1093/JAC/DKU574
Abstract: There are increasing concerns about treatment failure following treatment for rectal chlamydia with 1 g of azithromycin. A systematic review and meta-analysis was conducted to investigate the efficacy of 1 g of azithromycin as a single dose or 100 mg of doxycycline twice daily for 7 days for the treatment of rectal chlamydia. Medline, Embase, PubMed, Cochrane Controlled Trials Register, Australia New Zealand Clinical Trial Register and ClinicalTrials.gov were searched to the end of April 2014. Studies using 1 g of azithromycin or 7 days of doxycycline for the treatment of rectal chlamydia were eligible. Gender, diagnostic test, serovar, symptomatic status, other sexually transmitted infections, follow-up time, attrition and microbial cure were extracted. Meta-analysis was used to calculate pooled (i) azithromycin and doxycycline efficacy and (ii) efficacy difference. All eight included studies were observational. The random-effects pooled efficacy for azithromycin (based on eight studies) was 82.9% (95% CI 76.0%–89.8% I2 = 71.0% P & 0.01) and for doxycycline (based on five studies) was 99.6% (95% CI 98.6%–100% I2 = 0% P = 0.571), resulting in a random-effects pooled efficacy difference (based on five studies) of 19.9% (95% CI 11.4%–28.3% I2 = 48.5% P = 0.101) in favour of doxycycline. The efficacy of single-dose azithromycin may be considerably lower than 1 week of doxycycline for treating rectal chlamydia. However, the available evidence is very poor. Robust randomized controlled trials are urgently required.
Publisher: Springer Science and Business Media LLC
Date: 27-02-2018
Publisher: CSIRO Publishing
Date: 2015
DOI: 10.1071/SH14144
Abstract: Background An estimated 25 700 people live with diagnosed HIV (PLWH) in Australia and ~1200 newly diagnosed cases were notified in 2012. New HIV prevention strategies focus on in idual uptake of treatment however, a potential barrier is the financial burden of antiretroviral treatment (ART). We describe HIV ART dispensed and the estimated associated costs for PLWH in Victoria. Methods: A retrospective cross-sectional study of pharmacy data on ART dispensed between January 2012 and November 2013 from a hospital network, including Victoria’s largest sexual health clinic was conducted. Estimated annual patient costs of ART were calculated by the number of items dispensed per year, concession status, dispensing site and applicable co-payment. Results: A total of 60 225 dispensing records from 3903 in iduals were included this represented 83.8% of pharmaceutical benefits scheme-recorded ART dispensed in Victoria over this period. The estimated annual co-payment costs for patients without a concession card and who were collecting two medications was $433.20. One-fifth of patients (21.3%) collected four or more items, equating to an estimated annual cost of at least $866.40 without a concession card and $141.60 with a concession card. Of those dispensed four or more items, 40.4% were concession card holders. Conclusions: There may be meaningful patient costs associated with accessing ART for some PLWH. New HIV treatment-based prevention strategies need to consider financial vulnerabilities and appropriately targeted initiatives to alleviate patient costs associated with ART, ensuring they do not act as a barrier to commencement of and adherence to HIV treatment.
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.
Publisher: Public Library of Science (PLoS)
Date: 31-03-2011
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.
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.
Publisher: American Society for Microbiology
Date: 06-2017
DOI: 10.1128/JCM.02312-16
Abstract: Mycoplasma genitalium is a significant pathogen for which first-line treatment is becoming less effective due to increased resistance to macrolides. As conventional culture and antimicrobial susceptibility testing is not feasible for routine detection of this pathogen, molecular markers such as detection of mutations in the 23S rRNA gene have been described to predict resistance. Recently, a novel multiplex quantitative PCR (qPCR) assay, ResistancePlus MG, has been described for the simultaneous detection of Mycoplasma genitalium and macrolide resistance. In the current study, the clinical performance of the assay was evaluated on 1,089 consecutive urine and anogenital swab s les in symptomatic and asymptomatic male and female patients. Overall, 6.0% were positive for M. genitalium , with 63.1% having macrolide resistance-associated mutations. Compared to the laboratory-validated qPCR method targeting the 16S rRNA gene and Sanger sequencing to determine 23S rRNA mutations, the sensitivity and specificity of M. genitalium detection were 98.5% and 100% and for detection of macrolide resistance mutations were 100.0% and 96.2%, respectively. This assay offers a considerable advantage in clinical settings for M. genitalium testing by making the results of macrolide resistance and mutation analyses simultaneously available, which is increasingly important with escalating macrolide resistance.
Publisher: Public Library of Science (PLoS)
Date: 16-11-2012
Publisher: Springer Science and Business Media LLC
Date: 19-08-2015
Publisher: Public Library of Science (PLoS)
Date: 06-06-2016
Publisher: Oxford University Press (OUP)
Date: 08-01-2013
DOI: 10.1093/CID/CIS1210
Abstract: Mycoplasma genitalium (MG) is an emerging sexually transmitted infection (STI) that is potentially associated with reproductive tract sequelae in women. This study aimed to estimate MG incidence and treatment failure and provide estimates of organism load in infection. 1110 women aged 16-25 years were recruited from primary care clinics in Australia. Women were tested for MG at baseline, 6 months, and 12 months, and MG organism load was measured by quantitative polymerase chain reaction (PCR). MG-positive cases were screened for MG 23S ribosomal RNA (rRNA) gene point mutations shown to confer azithromycin resistance using high-resolution melt following PCR. MG incidence rate was 1.3 per 100 person-years (n=14 95% confidence interval [CI], .8-2.3) women reporting 3 or more sex partners in the last 12 months had an increased rate of incident infection (rate ratio [RR], 5.1 95% CI, 1.3-19.6]). There were 3 cases of MG reinfection (0.8 per 100 person-years [95% CI, .1-.9]. Organism load was higher for prevalent than incident infection (P=.04). There were 3 cases of treatment failure (9.4% [95% CI, 2.0-25.0]) organism load was higher in cases with treatment failure than in successfully treated cases (P<.01). An MG 23S rRNA mutation was detected in 5 cases (3 cases of treatment failure and 2 successfully treated). Although MG incidence was relatively low, testing should be recommended for women considered to be at increased risk based on sexual history. Our results also suggest that organism load might be important in azithromycin treatment failure.
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.
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.
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 05-2017
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.
Publisher: Oxford University Press (OUP)
Date: 03-11-2015
DOI: 10.1093/CID/CIU873
Abstract: To guide interpretation of gonorrhea tests of cure using nucleic acid lification testing, this study examined the persistence of Neisseria gonorrhoeae DNA following treatment for pharyngeal and rectal gonorrhea. Men who had sex with men diagnosed with pharyngeal or rectal gonorrhea underwent swabbing from the pharynx or rectum 7 and 14 days following treatment. Repeat testing for N. gonorrhoeae was undertaken using real-time polymerase chain reaction (PCR) assays targeting the opa gene and porA pseudogene. One hundred pharyngeal and 100 rectal gonorrhea infections in 190 men were included. For pharyngeal gonorrhea, positivity of N. gonorrhoeae DNA on both PCR assays was present at days 7 or 14 in 13% (95% confidence interval [CI], 6.4%-19.6%) and 8% (95% CI, 2.7%-13.3%), respectively. For rectal gonorrhea, DNA positivity was present in 6% (95% CI, 1.4%-10.7%) and 8% (95% CI, 2.7%-13.3%), respectively. Among 200 baseline pharyngeal and rectal isolates, there were 10 with ceftriaxone minimum inhibitory concentration (MIC) ≥0.06 mg/L and azithromycin MIC ≥0.5 mg/L, of which 3 (30%) had DNA detected at day 14 among the 190 isolates with lower ceftriaxone and azithromycin MICs, only 13 (7%) had persistent DNA (odds ratio, 5.8 [95% CI, 1.3-25.4] P = .019). One man initially infected with N. gonorrhoeae multiantigen sequence type 2400 had type 4244 infection at day 14, indicating reinfection. Pharyngeal and rectal gonorrhea DNA persisted in 8% of men 14 days after treatment. Persistence was associated with elevated ceftriaxone and azithromycin MICs. Persistence can also reflect reinfection.
Publisher: Elsevier BV
Date: 06-2014
DOI: 10.1016/J.VACCINE.2014.05.043
Abstract: HPV vaccination of men who have sex with men (MSM) prior to the commencement of sexual activity would have the maximum impact on preventing HPV and anal cancer in this population. However, knowledge and attitudes towards HPV vaccination among very young MSM have not been previously studied. Two hundred MSM aged 16 to 20 were recruited via community and other sources. Participants were asked about their knowledge and attitudes towards HPV and HPV vaccination. Most (80%, 95% confidence interval (CI) 72.2-87.2%) men were not willing to purchase the vaccine because of its cost (AUD$450). However, if the vaccine was offered to MSM free of charge, 86% (95% CI: 80-90%) reported they would be willing to disclose their sexuality to a health care provider in order to obtain the vaccine. Over half (54%, 95%: 47-61%) of men would only be willing to disclose their sexuality to receive the HPV vaccine after their first experience of anal intercourse. The age at first insertive anal intercourse and the age at first receptive anal intercourse were 0.21 (IQR: -2.5 to 3.2) and 0.17 (IQR: -2.9 to 2.7) years earlier than the age that men would be willing to disclose their sexuality to receive the HPV vaccine, respectively. Willingness to receive the vaccine at a younger age was associated with younger age at first insertive anal intercourse. Overall, very young MSM expressed high acceptance of HPV vaccination. Early, opportunistic vaccination of very young MSM may be feasible in settings where very young MSM have not been vaccinated through universal programs targeting school aged males. However, given HPV infections occur early on, the effectiveness of this approach will be less than vaccination targeting school aged boys.
Publisher: CSIRO Publishing
Date: 2011
DOI: 10.1071/SH10072
Abstract: Background: Our aim was to describe the use of and responses to a self-management website, ‘Health Map’, established to address the key chronic health issues of HIV-positive people. Methods: Health Map assessed health issues against current recommendations for: treatment adherence, monitoring CD4 counts and viral load, psychological health and physical activity, vaccination, cholesterol, fasting blood sugar, blood pressure, alcohol consumption, smoking, body mass index, and cervical screening for women and sexually transmissible infection (STI) screening for men who have sex with men (MSM). Results: A total of 552 people, with a mean age of 37 years, completed the full ‘Health Map’ program, of whom 536 (97%) were Australian, 425 (77%) were male, including 268 (63%) MSM. Online responses to several health indices were of concern: 49% missed at least one dose of antiretroviral therapy per month and only 41% had had an HIV viral load test in the 4 months prior. Only 43% reported regular physical activity, and 49% and 61% reported vaccination for hepatitis A and B. The proportion tested within the recommended periods for fasting cholesterol (40%), fasting blood sugar (35%) and cervical screening (43%) in women or STI screening for MSM (53%) were low. Conclusions: A substantial proportion of in iduals completing the online survey reported information that would suggest their HIV and more general health care is suboptimal. These data are consistent with community surveys and indicate the need for improvement in the chronic management of HIV.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2017
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.
Publisher: BMJ
Date: 16-10-2009
Abstract: This study aimed to determine if the Australian human papillomavirus (HPV) vaccination programme has had a population impact on presentations of genital warts. Retrospective study comparing the proportion of new clients with genital warts attending Melbourne Sexual Health Centre (MSHC) from January 2004 to December 2008. Australia provided free quadrivalent HPV vaccine to 12-18-year-old girls in a school-based programme from April 2007, and to women 26 years and younger through general practices from July 2007. 36,055 new clients attended MSHC between 2004 and 2008 and genital warts were diagnosed in 3826 (10.6% 95% CI 10.3 to 10.9). The proportion of women under 28 years with warts diagnosed decreased by 25.1% (95% CI 30.5% to 19.3%) per quarter in 2008. Comparing this to a negligible increase of 1.8% (95% CI 0.2% to 3.4%) per quarter from the start of 2004 to the end of 2007 also in women under 28 years generates strong evidence of a difference in these two trends (p<0.001). There was no evidence of a difference in trend for the quarterly proportions before and after the end of 2007 for any other subgroup, and on only one occasion was there strong evidence of a trend different to zero, for heterosexual men in 2008 in whom the average quarterly change was a decrease of 5% (95% CI 0.5% to 9.4% p = 0.031). The data suggest that a rapid and marked reduction in the incidence of genital warts among vaccinated women may be achievable through an HPV vaccination programme targeting women, and supports some benefit being conferred to heterosexual men.
Publisher: CSIRO Publishing
Date: 2013
DOI: 10.1071/SH12019
Abstract: Objective To determine young women’s experience of having a chlamydia (Chlamydia trachomatis) test as part of a chlamydia incidence study, and to determine how women who tested positive during the study experienced having a test compared with the experience of women who always tested negative. Methods: Women in an Australian chlamydia incidence study were tested at 3- to 6-monthly intervals during a 12-month period. At the final stage of the study, the women completed a questionnaire about how they felt about testing positive or how they anticipated they might feel about testing positive if they only tested negative. Questions about future sexual behaviour and testing were included. Results: The questionnaire was completed by 872 out of 1116 (78%) women, including 67 women who tested positive. Many women (75%) felt anxious when having a chlamydia test but women who tested positive were less concerned about their future health (61% v. 81%, P 0.01), were less concerned about their partner’s reactions (62% v. 79%, P 0.01) and were more likely to discuss their diagnosis with other people (57% v. 36%, P 0.01). Conclusions: The participants in the study were pleased to have been tested and supported a screening program. Women who tested positive were less concerned about having a positive result than women who tested negative anticipated they might be. Implications: Clinicians need to be aware that having a chlamydia test can cause anxiety in young women and for a screening program to be successful, this must be addressed.
Publisher: Oxford University Press (OUP)
Date: 23-12-2015
DOI: 10.1093/CID/CIU1162
Abstract: Our aim was to determine the efficacy of 1 g azithromycin and alternative antibiotic regimens in a prospective cohort of Mycoplasma genitalium-infected participants, and factors associated with azithromycin failure. Consecutive eligible M. genitalium-infected men and women attending the Melbourne Sexual Health Centre between July 2012 and June 2013 were treated with 1 g of azithromycin and retested by polymerase chain reaction (PCR) on days 14 and 28. Cure was defined as PCR negative on day 28. Cases failing azithromycin were treated with moxifloxacin, and those failing moxifloxacin were treated with pristinamycin. Pre- and posttreatment s les were assessed for macrolide resistance mutations (MRMs) by high-resolution melt analysis. Mycoplasma genitalium s les from cases failing moxifloxacin were sequenced for fluoroquinolone resistance mutations. Multivariable analysis was used to examine associations with azithromycin failure. Of 155 participants treated with 1 g azithromycin, 95 (61% [95% confidence interval {CI}, 53%-69%]) were cured. Pretreatment MRM was detected in 56 (36% [95% CI, 28%-43%]) participants, and strongly associated with treatment failure (87% [95% CI, 76%-94%] adjusted odds ratio, 47.0 [95% CI, 17.1-129.0]). All 11 participants who had MRM detected in posttreatment s les failed azithromycin. Moxifloxacin was effective in 53(88% [95% CI, 78%-94%]) of 60 cases failing azithromycin all failures had gyrA and parC mutations detected in pretreatment s les. Six of 7 patients failing moxifloxacin treatment received pristinamycin, and all were PCR negative 28 days after pristinamycin treatment. We report a high azithromycin failure rate (39%) in an M. genitalium-infected cohort in association with high levels of pretreatment macrolide resistance. Moxifloxacin failure occurred in 12% of patients who received moxifloxacin all had pretreatment fluoroquinolone mutations detected. Pristinamycin was highly effective in treating macrolide- and quinolone-resistant strains.
Publisher: Public Library of Science (PLoS)
Date: 17-02-2012
Publisher: BMJ
Date: 06-08-2014
DOI: 10.1136/SEXTRANS-2013-051131
Abstract: Incidence of hepatitis B has not been well studied recently in men who have sex with men (MSM) despite increases in sexual risk practices and other sexually transmitted infections. Our aim was to determine the incidence of hepatitis B infection among MSM and level of immunity to hepatitis B attending a sexual health service over 10 years. A cross-sectional analysis of all MSM attending Melbourne Sexual Health Centre (MSHC) from 1 July 2002 and 30 June 2012, and a retrospective cohort study of MSM who had attended MSHC on multiple occasions who had hepatitis serology done more than once. Of 10 031 MSM attending the clinic, 58.4% (95% CI 57.4% to 59.4%) (5655/9677) had hepatitis B surface antibody (HepBsAb), 10.6% (95% CI 10.0% to 11.4%) (840/7888) had core antibody (HepBcAb), and 3.7% (95% CI 3.0% to 4.5%) (95/2577) had surface antigen (HepBsAg). The proportion with HepBsAb decreased from 72% to 48% (p (trend)<0.001), with HepBcAb decreased from 12% to 8% (p (trend)=0.039) and with either HepBsAb or HepBcAb, decreased from 67% to 50% (p (trend)<0.001) from 2002 to 2012, but did not change for HepBsAg (p (trend)=0.08). Seven cases of hepatitis B occurred in 3540 person-years of observation, giving an incidence of 1.98 (95% CI 0.79 to 4.07) per 1000 person-years. The data suggest that the current level of immunity of about 50% has been sufficient to prevent any significant hepatitis B infection in the last 10 years. Continued high levels of vaccination are important for prevention.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2014
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.
Publisher: Springer Science and Business Media LLC
Date: 28-06-2017
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.
Publisher: Springer Science and Business Media LLC
Date: 24-04-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2018
Publisher: Springer Science and Business Media LLC
Date: 14-07-2015
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.
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 02-2018
Publisher: BMJ
Date: 03-2009
Abstract: To determine the prevalence and clinical associations of Mycoplasma genitalium in urethral, rectal and pharyngeal specimens collected from men who have sex with men (MSM) attending male-only saunas. A cross-sectional study of 521 MSM attending six male-only saunas in Melbourne was conducted between October 2001 and September 2002. Stored urine and rectal and pharyngeal swabs were tested for M genitalium by real-time polymerase chain reaction. The prevalence of M genitalium and clinical associations were determined. A high prevalence (12.9% 95% CI 10.2% to 15.9%) of sexually transmitted infections (STIs) was found in MSM. M genitalium (2.1% 95% CI 1.1% to 3.6%) was less common than Chlamydia trachomatis (8.1% 95% CI 5.9% to 10.6%, p<0.001), and Neisseria gonorrhoeae (4.8% 95% CI 3.2% to 6.9%, p = 0.02). M genitalium was most likely to be detected as an asymptomatic rectal (1.6% 95% CI 0.8% to 3.0%) or urethral infection (0.6% 95% CI 0.2% to 1.6%, p = 0.12), but was absent from the pharynx. In comparison, C trachomatis was more common in the rectum (6.2% 95% CI 4.3% to 8.6%) than urethra (1.8% 95% CI 0.9% to 3.2%, p = 0.004), and was uncommon in the pharynx (0.6% 95% CI 0.1% to 1.6%). Urethral infection with N gonorrhoeae (0.2% 95% CI 0.01% to 1.0%) was rare, but it was as common in the pharynx (2.5% 95% CI 1.4% to 4.2%) as the rectum (2.2% 95% CI 1.2% to 3.8%). No significant demographic or behavioural associations with M genitalium were identified. M genitalium was less common than C trachomatis and N gonorrhoeae in MSM attending male-only saunas and was most often detected as an asymptomatic rectal or a urethral infection but was absent from the pharynx. To inform STI screening strategies in MSM, more data are needed to understand how common M genitalium infection is in urethral and non-urethral sites in MSM, and how it contributes to clinical symptoms.
Publisher: Wiley
Date: 16-04-2013
DOI: 10.1111/HIV.12035
Abstract: Anal cancer is more common in HIV-positive homosexual men than in HIV-negative homosexual men and the general population. Earlier diagnosis leads to improved prognosis. We aimed to determine if regular anal inspection and digital examination of asymptomatic homosexual men attending for routine HIV care were acceptable and to record the rate of referral for diagnosis of potentially malignant anal lesions. We offered anal examinations to consecutive homosexual men with HIV infection aged ≥ 35 years during their routine HIV clinic visits, aiming to complete three examinations over a 12-month period. Acceptability questionnaires were completed at baseline and after each examination and doctors recorded examination findings and all resulting interventions. Hospital referral outcomes were collected and interventions were costed using the Australian Medical Benefits Schedule. Of 142 men who were offered enrolment in the study, 102 [72% 95% confidence interval (CI) 64-79%] participated. Following the initial anal examinations, four men were referred to surgeons. Cancer was excluded in three men (3% 95% CI 1-8%) and one was diagnosed with anal squamous cell carcinoma (SCC). Three men had anoscopy performed at the time and two were referred for colonoscopy. Ninety-eight per cent (95% CI 93-100%) of respondents said that they would probably have the examination next time. The intervention was estimated to cost approximately Australian $16 per examination. Regular anal digital examinations are an acceptable and inexpensive addition to the routine care of homosexual men with HIV infection.
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.
Publisher: BMJ
Date: 09-2015
Publisher: CSIRO Publishing
Date: 2011
DOI: 10.1071/SH11053
Abstract: In Australia, data for induced abortions (IA) is unreliable, although accurate information is essential for the development of policy and funding for services relating to IA. The rate of induced abortion was an incidental finding from questionnaire data collected for a longitudinal study of chlamydia in young women in Australia. We found a pregnancy rate of 7.2/100 woman years (95% confidence interval (CI): 5.7–9.0) (n = 76) and IA rate of 2.1/100 women years (95% CI: 1.4–3.2) (n = 22). Differences were found between States and Territories, information which might influence the development of services in regions of Australia.
Publisher: American Society for Microbiology
Date: 2018
DOI: 10.1128/JCM.01245-17
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.
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 11-2017
Publisher: BMJ
Date: 18-04-2016
DOI: 10.1136/SEXTRANS-2015-052195
Abstract: Pelvic inflammatory disease (PID) is an important cause of female infertility and can occur when micro-organisms such as chlamydia or gonorrhoea ascend to the upper genital tract. PID has been used as an outcome measure in chlamydia screening trials however, few data have quantified the PID burden that could be avoided by preventing chlamydia. We estimated the population attributable fraction (PAF) of PID associated with a current chlamydia or gonorrhoea infection among females 16-49 years attending an Australian sexual health clinic (SHC) (2006-2013). Using multivariable logistic regression, PAF estimates were adjusted for age and behavioural factors. Two separate analyses were undertaken: one among 'chlamydia-tested' women and one among a subset of chlamydia-tested women who were also tested for gonorrhoea ('chlamydia+gonorrhoea-tested'). A sensitivity analysis using multiple imputation was conducted to assess the impact of missing data on results. Among 15 690 chlamydia-tested women, 1279 (8.2%, 95% CI 7.7% to 8.6%) were chlamydia positive, 436 (2.8%, 95% CI 2.5% to 3.0%) had PID diagnosed and the adjusted PAF for chlamydia was 14.1% (95% CI 9.9% to 18.0%). Among the chlamydia+gonorrhoea-tested subset (n=8839), 681 (7.7%, 95% CI 7.2% to 8.3%) tested positive for chlamydia only, 30 (0.3%, 95% CI 0.2% to 0.5%) for gonorrhoea only, 22 (0.2%, 95% CI 0.2% to 0.4%) for chlamydia and gonorrhoea and 419 (4.7%, 95% CI 4.3% to 5.2%) had PID diagnosed. The adjusted PAF was highest for chlamydia only (12.4%, 95% CI 8.4% to 16.2%) compared with gonorrhoea only (0.9%, 95% CI -0.1% to 1.8%) or concurrent infections (1.0%, 95% CI 0.0% to 1.9%). In this high chlamydia prevalence SHC population, eliminating a current chlamydia infection might at most reduce PID by about 14%.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2010
Publisher: Mary Ann Liebert Inc
Date: 04-2016
Publisher: Oxford University Press (OUP)
Date: 15-07-2017
Publisher: Oxford University Press (OUP)
Date: 12-12-2013
DOI: 10.1093/CID/CIS1030
Abstract: Bacterial vaginosis (BV) recurrence posttreatment is common. Our aim was to determine if behaviors were associated with BV recurrence in women in a randomized controlled trial (RCT). Symptomatic 18- to 50-year-old females with BV (≥3 Amsel criteria and Nugent score [NS] = 4-10) were enrolled in a 3-arm randomized double-blind RCT Melbourne Sexual Health Centre, Australia, in 2009-2010. All 450 participants received oral metronidazole (7 days) and were equally randomized to vaginal clindamycin, lactobacillus-vaginal probiotic or vaginal placebo. At 1, 2, 3, and 6 months, participants self-collected vaginal smears and completed questionnaires. Primary endpoint was NS = 7-10. Cox regression was used to estimate hazard ratios (HRs) for risk of BV recurrence associated with baseline and longitudinal characteristics. Four hundred four (90%) women with postrandomization data contributed to analyses. Cumulative 6-month BV recurrence was 28% (95% confidence interval [CI], 24%-33%) and not associated with treatment. After stratifying for treatment and adjusting for age and sex frequency, recurrence was associated with having the same pre- osttreatment sexual partner (adjusted HR [AHR] = 1.9 95% CI, 1.2-3.0), inconsistent condom use (AHR = 1.9 95% CI, 1.0-3.3), and being non-Australian (AHR = 1.5 95% CI, 1.0-2.1), and halved with use of an estrogen-containing contraceptive (AHR = 0.5 95% CI, .3-.8). Risk of BV recurrence was increased with the same pre- osttreatment sexual partner and inconsistent condom use, and halved with use of estrogen-containing contraceptives. Behavioral and contraceptive practices may modify the effectiveness of BV treatment. ACTRN12607000350426.
Publisher: American Society for Microbiology
Date: 08-2016
DOI: 10.1128/JCM.01038-16
Abstract: The detection of Mycoplasma genitalium was evaluated on 1,080 urine s les by the use of a Panther instrument. Overall sensitivity, specificity, positive predictive values, and negative predictive values were 100%, 99.4%, 93.6%, and 100%, respectively. Detection of M. genitalium by the use of the Panther transcription-mediated lification assay offers a simple, accurate, and sensitive platform for diagnostic laboratories.
Publisher: Wiley
Date: 04-04-2016
DOI: 10.1002/IJC.30093
Abstract: Men who have sex with men (MSM) are at risk for human papillomavirus (HPV)-related anal cancer. Few data exist on antibody responses following incident anogenital infection with HPV in teenage MSM. A cohort of 200 MSM aged 16-20 years from Melbourne, Australia were assessed at baseline, 3, 6 and 12 months. At each visit anal and penile swabs were collected for HPV DNA and serum for HPV antibodies for genotypes 6, 11, 16 and 18 (Merck's Multiplex Assays using Luminex). The main outcome, seroconversion, was defined as the detection of HPV antibodies following a negative antibody result for the same HPV type at baseline. The seroincidence rates for HPV types 6, 11, 16 and 18 were: 19 (95% CI 12-26), 7 (3-12), 4 (1-8) and 6 (3-11) per 100 person-years, respectively. Men who experienced incident anal HPV infections from types 6/11 were significantly more likely to develop serum antibodies to the same HPV type(s) than those who experienced incident anal infections from types 16/18 [73 vs. 18%, odds ratio (OR) = 15, 95% CI: 2-118]. The median time between incident anal HPV infection and seroconversion for HPV 6, 11, 16 and 18 was: 91, 38, 161 and 182 days, respectively. Antibody responses against HPV types 6/11 were significantly more likely to occur following incident anal compared with incident penile infection with HPV types 6/11 (OR = 6, 95% CI: 2-21). The likelihood of antibody responses following anogenital HPV infections depends on the HPV type and site of infection.
Publisher: Springer Science and Business Media LLC
Date: 03-02-2011
Abstract: We aimed to determine the incidence of Hepatitis C (HCV) infection among HIV-infected men who have sex with men (MSM) attending a Sexual Health Centre. A retrospective cohort study was carried out among HIV-infected MSM seen at least once between February 2002 and March 2010. The analysis was restricted to MSM who had had a negative HCV antibody test at least 6 months after their diagnosis for HIV. Duration of follow up was taken from the date of HIV diagnosis to the first positive or last negative HCV antibody test. During the time 1445 HIV-infected men attended the clinic of whom 1065 (74%) were MSM. Of these, 869 (82%) were tested for HCV at any time after HIV diagnosis. Of these 869, 69% (620) tested HCV negative at least 6 months after their HIV diagnosis. These 620 men had a mean age of 34 years (range 17-72) at HIV diagnosis and a total of 4,359 person years (PY) of follow up. There were 40 incident cases of HCV, of which 16 were in injecting drug users (IDU) and 24 in non-IDU. The overall incidence of HCV among HIV-infected MSM was 0.9/100 PY (95% CI 0.6-1.2). The incidence among HIV-infected IDU was 4.7/100 PY (95% CI 2.7-7.5) while the incidence among HIV-infected non-IDU was 0.6/100 PY (95% CI 0.4-0.8) (hazard ratio of 8.7 and 95% CI 4.6-16.6, P 0.001). The majority (78%) were tested for HCV because they developed abnormal liver transaminases (n = 31) or hepatitis symptoms (n = 2), while others (n = 7) were identified through routine HCV testing. A considerable proportion of HIV-positive MSM who did not inject drugs contracted HCV, presumably via sexual transmission and the main trigger for investigation was abnormal liver transaminases.
Publisher: Public Library of Science (PLoS)
Date: 05-03-2013
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.
Publisher: Springer Science and Business Media LLC
Date: 02-2011
Publisher: Oxford University Press (OUP)
Date: 24-11-2015
DOI: 10.1093/CID/CIV785
Abstract: Mycoplasma genitalium has been causally linked with nongonococcal urethritis in men and cervicitis, pelvic inflammatory disease, preterm birth, spontaneous abortion, and infertility in women, yet treatment has proven challenging. To inform treatment recommendations, we reviewed English-language studies describing antimicrobial susceptibility, resistance-associated mutations, and clinical efficacy of antibiotic therapy, identified via a systematic search of PubMed supplemented by expert referral. Minimum inhibitory concentrations (MICs) from some contemporary isolates exhibited high-level susceptibility to most macrolides and quinolones, and moderate susceptibility to most tetracyclines, whereas other contemporary isolates had high MICs to the same antibiotics. Randomized trials demonstrated poor efficacy of doxycycline and better, but declining, efficacy of single-dose azithromycin therapy. Treatment failures after extended doses of azithromycin similarly increased, and circulating macrolide resistance was present in high levels in several areas. Moxifloxacin remains the most effective therapy, but treatment failures and quinolone resistance are emerging. Surveillance of M. genitalium prevalence and antimicrobial resistance patterns is urgently needed.
Publisher: Public Library of Science (PLoS)
Date: 24-02-2017
Publisher: Public Library of Science (PLoS)
Date: 09-03-2017
Publisher: American Society for Microbiology
Date: 06-2014
DOI: 10.1128/JCM.00286-14
Abstract: Pre- and postabrasion oral rinse s les (ORS) and a toothbrush s le detected human papillomavirus (HPV) DNA in at least one s le among 45 (26%) of 173 HIV-positive men who have sex with men. There was moderate agreement for HPV genotype detection between the preabrasion and postabrasion ORS (κ = 0.49 95% confidence interval [CI], 0.37 to 0.61). There was good agreement between postabrasion ORS and toothbrushes (κ = 0.70 95% CI, 0.60 to 0.80). The sensitivities for HPV genotypes detected were 80% (95% CI, 69 to 88) for preabrasion ORS, 65% (95% CI, 54 to 76) for postabrasion ORS, and 75% (95% CI, 63 to 84) for toothbrushes.
Publisher: Oxford University Press (OUP)
Date: 22-10-2016
DOI: 10.1093/CID/CIV899
Publisher: CSIRO Publishing
Date: 2011
DOI: 10.1071/SH10134
Abstract: The use of nucleic acid lification tests (NAAT), as well as or in preference to culture for non-genital sites is now recommended both in Australia and overseas because of their greater sensitivity and improved specificity. A survey of 22 Australian sexual health clinics who each year test over 14 500 men who have sex with men (MSM) show that culture remains the predominate method for detecting gonorrhoea at pharyngeal (64%) and rectal (73%) sites. This editorial discusses the potential disadvantages of using culture over NAAT in relation to optimal gonorrhoea control among MSM and advocates that significantly improved control would be achieved by moving to NAAT with the proviso that culture s les are taken wherever possible on NAAT-positive s les and from clients with urethritis to ensure continued surveillance for antimicrobial resistance.
Publisher: CSIRO Publishing
Date: 2010
DOI: 10.1071/SH09074
Abstract: The present study aimed to determine whether pelvic examinations change clinical management of women with asymptomatic chlamydia infection. Records for women with asymptomatic chlamydia who underwent a pelvic examination at a sexual health clinic in Melbourne, Australia (January 2006 to June 2007) were analysed retrospectively. Of 91 cases, 31 (34%) warranted examination one woman (1% 95% confidence interval: 0.5%, 6.4%) had muco-purulent cervicitis and mild tenderness, and was treated for possible pelvic inflammatory disease. These data suggest that a pelvic examination will lead to changes in treatment for very few women diagnosed with asymptomatic chlamydia infection.
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.
Publisher: Elsevier BV
Date: 08-2014
DOI: 10.1016/J.JADOHEALTH.2014.01.020
Abstract: To report on sexual behaviors and sexually transmitted infections (STIs) among men who have sex with men (MSM) in their teens, when many MSM engage in their first sexual experiences. MSM aged 16 to 20 years were recruited via community and other sources. Men completed a questionnaire about their sexual behaviors and were screened for gonorrhea, chlamydia, syphilis, and HIV. Two hundred men were included. The median age was 19 years. The median age at first insertive or receptive anal intercourse was 17 years. Half of men reported sex with mainly older men: these men were more likely to engage in receptive anal intercourse (48% vs. 25%, p < .001) than other men. Most men had engaged in insertive (87%) and receptive (85%) anal intercourse in the prior 12 months with 60% and 53% reporting inconsistent condom use with insertive and receptive anal intercourse partners, respectively. The median number of insertive anal intercourse partners was 3 and 1.5 (p < .001) among men reporting inconsistent and consistent condom use with insertive anal intercourse over the prior 12 months. The median number of receptive anal intercourse partners was 3 and 2 (p = .006) among men reporting inconsistent and consistent condom use with receptive anal intercourse over the prior 12 months. Pharyngeal gonorrhea, rectal gonorrhea, urethral chlamydia, rectal chlamydia, and syphilis were detected in 3.0%, 5.5%, 3.0%, 4%, and 2.0% of men, respectively. All men were HIV negative. Many of the teenage MSM in this study were at risk for STI. Preventative messages and STI screening interventions that are age appropriate need to be developed to reduce HIV and STI risk in this under-recognized group.
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/SH15143
Abstract: Background Pre-exposure prophylaxis (PrEP) may be an effective option for HIV prevention among heterosexual serodiscordant couples. However, there are knowledge gaps in social research about PrEP in heterosexual serodiscordant relationships, including motivations and barriers to its use and possible impacts of PrEP uptake on the sexual practices of these couples. The aim of this study was to explore the views of HIV-negative men and women in stable serodiscordant heterosexual relationships about the possible use of PrEP. Methods: Semi-structured interviews were used to understand participants’ views on the use of PrEP. Interviews were conducted face-to-face or by telephone and transcribed verbatim for thematic analysis. Results: In total, 13 HIV-negative partners were interviewed six men and seven women. Participants demonstrated a high interest in the use of PrEP for conception. PrEP was also considered an option for general HIV prevention, although men saw more benefits for this use than women. Participants’ main concerns around PrEP usage were about cost, efficacy, daily adherence and side-effects. HIV-positive partner support is likely to play a central role for PrEP uptake and adherence. Conclusions: This study is one of the first studies to explore the views of HIV-negative heterosexual partners in serodiscordant relationships around the use of PrEP while trying to conceive, as well as for general HIV prevention. These study results provide new insights for the further development of guidelines governing the use of PrEP for serodiscordant couples.
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.
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.
Publisher: BMJ
Date: 21-07-2014
DOI: 10.1136/SEXTRANS-2013-051391
Abstract: Open access to sexual health services may be inefficient if there are substantial unpredictable fluctuations in presentations. Our aim was to determine whether the number of presentations over the last 11 years was associated with certain factors. This study involved all in iduals presenting to Melbourne Sexual Health Centre (MSHC) from 2002 to 2012. The outcome measure was the number of presentations during a clinical session (half day). There were 270,070 presentations to the clinic among 86,717 in iduals. The factors associated with the largest difference in mean presentations per session were morning or afternoon (60 vs 51 per session), days of the week (57-67 per session), months of the year (93-112 per day), year (77-131 per day), maximum temperatures of 90th centile) were also strongly correlated with these same variables. Higher-risk heterosexuals (≤25 years of age) attended more commonly in the afternoons (37% of heterosexuals) than in the mornings (30%). No factor other than year of attendance substantially influenced the proportion of higher-risk men who have sex with men (MSM) (≥10 partners per year) who attended. A considerable proportion of the variability in presentations was explained by known factors that could predict client presentations to sexual health services and therefore allow optimal allocation of resources to match demand.
Publisher: BMJ
Date: 04-09-2013
DOI: 10.1136/BMJ.F5086
Publisher: Oxford University Press (OUP)
Date: 15-12-2008
DOI: 10.1086/593188
Abstract: Mycoplasma genitalium is a common cause of nongonococcal urethritis. Treatment trials have shown that doxycycline is inefficient, whereas a 5-day course of azithromycin eradicates the bacterium from 95% of infected men. The aim of the study was to establish the reason for the occasional treatment failures. Seven M. genitalium strains isolated from men who experienced azithromycin treatment failure were tested for in vitro susceptibility to macrolides with use of a cell culture-based method. The genetic basis for the drug resistance was established by sequencing parts of the 23S ribosomal RNA gene and the genes encoding the L4 and L22 proteins. Nine sets of specimens obtained before and after treatment from patients who experienced azithromycin treatment failure were examined with use of sequencing of polymerase chain reaction products. The 7 strains that were isolated from patients who experienced treatment failure with azithromycin had minimum inhibitory concentrations >8 microg/mL for azithromycin and erythromycin. Three different mutations at positions 2058 and 2059 (Escherichia coli numbering) in region V of the 23S rRNA gene were found. Of the 9 patients with specimens obtained before and after treatment, only 2 had an initial specimen in which the mutation was present, indicating that drug resistance was induced as the result of an inappropriate dosage of azithromycin. Development of macrolide resistance was shown to correlate with subsequent azithromycin treatment failure. The genetic basis for the drug resistance was shown to be mutations in region V of the 23S rRNA gene, which is well described in other Mollicutes. These findings raise concern about the use of single-dose azithromycin treatment of nongonococcal urethritis of unknown etiology.
Publisher: Public Library of Science (PLoS)
Date: 21-07-2014
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.
Publisher: BMJ
Date: 21-05-2013
DOI: 10.1136/SEXTRANS-2013-051077
Abstract: Culture is insensitive for the detection of pharyngeal gonorrhoea but isolation is pivotal to antimicrobial resistance surveillance. The aim of this study was to ascertain whether recommendations provided to clinicians (doctors and nurses) on pharyngeal swabbing technique could improve gonorrhoea detection rates and to determine which aspects of swabbing technique are important for optimal isolation. This study was undertaken at the Melbourne Sexual Health Centre, Australia. Detection rates among clinicians for pharyngeal gonorrhoea were compared before (June 2006-May 2009) and after (June 2009-June 2012) recommendations on swabbing technique were provided. Associations between detection rates and reported swabbing technique obtained via a clinician questionnaire were examined. The overall yield from testing before and after provision of the recommendations among 28 clinicians was 1.6% (134/8586) and 1.8% (264/15,046) respectively (p=0.17). Significantly higher detection rates were seen following the recommendations among clinicians who reported a change in their swabbing technique in response to the recommendations (2.1% vs. 1.5% p=0.004), swabbing a larger surface area (2.0% vs. 1.5% p=0.02), applying more swab pressure (2.5% vs. 1.5% p<0.001) and a change in the anatomical sites they swabbed (2.2% vs. 1.5% p=0.002). The predominant change in sites swabbed was an increase in swabbing of the oropharynx: from a median of 0% to 80% of the time. More thorough swabbing improves the isolation of pharyngeal gonorrhoea using culture. Clinicians should receive training to ensure swabbing is performed with sufficient pressure and that it covers an adequate area that includes the oropharynx.
Publisher: Springer Science and Business Media LLC
Date: 08-01-2013
DOI: 10.1007/S10461-012-0395-7
Abstract: Thirty-one gay and bisexual men were interviewed on the acceptability, potential use, benefits and limitations of rapid self-testing for HIV in Australia. The majority of men supported the introduction of rapid self-testing, and would be likely to, or would use the tests for home use. However, most reported they would use them for interim testing and not to replace conventional blood testing at health services as they could not detect other sexually transmitted infections or provide the professional expertise and support provided at health services.
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.
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.
Publisher: Springer Science and Business Media LLC
Date: 05-01-2017
Publisher: Cambridge University Press (CUP)
Date: 16-05-2016
DOI: 10.1017/S0950268816000996
Abstract: Repeat rectal chlamydia infection is common in men who have sex with men (MSM) following treatment with 1 g azithromycin. This study describes the association between organism load and repeat rectal chlamydia infection, genovar distribution, and efficacy of azithromycin in asymptomatic MSM. Stored rectal chlamydia-positive s les from MSM were analysed for organism load and genotyped to assist differentiation between reinfection and treatment failure. Included men had follow-up tests within 100 days of index infection. Lymphogranuloma venereum and proctitis diagnosed symptomatically were excluded. Factors associated with repeat infection, treatment failure and reinfection were investigated. In total, 227 MSM were included – 64 with repeat infections [28·2%, 95% confidence interval (CI) 22·4–34·5]. Repeat positivity was associated with increased pre-treatment organism load [odds ratio (OR) 1·7, 95% CI 1·4–2·2]. Of 64 repeat infections, 29 (12·8%, 95% CI 8·7–17·8) were treatment failures and 35 (15·4%, 95% CI 11·0–20·8) were reinfections, 11 (17·2%, 95% CI 8·9–28·7) of which were definite reinfections. Treatment failure and reinfection were both associated with increased load (OR 2·0, 95% CI 1·4–2·7 and 1·6, 95% CI 1·2–2·2, respectively). The most prevalent genovars were G, D and J. Treatment efficacy for 1 g azithromycin was 83·6% (95% CI 77·2–88·8). Repeat positivity was associated with high pre-treatment organism load. Randomized controlled trials are urgently needed to evaluate azithromycin's efficacy and whether extended doses can overcome rectal infections with high organism load.
Publisher: BMJ
Date: 06-2008
Abstract: This study aimed to obtain detailed data on the frequency of sexual practices among men who had sex with men (MSM) at sex-on-premises venues (SOPV) and to compare this with their sexual practices outside SOPV. A cross-sectional survey was undertaken of MSM at six SOPV between December 2006 and March 2007. Of 604 men approached, 200 (33%) participated. Men reported sexual contact with a median of two other men (range 0-28). Receptive and insertive anal intercourse was reported by 19.5% and 34.0%, respectively, and was unprotected in 2.5% and 6.0%. The frequency of other practices included: unprotected insertive and receptive penile-anal touching or rubbing without penetration, or "nudging" (26.5% and 20.0%) unprotected, transient insertive and receptive anal intercourse, or "dipping" (6.0% and 5.0%) and insertive and receptive anal fingering (38.5% and 32.5%). Approximately 40% of men who reported "nudging" reported that they had not engaged in any "anal sex". Compared with their practices with casual male partners outside SOPV, men having sex at SOPV were less likely to have receptive oral intercourse with ejaculation (odds ratio (OR) 0.4 95% CI 0.2 to 1.0, p = 0.04) and unprotected receptive anal intercourse (OR 0.3 95% CI 0.1 to 0.8, p = 0.01), but were more likely to have group sex (OR 2.0 95% CI 1.1 to 3.6, p = 0.03). Substantial penile-anal contact not involving anal intercourse occurred at SOPV and may explain anal infections in the absence of reported anal sex. Some higher risk practices were reported more frequently with male partners outside of these venues than with partners within SOPV.
Publisher: SAGE Publications
Date: 13-10-2015
Abstract: Cytological screening for anal cancer precursors is not always possible. We investigated digital ano-rectal examination (DARE) as a means of early anal cancer detection in HIV-positive men who have sex with men (MSM). We recruited 327 HIV-positive MSM aged 35 and over from clinics with HIV physicians in Melbourne, Australia, to receive an annual DARE. We analyzed baseline data from patient questionnaires regarding general, anal and sexual health, adverse effects from the anal examination, cancer worry, and quality of life. The majority of men (82%, 95% CI:78–87) felt relaxed during the DARE, 1% (95% CI:0–3) complained of pain, and 1% (95% CI:0–4) reported bleeding after the examination. Nearly all men (99%, 95% CI:96–100) were willing to continue with an annual DARE. Quality of life was unaffected with utility scores of 0.76 before examination vs. 0.77 two weeks after examination, (p = 0.41). An anal abnormality was detected in 86 men (27%, 95% CI:22–31), with one anal cancer identified. The specialist referral rate following DARE was 5% (95% CI:3–8). Recruitment rates were significantly associated with the clinic setting (sexual health centre 78%, general practice 13%, hospital 14%, p = 0.002) and specialty (sexual health physician 67%, general practitioner 20%, infectious disease physician 14%, p = 0.031). Annual DARE to detect anal cancer in HIV-positive MSM was acceptable for patients, with minimal side effects. Strategies to increase HIV physician’s patient recruitment would be needed if DARE were to be implemented in anal cancer screening.
Publisher: Public Library of Science (PLoS)
Date: 20-04-2012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2017
Publisher: Public Library of Science (PLoS)
Date: 03-04-2012
Publisher: CSIRO Publishing
Date: 2011
DOI: 10.1071/SH10144
Abstract: Background ‘TESTme’ is a sexually transmissible infection (STI) screening service for Victorian young people living in rural areas. We evaluated the effectiveness of advertising for this service over an 11-month pilot period. Methods: The advertising that was used included websites, a Facebook page, posters, flyers, business cards, wrist bands and professional development sessions for health nurses that occurred throughout the pilot period. We also used once-off methods including advertisements in newspapers, student diaries and short messages to mobile phones. Results: Twenty-eight clients had a consultation through TESTme. Twenty found the service through health professionals, six through the Melbourne Sexual Health Centre (MSHC) web page, one through the Facebook page and one through the student diary. The total direct costs incurred by the centre for advertising were $20 850. The advertising cost per client reached for each advertising method was $26 for health professionals, $80 for the MSHC web advertisement, $1408 for Facebook and $790 for the student diary. Other advertising methods cost $12 248 and did not attract any clients. Conclusion: Advertising STI health services for rural young people would be best to focus on referrals from other health services or health care websites.
Publisher: Wiley
Date: 02-07-2010
DOI: 10.1111/J.1468-1293.2009.00808.X
Abstract: Our aim was to compare three different definitions of treatment failure and discuss their use as quality outcome measures for a clinical service. Data for treatment-naïve patients who attended the Melbourne Sexual Health Centre (MSHC) between 1 January 2000 and 31 December 2008 were analysed. Definition 1 was the strict Food and Drug Administration (FDA) definition of treatment failure as determined using the time to loss of virological response (TLOVR) algorithm. Definition 2 defined treatment failure as occurring in those whose viral load never fell to or =400 copies/mL on any treatment (switching or stopping treatment with a viral load <400 copies/mL was permitted). Definition 3 was the same as definition 2 except that in iduals were also deemed to have failed if they stopped treatment for 6 months or longer. There were 310 antiretroviral-naïve patients who started treatment in the study period. Of these, 156 [50.3% 95% confidence interval (CI) 42.1-53.3%] experienced treatment failure under definition 1, 10 (3.2% 95% CI 1.5-5.8%) experienced treatment failure under definition 2, and 16 (4.5% 95% CI 2.5-7.4%) experienced treatment failure under definition 3 over the 108 months of follow-up. The probability of failing definition 1 was statistically different from the probability of failing definition 2 or 3 (P=0.01). There were significant differences in treatment failure for the three definitions. If definition 1 were used, the outcomes would be sufficiently common to enable clinics to be compared but would be less meaningful. If definition 2 or 3 were used, the events would be too rare to enable clinics to be compared, but it would be possible to set a benchmark level of success that clinics could aim to reach.
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.
Publisher: Public Library of Science (PLoS)
Date: 25-05-2012
Publisher: Elsevier BV
Date: 10-1987
DOI: 10.1016/0278-2626(87)90134-5
Abstract: When a normal dextral attempts to bisect a horizontal line placed across his/her midline, there is a tendency for the transection to be placed slightly to the left of true center, a tendency which may be a little more pronounced when the left hand is used. However, left-handed children at or younger than 5 years of age err substantially to the left with the left hand and to the right with the right hand. This symmetrical neglect of extents contralateral to the hand currently in use, which may possibly reflect relatively greater commissural immaturity in left-handers, was not seen in dextral children of comparable ages, whose performance closely followed adult patterns.
Publisher: Public Library of Science (PLoS)
Date: 03-2016
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.
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.
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.
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.
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.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 31-07-2016
Publisher: BMJ
Date: 18-04-2017
DOI: 10.1136/SEXTRANS-2016-052553
Abstract: Pelvic inflammatory disease (PID) occurs when pathogens, often sexually transmitted, ascend to the upper genital tract, yet a causative pathogen is not detected in a substantial proportion of diagnosed PID. We assessed the characteristics associated with PID in women in whom chlamydia, gonorrhoea, Mycoplasma genitalium (MG) and bacterial vaginosis (BV) were not detected ('pathogen-negative-PID'). Cross-sectional analysis of routinely collected clinical data from new female patients attending a sexual health clinic between 2006 and 2013. Women were eligible if they had been diagnosed with PID and tested for genital chlamydia, gonorrhoea, MG and BV. Logistic regression was conducted to identify characteristics associated with pathogen-negative-PID. Among 330 women with clinically diagnosed PID, 204 (61.8%, 95% CI 56.3% to 67.1%) had pathogen-negative-PID. Compared with pathogen-positive-PID, pathogen-negative-PID cases were more likely to be aged ≥30 years (adjusted odds ratio (AOR) 1.7, 95% CI 1.0 to 3.0), had less evidence of vaginal inflammation (AOR 0.5, 95% CI 0.3 to 0.9) and reported less unprotected sex (AOR 0.6, 95% CI 0.4 to 1.0). These findings highlight uncertainties around PID diagnosis and aetiology. Pathogen-negative-PID could represent (i) a false positive diagnosis where the woman does not have a sexually transmitted infection (STI) or PID, (ii) PID of another microbiological aetiology or associated with a past STI or (iii) PID where the cervical infection has cleared. However, until diagnostic biomarkers are available, PID treatment should be based on clinical features and sexual risk.
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.
Publisher: Oxford University Press (OUP)
Date: 05-06-2019
DOI: 10.1093/CID/CIY477
Publisher: Public Library of Science (PLoS)
Date: 20-11-2014
Publisher: Elsevier BV
Date: 11-2017
DOI: 10.1016/J.RESMIC.2017.04.001
Abstract: Vaginal eubiosis is characterised by beneficial lactobacillus-dominated microbiota. In contrast, vaginal dysbiosis (e.g. bacterial vaginosis, BV), characterised by an overgrowth of multiple anaerobes, is associated with an increased risk of adverse urogenital and reproductive health outcomes. A major distinguishing feature between the vaginal environment in states of eubiosis and dysbiosis is a high concentration of lactic acid, produced by lactobacilli, that acidifies the vagina in eubiosis versus a sharp drop in lactic acid and an increase in pH in dysbiosis. Here we review the antimicrobial, antiviral and immunomodulatory properties of lactic acid and the use of lactic acid and lactobacilli probiotics in preventing or treating BV.
Publisher: Elsevier BV
Date: 03-2018
Publisher: American Society for Microbiology
Date: 08-2014
DOI: 10.1128/JCM.00899-14
Abstract: Nongonococcal urethritis (NGU) is a common clinical syndrome, but no etiological agent is identified in a significant proportion of cases. Whether the spectrum of pathogens differs between heterosexual men (MSW) and men who have sex with men (MSM) is largely unstudied but of considerable clinical relevance. A retrospective review was done using the electronic medical record database of Melbourne Sexual Health Centre, Australia. Cases were first presentations of symptomatic acute NGU with ≥5 polymorphonuclear leukocytes (PMNL)/high-powered field (HPF) on urethral Gram stain between January 2006 and December 2011. First-stream urine was tested for Chlamydia trachomatis and Mycoplasma genitalium by PCR. Demographic, laboratory, and behavioral characteristics of cases were examined by univariate and multivariable analyses. Of 1,295 first presentations of acute NGU, 401 (32% 95% confidence interval [CI] of 29 to 34%) had C. trachomatis and 134 (11% 95% CI of 9 to 13%) had M. genitalium detected. MSM with acute NGU were less likely to have C. trachomatis (adjusted odds ratio [AOR] = 0.4 95% CI of 0.3 to 0.6) or M. genitalium (AOR = 0.5 95% CI of 0.3 to 0.8) and more likely to have idiopathic NGU (AOR = 2.4 95% CI of 1.8 to 3.3), to report 100% condom use for anal/vaginal sex (AOR = 3.6 95% CI of 2.7 to 5.0), or to have engaged in sexual activities other than anal/vaginal sex (AOR = 8.0 95% CI of 3.6 to 17.8). Even when C. trachomatis or M. genitalium was detected, MSM were more likely than MSW to report consistent condom use (OR = 4.7 95% CI of 2.6 to 8.3). MSM with acute NGU are less likely to have the established bacterial sexually transmitted infections (STIs) and more likely to report protected anal sex or sexual activity other than anal sex prior to symptom onset than MSW. These data suggest that the etiologic spectrum of pathogens differs between MSM and MSW in acute NGU and that relatively low-risk practices are capable of inducing acute NGU.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2015
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.
Publisher: SAGE Publications
Date: 15-07-2013
Abstract: Anal squamous cell carcinoma is more common in HIV-positive homosexual men than in the general population and prognosis worsens with increasing tumour size. To identify opportunities for earlier diagnosis, we aimed to determine size and visibility of anal squamous cell carcinoma at diagnosis. We conducted a retrospective review of medical records between 1992 and 2010 from one hospital radiotherapy centre, a major centre for HIV care, in Melbourne, Australia. Of 128 cases of anal squamous cell carcinoma, 24 (19%) were in HIV-positive men. At diagnosis, half (52%) of the tumours were externally visible and mean estimated tumour size was 36 mm (29 mm in HIV-positive and 38 mm in HIV-negative patients p = 0.04) and 114/121 (94%) tumours were 1 cm or larger. The most frequent symptoms were bleeding (43%) and pain (36%) and mean duration of symptoms was 22 weeks. This suggests most anal squamous cell carcinoma were visible or palpable for some time before diagnosis, meaning that screening high-risk groups by anal inspection and palpation is plausible.
Publisher: Oxford University Press (OUP)
Date: 03-08-2015
DOI: 10.1093/CID/CIV644
Abstract: Mycoplasma genitalium (MG) is associated with nongonococcal urethritis in men and cervicitis in women. Current guidelines recommend treatment with 1 gram of azithromycin however, treatment failure has increasingly been reported. This meta-analysis estimates treatment efficacy following treatment with 1 gram of azithromycin. Electronic databases were searched for articles published to the end of February 2015 using the following search terms: (Mycoplasma genitalium) AND (azithromycin OR zithromax OR [treatment efficacy]). Studies were included if they were English language, had participants aged ≥12 years diagnosed with urogenital MG, and had microbial cure measured within 12 months of treatment. Treatment efficacy was measured as microbial cure at last follow-up after treatment. A total of 21 studies, including 1490 participants, fulfilled the inclusion criteria. Most studies were observational, with only 5 controlled trials identified. The random-effects pooled microbial cure was 77.2% (95% confidence interval [CI], 71.1%-83.4% I(2) = 80.8%, P < .01). For the 12 studies conducted prior to 2009, pooled microbial cure was 85.3% (CI, 82.3%-88.3% I(2) = 19.7%, P = .25) for the 9 studies conducted since the beginning of 2009, pooled microbial cure was 67.0% (CI, 57.0%-76.9% I(2) = 80.9%, P < .01). The efficacy of a single dose of 1 gram of azithromycin for the treatment of urogenital MG has decreased to approach 60%. Even though most of the available evidence is based on observational studies that have considerable variability in s le size and timing of microbial cure, this low efficacy is of considerable concern. It is vital that new treatment options for MG are investigated.
Publisher: Wiley
Date: 2016
Publisher: Public Library of Science (PLoS)
Date: 04-09-2013
Publisher: Oxford University Press (OUP)
Date: 21-11-2014
Abstract: Anogenital human papillomavirus (HPV) is common among men who have sex with men (MSM) and causes anal cancer. This study examined the determinants of initial anogenital HPV infection among teenage MSM. Two hundred MSM aged 16 to 20 years were recruited via community and other sources. Men were tested for HPV DNA from the anus and penis. The proportion of men with anal HPV of any type increased from 10.0% in men reporting no prior receptive anal sex to 47.3% in men reporting ≥ 4 receptive anal sex partners (P < .001).A similar pattern was also seen with HPV type 16 (P = .044). The proportion of men with penile HPV increased from 3.7% in men reporting no prior insertive anal sex to 14.8% in men reporting ≥ 4 insertive anal sex partners (P = .014). Overall, 39.0% (95% confidence interval (CI), 32.2%-46.1%) of men had at least 1 HPV type: 23.0% (95% CI, 17.4%-29.5%) had a vaccine-preventable type (6, 11, 16 or 18). Early and high per partner transmission of HPV occurred between men soon after their first sexual experiences. HPV vaccination needs to commence early for maximal prevention of HPV among MSM.
Publisher: Public Library of Science (PLoS)
Date: 27-01-2014
Publisher: Elsevier BV
Date: 07-2015
DOI: 10.1016/J.AMEPRE.2015.01.014
Abstract: Chlamydia retesting 3 months after treatment is recommended to detect reinfections, but retesting rates are typically low. The purpose of this study is to determine if the addition of a postal home collection kit to a short message service (SMS) reminder at 3 months increases the percentage of patients retested for chlamydia at 1-4 months, compared to SMS alone. In this unblinded randomized controlled trial, participants were randomized 1:1 to intervention (home arm) or control (clinic arm) status. Participants included 200 each of women, heterosexual men, and men who have sex with men diagnosed and treated for chlamydia at sexual health services. Three months after chlamydia diagnosis, home arm participants received an SMS reminder and postal home collection kit (women, vaginal swab heterosexual men, Copan UriSwab men who have sex with men, UriSwab and rectal swab). The main outcome measures were the percentage of participants retested at 1-4 months after chlamydia diagnosis and the percentage in each arm with repeat positive tests, by risk group and overall, analyzed by intention to treat. Data were collected from 2011 to 2013 and analyzed in 2014. The percentage retested within 1-4 months of chlamydia diagnosis was significantly higher in home versus clinic arm participants among women (64% [66/103] vs 39% [38/97], p<0.001) heterosexual men (56% [57/101] vs 34% [34/99], p=0.002) men who have sex with men (62% [61/98] vs 44% [45/102], p=0.010) and overall (61% [184/302] vs 39% [117/298], p<0.001). The percentage in the home versus clinic arm with repeat positive tests was significantly higher among men who have sex with men (16% [16/98] vs 5% [5/102], p=0.021) and overall (10% [31/302] vs 4% [12/298], p=0.006). The addition of a postal home collection kit to routine SMS reminders resulted in substantial improvements in chlamydia retesting rates in all three risk groups and detection of more repeat positive tests, compared with SMS alone. Extending the intervention to other primary care settings with low retesting rates should be considered.
Publisher: Cold Spring Harbor Laboratory
Date: 23-05-2020
DOI: 10.1101/2020.05.22.109983
Abstract: There is a pressing need for detailed knowledge of the range of pathogens, extent of co-infection and clinical impact of reproductive tract infections (RTIs) among pregnant women. Here, we report on RTIs ( Mycoplasma genitalium, Chlamydia trachomatis , Neisseria gonorrhoeae , Trichomonas vaginalis , Treponema pallidum subspecies pallidum, bacterial vaginosis and vulvovaginal candidiasis) and other sexual and reproductive health indicators among 699 pregnant women in Papua New Guinea (PNG). We found widespread M. genitalium infection (12.5% of women), the first time this pathogen has been reported in PNG, with no evidence of macrolide resistance. Most pregnant women (76.2%) had at least one RTI, most of which are treatable. Excluding syphilis, sexually-transmitted infections were detected in 37.8% women. Syndromic management of infections is greatly inadequate and there was remarkably little use of contraception 98.4% report never having used barrier contraception. This work has implications for improving maternal and child health in PNG. This first report of Mycoplasma genitalium in Papua New Guinea finds a high burden (12.5%) among 699 pregnant women. Additionally, more than one in two women were positive for a treatable reproductive tract infection associated with poor health outcomes.
Publisher: Springer Science and Business Media LLC
Date: 05-06-2011
Abstract: To determine whether chlamydia positivity among heterosexual men (MSW) and chlamydia and gonorrhea positivity among men who have sex with men (MSM), are changing. Computerized records for men attending a large sexual health clinic between 2002 and 2009 were analyzed. Chlamydia and gonorrhea positivity were calculated and logistic regression used to assess changes over time. 17769 MSW and 8328 MSM tested for chlamydia and 7133 MSM tested for gonorrhea. In MSW, 7.37% (95% CI: 6.99-7.77) were chlamydia positive the odds of chlamydia positivity increased by 4% per year (OR = 1.04 95% CI: 1.01-1.07 p = 0.02) after main risk factors were adjusted for. In MSM, 3.70% (95% CI: 3.30-4.14) were urethral chlamydia positive and 5.36% (95% CI: 4.82-5.96) were anal chlamydia positive positivity could not be shown to have changed over time. In MSM, 3.05% (95% CI: 2.63-3.53) tested anal gonorrhea positive and 1.83% (95% CI: 1.53-2.18) tested pharyngeal gonorrhea positive. Univariate analysis found the odds of anal gonorrhea positivity had decreased (OR = 0.93 95% CI: 0.87-1.00 p = 0.05), but adjusting for main risk factors resulted in no change. Urethral gonorrhea cases in MSM as a percentage of all MSM tested for gonorrhea also fell (p 0.001). These data suggest that chlamydia prevalence in MSW is rising and chlamydia and gonorrhea prevalence among MSM is stable or declining. High STI testing rates among MSM in Australia may explain differences in STI trends between MSM and MSW.
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.
Publisher: Oxford University Press (OUP)
Date: 08-2023
DOI: 10.1093/OFID/OFAD427
Abstract: High levels of macrolide resistance and increasing fluoroquinolone resistance are making Mycoplasma genitalium increasingly difficult to treat. Minocycline is an alternative treatment for patients with macrolide-resistant M genitalium infections that have failed moxifloxacin, or for those with fluoroquinolone contraindications or resistance. Published efficacy data for minocycline for M genitalium are limited. We evaluated minocycline 100 mg twice daily for 14 days at Melbourne Sexual Health Centre (MSHC). Microbial cure was defined as a negative test of cure within 14–90 days after completing minocycline. The proportion cured and 95% confidence intervals (CIs) were calculated, and logistic regression was used to explore factors associated with treatment failure. We pooled data from the current study with a prior adjacent case series of patients with M genitalium who had received minocycline 100 mg twice daily for 14 days at MSHC. Minocycline cured 60 of 90 (67% [95% CI, 56%–76%]) infections. Adherence was high (96%) and side effects were mild and self-limiting. No demographic or clinical characteristics were associated with minocycline failure in regression analyses. In the pooled analyses of 123 patients, 83 (68% [95% CI, 58%–76%]) were cured following minocycline. Minocycline cured 68% of macrolide-resistant M genitalium infections. These data provide tighter precision around the efficacy of minocycline for macrolide-resistant M genitalium and show that it is a well-tolerated regimen. With high levels of macrolide resistance, increasing fluoroquinolone resistance, and the high cost of moxifloxacin, access to nonquinolone options such as minocycline is increasingly important for the clinical management of M genitalium.
Publisher: BMJ
Date: 24-08-2009
Abstract: In Victoria, Australia, legislation requires sex workers to undergo monthly testing for gonorrhoea, chlamydia and trichomonas, and 3-monthly for HIV and syphilis, despite extremely low rates of sexually transmitted infections (STI) in female sex workers (FSW). The aim of this study was to quantify the resources and opportunities lost from this screening. Computerised medical records of patients attending the Melbourne Sexual Health Centre (MSHC) between October 2005 and October 2008 were reviewed. Consultations with FSW accounted for 15.1% of total consultation time (5722 of 37,670 h) and of these, 2896 h (7.7%) were used for monthly consultations involving testing for gonorrhoea, chlamydia and trichomonas, but no serology (termed swab-only testing). Only 133 (3.2%) of the 4208 cases of STI (defined as gonorrhoea, chlamydia, trichomonas, early syphilis, mycoplasma genitalium or HIV) that were detected at MSHC during the study period were among FSW who underwent swab-only testing. 1726 (41%) STI were detected among men who have sex with men (MSM). The STI detected per 100 h of consultation time was (fourfold) higher for MSM (19) than for FSW (4). If FSW were tested only every 3 months for gonorrhoea, chlamydia, trichomonas, syphilis and HIV the 2896 h spent on monthly swab-only testing would have been available for higher-risk clients The current legislation requiring monthly STI testing is compromising the access for higher-risk in iduals to sexual health. Other countries contemplating mandatory testing need to consider the influence that the frequency of testing has on access to sexual health services for high-risk groups.
Start Date: 2018
End Date: 2020
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2016
End Date: 2018
Funder: Alfred Research Trusts, Alfred Health
View Funded ActivityStart Date: 2016
End Date: 2017
Funder: Commonwealth Scientific and Industrial Research Organisation
View Funded ActivityStart Date: 2018
End Date: 2019
Funder: Australian Centre for HIV and Hepatitis Virology Research
View Funded ActivityStart Date: 02-2021
End Date: 02-2026
Amount: $4,999,540.00
Funder: Australian Research Council
View Funded Activity