2008 Participant Summaries

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Study:
Screening pregnant women for chlamydia: what are the predictors of infection?

Researchers:

Marcus Y Chen, Christopher K Fairley, Deborah De Guingand, Jane Hocking, Sepehr Tabrizi, Euan M Wallace, Sonia Grover, Lyle Gurrin, Rob Carter, Marie Pirotta, Suzanne Garland

Publication:

Sexually Transmitted Diseases 2008;

            http://sti.bmj.com/cgi/rapidpdf/sti.2008.030700v1

Summary:
A cross-sectional study of pregnant women aged 16-25 years attending four antenatal services in Melbourne between October 2006 and July 2007 was carried out to determine what the associated risk factors were with chlamydial infection and whether the risk factors identified could be used for selective screening. The women were asked to complete a questionnaire and to provide a urine sample for chlamydia testing. Of 987 pregnant women included 3% had chlamydia infection and infection was associated with younger pregnant women of < 20 years and with those reporting more than one sex partner in the past year. Screening based on the selective criteria would have detected 72% of infections in the study, and 27% of women would have been screened. However, the authors caution that the harm caused by infections missed using selective criteria would need to be considered. In addition, local data on prevalence and risk factors, together with cost-effectiveness of different approaches should also be taken into account when decisions are being made about whether selective screening should be conducted.

Study:
Sex workers working within a legalized industry: their side of the story

Researchers:
J Groves, DC Newton, MY Chen, J Hocking, CS Bradshaw, CK Fairley

Publication:

Sexually Transmitted Infections 2008; 84: 3993-394

Summary:
In Victoria, the Prostitution Control Act 1994 allows licensed brothels, escort agencies and sex workers working privately for themselves to engage in sex work legally. This study was a cross sectional study of 97 women working in the legal sex industry in 38 of the 92 licensed brothels in Victoria during 2006 to investigate characteristics and work attitudes of female sex workers. The findings of the study indicate that the women are from diverse backgrounds and circumstances and hold varying attitudes to working in the sex industry. Many women have actively chosen sex work as an occupation based on the financial rewards and flexibility. Like many other women, these women are pursuing further education or training, supporting families or striving to attain financial goals. Many of these women do not express a desire to leave the sex industry.


Study:
How men with non-chlamydial, non-gonococcal urethritis are managed in Australasia

Researchers:
R Teague, CK Fairley, D Newton, C Bradshaw, B Donavan, F Bowden, R Cummings and MY Chen

Publication:

International Journal of STD & AIDS 2008; 19: 581-585

Summary:
The aim of this study was to ascertain how sexual health physicians in Australia and New Zealand manage men with chlamydia-negative non-gonococcal urethritis (NGU). A cross-section survey was sent out to all members of the Australasian Chapter of Sexual Health Medicine in July, 2006. Of 111 surveys that were completed, 73% of sexual health physicians believed that female partners of men who present with chlamydia-negative NGU were at risk of adverse reproductive health outcomes. At least 62% usually initiated some form of partner notification of female partners, but only 19% routinely tested and 65% sometimes tested for pathogens other than Chlamydia trachomatis or Neisseria gonorrhoeae. These included Mycoplasma genitalium, herpes simplex virus, ureaplasma species, Trichomonas vaginalis and adenoviruses. The authors caution that the risk of damage to relationships by inferring that an STI is present may outweigh the benefits of partner notification in cases where no pathogen is recovered from the male partner, since the risk of upper genital tract infection in women in these circumstances is unknown.


Study:
More than anal sex: the potential for sexually transmitted infection transmission among men visiting sex-on-premises venues (SOPV)

Researchers:
CW Phang, J Hocking, CK Fairley, C Bradshaw, P Hayes, MY Chen

Publication:

Sexually Transmitted Diseases 2008; 84: 217 - 219

Summary: 
A cross-sectional study was undertaken in men-who-have-sex-with-men (MSM) at six SOPV venues between December 2006 and March 2007 to obtain detailed data on the frequency of sexual practices compared to their sexual practices outside SOPV. Of 200 participants included, sexual contact during the SOPV visit was usually with two other men (ranging from 0-28); receptive and insertive anal intercourse was reported by 20% and 34% respectively; and was unprotected in 3% and 6%. The frequency of other practices included: unprotected insertive and receptive penile-anal touching or rubbing without penetration or “nudging” (27% and 20%); unprotected, transient insertive and receptive anal intercourse or “dipping” (6% and 5%); and insertive or receptive anal fingering (39% and 33%). Approximately 40% of men who reported “nudging” reported that they had not engaged in any “anal sex.” Compared with their practices with casual male partners outside SOPV, men at SOPV were less likely to have receptive oral intercourse with ejaculation and unprotected receptive anal intercourse, but were more likely to have group sex. Substantial penile-anal contact not involving anal intercourse occurred at SOPV and may explain anal infections in the absence of reported anal sex. Some higher risk practices were reported more frequently with male partners outside of these venues than with partners within SOPV.



Study:

Take the sex out of STI screening! Views of young women on implementing chlamydia screening in General Practice

Researchers:

Natasha L Pavlin, Rhian Parker, Christopher K Fairley, Jane M Gunn and Jane Hocking

Publication:

BMC Infectious Diseases 2008; 8:62

  http://www.biomedcentral.com/1471-2334/8/62

Summary:
The study aimed to find out what the attitudes of young women were to the introduction of chlamydial screening in General Practice (GP) in Australia. In depth face-to-face interviews were conducted with 24 young women from across Victoria, attending a randomly selected sample of general practices. Young women reported that they would accept age-based screening in general practice, during both sexual health and non-sexual health related consultations. Trust in their GP was a major factor for their acceptance of chlamydia screening. The women felt chlamydia screening should be offered to all young women rather than targeted at “high risk women” based on sexual history and particularly emphasised the importance of normalising and destigimatising chlamydia screening. Women reported that they did not want to be asked to provide a sexual history as part of being asked to have a chlamydia test.


Study:

Clinical significance of questionnaire – elicited or clinically reported anorectal symptoms for rectal Neisseria gonorrhoeae and Chlamydia trachomatis amongst men who have sex with men (MSM)

Researchers:

Nichole A Lister, Nadia J Chaves, Chee W Pang, Anthony Smith and Christopher K Fairley

Publication:
Sexual Health, 2008; 5: 77 - 82

Summary:
The study investigated the clinical value of whether using a questionnaire or clinically reported anorectal symptoms are reliable indicators of infection with N gonorrhoeae and C trachomatis in MSM.  During 2002 and 2003, 366 MSM were enrolled into the study. Of these, 20 were diagnosed with rectal gonorrhoea (5%) and 25 with chlamydia (7%). Overall ‘any’ anorectal symptoms reported in the questionnaire were the same in MSM with and without gonorrhoea (75% v 74%), but anal discharge and anal pain were more common in those with gonorrhoea. There was also no difference in reported symptoms in the questionnaire for those with and without chlamydia detected. Any anal symptoms were reported more often via the questionnaire than during a clinical consultation (75% v 16%; p <0.01), and symptoms reported in a clinical consultation were not associated with gonorrhoea or chlamydial detection. The absence of an association between symptoms and the presence of gonorrhoea or chlamydia infection highlights the importance of annual screening of MSM for sexually transmitted infections independent of symptoms.



Study:
Incidence of putative HIV superinfection and sexual practices among HIV-infected men who have sex with men (MSM)

Researchers:
Sidat MM, Mijch Anne M, Lewin SR, Hoy JF, Hocking J, Fairley Ck

Publication:
Sexual Health, 2008, 5: 1-7

Summary:
This study compared clients with HIV who had a rapid fall in their T cell count to clients whose T cell counts were stable.  We did this because one possible cause for a rapid fall in T cells is infection with a second HIV virus.  This is called ‘super infection’.  We found that over a 2 year period about 10 clients of the 145 that were studied had a rapid fall in T cell count.  This is a rate of about 3% per year.   The study did not allow us to look for the cause for this rapid fall, which may or may not have been an infection with a second HIV virus.  

We also found that there were no differences between these two groups in sexual practices that may have exposed them to another HIV virus such as unprotected anal intercourse.  However clients did frequently engage in unsafe sexual practices with casual partners who were HIV infected (more than 50%); or whose HIV serostatus was unknown. We concluded that if superinfection does occur, it is likely to occur at a rate of less than 4% per year                            



Study:
STI and HIV management among men-who-have-sex-with-men with and without HIV: Survey of medical practitioners who are members of Australian Society for HIV Medicine (ASHM)

Researchers:
Christopher K. Fairley, Glenda Fehler, Sharon R Lewin, Marian Pitts, Marcus Y. Chen, Catriona Bradshaw  and Jane S. Hocking

Publication:
Sexual Health (accepted March 2008)            

Summary:
Rates of HIV in New South Wales (NSW) have been stable, but have increased significantly in other Australian States.  The reasons for this are unknown and may be associated with differences in management of STIs and HIV in different states in Australia. Our aim was to determine if the use of suppressive treatment for genital herpes, the treatment of HIV or sexually transmitted infections (STI) screening practices, were different between states in Australia. This study was a cross sectional survey of medical practitioners who are S100 prescribers and members of ASHM. In general, there were no differences between clinical practices of practitioners in NSW and other states except that in NSW fewer practitioners tested HIV positive men who have sex with men (MSM) for syphilis annually (NSW: 78% v Others: 87%, P = 0.04) or treated MSM with advanced HIV disease (CD4 <150 X 106 cells/l) with acicylovir in the absence of herpes simplex virus (HSV) (NSW: 4% v Others: 13%, P = 0.03), and more practitioners in NSW tested HIV negative MSM for HSV type specific serology (NSW: 21% v Others: 11%, P =0.02).  It is unlikely that the minor differences in HSV and HIV treatment or STI screening practices among practitioners in NSW and other Australian states explains the differences in HIV notifications between these two areas.



Study:
The Australian Study for Understanding Women's Sexuality and Health (ASUWSH)

Researchers:
Richard Hayes, Lorraine Dennerstein, Catherine Bennett, Mohsin Sidat, Lyle Gurrin, Thiloma Munasinghe, Christopher Fairley

Publication:
What is the ‘true’prevalence of Female Sexual Dysfunctions and does the way we assess these conditions have an impact?" 
Journal Sexual Medicine, 2008, 5 (4): 777 - 787

Risk factors for Female Sexual Dysfunction in the general population: exploring factors associated with low sexual function and sexual distress.
Journal Sexual Medicine (accepted February 13, 2008).

Summary:
Female Sexual Dysfunction (FSD) includes disorders of desire, arousal, orgasm and sexual pain. FSD affects women’s health, relationships, and quality of life. Current medical definitions stipulate that both low sexual function and sexually-related personal distress need to be present for a diagnosis of FSD. This means that only those women who are distressed by their low levels of sexual function can be classified as having FSD. The distress component of FSD has gained attention in the scientific literature.  Also the methods used to assess FSD have come under increasing scrutiny.

The ASUWSH is the first Australia wide prevalence study investigating FSD to use validated assessment methods across a broad age range of women. This research has contributed to the debate in this area by comparing different methods used to assess FSD side by side in the one sample of women. The results demonstrate the substantial impact that different assessment methods can have when determining the numbers of women with FSD in the population. The data also show that the methods used to assess FSD can affect the risk factors that are reported in the medical literature. We have shown that the different aspects of FSD are associated with a different range of factors. For example, whilst relationship factors were particularly important to desire, biological factors (such as age and menopausal status) were particularly important to arousal and orgasm. Psychological factors, socio economic factors, and the importance placed on sex in ones life were also associated with aspects of FSD. The researchers would like to thank all those women who participated in this study for their time and important contribution to this research.