ORCID Profile
0000-0002-2369-5920
Current Organisations
University of Bern
,
Monash University
,
Alfred Health
,
University of Melbourne
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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: Cambridge University Press (CUP)
Date: 03-2015
DOI: 10.1016/J.EURPSY.2015.01.010
Abstract: The aim of this guidance paper of the European Psychiatric Association is to provide evidence-based recommendations on the early detection of a clinical high risk (CHR) for psychosis in patients with mental problems. To this aim, we conducted a meta-analysis of studies reporting on conversion rates to psychosis in non-overlapping s les meeting any at least any one of the main CHR criteria: ultra-high risk (UHR) and/or basic symptoms criteria. Further, effects of potential moderators (different UHR criteria definitions, single UHR criteria and age) on conversion rates were examined. Conversion rates in the identified 42 s les with altogether more than 4000 CHR patients who had mainly been identified by UHR criteria and/or the basic symptom criterion ‘cognitive disturbances’ (COGDIS) showed considerable heterogeneity. While UHR criteria and COGDIS were related to similar conversion rates until 2-year follow-up, conversion rates of COGDIS were significantly higher thereafter. Differences in onset and frequency requirements of symptomatic UHR criteria or in their different consideration of functional decline, substance use and co-morbidity did not seem to impact on conversion rates. The ‘genetic risk and functional decline’ UHR criterion was rarely met and only showed an insignificant pooled s le effect. However, age significantly affected UHR conversion rates with lower rates in children and adolescents. Although more research into potential sources of heterogeneity in conversion rates is needed to facilitate improvement of CHR criteria, six evidence-based recommendations for an early detection of psychosis were developed as a basis for the EPA guidance on early intervention in CHR states.
Publisher: Springer Science and Business Media LLC
Date: 06-01-2017
Publisher: Frontiers Media SA
Date: 20-11-2017
Publisher: Springer Science and Business Media LLC
Date: 28-06-2017
Publisher: Springer Science and Business Media LLC
Date: 24-04-2014
Publisher: Elsevier BV
Date: 07-2016
DOI: 10.1016/J.SCHRES.2016.04.032
Abstract: Altered motor behavior has consistently been reported in medication-naive adult patients with schizophrenia and first episode psychosis and adults at clinical high risk for psychosis (CHR). This study is the first to evaluate the prevalence of abnormal involuntary movements in a community s le of children and adolescents with and without CHR. We examined CHR in 102 children and adolescents aged 8-17years from the general population of the Canton Bern. Attenuated and brief intermittent psychotic symptoms, as well as basic symptoms, were assessed using the Structured Interview for Psychosis Risk Syndromes and the Schizophrenia Proneness Instrument, Child & Youth Version. Motor symptoms were assessed using the Abnormal Involuntary Movement Scale (AIMS). Additionally, psychosocial functioning, a neurocognitive test battery, and DSM-IV Axis I disorders were examined. Eleven (10.8%) participants met CHR criteria, 13 (12.7%, 5 with and 8 without CHR) met criteria for increased abnormal involuntary movements (AIMS≥2). Both AIMS total scores and the percentage of children with AIMS≥2 were significantly higher in the CHR group. Psychosocial functioning was reduced in subjects with abnormal involuntary movements, and movement abnormalities were linked to deficits in attention and perception but not to the presence of non-psychotic mental disorders. Our findings suggest that abnormal involuntary movements are linked to psychosis risk in children and adolescents from the general population. Thus, abnormal involuntary movements might represent an additional useful and easily accessible predictor of psychosis.
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 02-2018
Publisher: Springer Science and Business Media LLC
Date: 09-03-2011
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2017
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: Elsevier BV
Date: 05-2017
DOI: 10.1016/J.ENCEP.2017.01.005
Abstract: In children and adolescents, psychotic disorders already represent one of the leading causes of disability-adjusted life years. During the past two decades, early detection of risk for psychosis has been intensively investigated, and in particular, predictive power for early signs of risk has been initiated and translated into clinical practice. In particular, the attenuated and transient positive symptoms of the ultra-high risk criteria, and the basic symptom criterion "cognitive disturbances", open promising routes to an indicated prevention and have recently been considered by the European Psychiatric Association (EPA) as diagnostic criteria of a psychosis-risk syndrome. The EPA recently provided evidence-based recommendations on the early detection of clinical high risk (CHR) for psychosis in patients with mental distress. In 2015, experts in the field of early detection conducted a meta-analysis reporting on studies examining conversion rates to psychosis in non-overlapping s les meeting at least one of the main CHR criteria: ultra-high risk (UHR) and/or basic symptoms criteria, examining the effects of potential moderators (different UHR criteria definitions, single UHR criteria and age) on conversion rates. In the 42 identified s les, comprising more than 4000 CHR patients who had been mainly identified by means of UHR criteria and/or the basic symptom criterion 'cognitive disturbances' (COGDIS), conversion rates showed considerable heterogeneity. While UHR and COGDIS criteria were related to comparable conversion rates until a 2-year follow-up, rates for COGDIS were significantly higher for follow-up periods beyond 2 years. Differences in onset and frequency requirements of symptomatic UHR criteria, or in their different consideration of functional decline, substance use and co-morbidity, did not seem to have an impact on conversion rates. The 'genetic risk and functional decline' UHR criterion was rarely met and only showed an insignificant pooled s le effect. However, age significantly affected UHR conversion rates with lower rates in children and adolescents. Although more research into potential sources of heterogeneity in conversion rates is needed to facilitate improvement of CHR criteria, six evidence-based recommendations for the early detection of psychosis were developed as a basis for the EPA guidance on early intervention in CHR states. The EPA guidance on early intervention aimed to provide evidence-based recommendations on early intervention in CHR states of psychosis, assessed according to the EPA guidance on early detection. The recommendations were also made by experts in the field of early intervention in psychoses and derived from a meta-analysis of current empirical evidence on the efficacy of psychological and pharmacological interventions in CHR s les. Eligible studies had to investigate conversion rate and/or functioning as a treatment outcome in CHR patients defined by the ultra-high risk and/or basic symptom criteria. In addition to analyses of treatment effects on conversion rate and functional outcome, age and type of intervention were examined as potential moderators. Based on data from 15 studies (n=1394), early intervention generally produced significantly reduced conversion rates at 6- to 48-month follow-up compared to control conditions. However, early intervention failed to achieve significantly greater functional improvements because both early intervention and control conditions produced similar positive effects. With regard to the type of intervention, both psychological and pharmacological interventions produced significant effects on conversion rates but not on functional outcome relative to the control conditions. Early intervention in youth s les was generally less effective than in predominantly adult s les. Seven evidence-based recommendations for early intervention in CHR s les have been formulated, although more studies are needed to investigate the specificity of treatment effects and potential age effects in order to tailor interventions to the in idual treatment needs and risk status. Overall, age-related specificities and developmental transitions in the early detection and intervention in psychoses should be better accounted for in future research.
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: 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: 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: Elsevier BV
Date: 07-2022
DOI: 10.1016/J.YFRNE.2022.100987
Abstract: Alterations in hypothalamic-pituitary-adrenal (HPA) axis and its effector hormone cortisol have been proposed as one possible mechanism linking child maltreatment experiences to health disparities. In this series of meta-analyses, we aimed to quantify the existing evidence on the effect of child maltreatment on various measures of HPA axis activity. The systematic literature search yielded 1,858 records, of which 87 studies (k = 132) were included. Using random-effects models, we found evidence for blunted cortisol stress reactivity in in iduals exposed to child maltreatment. In contrast, no overall differences were found in any of the other HPA axis activity measures (including measures of daily activity, cortisol assessed in the context of pharmacological challenges and cumulative measures of cortisol secretion). The impact of several moderators (e.g., sex, psychopathology, study quality), the role of methodological shortcomings of existing studies, as well as potential directions for future research are discussed.
Publisher: Elsevier BV
Date: 08-2019
DOI: 10.1016/J.SCHRES.2018.12.039
Abstract: Schizotypy and clinical high risk (CHR) criteria can identify in iduals who are at increased risk for developing psychosis in community and patient s les. However, both approaches have rarely been combined, and very little is known about their associations. Therefore, we examined the factorial structure of CHR and related symptoms and schizotypy features as well as their interrelationship for the first time in a comprehensive approach. In a s le of 277 patients (22 ± 6 years) from two early detection services, structural equation modeling including confirmatory factor analysis was performed to test a theory-driven model using four Wisconsin Schizotypy Scales, 14 predictive basic symptoms (BS) of the Schizophrenia Proneness Instrument, and positive, negative, and disorganized symptoms from the Structured Interview for Psychosis-Risk Syndromes. The data fitted well to the six hypothesized latent factors consisting of negative schizotypy, positive schizotypy including perceptual BS, negative symptoms, positive symptoms, disorganized symptoms and cognitive disturbances. As postulated, schizotypy features were significantly associated with positive, negative and disorganized symptoms through cognitive disturbances. Additionally, positive and negative schizotypy also had a direct association with the respective symptom-domain. While the identified factorial structure corresponds well to dimensional models of schizotypy and psychoses, our model extends earlier models by indicating that schizotypy features are associated with positive, negative and disorganized symptoms directly or indirectly via subjective cognitive disturbances. This calls for more attention to subjective cognitive deficits in combination with heightened schizotypy in the early detection and intervention of psychoses - or even of an Attenuated Psychosis Syndrome.
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: Public Library of Science (PLoS)
Date: 17-07-2014
Publisher: American Society for Microbiology
Date: 2018
DOI: 10.1128/JCM.01245-17
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 11-2017
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: 12-12-2013
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: Oxford University Press (OUP)
Date: 18-12-2013
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: 05-03-2013
Publisher: Public Library of Science (PLoS)
Date: 04-04-2013
Publisher: Springer Science and Business Media LLC
Date: 02-2011
Publisher: Public Library of Science (PLoS)
Date: 09-03-2017
Publisher: Public Library of Science (PLoS)
Date: 24-02-2017
Publisher: Elsevier BV
Date: 05-2020
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: 25-10-2018
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: Elsevier BV
Date: 2021
Publisher: Elsevier BV
Date: 2020
DOI: 10.1016/J.BRAT.2019.103527
Abstract: The Ultra-High Risk (UHR) for psychosis group is known to be heterogeneous with erse outcomes. This study aimed to: 1. Identify subclasses of UHR in iduals based on trajectories of symptomatic and functional change over time, 2. Identify predictors of these trajectories. A s le of 304 UHR in iduals participating in the Neurapro trial were followed over an average of 40 months. All participants received cognitive-behavioural case management (CBCM). Symptomatic and functional profiles were investigated using latent class growth analysis. Multinomial regression was employed to investigate predictors of classes. Identified trajectories showed mostly parallel slopes (i.e. improving symptoms/functioning over time), which were primarily distinct regarding the severity of symptomatology/level of functioning at baseline (i.e. the intercept). Higher symptomatic/lower functioning classes were predicted by higher substance use, older age, female gender, and lower cognitive functioning. No ergent trajectories were identified as all classes improved over time. This may reflect effective treatment through CBCM, natural illness course, or effective engagement with mental health services. Nonetheless, classes highest in symptoms/lowest in functioning still showed considerable impairment during follow-up, highlighting the need for targeted intervention in these subgroups. The study emphasizes the need for more clinical attention directed towards UHR patients being female or using substances.
Publisher: S. Karger AG
Date: 2017
DOI: 10.1159/000477551
Abstract: b i Background: /i /b Cognitive-behavioural therapy (CBT) is the first-choice treatment in clients with ultra-high risk (UHR) for psychosis. However, CBT is an umbrella term for a plethora of different strategies, and little is known about the association between the intensity and content of CBT and the severity of symptomatic outcome. b i Methods: /i /b A s le of 268 UHR participants received 6 months of CBT with case management (CBCM) in the context of the multi-centre NEURAPRO trial with monthly assessments of attenuated psychotic symptoms (APS). Using multilevel regressions and controlling for the initial severity of APS, the associations between (1) number of CBCM sessions received and severity of APS and (2) specific CBCM components and severity of APS were investigated. b i Results: /i /b In month 1, a higher number of sessions and more assessment of symptoms predicted an increase in APS, while in month 3, a higher number of sessions and more monitoring predicted a decrease in the level of APS. More therapeutic focus on APS predicted an overall increase in APS. b i Conclusions: /i /b Our findings indicate that the association between intensity/content of CBCM and severity of APS in a s le of UHR participants depends on the length of time in treatment. CBCM may positively impact the severity of APS later in the course of treatment. Therefore, it would seem important to keep UHR young people engaged in treatment beyond this initial period. Regarding the specific content of CBCM, a therapeutic focus on APS may not necessarily be beneficial in reducing the severity of APS, a possibility in need of further investigation.
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: 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: 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: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2017
Publisher: Public Library of Science (PLoS)
Date: 03-04-2012
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: 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: Public Library of Science (PLoS)
Date: 25-05-2012
Publisher: Public Library of Science (PLoS)
Date: 31-03-2011
Publisher: Cambridge University Press (CUP)
Date: 19-07-2018
DOI: 10.1016/J.EURPSY.2018.06.009
Abstract: Absent or delayed help-seeking is considered to aggravate the immense personal and societal burden caused by mental disorders. Therefore, we cross-sectionally examined rates and clinical and sociodemographic moderators of early help-seeking for current clinician-assessed non-psychotic mental problems/disorders in the community. Altogether, 2683 in iduals of the Swiss Canton Bern (16–40 years old, response rate 63.4%) were interviewed by telephone for current axis-I problems/disorders using the Mini-International Neuropsychiatric Interview, for psychosocial functioning using the Social and Occupational Functioning Assessment Scale, and for help-seeking for mental problems. In total, 1122 (41.8%) reported mental problems. Of these, 769 (68.5%) affirmed any one screening question and 353 (31.5%) fulfilled criteria for any current axis-I disorder, and 396 (35.3%) reported any lifetime help-seeking (28.3% sought help in the past and 7.0% were in current treatment). In path analyses, current help-seeking was associated mainly by type and number of mental problems/disorders mediated by functional impairment, in addition to older age, no current partner, and past treatment. Our cross-sectional data indicate a gap in help-seeking for mental problems/disorders. The relationship between number of mental problems/disorders and help-seeking mediated by functional impairment confirm that in iduals commonly do not seek help until problems are severe enough to cause problems in occupational and psychosocial functioning, driving the already immense costs of mental disorders. Thus, c aigns promoting early help-seeking, including early diagnostic clarification of and support for subthreshold mental problems in terms of an indicated prevention, should focus on psychosocial functioning, aside from signs of mental illness.
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: 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: Public Library of Science (PLoS)
Date: 16-11-2012
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: 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: 09-2014
DOI: 10.1016/J.PSYCHRES.2014.04.045
Abstract: Patients with first-episode psychosis (FEP) often show dysfunctional coping patterns, low self-efficacy, and external control beliefs that are considered to be risk factors for the development of psychosis. Therefore, these factors should already be present in patients at-risk for psychosis (AR). We compared frequencies of deficits in coping strategies (Stress-Coping-Questionnaires, SVF-120/SVF-KJ), self-efficacy, and control beliefs (Competence and Control Beliefs Questionnaire, FKK) between AR (n=21) and FEP (n=22) patients using a cross-sectional design. Correlations among coping, self-efficacy, and control beliefs were assessed in both groups. The majority of AR and FEP patients demonstrated deficits in coping skills, self-efficacy, and control beliefs. However, AR patients more frequently reported a lack of positive coping strategies, low self-efficacy, and a fatalistic externalizing bias. In contrast, FEP patients were characterized by being overly self-confident. These findings suggest that dysfunctional coping, self-efficacy, and control beliefs are already evident in AR patients, though different from those in FEP patients. The pattern of deficits in AR patients closely resembles that of depressive patients, which may reflect high levels of depressiveness in AR patients. Apart from being worthwhile treatment targets, these coping and belief patterns are promising candidates for predicting outcome in AR patients, including the conversion to psychosis.
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: 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: 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: Public Library of Science (PLoS)
Date: 04-09-2013
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: Frontiers Media SA
Date: 28-01-2016
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: 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: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2017
Publisher: S. Karger AG
Date: 24-11-2021
DOI: 10.1159/000520008
Abstract: Depersonalization and derealization (DD) cause significant distress and are associated with poor role and social functional outcomes. Despite the relatively high prevalence of DD symptoms and the chronic course in those suffering from a DD disorder, there still exists a need for effective interventions. Preliminary evidence indicates that cognitive behavioral therapy (CBT) delivered in an in idual setting demonstrates some positive intervention effects for patients with DD regarding their symptom levels. By considering DD-specific treatment needs, a group therapy program was developed as an add-on therapy based on CBT techniques called PLAN D comprising the following elements: psychoeducation, lifestyle interventions, acceptance and mindfulness training, and new patterns of DD-related cognitions. In a pilot study, we present an 8-week group intervention for adolescents and young adults with DD disorder. To our knowledge, no standardized group intervention program for DD exists so far. Thus, this novel intervention represents a promising opportunity to positively influence long-term outcomes and course of DD.
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: Cambridge University Press (CUP)
Date: 10-2019
DOI: 10.1016/J.EURPSY.2019.08.008
Abstract: Understanding factors related to poor quality of life (QoL) and self-rated health (SRH) in clinical high-risk (CHR) for psychosis is important for both research and clinical applications. We investigated the associations of both constructs with CHR symptoms, axis-I disorders, and sociodemographic variables in a community s le. In total, 2683 (baseline) and 829 (3-year follow-up) in iduals of the Swiss Canton of Bern (age-at-baseline: 16–40 years) were interviewed by telephone regarding CHR symptoms, using the Schizophrenia Proneness Instrument for basic symptoms, the Structured Interview for Psychosis-Risk Syndromes for ultra-high risk (UHR) symptoms, the Mini-International Neuropsychiatric Interview for current axis-I disorders, the Brief Multidimensional Life Satisfaction Scale for QoL, and the 3-level EQ-5D for SRH. In cross-sectional structural equation modelling, lower SRH was exclusively significantly associated with higher age, male gender, lower education, and somatoform disorders. Poor QoL was exclusively associated only with eating disorders. In addition, both strongly interrelated constructs were each associated with affective, and anxiety disorders, UHR and, more strongly, basic symptoms. Prospectively, lower SRH was predicted by lower education and anxiety disorders at baseline, while poorer QoL was predicted by affective disorders at baseline. When present, CHR, in particular basic symptoms are already distressful for in iduals of the community and associated with poorer subjective QoL and health. Therefore, the symptoms are clinically relevant by themselves, even when criteria for a CHR state are not fulfilled. Yet, unlike affective and anxiety disorders, CHR symptoms seem to have no long-term influence on QoL and SRH.
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: Elsevier BV
Date: 10-2019
DOI: 10.1016/J.BRAT.2019.103442
Abstract: This systematic review and two-staged structural equation modelling meta-analysis (TSSEM) aimed to examine whether coping mediates the associations between locus of control, competence beliefs, and mental health in the general population and clinical s les. Eligible studies published until May 2017 were identified through systematic searches of PubMED and EMBASE. The review included 19 studies and the meta-analysis 15 studies. The review supports the assumption that coping mediates the associations between locus of control and competence beliefs, and mental health. TSSEM using a pooled s le of 3986 respondents and 225 cross-sectional effect sizes indicated that maladaptive coping mediates the association between maladaptive locus of control and mental health problems. On the contrary, adaptive coping did not mediate this association and was only significantly associated with competence beliefs and adaptive locus of control but, unexpectedly, not with mental health. Both maladaptive and adaptive locus of control but not competence beliefs had direct links to mental health problems that were independent of coping. Interventions should not only focus on enhancing adaptive coping as it might be more promising to diminish maladaptive locus of control, which may result in reduced maladaptive coping and, finally, improved mental health.
Start Date: 2018
End Date: 2020
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 02-2021
End Date: 02-2026
Amount: $4,999,540.00
Funder: Australian Research Council
View Funded Activity