Henrietta Williams

Adolescence and other risk factors for Chlamydia trachomatis genitourinary infection in women in Melbourne, Australia.

Objective: To establish the prevalence of and risk factors for Chlamydia trachomatis infection to determine the role of universal versus targeted testing. Methods: A prospective study of 1107 women attending two sexual and reproductive health clinics in Melbourne, Australia, was carried out. A questionnaire was used to establish risk factors. Urine samples were tested for C trachomatis by PCR. The main outcome measures were prevalence of and risk factors for C trachomatis infection. Results: Of 1107 recruitable women, 851 (76.9%) consented and were successfully tested. C trachomatis was detected in 18 (4.8% (95% CI 2.9 to 7.5)) of 373 women in the inner city and eight (1.7% (95% CI (0.7 to 3.3)) of 478 women in the suburban clinic. Of women under 25 years, 17 (6.2% (95% CI 3.7 to 9.8)) of 273 in the inner city in contrast with three (1.7% (95% CI 0.4 to 5.0)) of 174 in the suburban clinic were infected. In the inner city clinic, age under 25 years (OR 5.4 (95% CI 0.7 to 41.5)), vaginal discharge (OR 4.1 (95% CI 1.5 to 11.1)), and recent change of sexual partner (OR 4.6 (95% CI 1.6 to 12.9)) were associated with C trachomatis. In contrast, in the suburban clinic, only vaginal discharge (OR 3.5 (95% CI 0.9 to 14.3)) and recent change of sexual partner (OR 3.4 (95% CI 0.8 to 15.7)) were identified as risk factors. Multivariate analysis showed that recent change of partner (OR 4.5 (95% CI 1.5 to 13.8)) was the most strongly associated independent risk factor for infection in the inner city clinic. Conclusion: The high prevalence of C trachomatis indicates that universal testing should be undertaken in the inner city clinic. Young age may not be a risk factor for C trachomatis in more affluent populations with lower prevalence rates. No risk factors were identified with sufficient sensitivity and specificity to be useful for targeted testing. Prevalence and identifiable risk factors for C trachomatis are not transferable between populations, even in the same city.

Improving adolescent sexual and reproductive health. A view from Australia: learning from world's best practice.

There is increasing awareness worldwide of the importance of sexual and reproductive health in adolescents. Australias high rates of teenage pregnancy and increasing rates of sexually transmitted infections in young people reflect a failure to prioritise adolescent sexual and reproductive health on the public health agenda. This paper reviews adolescent sexual and reproductive health in Australia in comparison with international data, and examines the systemic, social and cultural factors that influence it. Based on comparisons with international best practice, recommendations are included for improvement in adolescent sexual and reproductive health within the Australian context.

Human papillomavirus prevalence in unvaccinated heterosexual males following a national female vaccination program

Background In Australia, high uptake of the quadrivalent human papillomavirus (4vHPV) vaccine has led to reductions in the prevalence of human papillomavirus (HPV) genotypes 6, 11, 16, and 18 in women and girls aged ≤25 years. We evaluated the impact of the program impact on HPV prevalence in unvaccinated male subjects. Methods Sexually active heterosexual male subjects aged 16-35 years were recruited in 2014-2016. Participants provided a self-collected penile swab sample for HPV genotyping (Roche Linear Array) and completed a demographic and risk factor questionnaire. Results The prevalence of 4vHPV genotypes among 511 unvaccinated male subjects was significantly lower in those aged ≤25 than in those aged >25 years: 3.1% (95% confidence interval, 1.5%-5.7%) versus 13.7% (8.9%-20.1%), respectively (P < .001); adjusted prevalence ratio, 0.22 (.09-.51; P < .001). By contrast, the prevalence of high-risk HPV genotypes other than 16 and 18 remained the same across age groups: 16.8% (95% confidence interval, 12.6%-21.9%) in men aged ≤25 years and 17.9% (12.4%-25.0%) in those aged >25 years (P = .76); adjusted prevalence ratio, 0.98, (.57-1.37; P = .58). Conclusions A 78% lower prevalence of 4vHPV genotypes was observed among younger male subjects. These data suggest that unvaccinated men may have benefited from herd protection as much as women from a female-only HPV vaccination program with high coverage.

Key informant perceptions of youth-focussed sexual health promotion programs in Australia

BACKGROUND This paper explores key informant (KI) perceptions of the barriers to effective sexual health promotion programs in Australia and suggests strategies to overcome these barriers. Three types of sexual health promotion programs were explored in this study: those targeting all young people (under 30), Aboriginal young people, and young people from culturally and linguistically diverse (CALD) backgrounds. METHODS The study utilised a qualitative approach and involved 33 semistructured interviews with sexual health professionals involved in funding or delivering Australian sexual health promotion programs or working clinically with individuals diagnosed with sexually transmissible infections. RESULTS Fourteen barriers to effective sexual health promotion programs were identified. Barriers included: difficulties associated with program evaluation, lack of involvement of the target community, the short-term nature of programs, problems with program resources and concerns about the content of programs. Additional barriers to programs targeting Aboriginal and CALD young people were also identified and included: a lack of cultural sensitivity; a failure to acknowledge differences in literacy, knowledge, and language skills; stigma and shame associated with sexual health; and the continued use of programs that lack inclusivity. KIs suggested strategies to overcome these barriers. CONCLUSION Sexual health promotion in Australia suffers from several barriers that are likely to impede the effectiveness of programs. In particular, poor or nonexistent program evaluation and lack of community involvement are among the key areas of concern. It is hoped that the findings of this study will be useful in informing and shaping future Australian sexual health promotions.

Replacement of conventional HIV testing with rapid testing: mathematical modelling to predict the impact on further HIV transmission between men

Background Rapid HIV testing is not permitted in Australia at the point of care. The authors evaluate the expected net effect of rapid HIV testing compared with standard serology diagnostic tests in terms of onward HIV transmission. Methods The authors used data for 174 men who had sex with men testing HIV-positive at the Melbourne Sexual Health Centre, Australia, in an agent-based mathematical model. Time of diagnosis is simulated according to conventional enzyme immunoassays or rapid HIV tests, with different window periods. The authors calculated the expected number of additional/averted transmissions due to missed or earlier diagnoses. Results Fourth generation rapid tests were simulated to miss ∼2–3% of diagnoses compared with conventional fourth generation enzyme immunoassay tests. However, in the remaining 97–98% of cases the rapid test would result in earlier detection of HIV. Overall, the rapid test would reduce time to patients receiving results by a median of ∼12 days. Assuming no changes in testing rates, the introduction of rapid testing diagnostic technologies would prevent one in every 2000–5000 HIV transmissions compared with the conventional diagnostic test. Conclusions Rapid tests would have a marginal benefit in reducing HIV transmission between men compared with conventional tests under assumptions of no changes in testing frequencies.

Use of computerized medical records to determine the feasibility of testing for chlamydia without patients seeing a practitioner.

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 samples, 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.

Sexually transmitted infections. Initiatives for prevention.

Sexually transmissible infections (STIs) are responsible for a significant burden of disease in both developed and developing countries and young people are disproportionately affected by STIs and their consequences. STI rates in young people are determined by a wide range of well documented influences. These include physiological, cognitive and behavioural factors, as well as environmental factors such as the social, and cultural context in which young people live. Despite the erecognition of these influences, their complex inter-relationships are less well documented and the evidence for interventions to reduce STIs in young people is similarly less clear. This paper explore tht most important factors that impact STI rates in young people in Australia and reviews interventions that have shown success, in Australia and elsewhere. In addition, promising strategies for the promotion of sexual health and reduction of STIs in young Australians, are discussed.

Women’s experiences of pelvic inflammatory disease: Implications for health-care professionals:

This study explored the health-care experiences of women diagnosed with pelvic inflammatory disease. Semi-structured interviews were conducted with 23 women diagnosed with pelvic inflammatory disease. Many women felt empowered about their health post-diagnosis; however, a smaller number reported becoming hyper-vigilant towards symptoms. Infertility was the greatest concern for women. Inadequate information and treatment resulted in negative health experiences, whereas clinician honesty and concern were viewed positively. The findings highlight the need for community education encouraging early presentation for the treatment of pelvic pain and emphasise the need for health practitioners to be responsive to the psychosocial aspects of pelvic inflammatory disease.

HIV is rare among low-risk heterosexual men and significant potential savings could occur through phone results

BACKGROUND The legislation in Victoria requires HIV-positive results to be given in person by an accredited health professional. Many sexual health clinics require all men to receive HIV results in person. Our aim was to determine the proportion of low-risk heterosexual men at a sexual health centre who tested HIV-positive. METHODS The electronic data on all HIV tests performed between 2002 and 2008 on heterosexual men at the Melbourne Sexual Health Centre (MSHC) was reviewed. The individual client files of all heterosexual men who tested HIV-positive were reviewed to determine their risks for HIV at the time that the HIV test was ordered. RESULTS Over the 6 years there were 33 681 HIV tests performed on men, of which 17 958 tests were for heterosexual men. From these heterosexual men, nine tested positive for the first time at MSHC (0.05%, 95% confidence interval (CI): 0.01%, 0.09%). These nine cases included six men who had had sex with a female partner from the following countries: Thailand, Cambodia, China, East Timor, Botswana and South Africa. Two men had injected drugs and one had a HIV-positive female partner. Of the 17 958 test results for heterosexual males, 14 902 (83% 95% CI: 84%, 86%) test results were for men who did not have a history of intravenous drug use or had sexual contact overseas. Of these 14 902 low-risk men, none tested positive (0%, 95% CI: 0, 0.00025). CONCLUSION Asking the 83% of heterosexual men who have an extremely low risk of HIV to return in person for their results is expensive for sexual health clinics and inconvenient for clients. We have changed our policy to permit heterosexual men without risk factors to obtain their HIV-negative results by phone.

Concordance of chlamydia infections of the rectum and urethra in same-sex male partnerships: a cross-sectional analysis.

BackgroundOur study aimed to describe the concordance of chlamydia infections of the rectum and urethra in men who have sex with men (MSM) and their male partners.MethodsThis was a cross-sectional study of chlamydia in MSM and their male sexual partners both attending Melbourne Sexual Health Centre (MSHC), Australia, between February 2011 and March 2015. We excluded partnerships where testing for chlamydia at both the rectum and urethra were not undertaken.ResultsOur study included 473 partnerships (946 men). 30 men had urethral chlamydia, of whom 14 (47%, 95% CI 28 to 66) had a partner with rectal chlamydia. 46 men had rectal chlamydia, of whom 14 (30%, 95% CI 18 to 46) had a partner with urethral chlamydia. The proportion of men with rectal chlamydia when their partner had urethral chlamydia was significantly higher than the proportion of men with urethral chlamydia when their partner had rectal chlamydia (McNemar’s p = 0.02).ConclusionsThis is the first study of chlamydia concordance in male sexual partnerships and suggests that transmission of chlamydia between the urethra and rectum may be less efficient than has been reported for transmission between the urethra and cervix in heterosexual couples. It also suggests that transmission from the urethra to the rectum may be more efficient than in the opposite direction.