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Needleman, Robert, Eric P. F. Chow, Janet M. Towns, Vincent J. Cornelisse, Tim Z. T. Yang, Marcus Y. Chen, Catriona S. Bradshaw, Ria Fortune, and Christopher K. Fairley. "Access to sexual health services after the rapid roll out of the launch of pre-exposure prophylaxis for HIV in Melbourne, Australia: a retrospective cross-sectional analysis." Sexual Health 15, no. 6 (2018): 528. http://dx.doi.org/10.1071/sh17182.
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Background On 26 July 2016, Victoria began a large study of HIV pre-exposure prophylaxis, called PrEPX, that involved the creation of around 2600 appointments over 3 months across multiple sites in Melbourne, Australia. At this time, the Melbourne Sexual Health Centre (MSHC) appeared to have a larger demand on its services. The aim of the present study was to determine whether this apparent increase in demand was substantially different from other demand fluctuations. Methods: Patients presenting to the MSHC from 2014 to 2016 were reviewed. Demographic characteristics, sexual risks and sexually transmitted infection diagnoses were extracted from the clinical database. Results: There were 115522 walk-in presentations for care and a rise in presentations in the week following the launch of the PrEPX study, but at least six similar peaks occurred that year. The peak coinciding with the launch of PrEPX was only apparent for men who have sex with men. There was a substantial increase in the proportion of patients who could not be seen (i.e. triaged out), from 10% in the week before PrEPX to 22.2% in the second week after, but this was primarily due to staff absences. At the time of the PrEPX study, data were collected on the duration of symptoms for common conditions and found no significant (P>0.29) change in the average duration of symptoms compared with that seen before the PrEPX launch. Conclusions: The increase in the number of medical consultations required for the PrEPX study did not result in excessive demand for public sexual health services.
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Pope, Jeanette, and Megan Counahan. "Evaluating the utility of surveillance data to decision makers in Victoria, Australia." Sexual Health 2, no. 2 (2005): 97. http://dx.doi.org/10.1071/sh04052.
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Objective. Evaluating the utility of surveillance data to decision makers in Victoria, Australia. Methods. A survey of all sexually transmitted infection program directors in Victoria, Australia, was undertaken to examine readership and use of annual and quarterly reports. Results. One hundred and sixteen programs in 86 organisations were identified as undertaking sexually transmitted infection control activities in Victoria. Around 17% of the directors never read the reports and others reported not finding the information contained in them useful. While we found the information generated from the surveillance system has an important role in triggering action for epidemics and pervades more general decision making by improving the general knowledge of sexually transmitted infection trends, the indicators are not seen as useful by most key stakeholders. Conclusions. Significant improvements in the utility of the system could be made by changes to the data output and key suggestions made by the stakeholders are outlined.
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Hocking, Jane S., Jessika Willis, Sepehr Tabrizi, Christopher K. Fairley, Suzanne M. Garland, and Margaret Hellard. "A chlamydia prevalence survey of young women living in Melbourne, Victoria." Sexual Health 3, no. 4 (2006): 235. http://dx.doi.org/10.1071/sh06033.
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Background: To estimate the population-based chlamydia prevalence among women aged 18 to 35 years living in Melbourne, Victoria, and to assess the feasibility of using mailed urine specimens to test women. Methods: A simple random sample of 11 001 households in Melbourne was selected from the telephone directory. Participants completed telephone interviews and provided urine specimens through the mail for chlamydia testing. Urines were tested using polymerase chain reaction. Results: 11 001 households were contacted, with 1532 households identified as including eligible women; telephone interviews were completed, with 979 women giving a response rate of 64%. Six hundred and fifty-seven women provided a urine specimen with a response rate of 43%. Among sexually active women aged 18–24 years, the chlamydia prevalence was 3.7% (95% CI: 1.2%, 8.4%) and 0.2% (95% CI: 0.0%, 1.1%) among 25–35 year olds. Chlamydia prevalence increased significantly with an increasing number of male sexual partners. Conclusions: This is the first study of its kind in Australia and shows that chlamydia prevalence increases with an increasing number of male sexual partners in the last 12 months. Mailed urine specimens are feasible for conducting population-based chlamydia-prevalence surveys but it is difficult to obtain high response rates with this methodology. Public health resources should now be directed towards investigating how to reach young women at increased risk of infection, ensuring that they are tested for chlamydia.
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Kong, Fabian Y. S., Jane S. Hocking, Chris Kyle Link, Marcus Y. Chen, and Margaret E. Hellard. "Sex and sport: sexual risk behaviour in young people in rural and regional Victoria." Sexual Health 7, no. 2 (2010): 205. http://dx.doi.org/10.1071/sh09071.
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Background: To determine the prevalence of chlamydia and understand sexual risk behaviour in 16–29 year olds in rural Victoria through a chlamydia testing program undertaken at local sporting clubs. Methods: Young people were recruited from the Loddon Mallee region of Victoria, Australia between May and September 2007. After a night of sporting practice, participants provided a first pass urine sample and completed a brief questionnaire about sexual risk behaviour. Those positive for chlamydia were managed by telephone consultation with a practitioner from Melbourne Sexual Health Centre. Results: A total of 709 young people participated (77% male, 23% female) in the study; 77% were sexually active. Overall chlamydia prevalence in sexually active participants was 5.1% (95% confidence interval [CI]: 3.4–7.3); 7.4% in females (95% CI: 3.5–13.6) and 4.5% in males (95% CI: 2.7–6.9). Approximately 60% of males and 20% of females consumed alcohol at high ‘Risky Single Occasion Drinking’ levels at least weekly and 60% had used an illicit drug in their lifetime. Nearly 45% reported having sex in the past year when they usually wouldn’t have because they were too drunk or high. Sexually transmissible infection (STI) knowledge was generally poor and only 25% used a condom the last time they had sex. Conclusion: Chlamydia prevalence was high in our study population. Many participants had poor knowledge about STIs and low condom use. These findings combined with high levels of risky alcohol use and having sex while intoxicated highlights the need for programs in rural and regional Victoria that combine both STI testing and prevention and education programs.
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Lee, D. M. "The incidence of sexually transmitted infections among frequently screened sex workers in a decriminalised and regulated system in Melbourne." Sexually Transmitted Infections 81, no. 5 (October 1, 2005): 434–36. http://dx.doi.org/10.1136/sti.2004.014431.
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Cornelisse, Vincent J., Christopher K. Fairley, Tiffany Phillips, Sandra Walker, and Eric PF Chow. "Fuckbuddy partnerships among men who have sex with men – a marker of sexually transmitted infection risk." International Journal of STD & AIDS 29, no. 1 (July 6, 2017): 44–50. http://dx.doi.org/10.1177/0956462417717647.
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‘Fuckbuddies’ are a type of regular sexual partner with whom men have ongoing sexual contact, generally in the absence of romantic attachment. We surveyed 989 men who have sex with men (MSM) at the Melbourne Sexual Health Centre, Australia, with the aim of determining the frequency of ‘fuckbuddy’ partnerships among sexual health clinic attendees and assessing their sexual risk. The majority (60%) of 1139 regular partnerships were described as ‘fuckbuddies’. Most MSM (63%) with a ‘fuckbuddy’ had multiple ‘fuckbuddies’. MSM with ‘fuckbuddies’ were more likely to also have casual sexual partners (odds ratio [OR] 5.7; 95% confidence interval 3.6–8.9) and had more casual sexual partners (median of 4 versus 1, p < 0.001) and more rectal chlamydia (12.4% versus 5.7%; adjusted OR 2.3; p < 0.05) than MSM without ‘fuckbuddies’, and this risk persisted after adjusting for total numbers of sexual partners. Our findings suggest that patients with ‘fuckbuddies’ are at particular risk of sexually transmitted infections. We argue that clinicians should specifically ask about ‘fuckbuddy’ partnerships as part of their risk assessment during patient interviews, as these patients may benefit from HIV prevention strategies such as pre-exposure prophylaxis (PrEP).
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Greaves, Kate E., Christopher K. Fairley, Jaimie L. Engel, Jason J. Ong, Elena Rodriguez, Tiffany R. Phillips, and Eric P. F. Chow. "Sexual mixing patterns among male–female partnerships in Melbourne, Australia." Sexual Health 19, no. 1 (March 8, 2022): 33–38. http://dx.doi.org/10.1071/sh21161.
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Background Individuals who have both opposite- and same-sex partners have the potential to pass sexually transmitted infections (STIs) between high- and low-risk populations. Our aim was to examine assortative sexual mixing in terms of same-sex activity among male–female partnerships. Methods This was a retrospective repeated cross-sectional study of male–female partnerships attending the Melbourne Sexual Health Centre (MSHC) from 2015 to 2019. Sex of sexual partners was collected via computer-assisted self-interview. We calculated the proportion of partnerships where at least one individual reported same-sex partners in the previous 12 months and the degree of assortativity by bisexuality. Results A total of 2112 male–female partnerships (i.e. 4224 individuals) were included, with a median age of 27 years (IQR 23–31). Overall, 89.3% (1885/2112) of male–female partnerships did not report any other same-sex partners; however, in 9.5% (201/2112) of partnerships, same-sex partners were reported by one individual and in 1.2% (26/2112) of partnerships, both individuals reported same-sex partners. Bisexuality appeared to be slightly assortative in male–female partnerships (r = 0.163, 95% CI: 0.150–0.176; P < 0.001). Conclusion One in 10 individuals in male–female partnerships had at least one same-sex partner within the previous 12 months. Individuals were minorly selective by bisexuality, suggesting the patterns of bisexual mixing in male–female partners are more variable and this may have a significant impact on STI transmission in heterosexual populations.
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Phillips, Tiffany R., Christopher K. Fairley, Catriona S. Bradshaw, Marjan Tabesh, Kate Maddaford, Jane S. Hocking, and Eric PF Chow. "Associations between oral sex practices and frequent mouthwash use in heterosexuals: a cross-sectional survey in Melbourne, Australia." BMJ Open 11, no. 1 (January 2021): e041782. http://dx.doi.org/10.1136/bmjopen-2020-041782.
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ObjectiveThis study aimed to determine the frequency of mouthwash use and its association to oral sex practice in heterosexuals.DesignA cross-sectional study.SettingData obtained from a sexual health clinic in Victoria, Australia, between March 2019 and April 2019.ParticipantsHeterosexual men and women attending the sexual health clinic answered a survey using computer-assisted self-interview.Primary and secondary outcome measuresUnivariable and multivariable logistic regression were performed to examine the association between frequent mouthwash use (ie, daily or weekly mouthwash use) and oral sex practices (including tongue kissing, fellatio, cunnilingus and insertive rimming).ResultsThere were 681 heterosexuals included in the analysis: 315 (46.3%) men and 366 (53.7%) women. Of participants, 302 (44.3%) used mouthwash frequently, 173 (25.4%) used mouthwash infrequently and 206 (30.2%) never used mouthwash. There was no significant difference in the proportion of frequent mouthwash users between men and women (46.4% of men vs 42.6% of women; p=0.329). The proportion of frequent mouthwash users increased with increasing age groups (39.3% in ≤24 years, 45.2% in 25–34 years and 52.8% in ≥35 years or older; ptrend=0.039) with those aged ≥35 years having a 1.80 times (95% CI: 1.12 to 2.89) higher odds of being a frequent mouthwash user than those aged ≤24 years. There were no significant associations between frequent mouthwash users had sexually transmitted infection (STI) risk after adjusting for age and country of birth.ConclusionOlder heterosexuals are more likely to use mouthwash. Given the high proportion and associations of mouthwash use in heterosexuals, future investigations related to oral STIs in this group should include mouthwash use.
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Phillips, Tiffany R., Christopher K. Fairley, Catriona S. Bradshaw, Marjan Tabesh, Kate Maddaford, Jane S. Hocking, and Eric PF Chow. "Associations between oral sex practices and frequent mouthwash use in heterosexuals: a cross-sectional survey in Melbourne, Australia." BMJ Open 11, no. 1 (January 2021): e041782. http://dx.doi.org/10.1136/bmjopen-2020-041782.
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ObjectiveThis study aimed to determine the frequency of mouthwash use and its association to oral sex practice in heterosexuals.DesignA cross-sectional study.SettingData obtained from a sexual health clinic in Victoria, Australia, between March 2019 and April 2019.ParticipantsHeterosexual men and women attending the sexual health clinic answered a survey using computer-assisted self-interview.Primary and secondary outcome measuresUnivariable and multivariable logistic regression were performed to examine the association between frequent mouthwash use (ie, daily or weekly mouthwash use) and oral sex practices (including tongue kissing, fellatio, cunnilingus and insertive rimming).ResultsThere were 681 heterosexuals included in the analysis: 315 (46.3%) men and 366 (53.7%) women. Of participants, 302 (44.3%) used mouthwash frequently, 173 (25.4%) used mouthwash infrequently and 206 (30.2%) never used mouthwash. There was no significant difference in the proportion of frequent mouthwash users between men and women (46.4% of men vs 42.6% of women; p=0.329). The proportion of frequent mouthwash users increased with increasing age groups (39.3% in ≤24 years, 45.2% in 25–34 years and 52.8% in ≥35 years or older; ptrend=0.039) with those aged ≥35 years having a 1.80 times (95% CI: 1.12 to 2.89) higher odds of being a frequent mouthwash user than those aged ≤24 years. There were no significant associations between frequent mouthwash users had sexually transmitted infection (STI) risk after adjusting for age and country of birth.ConclusionOlder heterosexuals are more likely to use mouthwash. Given the high proportion and associations of mouthwash use in heterosexuals, future investigations related to oral STIs in this group should include mouthwash use.
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Lee, David M., Christopher K. Fairley, Jun Kit Sze, Tim Kuo, Rosey Cummings, Jade Bilardi, and Marcus Y. Chen. "Access to sexual health advice using an automated, internet-based risk assessment service." Sexual Health 6, no. 1 (2009): 63. http://dx.doi.org/10.1071/sh08046.
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Background: The present study aimed to determine the sexual risk profile of people using an automated, internet-based service that allows internet users to receive recommendations on sexually transmissible infection screening (‘Check your risk’ (CYR), http://www.checkyourrisk.org.au/), and to compare this with that of patients attending the Melbourne Sexual Health Centre (MSHC) for the first time over the same 6-month period: January–June 2006. Methods: The characteristics of those who used CYR and those who attended MSHC were compared using a χ2-test for categorical variables and the Mann–Whitney U-test for non-parametric data. Results: There were 2492 users who accessed CYR and 2735 who attended MSHC over the period. The age of CYR users was similar to that of MSHC patients when compared according to risk groups. The median number of recent sexual partners reported by CYR users was similar to and not significantly lower than that reported by MSHC patients. Of the 309 CYR users who provided a rating for the CYR site, 215 (70%) rated it as being ‘useful’ to ‘very useful’. Conclusions: Individuals who accessed an automated, internet-based sexual risk assessment service were at substantial risk for sexually transmitted infections, similar to those attending a sexual health service.
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Borg, A. J., G. Medley, and S. M. Garland. "Prevalence of HPV in a Melbourne Female STD Population: Comparison of RNA and DNA Probes in Detecting HPV by Dot Blot Hybridization." International Journal of STD & AIDS 4, no. 3 (May 1993): 159–64. http://dx.doi.org/10.1177/095646249300400307.
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A total of 377 women, consecutively selected as first attenders to a sexually transmitted diseases clinic in Melbourne, Australia, were examined for overt Condylomata acuminata and were screened for genital HPV DNA types 6, 11, 16, 18, 31, 33 and (35) using 2 dot blot hybridization methods. Overall, there was a 90% positivity correlation between the 2 methods with HPV DNA being detected in 12% of ectocervical samples. Overt warts were found in 15% of the women and HPV DNA was detected at the cervix in 35% with cytology predicting HPV with or without dysplasia in 27%. Thirteen percent had a past history of warts but none on examination and HPV DNA was evident in 16% while 18% had cytological features of HPV. Those with no warts evident and no past history of warts had both HPV DNA and cytological features of HPV in 7%.
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Tabrizi, Sepehr N., Barbara A. Paterson, Christopher K. Fairley, Francis J. Bowden, and Suzanne M. Garland. "Comparison of tampon and urine as self-administered methods of specimen collection in the detection of Chlamydia trachomatis , Neisseria gonorrhoeae and Trichomonas vaginalis in women." International Journal of STD & AIDS 9, no. 6 (June 1, 1998): 347–49. http://dx.doi.org/10.1258/0956462981922386.
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1 Department of Microbiology, The Royal Women's Hospital, Victoria, 2 Menzies School of Health Research, Rocklands Drive, Tiwi, 3 Department of Epidemiology and Preventive Medicine, Alfred Hospital, Monash University, Prahran, Victoria and 4 AIDS/STD Unit, Centre for Disease Control, Territory Health Services, Darwin, Australia Summary: Self-administered sampling techniques for the detection of sexually transmitted diseases (STDs) are particularly useful due to their ease of collection and better patient compliance. Urine specimens, and recently tampons, have been described as methods of specimen collection for the detection of some STDs in women. In this study, 660 women had both first-void urine (FVU) and tampon specimens analysed by polymerase chain reaction (PCR) for the detection of Chlamydia trachomatis , Neisseria gonorrhoeae and Trichomonas vaginalis . Overall 6.5%, 10.1% and 17.9% of urine samples were positive whereas 7%, 21.2% and 22% of tampon specimens were positive for C. trachomatis , N. gonorrhoeae and T. vaginalis respectively. Tampon-collected specimens tested by PCR were more sensitive than urine specimens for the detection of N. gonorrhoeae and T. vaginalis ( P 0.001) and equally sensitive for the detection of C. trachomatis ( P =0.45). <
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Petersen, Rodney W., Sepehr N. Tabrizi, Suzanne Garland, and Julie A. Quinlivan. "Prevalence of Chlamydia trachomatis in a public colposcopy clinic population." Sexual Health 4, no. 2 (2007): 133. http://dx.doi.org/10.1071/sh06050.
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Background: Chlamydia trachomatis is a major public health issue, with notifications of this sexually transmitted disease continuing to rise in Australia. Women attending colposcopy clinics are referred for treatment of cervical abnormalities often associated with human papilloma virus (HPV) infection. There is evidence that women who have acquired one sexually transmitted infection, such as HPV, are at higher risk of acquiring another. Women attending colposcopy clinics may therefore be at risk of undiagnosed infection with C. trachomatis. Aim: To determine the prevalence of C. trachomatis in women attending a public metropolitan colposcopy clinic in Victoria. Methods: A cross-sectional study was performed. Institutional ethics committee approval and informed consent were obtained. Consecutive women attending the colposcopy clinic completed a questionnaire and had a swab collected from the endocervix for analysis by polymerase chain reaction for C. trachomatis. Positive screens were treated in accordance with best practice. Data were analysed with Minitab Version 2004 (Minitab Inc, State College, PA, USA). Results: Of 581 women approached to participate in the trial, consent was obtained from 568 women (98%) and final outcome data was available on 560 women (99%). The overall rate of chlamydial infection was 2.1% (95% CI 1.5–2.7%). However, in women aged 25 years or less the rate was 5.8% (95% CI 3.8–7.8%) and in women over 25 years it was only 0.9% (95% CI 0.4–1.4%). Apart from age, no other demographic factor was significantly associated with chlamydial infection. Conclusion: Although the prevalence of chlamydial infection in the colposcopy clinic population as a whole does not warrant a policy for routine screening, screening directed at women aged 25 years or less would gain the greatest yields in terms of cost efficacy. Such a policy should be implemented as standard practice.
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Akobi, William Kala, John Paul Oyore, and George Ochieng Otieno. "Effects of behavioural change communication on HIV and AIDS related high risk behaviour among fishermen in Homabay and Siaya Counties, Kenya." International Journal Of Community Medicine And Public Health 9, no. 6 (May 27, 2022): 2334. http://dx.doi.org/10.18203/2394-6040.ijcmph20221503.
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Background: Risky sexual behaviors such as sexual concurrency, sexual networks (fish for sex exchange) and unprotected sex, have been reported as the main cause of sexually transmitted diseases (STIs) /HIV infections among fisher folks. Behavioral change mechanisms as condom use and abstinence are some of interventions used in prevention HIV/AIDS spread in Kenya. Risky sexual behaviors increase risk of contracting STIs including HIV/AIDSMethods: This was a cross-sectional descriptive study involving 246 randomly selected fisher folks in Mbita- and Usenge along Lake Victoria. The survey used questionnaires to collect data among respondents. Using a sample frame in the beach management unit offices, fisherfolks were identified and invited to participate. Consent was obtained from participantsResults: The mean age of respondents was 31 years old. The 72% of the participants were directly involved in fishing. Participants who had extra marital relationship though married were 56.1% in Mbita and 47% in Usenge. Respondents who took alcohol with friends were 94.1% in Mbita and 96.2% in Usenge. Respondents who indicated that they had unprotected sex under influence of alcohol were 48.3% in Mbita and 77.1% in Usenge. Those who were sexually taken advantage of while under the influence of alcohol were 23.8% in Mbita and 38.3% in Usenge while those had sexually taken advantage of under the influence of alcohol were 18.3% in Mbita and 37.8% in Usenge.Conclusions: Targeted behaviour change communication (BCC) strategies designed specifically for fisherfolks is needed to curb high incidences of risky sexual behaviours noted among the fishermen.
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Pitts, Marian K., Suzanne J. Dyson, Doreen A. Rosenthal, and Suzanne M. Garland. "Knowledge and awareness of human papillomavirus (HPV): attitudes towards HPV vaccination among a representative sample of women in Victoria, Australia." Sexual Health 4, no. 3 (2007): 177. http://dx.doi.org/10.1071/sh07023.
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Background: A vaccine program is underway to protect women against human papillomavirus (HPV) and thus cervical cancer. Previous studies have reported very low levels of HPV knowledge and there has been concern that preventative vaccines might not be readily accepted, given that HPV is transmitted sexually and the optimal time for vaccination is before sexual debut. Methods: A computer-assisted telephone survey was carried out with a representative sample of 1100 women aged 18 to 61 years, randomly selected from households in Victoria, Australia, to investigate knowledge and attitudes about HPV and attitudes towards HPV vaccination. Results: Half of the participants (51%) had heard of HPV; most reported learning about it from the media. Most women indicated they would trust their general practitioner (96.3%), a gynaecologist or specialist doctor (99.6%), or a women’s health service (97.0%) for information about HPV. Few women (11.9%) had ever sought information about HPV and only 14.8% of the total sample had ever discussed HPV with a friend. Strong support was found for vaccination in general and there was also significant support for a HPV vaccine. Conclusion: The present study documents ways in which women learn about HPV and indicates the potential for success of a vaccination program.
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Kwena, Z. A., E. A. Bukusi, M. O. Ng'ayo, A. L. Buffardi, R. Nguti, B. Richardson, N. M. Sang, and K. Holmes. "Prevalence and risk factors for sexually transmitted infections in a high-risk occupational group: the case of fishermen along Lake Victoria in Kisumu, Kenya." International Journal of STD & AIDS 21, no. 10 (October 2010): 708–13. http://dx.doi.org/10.1258/ijsa.2010.010160.
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Goller, Jane L., Jacqueline Coombe, Meredith Temple-Smith, Helen Bittleston, Lena Sanci, Rebecca Guy, Christopher Fairley, et al. "Management of Chlamydia Cases in Australia (MoCCA): protocol for a non-randomised implementation and feasibility trial." BMJ Open 12, no. 12 (December 2022): e067488. http://dx.doi.org/10.1136/bmjopen-2022-067488.
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IntroductionThe sexually transmitted infection chlamydia can cause significant complications, particularly among people with female reproductive organs. Optimal management includes timely and appropriate treatment, notifying and treating sexual partners, timely retesting for reinfection and detecting complications including pelvic inflammatory disease (PID). In Australia, mainstream primary care (general practice) is where most chlamydia infections are diagnosed, making it a key setting for optimising chlamydia management. High reinfection and low retesting rates suggest partner notification and retesting are not uniformly provided. The Management of Chlamydia Cases in Australia (MoCCA) study seeks to address gaps in chlamydia management in Australian general practice through implementing interventions shown to improve chlamydia management in specialist services. MoCCA will focus on improving retesting, partner management (including patient-delivered partner therapy) and PID diagnosis.Methods and analysisMoCCA is a non-randomised implementation and feasibility trial aiming to determine how best to implement interventions to support general practice in delivering best practice chlamydia management. Our method is guided by the Consolidated Framework for Implementation Research and the Normalisation Process Theory. MoCCA interventions include a website, flow charts, fact sheets, mailed specimen kits and autofills to streamline chlamydia consultation documentation. We aim to recruit 20 general practices across three Australian states (Victoria, New South Wales, Queensland) through which we will implement the interventions over 12–18 months. Mixed methods involving qualitative and quantitative data collection and analyses (observation, interviews, surveys) from staff and patients will be undertaken to explore our intervention implementation, acceptability and uptake. Deidentified general practice and laboratory data will be used to measure pre-post chlamydia testing, retesting, reinfection and PID rates, and to estimate MoCCA intervention costs. Our findings will guide scale-up plans for Australian general practice.Ethics and disseminationEthics approval was obtained from The University of Melbourne Human Research Ethics Committee (Ethics ID: 22665). Findings will be disseminated via conference presentations, peer-reviewed publications and study reports.
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Durukan, Duygu, Tim R. H. Read, Gerald Murray, Michelle Doyle, Eric P. F. Chow, Lenka A. Vodstrcil, Christopher K. Fairley, et al. "Resistance-Guided Antimicrobial Therapy Using Doxycycline–Moxifloxacin and Doxycycline–2.5 g Azithromycin for the Treatment of Mycoplasma genitalium Infection: Efficacy and Tolerability." Clinical Infectious Diseases 71, no. 6 (October 20, 2019): 1461–68. http://dx.doi.org/10.1093/cid/ciz1031.
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Abstract Background Macrolide resistance in Mycoplasma genitalium (MG) exceeds 50% in many regions, and quinolone resistance is increasing. We recently reported that resistance-guided therapy (RGT) using doxycycline followed by sitafloxacin or 2.5 g azithromycin cured 92% and 95% of macrolide-resistant and macrolide-susceptible infections, respectively. We present data on RGT using doxycycline–moxifloxacin, the regimen recommended in international guidelines, and extend data on the efficacy of doxycycline–2.5 g azithromycin and de novo macrolide resistance. Methods Patients attending Melbourne Sexual Health Centre between 2017 and 2018 with sexually transmitted infection syndromes were treated with doxycycline for 7 days and recalled if MG-positive. Macrolide-susceptible cases received 2.5 g azithromycin (1 g, then 500 mg daily for 3 days), and resistant cases moxifloxacin (400 mg daily, 7 days). Test of cure was recommended 14–28 days post-antimicrobials. Results There were 383 patients (81 females/106 heterosexual males/196 men who have sex with men) included. Microbial cure following doxycycline–azithromycin was 95.4% (95% confidence interval [CI], 89.7–98.0) and doxycycline–moxifloxacin was 92.0% (95% CI, 88.1–94.6). De novo macrolide resistance was detected in 4.6% of cases. Combining doxycycline–azithromycin data with our prior RGT study (n = 186) yielded a pooled cure of 95.7% (95% CI, 91.6–97.8). ParC mutations were present in 22% of macrolide-resistant cases. Conclusions These findings support the inclusion of moxifloxacin in resistance-guided strategies and extend the evidence for 2.5 g azithromycin and presumptive use of doxycycline. These data provide an evidence base for current UK, Australian, and European guidelines for the treatment of MG.
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Plummer, Erica L., Lenka A. Vodstrcil, Kaveesha Bodiyabadu, Gerald L. Murray, Michelle Doyle, Rosie L. Latimer, Christopher K. Fairley, et al. "Are Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum Associated With Specific Genital Symptoms and Clinical Signs in Nonpregnant Women?" Clinical Infectious Diseases 73, no. 4 (January 27, 2021): 659–68. http://dx.doi.org/10.1093/cid/ciab061.
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Abstract Background There is limited evidence supporting an association between Mycoplasma hominis, Ureaplasma urealyticum, and Ureaplasma parvum with symptoms or disease in nonpregnant women. However, testing and reporting of these organisms frequently occurs, in part due to their inclusion in multiplex-PCR assays for sexually transmitted infection (STI) detection. We investigated if M. hominis, U. urealyticum, and U. parvum were associated with symptoms and/or signs in nonpregnant women attending a sexual health service. Methods Eligible women attending the Melbourne Sexual Health Centre completed a questionnaire regarding sexual practices and symptoms. Symptomatic women underwent examination. Women were assessed for bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC), and tested for M. hominis, U. urealyticum, and U. parvum, and 4 nonviral STIs using a commercial multiplex-PCR. Results 1272 women were analyzed. After adjusting for STIs and VVC, M. hominis was associated with abnormal vaginal discharge (aOR = 2.70, 95%CI:1.92–3.79), vaginal malodor (aOR = 4.27, 95%CI:3.08–5.91), vaginal pH > 4.5 (aOR = 4.27, 95%CI:3.22–5.66), and presence of clue cells (aOR = 8.08, 95%CI:5.68–11.48). Ureaplasma spp. were not associated with symptoms/signs. Bacterial vaginosis was strongly associated with M. hominis (aOR = 8.01, 95%CI:5.99–10.71), but was not associated with either Ureaplasma spp. In stratified analyses, M. hominis was associated with self-reported vaginal malodor and clinician-recorded vaginal discharge in women with BV, but not with symptoms/signs in women without BV. Conclusions Only M. hominis was associated with symptoms/signs, and these were manifestations of BV. Importantly, M. hominis was not associated with symptoms/signs in women without BV. These findings do not support routine testing for M. hominis, U. urealyticum, and U. parvum in nonpregnant women.
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Constantinou, Heidi, Christopher K. Fairley, Catriona S. Bradshaw, Edmond P. H. Choi, Kate Maddaford, Tiffany R. Phillips, and Eric P. F. Chow. "Factors associated with group sex in heterosexual males and females attending a sexual health clinic in Melbourne, Australia: a cross-sectional survey." Sexual Health 19, no. 1 (March 16, 2022): 39–45. http://dx.doi.org/10.1071/sh21224.
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Background There have been limited studies of group sex among heterosexual individuals. This study aimed to explore the factors associated with group sex among heterosexual males and females to improve risk assessment guidelines and inform sexually transmitted infection (STI) screening requirements. Methods A cross-sectional survey was conducted among heterosexual males and females aged ≥16 years attending the Melbourne Sexual Health Centre between March and April 2019. The survey asked about group sex participation, methods used to meet sexual partners, number of casual and/or regular partners, and injection drug use (IDU) in the previous 3 months. HIV and STI (chlamydia, gonorrhoea, syphilis) diagnoses were extracted. A multivariable logistic regression was conducted to identify the factors associated with group sex participation. Results A total of 698 participants (325 males, 373 females) were included and 4.7% (33/698) had participated in group sex in the previous 3 months. The proportion who participated in group sex increased with age (2.1% in 16–24 years, 5.5% in 25–34 years, 7.8% in ≥35 years, ptrend = 0.010). Meeting partners at sex venues (e.g. brothels) was associated with the highest odds of participating in group sex (aOR = 5.74, 95% CI: 1.20–27.44), followed by dating apps (aOR = 2.99, 95% CI: 1.36–6.58), friends/family (aOR = 2.99, 95% CI: 1.34–6.69) and social venues (e.g. bar) (aOR = 2.73, 95% CI: 1.18–6.30). Group sex was strongly associated with STI positivity (aOR = 6.24, 95% CI: 2.41–16.13). There was no association between group sex and sex, casual and/or regular partners, HIV positivity or IDU. Conclusion Heterosexual individuals participating in group sex had a six-fold risk of testing positive for STIs. Including group sex in a sexual history is useful to determine STI risk and inform testing practices. Safe sex messages on group sex that are delivered through multiple methods (e.g. at sex venues, social venues and dating apps simultaneously) would be beneficial.
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Phang, C., J. S. Hocking, C. K. Fairley, C. Bradshaw, P. Hayes, and M. Y. Chen. "26. MORE THAN JUST ANAL SEX: THE POTENTIAL FOR STI TRANSMISSION AMONG MEN VISITING SEX ON PREMISES VENUES IN MELBOURNE." Sexual Health 4, no. 4 (2007): 294. http://dx.doi.org/10.1071/shv4n4ab26.
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Objective: Sex On Premises Venues (SOPVs), where men have sex with other men, provide an environment where the transmission of sexually transmitted infections (STIs) is potentially enhanced. However, the extent to which SOPVs contribute to STI transmission is unknown. This study aimed to obtain detailed data on the types of sexual practices and frequency of these practices among men who have sex with men (MSM) visiting SOPVs in Melbourne, Australia. Methods: In a cross-sectional study, MSM visiting 6 Melbourne SOPVs between December 2006 and February 2007 were asked to complete an exit survey on the types of sexual practices and frequency of such practices they had engaged in at that visit. Of 447 men approached, 150 (34%) participated in the study. Results: The median age of participants was 42.5 years (range 20-79). Among participants who engaged in receptive oral sex (66%) and insertive oral sex (75%), the median number of such acts reported by each man during the visit was 2 (range 1-10) and 2 (range 1-10) respectively. Eleven men (7%) reported receptive oral sex with ejaculation into their mouth with a median of 1 act (range 1-3) per man. Among participants who engaged in receptive anal sex (19%) and insertive anal sex (38%), the median number of such acts per man during the visit was 1 (range 1-4) and 1 (range 1-8) respectively. Eleven men (7%) reported unprotected insertive anal sex with a median of 1 act (range 1-4) per man; 4 (3%) reported unprotected receptive sex. A substantial number of men who did not report any anal sex engaged in practices potentially capable of transmitting infections. Notably, 44 men (29%) reported unprotected rubbing or touching of their penis ('nudging') onto another man's anus without actual anal penetration with a total of 71 other men (median 1 act per man, range 1-10). When specifically asked, 17 (39%) of these men reported that they had not engaged in 'anal sex'. In addition, 32 men (21%) reported being the recipients of 'nudging' with 40 other men. Fourteen (44%) of these men reported not having had any 'anal sex'. Oro-anal sex, whether 'active' or 'passive', was reported by 57 (38%) of men, while 84 (56%) men reported anal penetration using fingers, whether receptive or insertive. A significant minority (11%) of men reported that their ability to have safe sex was compromised by the use of drugs or alcohol. Of note, 58 (39%) men reported having a regular male partner, with whom 23 (40%) had unprotected anal sex. And 13 (9%) reported having a regular female partner, with whom 10 (77%) reportedly had unprotected vaginal or anal sex. Conclusions: The potential for STI transmission between men visiting Melbourne SOPVs and to their partners outside these venues is high. The contribution of what might be perceived as 'safer' sex practices to the transmission of STIs among MSM may have been underrecognised.
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Akobi, William Kala, John Paul Oyore, and George Ochieng Otieno. "Interventional behavioural change communication on HIV and aids related high risk behaviour among fishermen in Homabay and Siaya Counties, Kenya." International Journal Of Community Medicine And Public Health 9, no. 12 (November 28, 2022): 4368. http://dx.doi.org/10.18203/2394-6040.ijcmph20223194.
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Background: Risky sexual behaviors such as sexual concurrency, sexual networks (fish for sex exchange) and unprotected sex, have been reported as the main cause of STIs/HIV infections among the fisher folks. Behavioural change mechanisms such as condom use, and abstinence are some of the interventions used in the prevention HIV/AIDS spread in Kenya.Methods: This was a follow up study on a three tie quasi-experimental study involving 246 randomly selected fisher folks in Mbita and Usenge along Lake Victoria. The study had three phases. baseline, intervention and endline. The survey used questionnaires to collect data among respondents. Using a sample frame in the beach management unit offices, fisherfolks were identified and invited to participate. Consent was obtained from participantsResults: Various variables were influenced by behavior change communication strategies used. These includes use of condom every time of sexual encounter p>0.000, risk associated with non-condom use p>0.004, stopping using condom and fear of getting HIV/AIDS p>0.009, Sexual intercourse without condom use is dangerous p>0.000, whether remembering to use condom every time of sex is difficult P.0.000, whether they are keeping many sexual partners p=0.004, receiving fish/money in exchange for sex in last six months p=0.006.Conclusions: Multiple sexual partners, non-condom use, fish for sex, alcohol consumption and circumcision were significantly associated with risky sexual behavior among the Fisherfolks, therefore other existing interventions need to be intensified to supplement behavior change communication to curb sexually transmitted diseases and further spread of HIV and AIDS.
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Chow, Eric P. F., Ria Fortune, Sheranne Dobinson, Trish Wakefield, Tim R. H. Read, Marcus Y. Chen, Catriona S. Bradshaw, Glenda Fehler, and Christopher K. Fairley. "Evaluation of the Implementation of a New Nurse-Led Express “Test-And-Go” Human Immunodeficiency Virus/Sexually Transmitted Infection Testing Service for Men Who Have Sex With Men at a Sexual Health Center in Melbourne, Australia." Sexually Transmitted Diseases 45, no. 6 (June 2018): 429–34. http://dx.doi.org/10.1097/olq.0000000000000777.
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Lee, D. M., C. K. Fairley, J. Kit Sze, T. Kuo, R. Cummings, J. Bilardi, and M. Y. Chen. "18. INCREASING ACCESS TO SEXUAL HEALTH ADVICE FOR HIGH RISK INDIVIDUALS THROUGH AN AUTOMATED, INTERNET BASED SERVICE." Sexual Health 4, no. 4 (2007): 291. http://dx.doi.org/10.1071/shv4n4ab18.
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Objective: It may be difficult for young people to know if they need testing for sexually transmitted infections and some primary care physicians may be unsure about what tests to order for patients with different risk profiles. Our aim was to help overcome these barriers by implementing an automated, internet based service that allowed internet users to receive specific recommendations for STI screening based on their online responses to a series of questions relating to their recent sexual practices ('Check Your Risk' (CYR), available at: www.mshc.org.au). This study evaluated this service and compared the risk profile of individuals using CYR with that of patients attending a sexual health centre in the same city over the same time period. Methods: An automated and individualised web based algorithm was developed using current recommendations for STI testing. The characteristics of individuals visiting CYR were compared to those attending the Melbourne Sexual Health Centre (MSHC) for the first time over the same 6 month period, from January to June 2006. Results: There were 2492 (59% men, 41% women) who visited the CYR online service and 2735 (59% men, 41% women) who attended the MSHC over the period. 513 (22%) of the men visiting CYR and 467 (18%) of the men visiting MSHC reported sex with other men, with a median of 6 (SD 26.4) and 6 (SD 29.4) partners in the previous 12 months respectively (p�=�0.9). 43 (1.8%) of the women visiting CYR and 54 (2.1%) of the women visiting MSHC reported sex with other women, with a median of 1 (SD 9.3) and 1 (SD 2.1) partners in the previous 12 months respectively (p�=�0.5). Among men reporting sex with women only, the median number of female sex partners in the preceding 12 months was 2 (SD 10.6) and 3 (SD 5.8) for those visiting CYR and MSHC respectively (p�=�0.8). For women reporting sex with men only, the median number of male partners was 2 (SD 11.1) and 2 (SD 4) for those visiting CYR and MSHC respectively (p�=�0.03). Participants responded favourably to the CYR online service, with 70% rating it as 'useful'; or 'very useful'. Conclusions: This internet based sexual risk assessment tool was accessed frequently by individuals with a high risk profile that was similar to those who attended the sexual health service in the same city. The CYR service cost A$4000 to set up. CYR effectively increased the outreach of the centre's services substantially, via the internet and was given a positive rating by the majority of its users.
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Henning, D., C. Parrott, T. Read, S. Cook, and CS Bradshaw. "Homelessness, sex and a tale of two sexually transmitted infections." International Journal of STD & AIDS, November 9, 2020, 095646242095890. http://dx.doi.org/10.1177/0956462420958904.
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The Young People’s Health Service (YPHS) is a free, nurse-led Primary Health Care Clinic, in Melbourne, for young people aged 12–24 who are experiencing homelessness. Sexually transmitted infection (STI) screening is routinely offered as part of comprehensive psychosocial assessments. We wanted to determine the number of people positive for Chlamydia trachomatis (Ct) and Mycoplasma genitalium (Mg), amongst this asymptomatic high-risk population. We also wanted to review our screening practice. All asymptomatic sexually active clients seen by YPHS between 2014 and 2016 were offered a first pass urine polymerase chain reaction-based test for Ct and Mg. Urine samples were taken for men and women. Positivity for Ct and Mg out of those tested was determined and association with gender examined. Between 2014–2016, 272 males and 278 females (n = 550) were screened for Ct, and 72 infections were detected (13.1%. Chlamydia positivity did not differ between males (n = 35; 12.9%, 95% confidence interval [CI]: 8.8–16.8) and females (n = 37; 13.3%, 95%CI: 9.3–17.3). Over the same period 273 males and 284 females were screened for Mg (n = 557) and 55 infections were detected (9.9%). A higher proportion of females (n = 35; 12.3%, 95%CI: 8.5–16.1) tested positive compared to males (n = 20; 7.3%, 95%CI: 4.2–10.4), p = 0.048. Our study demonstrates both Ct and Mg are prevalent in the population, Mg being more common in young women than young men. Referral for specialist care for macrolide-resistant Mg increased and the updated Australian STI management guidelines led to a review of practice.
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Turek, Evelyn M., Christopher K. Fairley, Marjan Tabesh, Tiffany R. Phillips, Catriona S. Bradshaw, Elena Rodriguez, and Eric P. F. Chow. "HIV, sexually transmitted infections and sexual practices among male sex workers attending a sexual health clinic in Melbourne, Australia, 2010-2018." Sexually Transmitted Diseases Publish Ahead of Print (September 2, 2020). http://dx.doi.org/10.1097/olq.0000000000001283.
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Tabesh, Marjan, Christopher K. Fairley, Jane S. Hocking, Deborah A. Williamson, Lei Zhang, Xianglong Xu, Catriona S. Bradshaw, Marcus Y. Chen, and Eric PF Chow. "Comparison of the patterns of chlamydia and gonorrhoea at the oropharynx, anorectum and urethra among men who have sex with men." Sexually Transmitted Infections, January 12, 2021, sextrans—2020–054632. http://dx.doi.org/10.1136/sextrans-2020-054632.
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ObjectiveChlamydia and gonorrhoea are common sexually transmitted infections that infect the oropharynx, anorectum and urethra in men who have sex with men (MSM). This study aimed to examine the pattern of infection at more than one site (multisite) for chlamydia and gonorrhoea among MSM.MethodsThis was a retrospective study of MSM attending the Melbourne Sexual Health Centre for the first time between 2018 and 2019. We included MSM aged ≥16 years who had tested for Neisseria gonorrhoeae and Chlamydia trachomatis at all three sites (oropharynx, anorectum and urethra). We compared infections that occurred at a single site (termed single-site infection) and those that occurred at more than one site (termed multisite infections).ResultsOf the 3938 men who were tested for chlamydia and gonorrhoea, 498/3938 men (12.6%, 95% CI 11.5% to 13.6%) had chlamydia at any site, of whom 400/498 (80.3%, 95% CI 78.9% to 81.2%) had single-site chlamydia infection, and 98/498 (19.7%, 95% CI 16.2% to 23.1%) had multisite infections. A similar proportion of men had gonorrhoea at any site (447/3938, 11.4%, 95% CI 10.3% to 12.2%), but among these 447 men, single-site infection was less common (256/447, 57.3%, 95% CI 52.6% to 61.7%, p<0.001) and multisite infection (191/447, 42.7%, 95% CI 38.2% to 47.3%, p<0.001) was more common than chlamydia. There were also marked differences by anatomical site. Urethral infection commonly occurred as single sites (75/122, 61.5%, 95% CI 52.8% to 70.1%) for chlamydia but uncommonly occurred for gonorrhoea (12/100, 12.0%, 95% CI 5.6% to 18.3%, p<0.001). In contrast, anorectal infection uncommonly occurred as multisite infection for chlamydia (98/394, 24.9%, 95% CI 20.6% to 29.1%) but was common (184/309, 59.5%, 95% CI 54.0% to 64.9%, p<0.001) for gonorrhoea.ConclusionsThe markedly different pattern of site-specific infection for chlamydia and gonorrhoea infections among the same MSM suggests significant differences in the transmissibility between anatomical sites and the duration of each infection at each site.