2005 Participant Summaries

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Study:
Introduction of screening guidelines for men who have sex with men at an STD clinic, the Melbourne Sexual Health Centre, Australia

Researchers:
Lister NA, Smith A, Fairley CK

Publication:

Sexual Health 2005; 2(4) 241-244

Summary: An observational study was conducted before and after the introduction of a computer reminder (alert) to investigate the impact of new screening guidelines for men-who-have-sex-with-men (MSM). The alert was installed one month after publication of the guidelines. There was a significant increase in the number of MSM tested for rectal chlamydial infection, and a decrease in pharyngeal testing. A high proportion had asymptomatic infection (7%). This finding is consistent with improved clinical practice following the introduction of computer reminders/alerts.


 

Study:
Men, bodily change and urethritis: a qualitative study.

Researchers:
Pitts MK, Smith AMA, Mischewski A, Fairley CK

Publication: 
Sexual Health 2005; 2(1): 25-28
    
Summary: 
Eighteen men were interviewed with a confirmed diagnosis of urethritis to obtain information on how men understand and interpret their bodily changes in the genital region, and whether they accurately are able to indicate the presence of a sexually transmitted infection (STI). The full range of bodily changes from minimal to major were described, and there appeared to be little, if any, relationship between the bodily changes observed and the subsequent clinical diagnosis. This would be important for physicians to recognize and for education campaigns to emphasize the lack of relation between signs and symptoms and likelihood of infection.



Study:
Higher-risk behavioral practices associated with bacterial vaginosis compared with vaginal candidiasis

Researchers:
Bradshaw CS, Morton AN, Garland SM, Morris MB, Moss LM, Fairley CK

Publication:
Obstetrics & Gynecology 2005; 106(1): 105-113
 
Summary: The study investigated whether bacterial vaginosis (BV) is associated with specific sexual practices or has features in common with a sexually transmitted disease. Behavioural associations were compared in women with BV and women with vaginal thrush (candidiasis). Of 157 women diagnosed with BV, indicators of high risk sexual behaviour such as a new sexual partner, a greater number of male partners in the last year, increased number of lifetime partners, less than 13 years of education, a past history of pregnancy and smoking were more commonly associated than among 146 women with vaginal thrush. Vaginal thrush was related to receptive anal and oral sex, and douching.

The study investigated whether bacterial vaginosis (BV) is associated with specific sexual practices or has features more in common with a sexually transmitted disease. Behavioural practices in women with BV compared to women with candidiasis were compared. BV was associated with indicators of high risk sexual behaviour such as a new sexual partner, a greater number of male partners in the last year, increased number of lifetime partners, less than 13 years of education, a past history of pregnancy and smoking. Conversely, candidiasis was not associated with these high-risk behaviours, and was instead related to practices such as receptive anal and oral sex and douching.  In conclusion the association between BV and practices that are strongly associated with STIs, in contrast to those observed with candidiasis, suggests a sexually transmitted aetiology.


 

Study:
Evaluation of a point-of-care test, BVBlue, and clinical and laboratory criteria for the diagnosis of bacterial vaginosis

Researchers:
Bradshaw CK, Morton AN, Garland SM, Horvath LB, Kuzevska I, Fairley CK.

Publication:
Journal of Clinical Microbiology 2005; 43(3): 1304-1308

Summary:
Bacterial vaginosis (BV) remains the commonest cause of abnormal vaginal discharge in women of reproducing age. BV is associated with increased susceptibility to HIV and sexually transmitted infections (STIs), and preterm delivery. Current diagnostic methods require access to microscopy and laboratory expertise. However the majority of women, particularly in high prevalence populations, do not have access to clinical services with onsite microscopy. A ‘point-of-care’ (rapid on-site) test for the diagnosis of BV, the BVBlue test was evaluated in 288 women attending the Centre with symptoms of abnormal discharge.  BVBlue performed well against conventional diagnostic methods for assessing women with symptoms suggestive of BV at the bedside, and significantly better than other simple tests such as vaginal pH and the amine test that do not require microscopy. BVBlue was sensitive (88%) and specific (95%) when compared to the Nugent method, and performed well against the Amsel method with a sensitivity of 88% and specificity of 91%. In summary BVBlue is a simple, rapid and objective test for the diagnosis of BV, and has the potential to facilitate prompt diagnosis and appropriate treatment of BV in the absence of microscopy. The majority of women at greatest risk of the sequelae of BV are not in settings where the conventional diagnostic methods are either practical or possible, and they would greatly benefit from access to rapid and reliable point-of-care tests to improve diagnosis and management of BV.



Study:
Symptoms of non-gonococcal urethritis in heterosexual men - a case control study

Researchers:
Iser P, Read T, Tabrizi S, Bradshaw C, Lee C, Horvath L, Garland S, Denham I,     Fairley CK    

Publication:
Sexually Transmitted Infections 2005; 81: 163-165
     
Summary:
This study was conducted to determine the bacterial and behavioural factors contributing to non-gonococcal urethral symptoms in men. Eighty men with urethral discharge, burning urine or urethral discomfort and 79 controls without any urethral symptoms were included in the study.  The study showed that heterosexual men with urethral symptoms are more likely to have bacteria isolated from their urine, including Chlamydia trachomatis, Gardnerella vaginalis and streptococci than the controls without symptoms. Unprotected vaginal and anal sex with a regular partner, sex with a casual partner, past urethral symptoms was reported more often in symptomatic men compared to the controls.  Chlamydia was detected more frequently in the symptomatic group with no urethritis than among controls. These results support our practice of offering treatment for Chlamydia and partner notification to all men attending the Centre with symptoms of urethritis and and a behavioural risk factor regardless of the presence of urethritis in their urethral smear.