2006 Participant Summaries

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Study:
Association between risk of acquiring HIV and beliefs and perceptions about the lived experience of HIV/AIDS among HIV-negative or untested men who have sex with men.

Researchers:
Sidat M, Rawstorne P, Lister N, Fairley CK

Publication:
AIDS Care 2006; 18(8): 934-941

Summary:
The aim was to assess whether the sexual behaviour of HIV-negative or untested men who have sex with men (MSM) was related to their perceptions of what it is like to live with HIV/AIDS, their beliefs or attitudes to highly active antiretroviral treatments (ART). Participants were asked to complete a self-report questionnaire asking about sexual practices, HIV testing, contact with HIV/AIDS epidemic, HIV treatment optimism and the perceived medical and social impact of being HIV-positive. Any unprotected anal intercourse with casual partners was used as the indicator of sexual risk. There were no differences between beliefs and attitudes about HIV/AIDS when the study group was divided into MSM engaging in unprotected anal intercourse with a casual partner or those who had not. In general, participants were pessimistic about life with HIV/AIDS, despite their risky behaviour and only a small proportion were optimistic about ART.

 


 

Study:
A survey of partner notification practices among general practitioners and their use of an internet resource for partner notification for Chlamydia trachomatis

Researchers:
Tomnay JE, Gebert R, Fairley CK

Publication:
Sexual Health 2006; 3(4): 217-220

Summary: In Australia, chlamydia is the most common notified sexually transmitted infection (STI) and because the symptoms are so mild, infections often remain undetected. Effective control would include improving partner notification. The aim of the study was to survey GPs to determine in which circumstances Victorian GPs offer chlamydia testing to patients, their attitudes to contact tracing, how often GPs use pre-printed partner notification letters and brochures and what proportion of GPs have immediate internet access in their consulting rooms. In addition, we also assessed whether GPs would access a website with treatment guidelines, a printable client brochure and a partner letter for clients (index case) to pass on to their exposed sexual partners. In the survey, we found that GPs most commonly test patients for chlamydia when signs and symptoms are present, patients report an infected partner or when they request a test. Women less than 25 years of age are the risk group most selected for screening programs were shown to be infrequently tested, and patients were considered responsible for partner notification.  The use of preprinted partner letters and brochures was uncommon. In this study, GPs reported that they could improve partner notification if further support was provided and when a website was provided with appropriate information, up to 25% of GPs in the study used it.

 


 

Study:
The Association of Atopobium vaginae and Gardnerella vaginalis with Bacterial Vaginosis and Recurrence after Oral Metronidazole Therapy

Researchers:
Bradshaw CS, Tabrizi SN, Fairley CK, Morton AN, Rudland E, Garland SM

Publication:
Journal of Infectious Diseases 2006; 194(6): 828 – 836

Summary:
Women presenting with symptoms of abnormal discharge or odor were included in a cross sectional study and those who were diagnosed with bacterial vaginosis (BV) were subsequently treated with metronidazole and monitored for one year or until they had a recurrence of BV.  Of 348 women with symptoms of abnormal discharge or odor, 50% had normal vaginal flora, 10% mixed normal and abnormal vaginal flora and 39% had BV. In women with BV, 99% had Gardnerella vaginalis and 96% had Atopobium vaginae detected, while G. vaginalis was common in women with normal flora (60%), A.vaginae was only detected in 12%. A.vaginae was rarely detected without G. vaginalis, and women with both organisms present had higher rates of recurrent BV (83%). Interestingly, A.vaginae was more specific for BV (77%) compared to G. vaginalis (35%), but its etiological role remains unclear.

  


 

Study:
Azithromycin failure in Mycoplasma genitalium urethritis

Researchers:
Bradshaw CS, Jensen JS, Tabrizi SN, Read TRH, Garland SM, Hopkins CA, Moss LM, Fairley CK

Publication:
Emerging Infectious Diseases 2006; 12(7): 1149-1152

Summary:
Mycoplasma genitalium is a common cause of non-gonococcal urethritis (NGU) and has been associated with persistent NGU. Single dose azithromycin is recommended for treatment of NGU, but no evidence based guidelines exist for the treatment of M. genitalium. A case controlled study of acute NGU revealed M. genitalium treatment failure rates of 28% following single dose therapy with azithromycin and reduced susceptibility of isolates in vitro. Recurrent urethral symptoms following azithromycin therapy only occurred in persons with persistent  M. genitalium infection and resolved with moxifloxacin, a fluoroquinolone. This study highlights the need for randomized controlled studies to determine optimal treatment for M. genitalium.

 


 

Study:    
Does the internet assist clients to carry out contact tracing? A randomized controlled trial using web-based information

Researchers:
    
Tomnay JE, Pitts MK, Kuo T, Fairley CK

Publication:  
International Journal of STD & AIDS 2006; 17(6): 391-394

Summary:
    
Partner notification (contact tracing) is an essential component of effective control of sexually transmitted infections (STIs). In the past decade there has been an increase in use of mobile phones, including SMS, the internet and email.  This study evaluated the safety and acceptance of a website for use in standard contact tracing compared to using a standard partner letter alone. Of 105 participants diagnosed with chlamydia and non-gonococcal urethritis, 32 received the standard partner letter for each partner and 73 received the partner letter with the website access address, user ID and passwords for their partner(s).  The password was valid for two visits only to the website. The website contained information on each infection, a printable letter for the partner to take to their own doctor, and an anonymous questionnaire. All index participants were contacted one week after attendance at our clinic and interviewed about the number of partners in the previous three months, which method of contact was used and the reaction of the partner(s).  The results indicated that providing a website with specific information about the infection to which a partner has been exposed does not harm the index client, the partner or the contact tracing process itself.

 


 

Study:
Re-infection of Neisseria gonorrhoeae and Chlamydia trachomatis infections among men who have sex with men

Researchers:

Lister NA, Smith A, Tabrizi SN, Garland SM, Fairley CK

Publication:
International Journal of STD & AIDS 2006; 17(6): 415-417

Summary:
The aim was to determine the incidence of re-infection of rectal gonorrhoea and rectal chlamydia in men-who-have-sex-with-men (MSM). Of 126 MSM diagnosed with gonorrhoea or chlamydia, 68 (54%) were retested. Among HIV-positive MSM, 17 of 21 (81%) were retested and eight were positive (47%), and among HIV-negative or unknown status MSM, 51 of 105 (49%) were retested and 13 (25%) were positive. Of the 21 positive cases, only five had symptoms. This study demonstrated that there are a high proportion of MSM diagnosed with rectal gonorrhoea and chlamydia that become re-infected within 12-18 months and regular follow-up rectal screening is recommended.

 


 

Study:
High recurrence rates of bacterial vaginosis over 12 months following oral metronidazole & factors associated with recurrence

Researchers:
Bradshaw CS, Morton AN, Hocking J, Garland SM, Morris MB, Moss LM, Horvath LB,  Kuzevska I, Fairley CK

Publication:
Journal of Infectious Diseases 2006; 193(11): 1478-1486

Summary: One hundred and thirty-nine women presenting with a diagnosis of symptomatic bacterial vaginosis (BV) were included. A series of laboratory tests were carried out, followed by treatment with metronidazole and the women were asked to return for follow-up visits at 1,3,6, and 12 months. High rates of reoccurrences over 12 months with BV (58%) and abnormal vaginal flora (69%) were recorded. Reoccurrences were associated with a previous history of BV, lack of hormonal contraceptive use, having a regular sexual partner and having a female sexual partner.
Current therapies are not effectively preventing reoccurrences of BV and abnormal vaginal flora in the majority of women. Progress in improving clinical management is impeded by the lack of knowledge of the specific causative agent(s).

 


 

Study:
Use of Delphi Sorting Technique to establish a core sexual history

Researchers:
Tideman RL, Pitts MK, Fairley CK

Publication:
International Journal of STD & AIDS 2006; 17: 170-172

Summary:
A core sexual history template was developed by a panel of eight experts in sexual health medicine to be used as a supplementary tool to assist sexual health physicians in assessing new clients attending sexual health clinics. The Delphi technique was employed and sexual history items from a previous study to generate a core sexual history were used. The Delphi technique involves a number of rounds of questionnaires in which experts respond to items concerning a topic. The responses are returned, collated, analysed and represented to the expert panel until consensus is reached. The advantages of generating a core sexual history template are that sexual history becomes standardised and adaptable to computer usage, efficiency of consultations could be increased in high workload situations, and a mechanism to collect surveillance information and to assess behavioural interventions is provided.

 


 

Study:
Etiologies of nongonococcal urethritis: bacteria, viruses, and the association with orogenital exposure

Researchers:
Bradshaw CS. Tabrizi SN. Read TR. Garland SM. Hopkins CA. Moss LM. Fairley CK

Publication:
Journal of Infectious Diseases 2006; 193(3):336-45

Summary:
To determine the pathogens and behaviours associated with nongonococcal urethritis (NGU), and the usefulness of the urethral smear in predicting the presence of pathogens, 329 men with symptoms and 307 without symptoms were included in the study. Overall, in addition to Chlamydia trachomatis and Mycoplasma genitalium, adenoviruses and herpes simplex type 1 were identified as significant causes of NGU, and were particularly associated with insertive oral sex and sex with men. Trichomonas vaginalis and herpes simplex type 2 were uncommon causes of NGU in this population, and Gardnerella vaginalis and Ureaplasma urealyticum and parvum  were not associated with NGU. A urethral smear was not always sufficiently sensitive to exclude urethral infections in men, and it was suggested that treatment decisions should rather be based on clinical features.


 

Study:
Client acceptability of the use of computers in a sexual health clinic

Researchers:
Tideman RL, Pitts MK, Fairley CK

Publication:
International Journal of STD & AIDS 2006; 17: 121-123

Summary:
Client acceptability of using computer-assisted-self-interviewing (CASI) for sensitive health related information in both research and clinical settings was evaluated. All new clients during the study period were invited to participate and complete a questionnaire which sought information on level of education and a series of questions relating to their level of computer skills. The questionnaire explored general attitudes of participants towards computer usage in the clinic setting and willingness to participate in CASI. Overall, 80% reported using a personal computer, 86% an ATM and 54% online billing. Only 2% had not used any of these forms of computer technology. The majority of clients (80%) were willing to enter their sexual behaviour and lifestyle and other details by computer in a private and secure manner before the consultation. Concerns that the personal quality of the consultation may be diminished were recorded by 17% of responders. The advantages of using a system like this routinely to collect clinical data is standardization of sexual history and improving efficiency of consultations in inadequately resourced services with rising case loads