Physicians' perceived barriers to management of sexually transmitted infections in Vietnam

The provision of sexual and reproductive health information and services to travellers: an exploratory survey of Australian travel medicine clinicians

BACKGROUND

International travel can increase the risk of exposure to infectious diseases including sexually transmissible infections (STI). Pre-travel medical consultation provides an opportunity for travel-related health risk assessments and advice. This study explored how travel medicine clinicians integrate sexual and reproductive health (SRH) services into clinical practice.

METHODS

A convenience sample of travel medicine clinicians completed a cross-sectional survey online or via hard-copy disseminated at an annual national Australian travel medicine conference.

RESULTS

Of the 67 respondents, most (n , 51; 76.1%) had a postgraduate qualification relevant to travel medicine and 55.2% (n , 37) had worked in travel medicine for over 10years. Only 22.4% (n , 15) reported conducting a SRH history/STI risk assessment for all travel patients. STI testing pre-departure was conducted on patient request (48, 71.6%), if symptomatic (32, 47.8%) or based on risk history (28, 41.8%). SRH information pre-departure was most frequently provided if prompted by patient questions (n , 42; 62.7%), or based on the patient's history (n , 37; 55.2%). Over half the sample (n , 40; 59.7%) expressed interest in further training in SRH.

CONCLUSION

Providing and engaging with additional training may assist travel medicine clinicians to take a more proactive approach to SRH consultations and STI testing. Additional research is needed to explore models of care that will allow comprehensive SRH and STI services to be integrated into standard pre- and post-travel care.

Can oral sex be performed safely among men who have sex with men (MSM) and transgender women in Bangladesh? Challenges, complexities and the way forward

Introduction

There is currently ample research and intervention initiatives addressing anal sex and sexually transmitted infections (STIs) among gender and sexually diverse people (i.e., men who have sex with men (MSM) and transgender women). However, oral sex and oral STIs are not prioritized to the same extent, despite their concerning implications. This article aimed to delineate the underlying contexts of unprotected oral sex and the management challenges of oral STIs.

Methodology

This qualitative study constituted 30 in-depth interviews, 14 focus group discussions, and 10 key-informant interviews with gender and sexually diverse people, service providers of HIV interventions and sexuality researchers. Thematic analysis conventions were applied.

Results

Findings revealed various contexts of unprotected oral sex. In particular, we found a discordance between pleasure and protected sex where participants believed the two phenomena were mutually exclusive, therefore they did not want to compromise their pleasure by using condoms. Moreover, their low awareness, risk perception, and unchallenged misconceptions about the harms of unprotected oral sex fueled their hesitancy to use condoms during oral sex. Compared to anal sex and STIs, oral sex and STIs were less prioritized in the current HIV intervention modalities, where healthcare providers lacked adequate knowledge and training about oral sex and oral STIs, as well as their complexities.

Conclusions

In Bangladesh and several other settings, oral sex is considered a taboo, thus imbuing silence about this issue and its complexities. In this context, it is integral to eradicate the taboos and silence surrounding oral sex and oral STIs in order to strengthen the overall STI management strategy. Therefore, HIV/STI prevention programs and mainstream healthcare facilities need to underscore oral STI interventions, otherwise this issue would remain under-prioritized.

[Evaluation of the approach to sexuality in primary care consultations in Spain: A multicentre comparative study (2004-2017)]

OBJECTIVE

To describe how sexuality is addressed in general practitioners' (GP) consultations, as well as to compare the results of a questionnaire carried out in 2017 that updated the data obtained from a 2004 survey.

MATERIAL AND METHODS

Descriptive, analytical, multicentre study with 2cross-sections. Of the 3,500 GP who met the selection criteria (holding current accreditation as a resident tutor and being an active worker at the time of the study), 598 doctors participated in the survey in 2017 and 357 in 2004.

RESULTS

In both studies, the majority (98.6% in 2017 and 96% in 2004) consider that the sexual sphere is an important component in people's health, but less than half (40, 6% in 2017 and 21.6% in 2004) systematically recorded it in their clinical history. The main source of training in sexuality in both studies were continuing education courses (50.6% in 2017 and 31.4% in 2004). The main barriers found in both studies were lack of time (85.5% in 2017 and 82.1% in 2004) and lack of training (75.2% in 2017 and 74.5% in 2004).

CONCLUSIONS

GP are aware of the importance of sexuality in people's health, despite this, few professionals systematically record it in their medical records. The main source of training in sexuality is continuing education courses, which has increased in recent years. The main barriers in both studies are lack of time and poor training.

Detection-Based Monetary Incentives to Improve Syphilis Screening Uptake: Results of a Pilot Intervention in a High Transmission Setting in Southern China

BACKGROUND

Underscreening of syphilis in clinical settings is a pervasive problem in resource-constrained settings where heavy patient loads and competing health priorities inhibit health providers' ability to meet screening coverage targets. A "detection-based" pay-for-performance (P4P) strategy can incentivize more targeted testing by rewarding providers with a monetary bonus for every confirmed case.

METHODS

Five clinics in a high transmission setting of China participated in the 6-month pilot intervention. Seropositive proportions during the P4P intervention were compared with those during the preintervention phase using multilevel logistic regression models adjusted for age and sex of clinic attendees.

RESULTS

There were 8423 patients that sought care at 1 of the 6 clinics over the course of the study. Adjusted odds of a positive syphilis screen were greater during the intervention period compared to the preintervention interval (odds ratio, 1.33; 95% confidence interval, 1.14-1.56). Variability in clinic-level effects was substantial given the small number of sites of this pilot study.

CONCLUSIONS

Results of this detection-based P4P pilot study demonstrate the feasibility and preliminary effectiveness of this approach for improving syphilis case detection in resource-constrained clinical settings. A fully powered randomized trial is needed to inform the full utility of this approach for improving sexually transmitted disease detection globally.

Communication About Sexual Matters With Women Attending a Danish Fertility Clinic: A Descriptive Study

Introduction

Several studies have shown that sexuality is an important aspect of life. Nevertheless, sexual matters are only rarely discussed between patients and doctors. Other studies have suggested that women undergoing fertility treatment compose a group of patients with low satisfaction in their sexual life.

Aim

To investigate how women at a fertility clinic desire and experience communication about sexual matters with doctors and to investigate the sexual function of these women.

Methods

A cross-sectional self-administered questionnaire survey of women attending a Danish fertility clinic over 4 months was performed. Descriptive statistics were calculated and presented as frequencies.

Main Outcome Measure

Communication about sexual matters with doctors included the women’s comfort, preferred and actual frequency of discussion, and initiation of the conversation. Sexual function included participants’ sexuality during the past year including certain sexual difficulties.

Results

Of the 201 participating women in the survey, most felt comfortable discussing sexual matters with doctors and preferred gynecologists for such discussions. There was a greater desire for communication than what was actually experienced by the women, and most wanted to initiate the conversation themselves. The women were less satisfied with their sexual life compared with a national control group, and they experienced sexual difficulties more often.

Conclusion

There is an unmet desire of women in fertility treatment for discussing sexual matters, and greater communication on this subject needs to be clinically implemented.

Eldridge KE, Giraldi A. Communication About Sexual Matters With Women Attending a Danish Fertility Clinic. A Descriptive Study. Sex Med 2017;5:e196–e202.