2009 Participant Summaries

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Study:
Mycoplasma genitalium in men who have sex with men at male-only saunas
 
Researchers: 
Bradshaw CS, Fairley CK, Lister NA, Chen SJ, Garland SM, Tabrizi NS
                 
Publication:
Sexually Transmitted Infections 2009; 85(6): 432-435
 
Summary:
A cross-sectional study of 521 men who have sex with men (MSM) attending six male-only saunas in Melbourne was conducted between October 2001 and September 2002 to determine the prevalence and clinical associations of Mycoplasma genitalium in urethral, rectal and pharyngeal specimens. Stored urine and rectal and pharyngeal swabs were tested for M genitalium by real-time polymerase chain reaction. A high prevalence (13%) of sexually transmitted infections (STIs) was found in MSM. M genitalium (2%) was less common than Chlamydia trachomatis (8%), and Neisseria gonorrhoeae (5%). M genitalium was most likely to be detected as an asymptomatic rectal (2%) or urethral infection (0.6%), but was absent from the pharynx. In comparison, C trachomatis was more common in the rectum (6%) than urethra (2%), and was uncommon in the pharynx (0.6%). Urethral infection with N gonorrhoeae (0.2%) was rare, but was as common in the pharynx (3%) as the rectum (2%). No significant demographic or behavioural associations with M genitalium were identified. M genitalium was less common than C trachomatis and N gonorrhoeae in MSM attending male-only saunas and was most often detected as an asymptomatic rectal or a urethral infection but was absent from the pharynx. To inform STI screening strategies in MSM, more data are needed to understand how common M genitalium infection is in urethral and non-urethral sites in MSM, and how it contributes to clinical symptoms.
 
Study:
Innovative resources could help improve partner notification for chlamydia in primary care.
 
Researchers:
Bilardi J, Fairley CK, Hopkins C, Temple-Smith M, Bowden F, Russell D, Pitts M, Tomnay J, Parker R, Pavlin N, Chen M
 
Publication: 
Sexually Transmitted Diseases 2009; 36(12): 779-783
 
Summary:
A postal survey of randomly selected general practitioners’ (GPs) was carried out to examine partner notification practices for chlamydia and to identify innovative resources that could improve partner notification for chlamydia in primary care. Of 521 eligible GPs, 234 (45%) returned a completed questionnaire. Ninety-five percent felt that it was their role to discuss partner notification with patients diagnosed with chlamydia; however, only 45% (105/232) were sure how best to assist their patients with this. Considerable variation was shown in the way partner notification was undertaken, including how far back in time GPs recommended contacting partners. GPs considered a wide range of possible resources useful, including a website supporting patients (90%), information sheets generated by practice software when chlamydia is diagnosed (90%), printed information packs for patients (85%), a website designed to assist GPs (80%), and referral to these websites via positive laboratory results (85%). Forty-three percent currently undertook patient delivered partner therapy for chlamydia. GPs reported a need for greater guidance and resources to assist with partner notification for chlamydia. Practice software with mechanisms that automatically direct GPs to resources utilizing the internet when chlamydia is diagnosed have wide appeal and the potential to improve the effectiveness of partner notification for chlamydia.


 

Study:
The psychosocial burden of HPV-related disease

Researchers:    
Marie Pirotta, Linh Ung, Alicia Stein, E Lynne Conway, Christopher Mast, Christopher K Fairley and Suzanne Garland

Publication:        
Sex Transm Inf published online 24 Aug 2009; doi:10.1136/sti.2009.037028

Summary:    
This study assessed the psychosocial burden of screening and testing for genital related human papillomavirus (HPV) disease using specially designed disease specific questionnaires. The participants included 331 women between 18 – 45 years of age attending the Royal Women’s Hospital or Melbourne Sexual Health Centre who had either experienced a normal cervical Papanicolaou (Pap) result, an abnormal Pap result, a biopsy confirming the presence of early cervical tumour forming cells or external genital warts (EGW). The results confirmed that that the burden of HPV is broader than just the disease it causes and even screening which eventuates in a normal result may have negative psychosocial repercussions. Participants who experienced an HPV-related diagnosis were generally better informed about HPV than women with normal Pap test results, probably because of information provided by the clinicians caring for them. However, being informed did not equate to less concern. Some were more anxious if aware that HPV was sexually transmitted, whereas others were less anxious, viewing acquisition of HPV as a common, almost inevitable, consequence of being sexual active. The largest impact of EGWs on quality of life was in the domains of sexual impact, self image, and transmission to partner. Consequently, prevention by vaccination of HPV-related disease that also allows less frequent cervical cytology screening of women with Pap tests will not only reduce health costs, but also the psychosocial burden on women.



Study:    
Patterns of treatment of external genital warts in Australian Sexual Health Clinics

Researchers:  
Marie V. Pirotta, Alicia N. Stein, Christopher K. Fairley, Andrea Morrow, E. Lynne Conway, John Chuah, Jenny McCloskey, Anna McNulty, Russell Waddell, Rob Carter, BA, and Suzanne Garland

Publication:
Sexually Transmitted Diseases 2009; 36 (6) 375-379

Summary:    
External genital warts (EGW) are a common sexually transmitted viral disease. This was a retrospective audit of 489 case notes from consecutive individuals who presented with a new diagnosis of EGWs to 1 of 5 sexual health clinics in Australia. Patients were included aged 18 to 45 years, presenting with a first ever episode of EGWs.
A quarter of patients (127) had another sexually transmitted infection diagnosed at presentation. Nearly half of the patients (224) presented only once for treatment. Most often, patients were treated with a single therapy  (382/489; 78%), usually cryotherapy (257; 53%). Staff applied the treatment in 361 (74%) cases. Although there was wide variation in treatment across sites, possibly reflecting local policies and budgets, no difference was found in resolving of warts by initial treatment chosen. The diagnosis and treatment of genital warts constitute a sizable proportion of clinical visits to the audited sexual health services and require a large input of staff time to manage, including the application of topical treatments. Our results help complete the picture of the burden of EGWs on Australian sexual health centers before the introduction of the HPV vaccine.



Study: 
A randomised controlled trial of the safety of candidate microbicide SPL7013 gel when applied to the penis

Researchers:    
Marcus Y. Chen, Iona Y. Millwood, Handan Wand, Mary Poynten, Matthew Law, John M. Kaldor,
Steve Wesselingh, Clare F. Price, Laura J. Clark, Jeremy R. A. Paull, and Christopher K. Fairley

Publication:
J Acquir Immune Defic Syndr 2009; 50:375–380

Summary:    
The safety of a candidate vaginal microbicide SPL7013 gel (VivaGel) was evaluated when applied to the penis. A study was carried out in thirty-six healthy men (18 circumcised, 18 uncircumcised) treated either with 3% SPL7013 gel (24) or placebo gel (12), applied once daily for 7 days. Genital toxicity was determined by interview, diary, and examination. There were 10 genital adverse events (AEs) in 6 men (25%) receiving SPL7013 gel and 5 genital AEs in 4 men (33%) receiving the placebo that were possibly or probably related to the study product. All genital AEs were mild and the most common were genital itching and mild inflammation of the skin at the site of application and all but one in the placebo group were transient. There were no abnormal vital signs or nongenital AEs observed, and laboratory results indicated no safety or tolerability issues with SPL7013 gel, irrespective of their circumcision status. Three percent SPL7013 gel was safe and well tolerated, and comparable with placebo, when administered to the penis of both circumcised and uncircumcised men once daily for 7 days, with no evidence of systemic absorption or toxicity.



Study:                 
What men who have sex with men think about the human papillomavirus vaccine

Researchers:     
D Simatherai, C S Bradshaw, C K Fairley, M Bush, S Heley, M Y Chen

Publication: 
       
Sexually Transmitted Infections 2009; 85 (2): 148-149

Summary:    
This study aimed to ascertain the attitudes of men who have sex with men (MSM) to the human papillomavirus (HPV) vaccine and to determine the age at which MSM would be willing to ask for the HPV vaccine in relation to their age of sexual debut. Of 205 MSM attending the Melbourne Sexual Health Centre between December 2007 and January 2008, 200 completed the study questionnaire. Only 30% were aware that there was a vaccine available for protection against infection with certain HPV types. When informed of the increased risk of anal cancer among MSM, 47% of MSM indicated that they would be willing to pay $A450 for the vaccine course. A total of 93% indicated that they would be willing to disclose that they were MSM to a health professional in order to obtain the vaccine for free, but not until a median age of 20 years: 2 years after the median age of sexual debut (18 years) and after a median of 15 sexual partners. If the HPV vaccine is targeted to MSM, the challenge will be for MSM to be vaccinated before they acquire HPV infection.



Study:    
The experience of providing young people attending general practice with an online risk assessment tool to assess their own sexual health risk
    
Researchers:    
Jade E Bilardi, Lena A Sanci, Christopher K Fairley, Jane S Hocking, Danielle Mazza, Dot J Henning, Susan M Sawyer, Michelle J Wills, Deborah A Wilson, Marcus Y Chen

Publication:        
BMC Infectious Diseases 2009; 9:29

Summary:        
The aim of this study was to measure the effect of offering an online sexual health assessment tool, Youth Check Your Risk (YCYR), on chlamydia testing rates among young people attending general practices. General practitioners at three practices in Melbourne, Australia, referred patients aged 16 to 24 years to YCYR at www.checkyourrisk.org.au  for use post consultation from March to October 2007. The proportion of young people tested for chlamydia before and during the implementation of the tool was compared. The intervention did not result in any significant increases in 16 to 24 year old males (2.7% to 3.0%) or females (6.3% to 6.4%) tested for chlamydia.
A small increase in the proportion of 16 to 19 year old females tested was seen (4.1% to 7.2%). The major reasons for low referral rates reported by practitioners included lack of time, discomfort with raising the issue of testing, and difficulty in remembering to refer patients.



Study:  
What female patients feel about the offer of a chaperone by a male sexual health practitioner
    
Researchers: 
   
C Simanjuntak, R Cummings, M Y Chen, H Williams, A Snow and C K Fairley

Publication:      
International Journal of STD & AIDS 2009; 20: 165–167
            
Summary:   
The aim of this study was to determine the experience and views of female patients when they were offered a chaperone by a male sexual health practitioner for a genital examination. Between November 2007 and January 2008, an anonymous survey was administered to female patients seen by male practitioners at Melbourne Sexual Health Centre. None of the 79 patients who were offered a chaperone and declined, reported that they were uncomfortable declining the offer. The qualitative analysis showed that some participants appreciated being offered the option of a chaperone even if they did not want one; and the professional attributes of the practitioner influenced their decision not to have a chaperone. Only 8% felt uncomfortable when asked if they would like a chaperone. The results reassure that when a female patient declines the offer of a chaperone within a sexual health clinic, the male practitioner can feel confident that this is the expression of the patient’s wish.


 

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 2009; 20 (1): 52-53

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.