2015 Participant Summaries

2015 Participant Summaries

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Study: 
Detection of Neisseria gonorrhoeae in the pharynx and saliva: implications for gonorrhoea transmission 

Researchers:
Chow EPF, Lee D, Tabrizi SN, Phillips S, Snow A, Cook S, Howden BP, Petalotis I, Bradshaw CS, Chen MY, Fairley CK 

Publication:
Sexually Transmitted Infections, Online First-November doi: 10.1136/sextrans-2015-052399 

Summary:
Men who have sex with men who tested positive for pharyngeal gonorrhoea at Melbourne Sexual Health Centre (MSHC) and returned to MSHC for treatment within 14 days between 13 October 2014 and 25 March 2015 were included in this study. Pharyngeal swabs and saliva samples were collected for culture and NAAT. Of 33 initially culture-positive pharyngeal swabs, 32 saliva samples and 31 pharyngeal swabs were positive by NAAT and 14 pharyngeal and 6 saliva samples were positive by culture within 14 days. There was a significant decline in the proportion of repeated positive pharyngeal culture samples over time. The rapid decline suggests pharyngeal gonorrhoea is short-lived, and the finding of gonorrhoea commonly in saliva, implicates this body fluid in the transmission of gonorrhoea. 



Study:
The impact of sex work on women’s personal romantic relationships and the mental separation of their work and personal lives: a mixed-methods study 

Researchers:
Bellhouse C, Crebbin S, Fairley CK, Bilardi JE 

Publication:
PLoS ONE 2015, 10(10):e0141575 doi:10.1371/journal.pone.0141575 

Summary:
Fifty-five women working in the indoor sex industry in Melbourne, Australia, were recruited to complete a self-report questionnaire about various aspects of their work, including the impact of sex work on their personal relationships. Questionnaires were completed anonymously. A further six women were interviewed to check the accuracy of the questionnaire findings. Most women (78%) reported that, overall, sex work affected their personal romantic relationships in predominantly negative ways, mainly relating to issues stemming from lying, trust, guilt and jealousy. A small number of women reported positive impacts from sex work including improved sexual self-esteem and confidence. Just under half of women were in a relationship at the time of the study and 51% reported their partner was aware of the nature of their work. Seventy-seven percent of single women chose to remain single due to the nature of their work. Many women used mental separation as a coping mechanism to manage the tensions between sex work and their personal relationships.



Study:
Dual Intervention to Increase Chlamydia Retesting: A Randomized Controlled Trial in Three Populations

Researchers:
Smith KS, Hocking JS, Chen MY, Fairley CK, McNulty AM, Read P, Bradshaw CS, Tabrizi SN, Wand H, Saville M, Rawlinson W, Garland SM, Donovan B, Kaldor JM, Guy RJ

Publication:
Am J Prev Med 2015 49(1): 1-11

Summary:
A repeat test for chlamydia 3 months after treatment is recommended to find reinfection, but retesting rates are typically low. This study compared sending a short message service (SMS) reminder to retest and a postal home collection kit 3 months after treatment of chlamydia to only sending an SMS reminder to return to the clinic for retesting. 200 women, 200 heterosexual men, and 200 men who have sex with men who were diagnosed and treated for chlamydia infection at sexual health services were included. Three months after their chlamydia diagnosis and treatment, half the participants in each group received an SMS reminder and the other half a postal home collection kit and SMS reminder. The number who retested within 1-4 months of their chlamydia diagnosis was much higher in the home kit retest group (61%) [184/302] versus those who received an SMS only to return to the clinic for retesting (39%) [117/298]: women: 64% [66/103] vs 39% [38/97], heterosexual men: (56% [57/101] vs 34% [34/99], men who have sex with men: (62% [61/98] vs 44% [45/102]. The home kit retest group with repeat positive tests was higher than the clinic retest group (10% [31/302] vs 4% [12/298] and among men who have sex with men (16% [16/98] vs 5% [5/102]. The addition of a postal home collection kit to routine SMS reminders resulted in large improvements in chlamydia retesting rates in all three test groups and detection of more repeat positive tests, compared with SMS alone.



Study:

Persistence of Neisseria gonorrhoeae DNA following treatment for pharyngeal and rectal gonorrhea is influenced by antibiotic susceptibility and re-infection

Researchers:
Bissessor M, Whiley DM, Fairley CK, Bradshaw CS, Lee DM, Snow AS, Lahra M, Hocking JS, Chen MY

Publication:
Clinical Infectious Diseases 2015 60(4): 557-563

Summary:
This study examined the presence of Neisseria gonorrhoeae DNA following treatment for throat and rectal gonorrhoea. Men who had sex with men who were diagnosed with throat or rectal gonorrhoea had swabs taken from the throat or rectum 7 and 14 days following treatment. Repeat testing for gonorrhoea DNA was undertaken using 2 different polymerase chain reaction (PCR) tests. One hundred throat and 100 rectal gonorrhoea infections in 190 men were included. For throat gonorrhoea, gonorrhoea DNA was present in 13% of men at day 7 and 8% at day 14 for both PCR tests. For rectal gonorrhoea, gonorrhoea DNA was present in 6% of men at day 7 and 8% at day 14 for both PCR tests. Throat and rectal gonorrhoea DNA was present in 8% of men 14 days after treatment. Persistent gonorrhoea DNA may be more common in settings where infections with gonorrhoea are resistant to treatment or may reflect reinfection. Tests of cure following treatment should be maintained using culture


 

Study:

Site-specific human papillomavirus infection in adolescent men who have sex with men: an observational cohort study

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

Publication:
The Lancet Infectious Diseases
2015, 15(1) 65-73

Summary:
Men who have sex with men (MSM) have an increased risk of anogenital human papilomavirus (HPV) infection, which can lead to HPV-related anogenital lesions such as warts, anal intraepithelial neoplasia, and anal cancer. Some of these HPV types are preventable with vaccines. The incidence of anal, penile, and oral HPV infection and the chance of HPV spreading to a partner was estimated for teenage MSM. Teenage MSM were enrolled aged 16–20 years with low sexual exposure and a low prevalence of HPV in Melbourne (VIC, Australia). At baseline, 3, 6, and 12 months, a swab from the anal canal was collected, and participants self-collected a swab from the penis and provided an oral rinse. HPV infection was measured by the presence of HPV DNA in the anus, penis, or mouth at any time in the 12 months. A definite incident of HPV infection was defined if the same HPV type was detected more than once from the same site in men who had a negative HPV test at baseline. A possible incident HPV infection was defined if there was only one positive test during the 12 month study period. There were 200 MSM enrolled between Sept 20, 2010, and Aug 24, 2012. Over the 12 months of  follow-up, 48 definite cases and 107 possible HPV infections were found in the anus, ten definite and 34 possible on the penis, and no definite and 6 possible infections in the mouth. The chance of HPV spreading from the penis to the anus was estimated at approximately 33% whereas from the anus to the penis varied from 1 – 14%. The vaccination coverage in MSM will need to be high with these high incidence rates.

This study is registered at the Australian New Zealand Clinical Trials Registry and ClinicalTrials.gov, numbers ACTRN12611000857909 and NCT01422356



 

Study:
Incident bacterial vaginosis (BV) in women who have sex with women is associated with behaviors that suggest sexual transmission of BV

Researchers:
Vodstrcil LA, Walker SM, Hocking JS, Law M, Forcey DS, Fehler G, Bilardi JE, Chen MY, Fethers KA, Fairley CK, Bradshaw CS         

Publication: 
Clinical Infectious Diseases 2015 60(7): 1042-1053

Summary:
We conducted a nationwide study of women who have sex with women (WSW) to investigate new episodes of BV. Women who tested negative for BV over three weeks were included together with their regular female sexual partner (FSP) for a 24-month study. Each participant completed a 3-monthly questionnaire and self-collected vaginal swabs for evaluation of BV. 298 participants enrolled and 122 co-enrolled with their regular FSP. There were 51 new cases of BV and these related to exposure to a new sexual partner, a partner with BV symptoms, receptive oral sex and the onset of BV symptoms. Women whose partners were BV-negative had a greatly reduced risk of getting BV. These data highlight the strong influence of sexual relationships and behaviours on acquiring BV and support the idea that the exchange of vaginal bacterial species between women with BV is sexually transmitted.


 

 

Study: 
Why are we not screening for anal cancer routinely - HIV physicians' perspectives on anal cancer and its screening in HIV-positive men who have sex with men: a qualitative study

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

Publication:
BMC Public Health  2015 15:67

Summary:
Anal cancer is a priority health issue in HIV positive men who have sex with men. Anal cancer screening may be aimed at either detecting the presence of early lesions (high grade anal intraepithelial neoplasia (HGAIN) or early anal cancer. To date no study has explored the views of HIV physicians about anal cancer and its screening. We conducted in depth interviews with 20 HIV physicians (Infectious diseases, Immunology, Sexual health, General practice) in different settings (hospital, sexual health centres, and general practice) from around Australia. Framework analysis was used to identify themes. HIV physicians viewed anal cancer as a significant health issue and all agreed on the importance of anal cancer screening amongst HIV positive MSM if a valid screening method was available. Barriers for utilizing anal cytology was based primarily on the theme of insufficient evidence (e.g. no studies demonstrating reduction in mortality following screening or effective treatments for HGAIN). Barriers for utilizing DARE for early cancer detection were based on systemic factors (e.g. lack of opportunity, lack of priority, differences in HIV care practices); health provider factors (lack of evidence, difficulty discussing with patients, lack of confidence in DARE) and patient factors (perceived discomfort of DARE for patients, low anal cancer risk awareness). Physicians were willing to consider the idea of patient self-examination and partner-examination although concerns were raised regarding its reliability and issues surrounding partner dynamics. HIV physicians remain ambivalent regarding the most effective means to screen for anal cancer. More research is needed to address the physicians’ concerns before anal cancer screening can be implemented into routine HIV care.


 


Study:
Exposing the gaps in awareness, knowledge and estimation of risk for anal cancer in men who have sex with men living with HIV: a cross-sectional survey in Australia.

Researchers:
Ong JJ, Chen M, Grulich AG, Walker S, Temple-Smith M, Bradshaw CS, Garland SM, Hilman R, Templeton D, Hocking J, Beng E, Tee BK, Fairley CK

Publication: 
Journal of the International AIDS Society 2015 18: 19895

Summary:
Anal cancer is significantly higher in men who have sex with men (MSM) living with HIV when compared to the general population. We aimed to measure their awareness, knowledge and perceived level of personal risk for anal cancer to help inform educational strategies for this group. A study of 327 HIV positive MSM in Melbourne, Australia, attending clinical settings such as sexual health centres, tertiary hospitals, HIV outpatients and high HIV caseload general practices completed a written questionnaire in 2013/14. Poor knowledge was categorised as those who had never heard of anal cancer, or scored 5 or less out of 10 in the knowledge questions. Underestimation of risk was categorised for men who considered themselves as having the same or lower risk for anal cancer compared to the general population. Of 72% who had heard of anal cancer, 47% could not identify any risk factors for anal cancer. Of the total men surveyed, 51% underestimated their risk for anal cancer. The results showed that men who underestimated their risk were older, had poor anal cancer knowledge, and had more likely ever had an anal examination. They were also less likely to consult a physician if they had an anal abnormality, had receptive anal sex or spoke English at home. This survey of MSM living with HIV showed that their awareness, knowledge level and estimation of risk for anal cancer was limited. Further educational and public health initiatives are needed to improve knowledge and understanding of anal cancer risk in MSM living with HIV.


 

Study:
Anal HPV detection in men who have sex with men living with HIV according to age group and recent anal sexual behaviours: Baseline analysis of the anal cancer examination (ACE) study

Researchers: 
Ong JJ, Chen MY, Tabrizi SN, Grulich AE, Cornall A, Garland SM, Jin F, Tee BK, Eu B, Tee BK, Fairley CK

Publication:
Sexually Transmitted Infections Online First, published on October 13, 2015; 0:1–3. doi:10.1136/sextrans-2015-052121

Summary:
Men who have sex with men (MSM) living with HIV are at high risk of infection with high-risk human papillomavirus (HPV), the cause of anal cancer. We assess whether anal HPV DNA detection is related to recent anal sexual activity, what types of anal sexual activity or the persistence of HPV genotypes. We analysed 281 anal swabs taken at the baseline of a 2-year prospective anal cancer screening study of MSM living with HIV from four HIV clinics in Melbourne, Australia. Anal HPV detection was grouped by age and anal sexual behaviours. The majority (80%) of men were positive for any HPV and 59% were positive for high-risk HPV genotypes with no significant differences by age groups. In men who reported no receptive anal sexual activity in the last six months (22%), high risk HPV was found in 53% compared to 60% who had anal sexual activity. Anal HPV in MSM living with HIV is detected in the majority of men throughout all age groups. Anal HPV detection remains high even in men reporting no anal sexual activity in the preceding six months



 

Study:
Baseline findings from the anal cancer examination (ACE) study: screening using digital ano-rectal examination in HIV-positive men who have sex with men

Researchers:
Ong JJ, Grulich AE, Walker S, Hoy J, Read TRH, Bradshaw CS, Garland SM, Hillman R, Templeton D, Hocking JS, Eu B, Tee BK, Fairley CK
                                  

Publication:
Journal of Medical Screening; Online First, published on October 13, 2015 as doi: 10.1177/0969141315604658
 

Summary:
We investigated digital ano-rectal examination (DARE) as a way to detect early anal cancer in HIV-positive men who have sex with men (MSM). We recruited 327 HIV-positive MSM aged 35 and over from clinics with HIV physicians in Melbourne, Australia, to receive an annual DARE. We analysed responses from patient questionnaires about their anal and sexual health, adverse effects from the anal examination, cancer worry, and quality of life. The majority of men (82%) felt relaxed during the DARE, 1% complained of pain, and 1% reported bleeding after the examination. Nearly all men (99%) were willing to continue with an annual DARE. An anal abnormality was detected in 86 men (27%) and the majority of abnormalities were dealt with by the HIV physicians. There were 17 men (5%) referred to a specialist with an uncertain diagnosis of which one had anal cancer confirmed. Recruitment rates for the study varied depending on clinical setting (sexual health centre 78%, general practice 13%, hospital 14%) and the clinician's specialty (sexual health physician 67%, general practitioner 20%, and infectious disease physician 14%). Annual DARE to detect anal cancer in HIV-positive MSM was acceptable for patients, with minimal side effects or quality of life effects. Strategies to increase HIV physician’s patient recruitment would be needed if DARE were to be implemented in anal cancer screening.


 

 

Study:
Detection of Neisseria gonorrhoeae from the tonsils and posterior oropharynx

Researchers:
Bissessor M,  Whiley DM, Snow A, Lee DM, Fairley CK, Peel J, Bradshaw CS, Hocking JS, Lahra MM, Chen MY

Publication:
Journal of Clinical Microbiology
53 (11): 3624 - 3626 doi:

Summary:
This study compared culture of gonorrhoea from the back of the throat to the tonsils, and used sensitive DNA gonococcal tests to determine the amount of gonococcal DNA in samples from each site. One hundred men with previous culture positive throat infections were included. The men were called back for treatment and retested. The test used for detecting gonococcal DNA was similar for both sites with 84% detected from the tonsils and 81% from the back of the throat. Culture was positive in 62% from the tonsils and 52% from the back of the throat at retest. The results showed that culture performed better when the amount of gonococcal DNA was higher in the samples for both sites. The results suggest for the best yield for culture which is required for testing for antibiotics to use for treatment of gonorrhoea, is to collect a sample that includes both sites to obtain sufficient bacteria to support culture of the bacteria



 

Study:
Chlamydia screening for pregnant women aged 16 to 25 years attending an antenatal service: a cost-effectiveness study

Researchers:
Ong JJ, Chen M, Hocking J, Fairley CK, Carter R, Bulfone L, Hseuh A

Publication:
BJOG
(Online First – August 2015) doi: 10.1111/1471-0528.13567

Summary: 
We have previously shown that selective screening on the basis of being a teenager or reporting more than one sexual partner in the last year would screen 27% of women and detect 72% of infections in antenatal settings in Australia where chlamydia prevalence was 3%. Given that 1044 out of 1087 (96%) of women aged 16–25 years approached accepted screening for chlamydia, we proposed that it was practical to offer screening to all pregnant women aged 16–25 years during an antenatal visit. The results of these studies were used to model the cost effectiveness of routine screening in pregnant women using different outcomes associated with various health events for chlamydia screening and no screening. We found that screening all pregnant women aged 16–25 years, compared with no screening or selective screening was cost-effective in both cases, and could result in cost savings when the chlamydia prevalence rate was relatively higher. The advantage for screening the antenatal population means clinicians do not have to ask about a sexual history which may be more acceptable to clinicians and pregnant women alike, as it is unclear how reliable sexual histories may be as a tool for selecting women for chlamydia screening. Also, as rates of chlamydia continue to rise, especially in young people the case for putting into practice screening of all pregnant women aged 16–25 years strengthens