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Sexually transmitted diseases 04/2013; 40(4):290-291. · 2.58 Impact Factor
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BMC Infectious Diseases 03/2013; 13(140). · 3.12 Impact Factor
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ABSTRACT: OBJECTIVES: Human papillomavirus (HPV) types 6 and 11 are most commonly associated with ano-genital warts. There are few data on the sero-epidemiology of HPV6 and HPV11 among homosexual men. METHODS: Behavioural data and sera for antibodies to HPV6 and HPV11 capsid protein L1 werecollected annually for 1427 HIV negative and 245 HIV positive homosexual men. For HIV negative men, a combined variable, HPV6/11, was created (HPV 6 and/or 11) to analyse predictors of seroprevalence and seroincidence. RESULTS: High rates of HPV6 and HPV11 seroprevalence were found (39.2 - 53.2% of men). For HPV6/11 (HIV negative men only), seroprevalence was associated with higher numbers ofsexual partners, longer history of sexual activity and seropositivity for several sexually transmissible infections. Each year, 12.6% of men younger than 25 years seroconverted. Seroincidence (5.9/100PY) was associated with younger age, more recent male sexual partners, receptive anal fingering and anal chlamydia. Seropositivity and seroconversion were strongly associated with past and incident anal warts. CONCLUSIONS: HPV6 and HPV11 seropositivity were common among homosexual men. Among HIV negative men, HPV 6/11 seroprevalence and seroincidence correlated closely with markers of sexual activity. The high numbers of young men seroconverting each year suggests a role for prophylactic vaccination of young gay men. SUMMARY: Ano-genital warts, caused by human papillomavirus, are very common. In a community cohort of Australian homosexual men, HPV6 and 11 seroprevalence and seroincidence were high and were associated with past and incident anal warts and other markers of sexual activity.
The Journal of infection 03/2013; · 4.13 Impact Factor
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ABSTRACT: BACKGROUND: There has been a rapid decline in the number of young heterosexuals diagnosed with genital warts at outpatient sexual health services since the national human papillomavirus (HPV) vaccination program started in Australia in 2007. We assessed the impact of the vaccination program on the number of in-patient treatments for genital warts. METHODS: Data on in-patient treatments of genital warts in all private hospitals were extracted from Medicare website. Medicare is the universal health insurance scheme of Australia. In the vaccine period (2007--2011) and pre-vaccine period (2000--2007) we calculated the percentage change in treatment numbers and trends in annual treatment rates in private hospitals. Australian population data were used to calculate rates. Summary rate ratios of average annual trends were determined. RESULTS: Between 2000 and 2011, 6,014 women and 936 men aged 15--44 years underwent in-patient treatment for genital warts in private hospitals. In 15--24 year old women, there was a significant decreasing trend in annual treatment rates in the vaccine period (overall decrease of 85.3% in treatment numbers from 2007 to 2011) compared to no significant trend in the pre-vaccine period (summary rate ratio (SRR) = 0.33, p < 0.001). In 25--34 year old women, declining trends were seen in both vaccine and pre-vaccine periods (overall decrease of 33% vs. 24.3%), but the rate of change was greater in the vaccine period (SRR = 0.60, p < 0.001). In 35--44 year old women, there was no significant change in both periods (SRR = 0.91, p = 0.14). In 15--24 year old men, there was a significant decreasing trend in annual treatment rates in the vaccine period (decrease of 70.6%) compared to an increasing trend in the pre-vaccine period (SRR = 0.76, p = 0.02). In 25--34 year old men there was a significant decreasing trend in the vaccine period compared to no change in the pre-vaccine period (SRR = 0.81, p = 0.04) and in 35--44 year old men there was no significant change in both periods, but the rate of change was greater in the vaccine period (SRR = 0.70, p = 0.02). CONCLUSIONS: The marked decline in in-patient treatment of genital warts in the youngest women is probably attributable to the HPV vaccine program. The moderate decline in in-patient treatments for genital warts in men probably reflects herd immunity.
BMC Infectious Diseases 03/2013; 13(1):140. · 3.12 Impact Factor
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ABSTRACT: Background: In many countries, low Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) screening rates among young people in primary-care have encouraged screening programs outside of clinics. Nucleic acid amplification tests (NAATs) make it possible to screen people in homes with self-collected specimens. We systematically reviewed the strategies and outcomes of home-based CT/NG screening programs. Methods: Electronic databases were searched for home-based CT and/or NG screening studies published since January 2005. Screening information (e.g. target group, recruitment and specimen-collection method) and quantitative outcomes (e.g. number of participants, tests and positivity) were extracted. The screening programs were classified into seven groups on the basis of strategies used. Results: We found 29 eligible papers describing 32 home-based screening programs. In seven outreach programs, people were approached in their homes: a median of 97% participants provided specimens and 76% were tested overall (13717 tests). In seven programs, people were invited to receive postal test-kits (PTKs) at their homes: a median of 37% accepted PTKs, 79% returned specimens and 19% were tested (46225 tests). PTKs were sent along with invitation letters in five programs: a median of 33% returned specimens and 29% of those invited were tested (15126 tests). PTKs were requested through the internet or phone without invitations in four programs and a median of 32% returned specimens (2666 tests). Four programs involved study personnel directly inviting people to receive PTKs: a median of 46% accepted PTKs, 21% returned specimens and 9.1% were tested (341 tests). PTKs were picked-up from designated locations in three programs: a total of 6765 kits were picked-up and 1167 (17%) specimens were returned for screening. Two programs used a combination of above strategies (2395 tests) but the outcomes were not reported separately. The overall median CT positivity was 3.6% (inter-quartile range: 1.7-7.3%). Conclusions: A variety of strategies have been used in home-based CT/NG screening programs. The screening strategies and their feasibility in the local context need to be carefully considered to maximize the effectiveness of home-based screening programs.
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The Medical journal of Australia 02/2013; 198(2):83-4. · 2.81 Impact Factor
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Jennifer Walker,
Christopher K Fairley,
Catriona S Bradshaw,
Sepehr N Tabrizi,
Jimmy Twin,
Marcus Y Chen,
Nicole Taylor, Basil Donovan,
John M Kaldor,
Kathleen McNamee, [......],
Sandra Walker,
Marian Currie,
Hudson Birden,
Francis J Bowden,
Jane Gunn,
Marie Pirotta,
Lyle Gurrin,
Veerakathy Harindra,
Suzanne M Garland,
Jane S Hocking
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ABSTRACT: Background. Mycoplasma genitalium (MG) is an emerging sexually transmitted infection (STI) that is potentially associated with serious reproductive tract sequelae in women. This study aimed to estimate rates of MG incidence and treatment failure and provide estimates of organism load for MG infections.Methods. 1110 women aged 16 to 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 PCR. All MG positive cases were also screened for MG 23S rRNA gene point mutations shown to confer azithromycin resistance using high resolution melt following PCR.Results. MG incidence rate was 1.3 per 100 person years (95% CI: 0.8, 2.3) (n=14) and women reporting three or more sex partners in the last 12 months had an increased rate of incident infection [RR=5.1 (95%CI: 1.3, 19.6)]. There were 3 cases of MG re-infection with a re-infection rate of 0.8 per 100 person years (95% CI: 0.1, 0.9). Organism load was higher for prevalent than incident infection (p=0.04). There were 3 cases of treatment failure cases [9.4% (95%CI: 2.0, 25.0)] and organism load was higher in the cases with treatment failure than the successfully treated cases (p<0.01). An MG 23S rRNA mutation was detected in 5 cases; 3 cases of treatment failure and 2 successfully treated cases.Conclusions. While MG incidence was relatively low, testing should be recommended for women considered to be at increased risk of infection based on sexual history. Our results also suggest that organism load might be important in influencing azithromycin treatment failure.
Clinical Infectious Diseases 01/2013; · 9.15 Impact Factor
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ABSTRACT: OBJECTIVES: To determine if the provision of condoms to prisoners in two Australian state prison systems with different policies affects sexual behaviour. In New South Wales' (NSW) prisons, condoms are freely distributed, while in Queensland prisons none are distributed. METHODS: We used a computer-assisted telephone interview to survey randomly selected prisoners in both states about their sexual behaviour in prison. RESULTS: Two thousand and eighteen male prisoners participated. The proportion of prisoners reporting anal sex in prison was equally low in NSW (3.3%) and Queensland (3.6%; p=0.8). A much higher proportion of prisoners who engaged in anal sex in NSW (56.8%) than Queensland (3.1%; p<0.0001) reported they had used a condom if they had had anal sex in prison. Sexual coercion was equally rare in both prison systems. CONCLUSIONS: We found no evidence that condom provision to prisoners increased consensual or non-consensual sexual activity in prison. If available, condoms were much more likely to be used during anal sex. Condoms should be made available to prisoners as a basic human right.
Sexually transmitted infections 01/2013; · 2.18 Impact Factor
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ABSTRACT: We report the prevalence of penile implants among prisoners and determine the independent predictors for having penile implants. Questions on penile implants were included in the Sexual Health and Attitudes of Australian Prisoners (SHAAP) survey following concerns raised by prison health staff that increasing numbers of prisoners reported having penile implants while in prison.
Computer-Assisted Telephone Interviewing (CATI) of a random sample of prisoners was carried out in 41 prisons in New South Wales and Queensland (Australia). Men were asked, "Have you ever inserted or implanted an object under the skin of your penis?" If they responded Yes: "Have you ever done so while you were in prison?" Univariate logistic regression and logistic regression were used to determine the factors associated with penile implants.
A total of 2,018 male prisoners were surveyed, aged between 18 and 65 years, and 118 (5.8%) reported that they had inserted or implanted an object under the skin of their penis. Of these men, 87 (73%) had this done while they were in prison. In the multivariate analysis, a younger age, birth in an Asian country, and prior incarceration were all significantly associated with penile implants (p<0.001). Men with penile implants were also more likely to report being paid for sex (p<0.001), to have had body piercings (p<0.001) or tattoos in prison (p<0.001), and to have taken non-prescription drugs while in prison (p<0.05).
Penile implants appear to be fairly common among prisoners and are associated with risky sexual and drug use practices. As most of these penile implants are inserted in prison, these men are at risk of blood borne viruses and wound infection. Harm reduction and infection control strategies need to be developed to address this potential risk.
PLoS ONE 01/2013; 8(1):e53065. · 4.09 Impact Factor
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Catriona S Bradshaw,
Jennifer Walker,
Christopher K Fairley,
Marcus Y Chen,
Sepehr N Tabrizi, Basil Donovan,
John M Kaldor,
Kathryn McNamee,
Eve Urban,
Sandra Walker,
Marian Currie,
Hudson Birden,
Francis Bowden,
Suzanne Garland,
Marie Pirotta,
Lyle Gurrin,
Jane S Hocking
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ABSTRACT: To determine prevalence and incidence of bacterial vaginosis (BV) and risk factors in young sexually-active Australian women.
1093 women aged 16-25 years were recruited from primary-care clinics. Participants completed 3-monthly questionnaires and self-collected vaginal smears 6-monthly for 12-months. The primary endpoint was a Nugent Score = 7-10 (BV) and the secondary endpoint was a NS = 4-10 (abnormal flora [AF]). BV and AF prevalence estimates and 95% confidence intervals (95%CI) were derived, and adjusted odds ratios (AOR) calculated to explore epidemiological associations with prevalent BV and AF. Proportional-hazards regression models were used to examine factors associated with incident BV and AF.
At baseline 129 women had BV [11.8% (95%CI: 9.4-14.2)] and 188 AF (17.2%; 15.1-19.5). Prevalent BV was associated with having a recent female partner [AOR = 2.1; 1.0-4.4] and lack of tertiary-education [AOR = 1.9; 1.2-3.0]; use of an oestrogen-containing contraceptive (OCC) was associated with reduced risk [AOR = 0.6; 0.4-0.9]. Prevalent AF was associated with the same factors, and additionally with >5 male partners (MSP) in 12-months [AOR = 1.8; 1.2-2.5)], and detection of or [AOR = 2.1; 1.0-4.5]. There were 82 cases of incident BV (9.4%;7.7-11.7/100 person-years) and 129 with incident AF (14.8%; 12.5-17.6/100 person-years). Incident BV and AF were associated with a new MSP [adjusted rate ratio (ARR) = 1.5; 1.1-2.2 and ARR = 1.5; 1.1-2.0], respectively. OCC-use was associated with reduced risk of incident AF [ARR = 0.7; 0.5-1.0].
This paper presents BV and AF prevalence and incidence estimates from a large prospective cohort of young Australian women predominantly recruited from primary-care clinics. These data support the concept that sexual activity is strongly associated with the development of BV and AF and that use of an OCC is associated with reduced risk.
PLoS ONE 01/2013; 8(3):e57688. · 4.09 Impact Factor
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ABSTRACT: In many countries, low Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) screening rates among young people in primary-care have encouraged screening programs outside of clinics. Nucleic acid amplification tests (NAATs) make it possible to screen people in homes with self-collected specimens. We systematically reviewed the strategies and outcomes of home-based CT/NG screening programs.
Electronic databases were searched for home-based CT and/or NG screening studies published since January 2005. Screening information (e.g. target group, recruitment and specimen-collection method) and quantitative outcomes (e.g. number of participants, tests and positivity) were extracted. The screening programs were classified into seven groups on the basis of strategies used.
We found 29 eligible papers describing 32 home-based screening programs. In seven outreach programs, people were approached in their homes: a median of 97% participants provided specimens and 76% were tested overall (13717 tests). In seven programs, people were invited to receive postal test-kits (PTKs) at their homes: a median of 37% accepted PTKs, 79% returned specimens and 19% were tested (46225 tests). PTKs were sent along with invitation letters in five programs: a median of 33% returned specimens and 29% of those invited were tested (15126 tests). PTKs were requested through the internet or phone without invitations in four programs and a median of 32% returned specimens (2666 tests). Four programs involved study personnel directly inviting people to receive PTKs: a median of 46% accepted PTKs, 21% returned specimens and 9.1% were tested (341 tests). PTKs were picked-up from designated locations in three programs: a total of 6765 kits were picked-up and 1167 (17%) specimens were returned for screening. Two programs used a combination of above strategies (2395 tests) but the outcomes were not reported separately. The overall median CT positivity was 3.6% (inter-quartile range: 1.7-7.3%).
A variety of strategies have been used in home-based CT/NG screening programs. The screening strategies and their feasibility in the local context need to be carefully considered to maximize the effectiveness of home-based screening programs.
BMC Public Health 01/2013; 13:189. · 2.00 Impact Factor
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ABSTRACT: OBJECTIVE: To measure the effect on genital warts of the national human papillomavirus vaccination programme in Australia, which started in mid-2007. DESIGN: Trend analysis of national surveillance data. SETTING: Data collated from eight sexual health services from 2004 to 2011; the two largest clinics also collected self reported human papillomavirus vaccination status from 2009. PARTICIPANTS: Between 2004 and 2011, 85 770 Australian born patients were seen for the first time; 7686 (9.0%) were found to have genital warts. MAIN OUTCOME MEASURE: Rate ratios comparing trends in proportion of new patients diagnosed as having genital warts in the pre-vaccination period (2004 to mid-2007) and vaccination period (mid-2007 to the end of 2011). RESULTS: Large declines occurred in the proportions of under 21 year old (92.6%) and 21-30 year old (72.6%) women diagnosed as having genital warts in the vaccination period-from 11.5% in 2007 to 0.85% in 2011 (P<0.001) and from 11.3% in 2007 to 3.1% in 2011 (P<0.001), respectively. No significant decline in wart diagnoses was seen in women over 30 years of age. Significant declines occurred in proportions of under 21 year old (81.8%) and 21-30 year old (51.1%) heterosexual men diagnosed as having genital warts in the vaccination period-from 12.1% in 2007 to 2.2% in 2011 (P<0.001) and from 18.2% in 2007 to 8.9% in 2011 (P<0.001), respectively. No significant decline in genital wart diagnoses was seen in heterosexual men over 30 years of age. In 2011 no genital wart diagnoses were made among 235 women under 21 years of age who reported prior human papillomavirus vaccination. CONCLUSIONS: The significant declines in the proportion of young women found to have genital warts and the absence of genital warts in vaccinated women in 2011 suggests that the human papillomavirus vaccine has a high efficacy outside of the trial setting. Large declines in diagnoses of genital warts in heterosexual men are probably due to herd immunity.
BMJ (Clinical research ed.). 01/2013; 346:f2032.
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Anna L Bowring,
Jane L Goller,
Maelenn Gouillou,
Caroline Harvey,
Deborah Bateson,
Kathleen McNamee,
Christine Read,
Douglas Boyle,
Lynne Jordan,
Robyn Wardle,
Anne Stephens, Basil Donovan,
Rebecca Guy,
Margaret Hellard
Sexual Health 12/2012; · 1.45 Impact Factor
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Sexual Health 12/2012; · 1.45 Impact Factor
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ABSTRACT: BACKGROUND: Syphilis is a growing public health problem among men who have sex with men (MSM) globally. Rapid and accurate detection of syphilis is vital to ensure patients and their contacts receive timely treatment and reduce ongoing transmission. METHODS: We evaluated a PCR assay for the diagnosis of Treponema pallidum using swabs of suspected early syphilis lesions in longitudinally assessed MSM. RESULTS: We tested 260 MSM for T pallidum by PCR on 288 occasions: 77 (26.7%) had early syphilis that was serologically confirmed at baseline or within six weeks, and 211 (73.3%) remained seronegative for syphilis. Of 55 men with primary syphilis, 49 were PCR positive, giving a sensitivity of 89.1% (95% CI: 77.8%-95.9%) and a specificity of 99.1% (95% CI: 96.5%-99.9%). Of 22 men with secondary syphilis, 11 were PCR positive, giving a sensitivity of 50% (95% CI: 28.2%-71.8%) and a specificity of 100% (95% CI: 66.4%-71.8%). Of the 77 syphilis cases, 43(56%) were HIV positive and the sensitivity and specificity of the PCR test did not vary by HIV status. The PCR test was able to detect up to five (10%) primary infections that were initially seronegative, including one HIV positive man with delayed seroconversion to syphilis (72 to 140 days) and one HIV positive man who did not seroconvert to syphilis over 14 months follow-up. Both men had been treated for syphilis within a week of the PCR test. CONCLUSIONS: T pallidum PCR is a potentially powerful tool for the early diagnosis of primary syphilis, particularly where a serological response has yet to develop.
BMC Infectious Diseases 12/2012; 12(1):353. · 3.12 Impact Factor
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ABSTRACT: To assess notification trends for chlamydia and gonorrhoea infections in Indigenous Australians compared with non-Indigenous Australians in 2000-2009. Design and setting: We assessed trends in national notification rates using univariate Poisson regression and summary rate ratios.
Crude notification rates and summary rate ratios, by Indigenous status, sex, age and area of residence.
Over the 10-2012 period studied, chlamydia notification rates per 100 000 increased by 80% from 1383 in 2000 to 2494 in 2009 among Indigenous people, and by 335% from 51 in 2000 to 222 in 2009 among non-Indigenous people. The Indigenous versus non-Indigenous summary rate ratio was 23.92 (95% CI, 23.65-24.19; P < 0.001). Gonorrhoea notification rates per 100 000 increased by 22% from 1347 in 2000 to 1643 in 2009 among Indigenous people, and by 70% from 10 in 2000 to 17 in 2009 among non-Indigenous people. The gonorrhoea summary notification rate ratio in Indigenous compared with non-Indigenous people was 173.78 (95% CI, 170.81-176.80; P < 0.001). In Indigenous people, the highest chlamydia and gonorrhoea notification rates were in women, 15-19-2012-olds, and those living in remote areas.
Chlamydia and gonorrhoea notification rates have increased in both populations but were higher among Indigenous people. Our findings highlight the need for targeted prevention programs for young people, especially Indigenous Australians residing in remote areas.
The Medical journal of Australia 12/2012; 197(11):642-6. · 2.81 Impact Factor
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Sexual Health 11/2012; · 1.45 Impact Factor
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Jennifer Walker,
Sandra Walker,
Christopher K Fairley,
Jade Bilardi,
Marcus Y Chen,
Catriona S Bradshaw,
Eve Urban,
Marie Pirotta,
Hudson Birden, Basil Donovan,
John M Kaldor,
Jane Gunn,
Jane S Hocking
Sexual Health 11/2012; · 1.45 Impact Factor
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ABSTRACT: Background We sought to determine whether gay men would be willing to increase syphilis testing and partner notification, and assessed the possible epidemiological impact these changes might have in the Australian population. Methods: We conducted an online survey (n=2306) and focus groups to determine whether interventions to increase testing for syphilis and enhanced partner notification are likely to be acceptable to gay men in Australia. An individual-based mathematical model was developed to estimate the potential population-level impact of changes in these factors. Results: Of all men surveyed, 37.3% felt they should test more frequently for sexually transmissible infections. Men who recent unprotected anal intercourse with casual partners and men who reported a higher number of partners were more likely to indicate a greater willingness to increase testing frequency. HIV-positive men were more likely to indicate that their frequency of syphilis testing was adequate, incorporated as part of their regular HIV monitoring. Lack of convenience was the main barrier reported. Partner notification was broadly acceptable, although perceived stigma presented a potential barrier. The mathematical model indicated that increasing testing rates would have a substantial impact on reducing rates of syphilis infection among gay men and partner notification would further reduce infections. Conclusions: Interventions promoting testing for syphilis among gay men and increases in partner notification may be acceptable to gay men and are likely to result in decreased infection rates. Rapid testing and modern communication technologies could strengthen these interventions, and have an impact on the syphilis epidemic.
Sexual Health 11/2012; 9(5):472-80. · 1.45 Impact Factor
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ABSTRACT: OBJECTIVES: Systematic review of the performance and operational characteristics of point-of-care (POC) tests for the diagnosis of Neisseria gonorrhoeae. METHODS: We searched PubMed and Embase until August 2010 using variations of the terms: 'rapid test', 'Neisseria gonorrhoeae' and 'evaluation'. RESULTS: We identified 100 papers, 14 studies were included; nine evaluated leucocyte esterase (LE) dipsticks and three immunochromatographic strips, and two clinical audits of microscopy were identified. Of the field evaluations the gold standard was nucleic acid amplification technology in six studies and bacterial culture in the other six. In four studies, 50% or more of the patients were symptomatic. The median sensitivity of LE dipsticks was 71% (range 23-85%), median specificity was 70% (33-99%), median positive predictive value (PPV) was 19% (5-40%) and median negative predictive value (NPV) was 95% (56-99%). One LE study found a sensitivity of 23% overall, increasing to 75% in symptomatic women. LE dipsticks mostly involved three steps and took under 2 min. The median sensitivity of immunochromatographic tests (ICT) was 70% (60-94%), median specificity was 96% (89-97%), median PPV was 56% (55-97%) and median NPV was 93% (92-99%). Immunochromatic strips involved five to seven steps and took 15-30 min. Specificity of microscopy ranged from 38% to 89%. CONCLUSIONS: ICT and LE tests had similar sensitivities, but sensitivity results may be overestimated as largely symptomatic patients were included in some studies. ICT had a higher specificity in women than LE tests. The findings highlight the need for improved POC tests for diagnosis of N gonorrhoeae and more standardised evaluations.
Sexually transmitted infections 10/2012; · 2.18 Impact Factor
