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Vodstrcil LA, Plummer EL, Doyle M, Murray GL, Bodiyabadu K, Jensen JS, Whiley D, Sweeney E, Williamson DA, Chow EPF, Fairley CK, Bradshaw CS. Combination therapy for Mycoplasma genitalium, and new insights into the utility of parC mutant detection to improve cure. Clin Infect Dis 2022; 75:813-823. [PMID: 34984438 DOI: 10.1093/cid/ciab1058] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Mycoplasma genitalium (MG) infection is challenging to cure due to rising antimicrobial resistance and limited treatment options. METHODS This was a prospective evaluation of the efficacy and tolerability of resistance-guided combination antimicrobial therapy for MG-treatment at Melbourne Sexual Health Centre (August 2019-December 2020). All patients received 7-days doxycycline prior to combination therapy based on the macrolide-resistant profile. Macrolide-susceptible infections received combination doxycycline+azithromycin (1g day-1, 500mg days-2-4) and macrolide-resistant infections combination doxycycline+moxifloxacin (400mg daily 7-days). Adherence and adverse effects were recorded at test-of-cure, recommended 14-28-days after antimicrobial completion. Sequencing was performed to determine the prevalence of single nucleotide polymorphisms (SNPs) in the parC gene and their association with moxifloxacin-treatment outcomes in macrolide-resistant infections. RESULTS Of 100 patients with macrolide-susceptible MG treated with doxycycline+azithromycin, 93 were cured (93.0%; 95%CI:86.1%-97.1%). Of 247 patients with macrolide-resistant MG receiving doxycycline+moxifloxacin, 210 were cured (85.0%; 95%CI:80.0%-89.2%). parC sequencing was available for 164 (66%) macrolide-resistant infections; 29% had SNPs at parC S83 or D87 (23% S83I). The absence of SNPs at parC S83/D87 was associated with 98.3% cure (95%CI:93.9-99.8%) following doxycycline+moxifloxacin. The presence of the parC S83I-SNP was associated with failure in 62.5% (95%CI:45.8-77.3%). Side-effects were common (40-46%) and predominantly mild and gastrointestinal. CONCLUSION Combination doxycycline+azithromycin achieved high cure for macrolide-susceptible infections. However, in the context of a high prevalence of the parC S83I mutation (23%) in macrolide-resistant infections, doxycycline+moxifloxacin cured only 85%Infections that were wildtype for S83/D87 experienced high cure following doxycycline+moxifloxacin, supporting the use of a parC-resistance/susceptibility testing strategy in clinical care.
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Htaik K, Fairley CK, Bilardi JE, Chow EPF, Ong JJ, Chen MY. Evaluation of the Online Partner Messaging Service for Sexually Transmitted Infections Let Them Know. Sex Transm Dis 2022; 49:12-14. [PMID: 34618782 DOI: 10.1097/olq.0000000000001505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There are limited data on the extent of use of online services that support partner notification for sexually transmitted infections. The online partner notification service Let Them Know was implemented in 2008 to support partner messaging for chlamydia in Australia. In 2010, the service was expanded to include gonorrhea, syphilis, Mycoplasma genitalium, and Trichomonas vaginalis. We aimed to determine usage of Let Them Know between 2011 and 2019. METHODS The number of text messages sent via Let Them Know for each infection between 2011 and 2019 was extracted by using Microsoft SQL Server Management Studio. Users who sent a text message were asked "Were you more likely to let a partner know because of this website?" RESULTS The number of text messages sent for each infection increased over the evaluation period with a total of 148,256 text messages sent from the service. Sixty-nine percent (103,026) of users indicated that they were more likely to let a partner know because of the website. The number of text messages increased between 2011 and 2019 from 4,666 to 17,889 (283%) for chlamydia, from 2101 to 6328 (201%) for gonorrhea, from 1895 to 4908 (159%) for syphilis, from 703 to 1953 (178%) for M. genitalium, and from 173 to 629 (264%) for trichomonas. CONCLUSIONS This fully automated partner messaging service showed high and increasing use with data suggesting it helped most users contact partners.
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Abraham E, Fairley CK, Aung ET, Bradshaw CS, Chen MY, Phillips TR, Chow EPF. Trichomoniasis among men presenting to a sexual health clinic in Melbourne, Australia. Sex Health 2022; 19:70-73. [DOI: 10.1071/sh21240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/29/2022] [Indexed: 11/23/2022]
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Chow EPF, Fairley CK, Zou H, Wigan R, Garland SM, Cornall AM, Atchison S, Tabrizi SN, Chen MY. Human papillomavirus antibody levels following vaccination or natural infection among young men who have sex with men. Clin Infect Dis 2021; 75:323-329. [PMID: 34971362 DOI: 10.1093/cid/ciab1052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Australia introduced a school-based gender-neutral human papillomavirus (HPV) vaccination program for schoolgirls and boys aged 12-13 years in 2013. We examined HPV type specific antibody levels in unvaccinated young men who have sex with men (MSM) with natural infection and compared these to levels in those vaccinated against HPV. METHODS Serum specimens at baseline were collected from MSM aged 16-20 years in the HYPER1 and HYPER2 studies, conducted between 2010-2013 and 2017-2019, respectively. Merck's 4-plex HPV competitive Luminex Immunoassay was used to quantify HPV6, 11, 16 and 18 specific antibodies. We compared antibody levels for each HPV genotype between unvaccinated men (HYPER1) and vaccinated men (HYPER2) using the Mann-Whitney U test. RESULTS There were 200 unvaccinated men and 127 vaccinated men included in the analysis. Median antibody levels among vaccinated men were significantly higher than levels among unvaccinated men for HPV6 (223 mMU/ml vs 48 mMU/ml, p<0.0001), HPV11 (163 mMU/ml vs 21 mMU/ml, p<0.0001), HPV16 (888 mMU/ml vs 72 mMU/ml, p<0.0001) and HPV18 (161 mMU/ml vs 20 mMU/ml, p<0.0001). The median time between antibody level measurement and last vaccine dose was 47.7 (IQR 40.4 to 54.1) months. Antibody levels did not change over time for up to 66 months for all four genotypes among vaccinated men. CONCLUSION Among young MSM vaccinated with the quadrivalent HPV vaccine, antibody levels for HPV 6, 11, 16 and 18 were significantly higher than those in unvaccinated MSM following natural infection. Antibody levels following vaccination appeared to remain stable over time.
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Xu X, Chow EPF, Ong JJ, Shen M, Wang C, Hocking JS, Fairley CK, Zhang L. Modelling the potential role of saliva use during masturbation in the transmission of Neisseria gonorrhoeae at multiple anatomical sites. Sex Health 2021; 18:466-474. [PMID: 34914887 DOI: 10.1071/sh21138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/05/2021] [Indexed: 11/23/2022]
Abstract
Background Neisseria gonorrhoeae can be cultured from saliva in men with pharyngeal gonorrhoea and could theoretically be transmitted from the pharynx to the urethra when saliva is used as a lubricant for masturbation. In this work, we proposed that saliva use during masturbation may be a potential transmission route of gonorrhoea. Methods We analysed the transmission of Neisseria gonorrhoeae at the oropharynx, urethra and anorectum with mathematical models among men who have sex with men using data from six different studies. Model 1 included transmission routes (oral sex, anal sex, rimming, kissing, and three sequential sex practices). In Model 2, we added saliva use during solo masturbation and mutual masturbation to model 1. Results Model 2 could replicate single site infection at the oropharynx, urethra and anorectum and multi-site infection across six different datasets. However, the calibration of Model 2 was not significantly different from Model 1 across four datasets. Model 2 generated an incidence of gonorrhoea from masturbation of between 5.2% (95% CI: 3.2-10.1) to 10.6% (95% CI: 5.8-17.3) across six data sets. Model 2 also estimated that about one in four cases of urethral gonorrhoea might arise from solo masturbation and mutual masturbation. Conclusions Our models raise the possibility that saliva use during masturbation may play a role in transmitting gonorrhoea. This is an important area to explore because it contributes to the knowledge base about gonorrhoea transmission.
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Aung ET, Chen MY, Fairley CK, Higgins N, Williamson DA, Tomnay JE, Cook KA, Peel J, Dharmakulasinghe V, Alpren C, Chow EPF. Spatial and Temporal Epidemiology of Infectious Syphilis in Victoria, Australia, 2015-2018. Sex Transm Dis 2021; 48:e178-e182. [PMID: 33859143 DOI: 10.1097/olq.0000000000001438] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT This analysis of notified syphilis cases in Victoria, Australia between 2015 and 2018 shows that the syphilis epidemic in Victoria has become more generalized, with increases among heterosexual men and women residing in outer Melbourne suburbs-areas that differ from those of gay men.
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Phillips TR, Constantinou H, Fairley CK, Bradshaw CS, Maddaford K, Chen MY, Hocking JS, Chow EPF. Oral, Vaginal and Anal Sexual Practices among Heterosexual Males and Females Attending a Sexual Health Clinic: A Cross-Sectional Survey in Melbourne, Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312668. [PMID: 34886391 PMCID: PMC8657198 DOI: 10.3390/ijerph182312668] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 11/18/2022]
Abstract
Sex practices among heterosexuals are not well studied. We aimed to explore sexual practices among heterosexuals attending a sexual health clinic. This cross-sectional survey was conducted at Melbourne Sexual Health Centre between March and April 2019. Data were collected on kissing, oral sex (fellatio or cunnilingus), vaginal sex, anal sex and rimming in the previous 3 months. Univariable and multivariable logistic regression analyses were performed to examine the associations between engaging in anal sex and other sex practices. There were 709 participants (333 men; 376 women) who were eligible and completed the survey (response rate was 24.6%). In the past 3 months, most participants had had vaginal sex (n = 677; 95.5%), with a mean of 3.0 (standard deviation (SD): 3.9) vaginal sex partners, and half reported engaging in condomless vaginal sex in the past 3 months (n = 358; 50.1%). A total of 135 (19.0%) participants had had anal sex, with a mean of 1.3 (SD: 1.0) anal sex partners, with 63.5% (n = 94) engaging in any condomless anal sex in the past 3 months. Most participants (n = 637, 89.8%) had received oral sex in the past 3 months; this proportion did not differ by age group or gender. Women (n = 351, 93.4%) were more likely to perform oral sex than men (n = 275; 82.6% men) (p < 0.001) and to have received rimming (26.6% women vs. 12.6% men; p < 0.001). Men were more likely to have performed rimming (25.5% men vs. 9.3% women; p < 0.001). After adjusting for age, number of partners and sexual practice, anal sex was associated with being ≥35 years (adjusted odds ratio (aOR): 2.3; 95% CI: 1.2–4.2), receiving rimming (aOR: 3.8; 95% CI: 2.4–6.0) and performing rimming (aOR: 2.8; 95% CI: 1.8–4.6). Rimming and anal sex are practiced by one-fifth or more of heterosexuals. Older heterosexuals were more likely to engage in anal sex and to perform rimming. Future research should consider the benefits of testing extragenital sites where appropriate.
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Aboud L, Xu Y, Chow EPF, Wi T, Baggaley R, Mello MB, Fairley CK, Ong JJ. Diagnostic accuracy of pooling urine, anorectal, and oropharyngeal specimens for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae: a systematic review and meta-analysis. BMC Med 2021; 19:285. [PMID: 34819068 PMCID: PMC8614052 DOI: 10.1186/s12916-021-02160-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/13/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) at genital and extragenital sites is needed for most key populations, but molecular diagnostic tests for CT/NG are costly. We aimed to determine the accuracy of pooled samples from multiple anatomic sites from one individual to detect CT/NG using the testing of a single sample from one anatomic site as the reference. METHODS In this systematic review and meta-analysis, we searched five databases for articles published from January 1, 2000, to February 4, 2021. Studies were included if they contained original data describing the diagnostic accuracy of pooled testing compared with single samples, resource use, benefits and harms of pooling, acceptability, and impact on health equity. We present the pooled sensitivities and specificities for CT and NG using a bivariate mixed-effects logistic regression model. The study protocol is registered in PROSPERO, an international database of prospectively registered systematic reviews (CRD42021240793). We used GRADE to evaluate the quality of evidence. RESULTS Our search yielded 7814 studies, with 17 eligible studies included in our review. Most studies were conducted in high-income countries (82.6%, 14/17) and focused on men who have sex with men (70.6%, 12/17). Fourteen studies provided 15 estimates for the meta-analysis for CT with data from 5891 individuals. The pooled sensitivity for multisite pooling for CT was 93.1% [95% confidence intervals (CI) 90.5-95.0], I2=43.3, and pooled specificity was 99.4% [99.0-99.6], I2=52.9. Thirteen studies provided 14 estimates for the meta-analysis for NG with data from 6565 individuals. The pooled sensitivity for multisite pooling for NG was 94.1% [95% CI 90.9-96.3], I2=68.4, and pooled specificity was 99.6% [99.1-99.8], I2=83.6. Studies report significant cost savings (by two thirds to a third). CONCLUSION Multisite pooled testing is a promising approach to improve testing coverage for CT/NG in resource-constrained settings with a small compromise in sensitivity but with a potential for significant cost savings.
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Chow EPF, Fairley CK, Williamson DA, Chen MY. Spatial mapping of gonorrhoea notifications by sexual practice in Victoria, Australia, 2017-2019. Aust N Z J Public Health 2021; 45:672-674. [PMID: 34762335 DOI: 10.1111/1753-6405.13180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Htaik K, Fairley CK, Chen MY, Wigan R, Rodriguez E, Bradshaw CS, Chow EPF. Human Papillomavirus Vaccine Course Completion Among Gay and Bisexual Men Who Have Sex With Men From a Time-Limited HPV Vaccination Catch-Up Program in Victoria, Australia. Front Public Health 2021; 9:754112. [PMID: 34692631 PMCID: PMC8528960 DOI: 10.3389/fpubh.2021.754112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background: To examine completion of the human papillomavirus (HPV) vaccination 3-dose regimen and factors associated with completion among men who have sex with men (MSM) aged ≤ 26 years participating in a time-limited HPV catch-up vaccination program in Victoria, Australia. Methods: MSM who received their first dose of HPV vaccine at Melbourne Sexual Health Centre in 2017 were followed until October 2019. Vaccination completion was defined as those who received three doses. Multivariable logistic regression was performed to examine factors associated with vaccine completion. Results: 931 of 1,947 (47.8%) eligible men received at least one dose of HPV vaccine, 750 (38.5%) received two and 590 (30.3%) received three doses. The median time to receiving the second and third dose was 2.8 (IQR = 2.1–4.8) and 7.2 (IQR = 6.3–10.7) months, respectively. Gay men had higher odds of receiving three doses compared to bisexual men (aOR = 2.17; 95%CI: 1.16–4.04). Compared with HIV-negative MSM not taking PrEP, HIV-positive MSM were more like to complete vaccination (aOR = 3.92, 95%CI: 1.62–9.47) but no difference was found compared to HIV-negative men taking PrEP (aOR = 1.55; 95%CI: 0.95–2.53). Conclusion: Less than one-third of men aged ≤ 26 years completed the three doses of HPV vaccine. Further studies are needed to understand the barriers of men not completing the vaccine.
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Chow EPF, Lee D, Bond S, Fairley CK, Maddaford K, Wigan R, Fehler G, Lange SA, De Petra V, Bissessor M, Bradshaw CS, Howden BP, Hocking JS, Williamson DA, Chen MY. Nonclassical Pathogens as Causative Agents of Proctitis in Men who Have Sex With Men. Open Forum Infect Dis 2021; 8:ofab137. [PMID: 34671693 PMCID: PMC8521645 DOI: 10.1093/ofid/ofab137] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background This study aimed to identify enteric and sexually acquired rectal pathogens,
other than chlamydia and gonorrhea, associated with symptomatic proctitis in
men who have sex with men (MSM). Methods Anorectal swab samples were obtained from MSM presenting with rectal symptoms
and a clinical diagnosis of proctitis at the Melbourne Sexual Health Centre
between January 2017 and March 2019. Samples that tested positive for
Neisseria gonorrhoeae and Chlamydia
trachomatis were excluded. As a comparison group, anorectal
samples were also obtained from MSM not reporting symptoms of proctitis
between November 2018 and February 2019. Samples from both groups were
tested for 15 viral, bacterial, and protozoal enteric pathogens using
polymerase chain reaction. Results Anorectal samples from 499 men with symptomatic proctitis and 506
asymptomatic men were analyzed. Age, HIV status, and pre-exposure
prophylaxis (PrEP) use did not differ between men with proctitis and
asymptomatic men. Treponema pallidum was more common in men
with proctitis (risk difference [RD], 3.6%; 95% CI, 2.0%–5.2%). Most
men with anorectal T. pallidum presented with painful anal
primary infections. Shigella spp. was more common among men
with proctitis compared with asymptomatic men (RD, 1.8%; 95% CI,
0.1%–3.5%). Most men with Shigella did not report
diarrhea. Mycoplasma genitalium was more common in men with
proctitis (RD, 4.3%; 95% CI, 1.1%–7.5%). Herpes simplex virus
(HSV)–1 (RD, 10.1%; 95% CI, 6.8%–13.3%) and HSV-2 (RD, 7.2%; 95%
CI, 4.5%–10.0%) were more common with proctitis. Conclusions Testing for T. pallidum, Shigella, and HSV
should be considered in MSM presenting with symptomatic proctitis. These
data provide support for M. genitalium as a significant
cause of proctitis. A comprehensive diagnostic evaluation is required for
MSM with proctitis.
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Xu X, Chow EPF, Shen M, Zou Z, Wang C, Ong JJ, Fairley CK, Zhang L. Potential effect of antiseptic mouthwash on the incidence of Neisseria gonorrhoeae among men who have sex with men: a mathematical modelling study. BMJ Open 2021; 11:e052823. [PMID: 34620667 PMCID: PMC8499270 DOI: 10.1136/bmjopen-2021-052823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES The incidence of Neisseria gonorrhoeae and its antimicrobial resistance is increasing in many countries. Antibacterial mouthwash may reduce gonorrhoea transmission without using antibiotics. We modelled the effect that antiseptic mouthwash may have on the incidence of gonorrhoea. DESIGN We developed a mathematical model of the transmission of gonorrhoea between each anatomical site (oropharynx, urethra and anorectum) in men who have sex with men (MSM). We constructed four scenarios: (1) mouthwash had no effect; (2) mouthwash increased the susceptibility of the oropharynx; (3) mouthwash reduced the transmissibility from the oropharynx; (4) the combined effect of mouthwash from scenarios 2 and 3. SETTING We used data at three anatomical sites from 4873 MSM attending Melbourne Sexual Health Centre in 2018 and 2019 to calibrate our models and data from the USA, Netherlands and Thailand for sensitivity analyses. PARTICIPANTS Published available data on MSM with multisite infections of gonorrhoea. PRIMARY AND SECONDARY OUTCOME MEASURES Incidence of gonorrhoea. RESULTS The overall incidence of gonorrhoea was 44 (95% CI 37 to 50)/100 person-years (PY) in scenario 1. Under scenario 2 (20%-80% mouthwash coverage), the total incidence increased (47-60/100 PY) and at all three anatomical sites by between 7.4% (5.9%-60.8%) and 136.6% (108.1%-177.5%). Under scenario 3, with the same coverage, the total incidence decreased (20-39/100 PY) and at all anatomical sites by between 11.6% (10.2%-13.5%) and 99.8% (99.2%-100%). Under scenario 4, changes in the incidence depended on the efficacy of mouthwash on the susceptibility or transmissibility. The effect on the total incidence varied (22-55/100 PY), and at all anatomical sites, there were increases of nearly 130% and large declines of almost 100%. CONCLUSIONS The effect of mouthwash on gonorrhoea incidence is largely predictable depending on whether it increases susceptibility to or reduces the transmissibility of gonorrhoea.
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Khawar L, McManus H, Vickers T, Chow EPF, Fairley CK, Donovan B, Machalek DA, Regan DG, Grulich AE, Guy RJ, McGregor S. Genital warts trends in Australian and overseas-born people in Australia: A cross-sectional trend analysis to measure progress towards control and elimination. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 16:100251. [PMID: 34590059 PMCID: PMC8403758 DOI: 10.1016/j.lanwpc.2021.100251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/19/2021] [Accepted: 07/27/2021] [Indexed: 11/17/2022]
Abstract
Background: Substantial declines in genital warts have been observed in countries with quadrivalent/nonavalent human papillomavirus (q/n HPV) vaccination programmes, with Australia showing the most pronounced and long-term reductions. No study has assessed progress towards elimination of genital warts in a nation-wide sample of patients, and migrants' contribution to population-level control of genital warts. We assessed Australia's progress towards genital warts elimination by examining trends in diagnoses in Australian- and overseas-born patients of sexual health clinics (SHCs) across Australia. Methods: A cross-sectional trend analysis of new genital warts diagnoses among first-time patients of 34 SHCs, between 2004 and 2018, was performed. Rate ratios (RR) were calculated using Poisson regression models, for comparing trends in proportions of new genital warts diagnoses in Australian- and overseas-born patients during the pre-vaccination era (2004-2007) and the vaccination era (2008-2018), and by 2018 relative to 2004-2007. Findings: A total of 439,957 new patients (Australian-born: 230,230; overseas-born: 209,727) were seen at SHCs, 6•4% were diagnosed with genital warts (Australian-born: 7•1%; overseas-born: 5•6%). By 2018, there had been a 64% reduction in the proportion of all SHC patients with a genital warts diagnosis relative to 2004-2007 (RR: 0•36, 95% CI: 0•35-0•38). The decline was more pronounced at 72% (RR: 0•28, 95% CI: 0 •27-0•30) among Australian-born patients, with the greatest reduction in women and men aged <21 years, at 98% (RR: 0•02, 95% CI: 0•01-0•03) and 92% (RR: 0•08, 95% CI: 0•06-0•11), respectively. By 2018, there was a 49% reduction in the proportion of overseas-born patients diagnosed with genital warts (RR: 0•51, 95% CI:0•48-0•54), and a 21% reduction in overseas-born patients from countries with no or bivalent HPV (bHPV) vaccination programme (RR: 0•79, 95% CI: 0•71-0•90). Interpretation: The substantial reductions in Australian-born people is a testament to the efficacy of quadrivalent (qHPV) and nonavalent (nHPV) vaccines and the high and wide-spread vaccination coverage in Australia. However, population-wide elimination of genital warts in Australia is dependent on other countries initiating or expanding their own HPV vaccination programmes. Funding: The Australian Government Department of Health and Seqirus Australia.
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Aung ET, Fairley CK, Ong JJ, Bilardi JE, Chen MY, Chow EPF, Phillips TR. Exploring the attitudes of men who have sex with men on anal self-examination for early detection of primary anorectal syphilis: a qualitative study. BMC Infect Dis 2021; 21:982. [PMID: 34544383 PMCID: PMC8453991 DOI: 10.1186/s12879-021-06686-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/13/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Studies show men who have sex with men (MSM) practising receptive anal sex are more likely to present with secondary syphilis, suggesting anorectal primary lesions are being missed. Regular anal self-examination might be able to detect anorectal syphilis lesions, hence potentially reducing transmission. This study aimed to explore the attitudes of MSM on performing anal self-examination to detect primary syphilis. METHODS In this qualitative study, 20 MSM over 18 years of age were purposively sampled from a sexual health clinic to participate in semi-structured interviews. Interviews were recorded, transcribed verbatim and data analysed thematically. RESULTS Four major themes and 12 sub-themes were generated from the study: (1) reasons for performing anal self-examination, (2) preferred educational resources for anal self-examination, (3) attitudes towards partner anal examination, and (4) acceptability of anal self-examination. Most participants had performed some form of anal self-examination in the past, and, just over half performed regularly for mostly health-related concerns. Most participants who infrequently or never performed anal self-examination were agreeable to perform regularly if it was recommended by health professionals with appropriate guidance. Participants preferred education on anal self-examination from health professionals and trusted online learning resources. CONCLUSION Our study showed MSM were agreeable to anal self-examination however would like to receive education and training to gain more confidence in conducting anal self-examination as a screening tool. Further studies are required to explore the adherence and acceptability of anal self-examination for syphilis prior to studies examining efficacy. The study provides foundation for any future policy aiming at utilising anal self-examination as a screening tool for syphilis among MSM.
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Peel J, Chow EPF, Denham I, Schmidt T, Buchanan A, Fairley CK, Williamson DA, Bissessor M, Chen MY. Clinical Presentation of Incident Syphilis Among Men Who Have Sex with Men Taking HIV Pre-Exposure Prophylaxis in Melbourne, Australia. Clin Infect Dis 2021; 73:e934-e937. [PMID: 33522575 DOI: 10.1093/cid/ciab052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Current international guidelines on human immunodeficieny virus (HIV) Pre-Exposure Prophylaxis (PrEP) recommend serological screening for syphilis at routine 3-monthly PrEP appointments. The aim of our study was to describe the pattern of clinical presentation of syphilis among men who have sex with men (MSM) taking PrEP. We were interested in whether syphilis is detected through screening at scheduled3-monthly PrEP clinic appointments or whether primary or secondary syphilis presented at unscheduled interval visits. METHODS This was a retrospective study of MSM attending the PrEP clinic at the Melbourne Sexual Health Centre between February 2016 and March 2019. Serological screening for syphilis was routinely undertaken at 3-monthly PrEP clinic appointments. Diagnoses of early syphilis were identified from PrEP clinic visits and from interim walk-in STI clinic attendances. RESULTS There were 69 cases of early syphilis among 61 MSM taking PrEP during the study period. There were 24 (35%) primary, 16 (23%) secondary, and 29 (42%) early latent infections. The incidence of early syphilis was 8.6 per 100 person-years. A substantial proportion of primary (58%) and secondary (44%) syphilis diagnoses were made at interim STI clinic attendances, between PrEP appointments. CONCLUSIONS Syphilis screening at routine 3-monthly PrEP visits alone fails to detect a proportion of primary and secondary syphilis infections and may be insufficient in preventing onward transmission. Education of MSM taking PrEP regarding the risk of syphilis and symptom recognition is necessary together with access to syphilis testing between PrEP visits.
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Farquharson RM, Fairley CK, Ong JJ, Phillips TR, Chow EPF. Time to healthcare-seeking following the onset of STI-associated symptoms during two waves of the COVID-19 pandemic in Melbourne, Australia. Sex Transm Infect 2021; 98:388-389. [PMID: 34385368 DOI: 10.1136/sextrans-2021-055204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/24/2021] [Indexed: 11/03/2022] Open
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Coombe J, Kong FYS, Bittleston H, Williams H, Tomnay J, Vaisey A, Malta S, Goller JL, Temple-Smith M, Bourchier L, Lau A, Chow EPF, Hocking JS. Love during lockdown: findings from an online survey examining the impact of COVID-19 on the sexual health of people living in Australia. Sex Transm Infect 2021; 97:357-362. [PMID: 33203737 PMCID: PMC7670557 DOI: 10.1136/sextrans-2020-054688] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/22/2020] [Accepted: 10/03/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Australia recorded its first case of COVID-19 in late January 2020. On 22P March 2020, amid increasing daily case numbers, the Australian Government implemented lockdown restrictions to help 'flatten the curve'. Our study aimed to understand the impact of lockdown restrictions on sexual and reproductive health. Here we focus on sexual practices. METHODS An online survey was open from the 23PP April 2020 to 11P May 2020. Participants were recruited online via social media and other networks and were asked to report on their sexual practices in 2019 and during lockdown. Logistic regression was used to calculate the difference (diff) (including 95% CIs) in the proportion of sex practices between time periods. RESULTS Of the 1187 who commenced the survey, 965 (81.3%) completed it. Overall, 70% were female and 66.3% were aged 18-29 years. Most (53.5%) reported less sex during lockdown than in 2019. Compared with 2019, participants were more likely to report sex with a spouse (35.3% vs 41.7%; diff=6.4%; 95% CI 3.6 to 9.2) and less likely to report sex with a girl/boyfriend (45.1% vs 41.8%; diff=-3.3%; 95% CI -7.0 to -0.4) or with casual hook-up (31.4% vs 7.8%; 95% CI -26.9 to -19.8). Solo sex activities increased; 14.6% (123/840) reported using sex toys more often and 26.0% (218/838) reported masturbating more often. Dating app use decreased during lockdown compared with 2019 (42.1% vs 27.3%; diff= -14.8%; 95% CI -17.6 to -11.9). Using dating apps for chatting/texting (89.8% vs 94.5%; diff=4.7%; 95% CI 1.0 to 8.5) and for setting up virtual dates (2.6% vs 17.2%; diff=14.6%; 95% CI 10.1 to 19.2) increased during lockdown. CONCLUSION Although significant declines in sexual activity during lockdown were reported, people did not completely stop engaging in sexual activities, highlighting the importance of ensuring availability of normal sexual and reproductive health services during global emergencies.
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Chow EPF, Carter A, Vickers T, Fairley CK, McNulty A, Guy RJ, Regan DG, Grulich AE, Callander D, Khawar L, Machalek DA, Donovan B. Effect on genital warts in Australian female and heterosexual male individuals after introduction of the national human papillomavirus gender-neutral vaccination programme: an analysis of national sentinel surveillance data from 2004-18. THE LANCET. INFECTIOUS DISEASES 2021; 21:1747-1756. [PMID: 34339639 DOI: 10.1016/s1473-3099(21)00071-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/21/2020] [Accepted: 02/03/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND In Australia, the government-funded human papillomavirus (HPV) vaccination programme was introduced in April, 2007, for girls and young women, and in February, 2013, for boys. As of Dec 31, 2018, all Australian-born female individuals younger than 38 years and male individuals younger than 21 years have been eligible for the free quadrivalent or nonavalent HPV vaccine. We aimed to examine the trends in genital wart diagnoses among Australian-born female and heterosexual male individuals who attended sexual health clinics throughout Australia before and after the introduction of the gender-neutral HPV vaccination programme in February, 2013. METHODS We did a serial cross-sectional analysis of genital wart diagnoses among Australian-born female and heterosexual male individuals attending a national surveillance network of 35 clinics between Jan 1, 2004, and Dec 31, 2018. We calculated prevalence ratios of genital warts, using log-binomial regression models, for the female-only vaccination period (July 1, 2007, to Feb 28, 2013), gender-neutral vaccination period (March 1, 2013, to Dec 31, 2018), and the whole vaccination period (July 1, 2007, to Dec 31, 2018) compared with the pre-vaccination period (Jan 1, 2004, to June 30, 2007). FINDINGS We included 121 038 men and 116 341 women in the analysis. Overall, we observed a 58% reduction (prevalence ratio 0·42, 95% CI 0·40-0·44) in genital wart diagnoses in female individuals and a 45% reduction (0·55, 0·53-0·57) in genital wart diagnoses in heterosexual male individuals after the introduction of the vaccination programme in 2007. The largest reduction in genital warts was observed in younger individuals, and there was a decreasing magnitude of reduction with increasing age (80%, 72%, 61%, 41%, and 16% reductions in female individuals aged 15-20 years, 21-25 years, 26-30 years, 31-35 years, and ≥36 years, respectively; 70%, 61%, 49%, 37%, and 29% reductions in male individuals aged 15-20 years, 21-25 years, 26-30 years, 31-35 years, and ≥36 years, respectively). Significant reductions observed in female individuals (0·32, 0·28-0·36) and male individuals (0·51, 0·43-0·61) aged 15-20 years in the female-only vaccination period were followed by a more substantial reduction in female individuals (0·07, 0·06-0·09) and male individuals (0·11, 0·08-0·15) aged 15-20 years in the gender-neutral vaccination period. INTERPRETATION The national gender-neutral HPV vaccination programme has led to substantial and ongoing reduction in genital warts among Australian female and heterosexual male individuals, with a marked reduction in young individuals who received the vaccine at school. FUNDING Seqirus Australia and the Australian Government Department of Health.
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Constantinou H, Fairley CK, Hocking JS, Bradshaw CS, Choi EPH, Maddaford K, Phillips TR, Chow EPF. Associations Between Methods of Meeting Sexual Partners and Sexual Practices Among Heterosexuals: Cross-sectional Study in Melbourne, Australia. JMIR Form Res 2021; 5:e26202. [PMID: 34283024 PMCID: PMC8335617 DOI: 10.2196/26202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/04/2021] [Accepted: 05/31/2021] [Indexed: 11/19/2022] Open
Abstract
Background The association between meeting partners on the web and sexual practices has been understudied in heterosexuals. Objective This study aims to examine the associations between the methods of meeting partners and sexual practices and HIV and sexually transmitted infections (STIs) in heterosexuals. Methods We conducted a survey among heterosexuals attending the Melbourne Sexual Health Centre in 2019. This survey asked about the methods through which the participants engaged in meeting their sexual partners, sexual practices, and intravenous drug use (IVDU) over the past 3 months. The participants’ HIV and STI (chlamydia, gonorrhea, and syphilis) status was obtained from clinical testing. Multivariable logistic regression was used to examine the association between each method of meeting and the participants’ sexual practices, IVDU, and STI status. Results A total of 698 participants (325 men and 373 women) were included in the study. Most of the participants reported using only one method to meet partners (222/325, 68.3% men; 245/373, 65.7% women; P=.05). The men met partners most commonly at social venues (eg, bar, pub, or party; 126/325, 38.8%), whereas the women met partners most commonly through friends or family (178/373, 47.7%). Paying for sex was associated with men meeting partners at sex venues (adjusted odds ratio [AOR] 145.34, 95% CI 26.13-808.51) and on the internet (AOR 10.00, 95% CI 3.61-27.55). There was no association between IVDU and methods of meeting. Social venues were associated with condomless vaginal sex among men (AOR 3.31, 95% CI 1.94-5.71) and women (AOR 2.58, 95% CI 1.61-4.13) and testing positive for STI among men (AOR 3.04, 95% CI 1.24-7.48) and women (AOR 3.75, 95% CI 1.58-8.89). Conclusions Heterosexuals who met partners at social venues had a more than threefold risk of testing positive for STIs, indicating that heterosexuals may benefit from health promotion campaigns that are delivered through a public setting.
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Tran H, Saleem K, Lim M, Chow EPF, Fairley CK, Terris-Prestholt F, Ong JJ. Global estimates for the lifetime cost of managing HIV. AIDS 2021; 35:1273-1281. [PMID: 33756510 DOI: 10.1097/qad.0000000000002887] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE There are an estimated 38 million people with HIV (PWH), with significant economic consequences. We aimed to collate global lifetime costs for managing HIV. DESIGN We conducted a systematic review (PROSPERO: CRD42020184490) using five databases from 1999 to 2019. METHODS Studies were included if they reported primary data on lifetime costs for PWH. Two reviewers independently assessed the titles and abstracts, and data were extracted from full texts: lifetime cost, year of currency, country of currency, discount rate, time horizon, perspective, method used to estimate cost and cost items included. Descriptive statistics were used to summarize the discounted lifetime costs [2019 United States dollars (USD)]. RESULTS Of the 505 studies found, 260 full texts were examined and 75 included. Fifty (67%) studies were from high-income, 22 (29%) from middle-income and three (4%) from low-income countries. Of the 65 studies, which reported study perspective, 45 (69%) were healthcare provider and the remainder were societal. The median lifetime costs for managing HIV differed according to: country income level: $5221 [interquartile range (IQR)]: 2978-11 177) for low-income to $377 820 (IQR: 260 176-541 430) for high-income; study perspective: $189 230 (IQR: 14 794-424 069) for healthcare provider, to $508 804 (IQR: 174 781-812 418) for societal; and decision model: $190 255 (IQR: 13 588-429 772) for Markov cohort, to $283 905 (IQR: 10 558-453 779) for microsimulation models. CONCLUSION Estimating the lifetime costs of managing HIV is useful for budgetary planning and to ensure HIV management is affordable for all. Furthermore, HIV prevention strategies need to be strengthened to avert these high costs of managing HIV.
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Kilner A, Fairley CK, Burrell S, Bradshaw CS, Chen MY, Chow EPF. Age pattern of sexual activities with the most recent partner among men who have sex with men in Melbourne, Australia: a cross-sectional study. BMJ SEXUAL & REPRODUCTIVE HEALTH 2021; 47:e4. [PMID: 32868336 DOI: 10.1136/bmjsrh-2020-200720] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Sexual behavioural studies among men who have sex with men (MSM) are predominantly focused on penile-anal intercourse. Other non-anal sexual activities are under-studied. This study aimed to examine the age pattern of a range of sexual activities among MSM with the most recent male sex partner. METHODS We conducted a survey among MSM attending the Melbourne Sexual Health Centre in 2017. This survey asked about nine different sexual activities with their most recent regular and casual partner. A Chi-square trend test was used to examine the age patterns of each sexual activity. RESULTS A total of 1596 men answered the survey and their median age was 30 (IQR 25-37) years. With casual partners, kissing was the most common activity (92.4%), followed by performing penile-oral sex (86.0%) and receiving penile-oral sex (83.9%). The least common activity was insertive rimming (38.1%). Young men were more likely to engage in kissing (ptrend<0.001), receptive rimming (ptrend=0.004) and receptive penile-anal sex (ptrend<0.001) but they were less likely to have insertive penile-anal sex compared with older MSM. With regular partners, the most common activity was kissing (97.4%), followed by touching penises (90.0%) and performing penile-oral sex (88.3%). Age was not associated with most types of sexual activity with regular partners except mutual masturbation and receptive penile-anal sex. Younger men were more likely to masturbate mutually (ptrend=0.028) and engage in receptive penile-anal sex (ptrend=0.011). CONCLUSIONS The pattern of sexual activities shows age-related differences with casual partners but less so with regular partners in MSM.
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Latimer RL, Vodstrcil LA, Plummer EL, Doyle M, Murray GL, Fairley CK, Bodiyabadu K, Read TRH, Kaiser M, Mokany E, Guy R, Chow EPF, Bradshaw C. The clinical indications for testing women for Mycoplasma genitalium. Sex Transm Infect 2021; 98:277-285. [PMID: 34210839 DOI: 10.1136/sextrans-2020-054818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 05/29/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND While the contribution of Mycoplasma genitalium (MG) to symptoms in men is well described, less is known about its association with common genital symptoms in women. We aimed to determine the prevalence of MG and macrolide resistance, and its association with common genital symptoms in women attending a sexual health service, to inform indications for testing and clinical practice. METHODS We undertook a cross-sectional study of symptomatic and asymptomatic women attending Melbourne Sexual Health Centre (MSHC), between April 2017 and April 2019. Women were tested for MG and macrolide resistance, Chlamydia trachomatis (CT), Neisseria gonorrhoeae, Trichomonas vaginalis, bacterial vaginosis and vulvovaginal candidiasis. Women completed a questionnaire on symptoms, and symptomatic women underwent examination. The prevalence of MG (and macrolide resistance) and other genital infections was calculated with 95% CIs, and associations between these outcomes and specific genital symptoms were examined using logistic regression. RESULTS Of 1318 women, 83 (6%, 95% CI: 5% to 8%) had MG, of which 39 (48%, 95% CI: 36% to 59%) had macrolide-resistant MG; 103 (8%, 95% CI: 6% to 9%) women had CT. MG prevalence was similar in asymptomatic (10 of 195; 5%) and symptomatic (73 of 1108; 7%) women, p=0.506. MG was associated with mucopurulent cervicitis on examination (adjusted OR=4.38, 95% CI: 1.69 to 11.33, p=0.002), but was not associated with other specific genital symptoms or signs. CONCLUSIONS MG was as common as CT among women attending MSHC. MG was not associated with genital symptoms, but like CT, was significantly associated with cervicitis. These data provide evidence that routine testing for MG in women with common genital symptoms is not indicated. The presence of macrolide resistance in 48% of women supports use of resistance-guided therapy.
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Choi KWY, Choi EPH, Chow EPF, Wan EYF, Wong WCW, Wong JYH, Fong DYT. The Experience of Using Dating Applications for Sexual Hook-Ups: A Qualitative Exploration among HIV-Negative Men Who Have Sex With Men in Hong Kong. JOURNAL OF SEX RESEARCH 2021; 58:785-794. [PMID: 33656408 DOI: 10.1080/00224499.2021.1886227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Men who have sex with men (MSM) use dating applications (apps) to explore various romantic and sexual relationships. This qualitative study aimed to describe HIV-negative MSM's experiences with app usage, the sexual activities arranged accordingly and their experiences in using dating apps to arrange sexual encounters. Thirty-one MSM who were sexually active and who used dating apps were recruited. Individual semi-structured interviews were conducted. Qualitative data were thematically analyzed to outline significant phenomena and perceptions. The factors associated with matching on apps included sex roles, human immunodeficiency virus serostatus and availability of a venue for meetup. Facilitated by these apps, diverse types of sexual encounters were arranged. Condoms were typically used for safer intercourse, except by people who were younger and inexperienced or when drugs were consumed before or during sex (chemsex). Extensive interest in non-penetrative sexual behaviors was expressed by our sample. Searching for post-exposure prophylaxis methods and/or sexual health screenings was common after exposure to risk of infections. Sexually abusive encounters were followed by changes in sex-searching habits and lowered trust in relationship formation. The results of this study are important for the development of appropriate interventions to promote safer sexual practices among HIV-negative MSM dating app users.
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Gan J, Kularadhan V, Chow EPF, Fairley CK, Hocking JS, Kong FYS, Ong JJ. What do young people in high-income countries want from STI testing services? A systematic review. Sex Transm Infect 2021; 97:574-583. [PMID: 34193529 DOI: 10.1136/sextrans-2021-055044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/09/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND There are upward trends of STI rates among young people in most high-income countries. We reviewed the literature to provide a summary of information to support health services with the aim of increasing testing of STIs among young people living in high-income countries. METHODS We conducted a systematic review (Prospero: CRD42020179720) using PubMed, Embase, PsychINFO and CINAHL. The search was performed on 10 January 2020 for studies between January 2000 and 10 January 2020. Two reviewers independently screened articles, and any discrepancies were resolved by a third reviewer. Studies were included if they were performed in high-income countries and contained data on both young people (<26 years) and STI testing preferences. Data regarding the characteristics of STI testing services that young people preferred was extracted. We categorised these characteristics using the framework of a social-ecological model. RESULTS We identified 1440 studies, and 63 studies were included in the final review. We found 32 studies that addressed individual factors, 62 studies that addressed service factors and 17 studies that addressed societal factors. At an individual level, we identified eight attributes including the need for improved sexual health education. At a service level, 14 attributes were identified including preferences from different subgroups of young people (such as sexual and ethnic minorities) for the types of services. At a societal level, we identified two attributes including the need to address stigma associated with STIs. CONCLUSION We provide an overview of the growing body of literature capturing the preferences of young people for STI testing services. To optimise the uptake of STI testing among young people, factors from all socioecological levels should be considered. In addition, understanding and accounting for distinct preferences from subgroups of young people could increase demand for STI testing services for those at greatest need.
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Kong FYS, Hatzis CL, Lau A, Williamson DA, Chow EPF, Fairley CK, Hocking JS. Treatment efficacy for pharyngeal Neisseria gonorrhoeae: a systematic review and meta-analysis of randomized controlled trials. J Antimicrob Chemother 2021; 75:3109-3119. [PMID: 32747940 DOI: 10.1093/jac/dkaa300] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/09/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Rising gonorrhoea rates require highly effective treatments to reduce transmission and prevent development of antimicrobial resistance. Currently the most effective treatments for pharyngeal gonorrhoea remain unclear. This review aimed to estimate treatment efficacy for pharyngeal gonorrhoea. METHODS Online bibliographic databases were searched for the period 1 January 2000 to 17 September 2019 for treatments of gonorrhoea. All randomized controlled trials (RCTs) with data on pharyngeal gonorrhoea among participants aged 15 years or above, published in English, were included. Meta-analyses (random effects) were used to estimate the treatment efficacy, defined as microbiological cure, among currently recommended monotherapies and dual therapies, previously recommended but no longer used regimens and emerging drugs under evaluation. Side effects were also summarized. The study protocol was registered on PROSPERO (CRD42020149278). RESULTS There were nine studies that included 452 participants studying 19 treatment regimens. The overall treatment efficacy for pharyngeal gonorrhoea was 98.1% (95% CI: 93.8%-100%; I2 = 57.3%; P < 0.01). Efficacy was similar for single (97.1%; 95% CI: 90.8%-100.0%; I2 = 15.6%; P = 0.29) and dual therapies (98.0%; 95% CI: 91.4%-100%; I2 = 79.1%; P < 0.01). Regimens containing azithromycin 2 g or ceftriaxone were similarly efficacious. The summary efficacy estimate for emerging drugs was 88.8% (95% CI: 76.9%-97.5%; I2 = 11.2%; P = 0.34). Small sample sizes in each trial was a major limitation. CONCLUSIONS Regimens containing ceftriaxone or azithromycin 2 g, alone or as part of dual therapies are the most efficacious for pharyngeal gonorrhoea. Further pharyngeal-specific RCTs with adequate sample sizes are needed.
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