Caron Marks

Sexually transmitted infections and risk behaviours in women who have sex with women

Objectives: To assess the prevalence of sexually transmitted infections (STIs) and blood borne viruses, risk behaviours, and demographics in women who have sex with women (WSW). Methods: Retrospective cross sectional study using a multivariate model. Demographic, behavioural, and morbidity data were analysed from standardised medical records of patients attending a public STI and HIV service in Sydney between March 1991 and December 1998. All women with any history of sex with a woman were compared with women who denied ever having sex with another woman (controls). Results: 1408 WSW and 1423 controls were included in the study. Bacterial vaginosis (BV) was significantly more common among WSW (OR 1.7, p<0.001). Abnormalities on cervical cytology were equally prevalent in both groups, except for the higher cytological BV detection rate in WSW (OR 5.3, p=0.003). Genital herpes and genital warts were common in both groups, although warts were significantly less common in WSW (OR 0.7, p=0.001). Prevalence of gonorrhoea and chlamydia were low and there were no differences between the groups. The prevalence of hepatitis C was significantly greater in WSW (OR 7.7, p<0.001), consistent with the more frequent history of injecting drug use in this group (OR 8.0, p<0.001). WSW were more likely to report previous sexual contact with a homo/bisexual man (OR 3.4, p<0.001), or with an injecting drug user (OR 4.2, p<0.001). Only 7% of the WSW reported never having had sexual contact with a male. Conclusion: We demonstrated a higher prevalence of BV, hepatitis C, and HIV risk behaviours in WSW compared with controls. A similar prevalence of cervical cytology abnormalities was found in both groups. Measures are required to improve our understanding of STI/HIV transmission dynamics in WSW, to facilitate better health service provision and targeted education initiatives.

HIV, sexually transmitted infections, and risk behaviours in male commercial sex workers in Sydney.

Objectives: To assess prevalence of HIV and sexually transmitted infections (STIs), risk behaviours, and demographics in male commercial sex workers (CSWs)/prostitutes in Sydney. Methods: Retrospective, cross sectional study with two comparison groups. Demographic, behavioural, and morbidity data were analysed from standardised medical records of patients attending a public STI and HIV service in Sydney between January 1991 and March 1998. Two comparison groups were used: female CSWs and non-CSW working homosexual men who attended over the same time. Results: 94 male CSWs, 1671 female CSWs, and 3541 non-CSW working homosexual men were included. The prevalence of HIV in male CSWs tested (6.5%) was significantly greater than in female CSWs (0.4%, p=0.0001), but less than in non-CSW homosexual men (23.9%, p<0.0001). Genital warts occurred significantly more frequently in male CSWs than in comparison groups. Prevalence of other STIs was similar in all groups. Male CSWs saw significantly fewer clients per week than female CSWs and male and female CSWs used condoms with almost all clients. Male CSWs reported significantly more non-work sexual partners than female CSWs and non-CSW homosexual men and were significantly more likely to have unprotected penetrative sex with their non-work partners than non-CSW homosexual men. Injecting drug use was significantly more frequent in male CSWs than in both comparison groups. Conclusions: Although male CSWs use condoms with clients, they are more likely to practise unsafe sex with non-work partners (especially women) and inject drugs than female CSWs and non-CSW homosexual men. Some men with HIV are working within the commercial sex industry. Targeted health education to encourage safer drug use and safer sex outside work is needed.

Sexual and demographic risk factors for herpes simplex type 1 and 2 in women attending an antenatal clinic

Objective: To establish risk factors for the presence of HSV-2 and HSV-1 infections in pregnant women. Design, population, and setting: A prospective study of 3306 women attending the antenatal department Westmead Hospital, Sydney, between June 1995 and April 1998. Methods: Women completed a self administered questionnaire to establish risk factors for the presence of HSV-2 and HSV-1. Sera were tested for antibodies to HSV-2 and HSV-1. Data were analysed using spss and sas. Main outcome measures: Seroprevalence of and risk factors for HSV-2 and HSV-1. Results: 375 (11.3% (95% CI 10.3–12.5)) women were HSV-2 antibody positive. Increasing age, Asian country of birth, lower education level, public hospital status, confirmed genital herpes, a partner with genital herpes, early age of first sex, more than one lifetime sexual partner, and previous chlamydia infection were independently associated with HSV-2 seropositivity. Of 408 women tested for HSV-1 antibodies, 323 (79.2% (95% CI 74.9–83.0)) were positive. Oral herpes, oral blisters or sores, and being HSV-2 seropositive were independently associated with HSV-1 seropositive status. When the logistic regression model was rerun without HSV-2 status, parity of two or more and one or more sexual partners in the past 3 months were significant predictors of HSV-1 seropositivity. Conclusions: The presence of antibodies to HSV-2 and HSV-1 is related to a number of sexual and demographic risk factors. Public health campaigns directed at encouraging young people to delay the onset of sexual activity and reduce the number of sexual partners need to be evaluated. However, the possible availability of an HSV-2 vaccine that is able to protect over 70% of women offers the best hope for control of genital herpes.

Assessment of risk for pelvic inflammatory disease in an urban sexual health population

Objectives: To determine the sexual and demographic risk factors for the acquisition of presumptive pelvic inflammatory disease (PID). Methods: A retrospective, case-control study in women, who attended the Sydney Sexual Health Centre (SSHC), between April 1991 and December 1997. Logistic regression analysis was used to adjust for confounding variables. Results: 741 women with PID and an equal number of controls were included. Cases were significantly younger than controls (p<0.001). 42% of cases were born in north or South East Asia, compared with 12% of the controls (p<0.001). The adjusted odds ratio for being born in north or South East Asia was 2.8 (95% CI 1.70–4.46), for not speaking English at home was 1.6 (95% CI 1.02–2.55), for having had previous PID was 5.9 (95% CI 3.59–9.73), and for being employed in the commercial sex industry and being born in north or South East Asia was 2.8 (95% CI 1.22–6.22). Women aged 15–19 were at considerable risk of developing PID (OR 5.3 (95% CI 2.76–10.11)). Women with previous human papillomavirus infection were significantly less likely to develop PID (OR 0.6 (95% CI 0.42–0.79)). The use of IUCDs (OR 4.5 (95% CI 2.14–9.39)), condoms (OR 1.4 (95% CI 1.03–1.87)), and not using contraception (OR 1.8 (95% CI 1.20–2.76)) was each associated with an increased risk. Conclusions: Several measures may help to reduce the burden of PID. Women should be encouraged to delay the onset of sexual activity and IUCDs should not be used in young women. Sexual health services for women whose home language is not English, and for commercial sex workers born in north or South East Asia should be improved.

Diagnosing PID--getting the balance right.

The objective of the study was to determine the clinical manifestations and diagnostic criteria used to diagnose presumptive pelvic inflammatory disease (PID) at the Sydney Sexual Health Centre (SSHC). The study was a retrospective, case-note review of all women diagnosed with presumptive PID between April 1991 and December 1997. Seven hundred and thirteen women were included. The commonest recorded symptoms were vaginal discharge (68%), lower abdominal pain (65%) and dyspareunia (57%), while adnexal tenderness (83%), cervical motion tenderness (75%) and cervicitis (56%) were the most frequently recorded examination findings. Sixty-two per cent were prescribed doxycycline and metronidazole. The recording of signs and symptoms in women with presumptive PID was poor and only 22% met the current Centers for Disease Control (CDC) diagnostic criteria. It is likely that PID is over diagnosed in this group of women. This may lead to under diagnosis of other conditions causing pelvic pain and may be detrimental to reproductive health.

Australian sexual health nurses: variations in practice.

Objectives: The study aimed to describe the scope of practice of Australian Sexual Health Nurses in order to inform development of nationally consistent role functions. Method: Descriptive cross sectional survey of 201 sexual health nurses utilising an anonymous self-administered questionnaire with reply paid envelope which was sent to members of the Australian Sexual Health Nurses Association along with a letter which encouraged them to ask non member sexual health nurses to also complete a questionnaire. Major findings: Despite the fact that most Australian Sexual Health Nurses are employed in sexual health centres and family planning clinics, this study showed the scope of their practice to be extremely varied both in and between states/territories. Conclusion: The scope of practice of Australian sexual health nurses is varied. While questions remain as to the reasons for difference, the authors argue that the specialty needs to work toward a national model for basic sexual health nursing care. It is recommended that this model be based on knowledge of and rationales for variations in practice.

Opting off the New South Wales Pap Test Register in a sexual health setting

Objectives: To determine the proportion of women having a Pap smear at Sydney Sexual Health Centre (SSHC) who opted off the NSW Pap Test Register (PTR) and to establish the characteristics of these women.