2014 Participant Summaries

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Study:                        
Factors associated with participation and attrition in a longitudinal study of bacterial vaginosis in Australian women who have sex with women

Researchers:            
Forcey D, Walker S, Vodstrcil L, Fairley CK, Bilardi J, Law M, Hocking JS, Fethers K, Petersen S, Bellhouse C, Bradshaw CS
          

Publication:        
PLoS ONE  2014 9(11): e113452

Summary:                 
Understanding the reasons that motivate individuals to participate and remain in studies with long follow-up periods was looked at using a questionnaire in 457 women who were recruited into a study of bacterial vaginosis (BV) in women who have sex with women. Of 334 women found to be BV negative at recruitment, 298 enrolled in the next part of the study which was over 2 years to gather more data every 6 months from these same individuals. Of 298 women enrolled, 248 remained until the end of the study compared to 50 who were lost before the study was completed. Women with a male sexual partner at enrolment and being younger than 30 years were more likely to leave the longer study before it was completed. Women were also less inclined to join the longer study if they smoked, had lower educational levels, had a history of BV symptoms or genital warts. Women together with their regular female sexual partner were more likely to enroll in the longer study. During the longer study women reported high acceptability of study procedures and processes, knowledge increase about BV and referring others to the study.



Study:                        
Exploring anal self-examination as a means of screening for anal cancer in HIV positive men who have sex with men: a qualitative study.

Researchers:            
Ong JJ, Temple-Smith M, Chen MY, Walker SM, Grulich AE, Fairley CK
                 

Publication:              
BMC Public Health 2014, 14: 1257

Summary:                 
Anal cancer is relatively common in HIV-positive men who have sex with men (MSM). As early diagnosis of anal cancer is associated with increased survival, innovative ways such as anal self-examination (ASE) should be explored. Interviews were conducted with 20 HIV-positive MSM from a range of ages (35 to 78 years) to explore if ASE is acceptable as a method of anal cancer screening. Seventeen out of 20 men had conducted an ASE before - six (35%) were for medical reasons, six (35%) for sexual reasons, three (18%) for both medical and sexual reasons, and two (12%) for leaning purposes. Only 5 men were confident in being able to find an abnormality. While men were generally comfortable with the idea of ASE as a means for detecting anal cancer, discomfort with any anal examinations and anxiety about finding an abnormality were expressed and health professional examinations were preferred. Concerns for lack of awareness of anal cancer risk and ignorance of anal cancer symptoms, inadequate physical flexibility and the importance of hygiene were also raised. ASE may be an acceptable means for anal cancer detection in HIV-positive MSM but training in detecting abnormalities is needed.



Study:
A narrative review of the barriers and facilitators to chlamydia testing in general practice

Researchers:
Yeung A, Hocking JS, Fairley CK, Temple-Smith M
                                 

Publication:
Australian Journal of Primary Health. (July 2014)
dx.doi.org/10.1071/PY13158

Summary:
As the cornerstone of Australian primary health care, general practice is a setting well suited for regular chlamydia testing but testing rates remain low. This review examines the barriers and facilitators to chlamydia testing in general practice. Six databases – Medline, PubMed, Meditext, PsycInfo, Scopus and Web of Science – were used to identify peer-reviewed publications that addressed barriers and facilitators to chlamydia testing in general practice using the following terms: ‘chlamydia test’, ‘STI test’, ‘general practice’, ‘primary care’, ‘family medicine’, ‘barriers’, ‘facilitators’ and ‘enablers’ from 1997 until November 2013. Data about the study design and key findings were extracted from the publications. A framework method was used to manage the data and organise publications into three categories –patient, general practitioner, and general practice. Key findings were then classified as a barrier or facilitator. Sixty-nine publications were included, with 41 quantitative studies, 17 qualitative studies, and 11 using mixed methods. Common barriers identified in all three groups included a lack of knowledge, awareness or training, demands on time and workload, and the social context of testing. Facilitators included the normalisation of testing, the use of nurses and other practice staff, education and incentives. Numerous barriers and facilitators to chlamydia testing in general practice have been identified. While the barriers are well studied, many of the facilitators are not as well researched, and highlight areas for further study.

 


 

Study:
Detection of Oral Human Papillomavirus in HIV-Positive Men Who Have Sex with Men 3 Years after Baseline: A Follow Up Cross-Sectional Study

Researchers:
Ong JJ, Read TRH, Vodstrcil LA, Walker S, Chen MY, Bradshaw CS, Garland SM, Tabrizi SN, Cornall A, Grulich AE, Hocking JS, Fairley CK 

Publication:
PLOS One, 2014; 9(7) e102138 doi:10.1371/journal.pone 0102138

Summary:
Human papillomavirus (HPV) can cause throat cancer. The natural history of oral HPV in HIV-positive men who have sex with men (MSM) is unclear. Detection of oral human papillomavirus in 173 HIV-positive MSM using oral rinse samples 3 years apart was investigated. Of 173 men tested in 2010, 17% had at least one HPV type, 9% had at least one high risk HPV type, and 5% had HPV 16 detected. In 2013, 19% had at least one HPV type, 12% had at least one high risk HPV type and 4% had HPV 16 detected. Of 30 men at baseline (2010) with any HPV detected, 47% had at least one persistent type in 2013. Of the 15 men in 2010 with high risk HPV, 40% had at least one persistent high risk HPV type 3 years later. In HIV-positive MSM, 43% had at least one of the same HPV types and 40% of men had a least one high-risk HPV type detected again three years later. The same oral HPV type was detected again after 3 years in nearly half of HIV-positive men who have sex with men. .  Persistence of oral HPV in HIV-positive MSM may explain why there is a higher rate of mouth and throat cancer.

Study:
How very young men who have sex with men view vaccination against human papillomavirus

Researchers:
Zou H, Grulich AE, Cornall AM, Tabrizi SN, Garland SM, Prestage G, Bradshaw CS, Hocking JS, Morrow A, Fairley CK, Chen MY

                                   

Publication:
Vaccine, 2014; 32(31): 3936–3941

Summary:
HPV vaccination of men who have sex with men (MSM) prior to their first sexual activity would have the maximum impact on preventing HPV and anal cancer in this population. Two hundred MSM aged 16 to 20 were recruited via community and other sources and participants were asked about their knowledge and attitudes towards HPV and HPV vaccination. Most men (80%) were not willing to purchase the vaccine because of the cost (AUD$450). However, if the vaccine was offered to MSM free of charge, 86% reported they would be willing to disclose their sexuality to a health care provider in order to obtain the vaccine. Over half 54% of men would only be willing to disclose their sexuality to receive the HPV vaccine after their first experience of anal intercourse. Overall, very young MSM expressed high acceptance of HPV vaccination. About half of participants had already been sexually active before the age at which they were willing to access the vaccine. This raises the question as to how effective selective vaccination of MSM would be in preventing HPV acquisition. Ideally vaccination would be given before the onset of any sexual activity but the reality is that at present, there are no countries other than Australia that offer free, universal school based HPV vaccine programs.  Early vaccination of very young MSM may be feasible in settings through universal programs targeting school aged males.
 

Study:
When two is better than one’ – Differences in characteristics of women using condoms only compared to those using condoms with an effective contraception in Victoria, Australia

Researchers:
Ong J, Temple-Smith M, Wong W, McNamee K, Fairley CK

Publication:
Journal of Women's Health, 2014; 23(2): 168-174

Summary:
High rates of unintended pregnancy remain around the world. Combining a condom with an additional effective contraceptive method like the pill or an implant protects more effectively against unintended pregnancy than using condoms alone. Women attending Family Planning Victoria Clinics from April to July 2011 were approached to complete a questionnaire about their contraception use in the last 3 months. Of 1,006 women surveyed, 872 women stated it was 'very important' or 'important' to avoid pregnancy at this stage of their life. Of these 872 women, 690 reported male condom use: 274 women used male condoms together with another effective contraceptive and 416 used male condoms only. Combination use when compared to condom use alone was linked to a discussion with a health professional in the last 12 months; satisfaction with current contraception; having more than 1 partner in the last 3 months and past pregnancy. Of those women who relied on male condoms alone, only 19% were using condoms with every sexual act. In a group of women not intending to be pregnant who were using male condoms, a significant number remained at risk for unintended pregnancy due to inconsistent use of male condoms and poor use of an additional effective contraceptive. There is a need for better education and consideration of promoting effective dual contraception to those who currently only use male condoms only to reduce rates of unintended pregnancy.


Study:
Improving oral HPV detection using toothbrush sampling in HIV positive men who have sex with men

Researchers:
Ong J, Read T, Chen M, Walker S, Law M, Bradshaw C, Garland S, Tabrizi S, Cornall A, Grulich A, Hocking J, Fairley CK
     

Publication:
Journal of Clinical Microbiology, 2014; 52 (6) 2206 - 2209

Summary:
Human papillomavirus (HPV) causes some forms of oropharyngeal cancer. High risk HPV is detected in more than half of the patients with this form of cancer and HPV type 16 is the most common.  HPV detection varies by the sample type method used. We looked at 3 sampling methods to see which method worked best. Participants provided 3 samples for HPV detection and typing. The first sample was an oral rinse sample that involved swishing and gargling with 20 ml of a sterile saline solution in the mouth and throat cavity for 20 to 30 seconds and then spitting it into a sterile specimen cup. The second type was an oral rinse sample collected directly after each participant brushed their teeth with a new toothbrush that involved swishing and gargling with 20 ml of a sterile saline solution in the mouth and throat cavity for 20 to 30 seconds and then spitting it into a sterile specimen cup. Following use, the tooth brush was mixed in saline to obtain the third sample. Both oral rinse samples and the toothbrush sample detected HPV DNA in at least one sample among 45 (26%) of 173 HIV-positive men who have sex with men. HPV genotypes were detected in 80% of the before brushing rinse, 65% for the after brushing oral rinse, and 75% for the toothbrush samples. The findings suggest that multiple sampling methods may be needed to maximize oral HPV detection.

 


Study:
Sexual behaviours and risk for sexually transmitted infections among teenage men who have men

 

Researchers:
Zou H, Prestage G, Fairley CK, Grulich AE, Garland SM, Hocking JS, Bradshaw CS, Cornall AM, Tabrizi SN, Morrow A, Chen MY.

Publication:
Journal of Adolescent Health (January 2014)

Summary:
Men who have sex with men (MSM) aged 16 to 20 years were recruited via community and other sources. Two hundred men completed a questionnaire about their sexual behaviours and were tested for gonorrhea, chlamydia, syphilis, and HIV. The average age at first insertive or receptive anal sex was 17 years. Half of the men reported having sex with mainly older men. Men within this age group were more likely to engage in receptive anal sex than other men (48% vs. 25%). Most men had engaged in insertive anal sex (87%) and receptive anal sex (85%) in the past 12 months. Condom use in the last 12 months reported as sometimes with insertive anal sex was 60% and receptive anal sex 53%. The average number of insertive anal sex partners over the past 12 months was 3 among men reporting sometimes using condoms compared to 1.5 partners among those always using condoms. The average number of receptive anal sex partners over the past 12 months was 3 among men using condoms sometimes and 2 among men reporting always using condoms. Pharyngeal gonorrhea was detected in the throat of 3% of men, rectal gonorrhea in 6%, urethral chlamydia in 3%, rectal chlamydia in 4%, and syphilis in 2% of men. All men were HIV negative. Preventative messages and STI screening interventions that are age appropriate need to be developed to reduce HIV and STI risk in this under-recognized group.

 


Study:
The influence of behaviours and relationships on the vaginal microbiota of women and their female partners: The WOW Health Study

 

Researchers:
Bradshaw CS, Walker SM, Vodstrcil LA, Bilardi JE, Law M, Hocking JS, Fethers KA, Fehler G, Petersen S, Tabrizi SN, Chen MY, Garland SM, Fairley CK                                  

Publication:
JID, 2014; 209: 1562 -1572

Summary:
A study of women-who-have-sex-with women (WSW) with bacterial vaginosis (BV) was carried out to look at behaviours that may influence the vaginal microorganisms of women and their female partners. Women between the ages of 18-55 years were recruited nationally. Participants completed questionnaires and self-collected vaginal swabs weekly on 3 occasions for BV assessment. 458 participants were recruited of which 192 were co-enrolled with their female partner (96 couples). BV was detected in 125 women (27%). BV was found more often in females who smoked, and who had 4 or more lifetime female partners, and when a female partner had BV symptoms. 375 (88%) participants had stable normal vaginal flora. Co-enrolled couples were less likely to have BV (31% vs 23%). Long term sexually-active WSW partnerships were more likely to have normal vaginal microorganisms.


Study:
Effects of Oral Garlic on Vaginal Candida Colony Counts: A Randomised Placebo Controlled  Double Blind Trial
 
Researchers:
Watson C, Grando D, Fairley CK, Hondros P, Garland SM, Myers S, Pirotta M
                                   
Publication:
BJOG, 2014; 12(4): 498–506
 
Summary: 
Garlic is effective against Candida species in vitro, and along with other alternative therapies, is used by women with vulvovaginal candidiasis. This study looked at whether oral garlic reduced vaginal candida counts in women with Candida species and no symptoms during the second half of their menstrual cycle. Sixty-three asymptomatic women who were culture-positive for Candida species at screening were included. Participants were either given three garlic tablets or placebo orally, twice daily, for 14 days prior to their next menstrual period and also collected a daily swab for 14 days for Candida species culture testing. The amount of Candida species present was determined in all samples provided. No difference was found between the group taking garlic tablets or placebo. This study provided no evidence to inform clinical practice in the use of garlic in vaginal candidiasis. Further studies might investigate longer courses or topical formulations

 



Study:
Early acquisition of anogenital human papillomavirus among teenage men who have sex with men
 
Researchers:
Zou H, Tabrizi SN, Grulich AE, Garland SM, Hocking JS, Bradshaw CS, Morrow A, Prestage G, Cornall AM, Fairley CK, Chen MY
                                   
Publication:
Journal of Infectious Diseases, 2014; 209(5):642-651

Summary:
Anogenital human papillomavirus (HPV) is common among men who have sex with men (MSM) and causes anal cancer. This study examined factors associated with first anogenital HPV infection among teenage MSM. Two hundred MSM aged 16 to 20 years were recruited via community and other sources. Men were tested for HPV DNA from the anus and penis. The proportion of men with anal HPV of any type increased from 10% in men reporting no prior receptive anal sex to 47% in men reporting 4 or more receptive anal sex partners. A similar pattern was also seen with HPV type 16. The proportion of men with penile HPV increased from 4% in men reporting no prior insertive anal sex to 15% in men reporting 4 or more insertive anal sex partners. Overall, 39% of men had at least 1 HPV type: 23% had a vaccine-preventable type (6, 11, 16 or 18). Early and high per partner transmission of HPV occurred between men soon after their first sexual experiences. HPV vaccination needs to commence early for maximal prevention of HPV among MSM.


 
 
Study:
Chlamydia trachomatis prevalence in young people attending primary care services in rural and regional Australia: a cross-sectional survey
 
Researchers:
Yeung AH, Temple-Smith M, Fairley CK, Vaisey A, Guy R,  Law M, Low N, Bingham A, Gunn J, Kaldor J, Donovan B, Hocking
                                   
Publication: 
MJA, 2014; 200(3): 170-175
 
 
Summary:
A survey was conducted in sexually experienced 16–29-year-olds from 134 general practice clinics in 54 rural and regional towns in four states and in nine metropolitan clinics. Participants completed a questionnaire and were tested for chlamydia. Of 4284 participants, 197 tested positive for chlamydia (5%). Prevalence was similar in men (5%) and women (4%) and high in those reporting genital symptoms or a partner with a sexually transmissible infection (STI). In men with symptoms, 17% had chlamydia compared to 10% of women with symptoms. Nearly three-quarters of chlamydia cases (73%) were found in patients with no symptoms attending for non-sexual health reasons. Chlamydia prevalence was slightly higher in participants from rural and regional areas (5%) than those from metropolitan areas (3%). A chlamydia infection was more likely to be found in men who had three or more partners in the past 12 months; used condoms some of the time; and had a previous infection with chlamydia. In women, a chlamydia infection was more likely to be found in women with more than 2 partners in the past 12 months; a previous infection with chlamydia; and were of age 16 to 19 years. Testing only those with genital symptoms or a partner with an STI would have missed three-quarters of cases. Most men and women are amenable to being tested in general practice, even in rural and regional areas.




Study: 
Exploring the acceptability of online sexually transmissible infection testing for rural young people in Victoria

Researchers: 
Jane E Tomnay, Lisa Bourke and Christopher K. Fairley
         
Publication:
Australian Journal of Rural Health, 2014; 22(1): 40-44
 
Summary:
Seven focus groups were held with fifty 16 to 25 year olds, grouped by gender and age in two small country towns for their views on accessible and acceptable services for STI testing that included a free telephone consultation or an online website for testing with postal samples. The group of younger people (less than 18years) raised more concerns with using their local GP services. Trust, confidentiality, costs and parent involvement were some of the issues discussed and thus were more inclined to using online services for testing and treatment. Whereas the older group (18 years or over and less than 25 years) felt it was easier to go and see a doctor than to use online or telephone consultations. There was less discussion about availability of services and more discussion about privacy, trust, reliability in using generalist health care providers for sexual health needs in rural communities. Free online testing services address issues of access for rural young people. Barriers to rural sexual health services may remain. Free online STI testing services are acceptable to these rural young people.