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Peel J, Brousse de Gersigny J, Teague R, Howard J, Bradshaw C, Chen M, Bissessor M. Reproductive health among women living with HIV attending Melbourne Sexual Health Centre for HIV care from February 2019 to February 2020. Sex Health 2024; 21:NULL. [PMID: 38164810 DOI: 10.1071/sh23122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Women living with HIV are a minority population with unique care needs. Rates of unintended pregnancy are higher among women living with HIV versus HIV negative women. However, uptake of contraception among women living with HIV including long-acting-reversible contraceptives (LARCs) remains low. This quality improvement project aimed to identify gaps in reproductive healthcare for women living with HIV attending Melbourne Sexual Health Centre (MSHC). METHODS We performed a retrospective review of women living with HIV attending MSHC for HIV care February 2019-February 2020. Women aged over 45years were excluded. Primary outcomes included proportion using contraception, methods used and whether a sexual or reproductive health history had been taken in the past year. RESULTS A total of 100 women were included, predominantly born overseas (Asia, 38%; sub-Saharan Africa, 34%). Of these, 5% were pregnant, 16% were trying to conceive and 1% were undergoing elective oocyte preservation. Of the remaining 74 women, 48.6% were using any form of contraception, including 17.6% women using less-effective methods (withdrawal and condoms), 6.8% using the combined oral contraceptive pill, 18.9% using LARCs and 5.4% using permanent methods. Sexual activity status was documented for 61% women, 1% declined to answer and not documented for 38% women. CONCLUSIONS Rate of contraceptive use in this study was lower than previously reported among women living with HIV in Australia; however, our findings suggest contraceptive methods may be changing in light of undetectable equals untransmittable and increased fertility desires. Discussions regarding sexual activity and reproductive health were limited. Mechanisms to increase clinician-patient discourse regarding these important issues should be explored.
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Affiliation(s)
- Joanne Peel
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and Department of Infectious Diseases, Alfred Hospital, Melbourne, Vic., Australia
| | | | - Richard Teague
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia
| | - Jayne Howard
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia
| | - Catriona Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - Marcus Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - Melanie Bissessor
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic., Australia
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Ong JJ, Lim A, Bradshaw C, Taylor-Robinson D, Unemo M, Horner PJ, Vickerman P, Zhang L. Cost-effectiveness of testing for Mycoplasma genitalium among men who have sex with men in Australia. Sex Transm Infect 2023; 99:398-403. [PMID: 36958826 DOI: 10.1136/sextrans-2022-055611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/23/2023] [Indexed: 03/25/2023] Open
Abstract
OBJECTIVES Mycoplasma genitalium (MG) disproportionately affects men who have sex with men (MSM). We determined the cost-effectiveness of different testing strategies for MG in MSM, taking a healthcare provider perspective. METHODS We used inputs from a dynamic transmission model of MG among MSM living in Australia in a decision tree model to evaluate the impact of four testing scenarios on MG incidence: (1) no one tested; (2) symptomatic MSM; (3) symptomatic and high-risk asymptomatic MSM; (4) all MSM. We calculated the incremental cost-effectiveness ratios (ICERs) using a willingness-to-pay threshold of $A30 000 per quality-adjusted life year (QALY) gained. We explored the impact of adding an antimicrobial resistance (AMR) tax (ie, additional cost per antibiotic consumed) to identify the threshold, whereby any testing for MG is no longer cost-effective. RESULTS Testing only symptomatic MSM is the most cost-effective (ICER $3677 per QALY gained) approach. Offering testing to all MSM is dominated (ie, higher costs and lower QALYs gained compared with other strategies). When the AMR tax per antibiotic given was above $150, any testing for MG was no longer cost-effective. CONCLUSION Testing only symptomatic MSM is the most cost-effective option, even when the potential costs associated with AMR are accounted for (up to $150 additional cost per antibiotic given). For pathogens like MG, where there are anticipated future costs related to AMR, we recommend models that test the impact of incorporating an AMR tax as they can change the results and conclusions of cost-effectiveness studies.
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Affiliation(s)
- Jason J Ong
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- London School of Hygiene and Tropical Medicine, London, UK
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Aaron Lim
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Catriona Bradshaw
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | | | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, Örebro University, Orebro, Sweden
- Institute for Global Health, University College London, London, UK
| | - Paddy J Horner
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lei Zhang
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
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3
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Banerjee S, Richardson D, Concin N, Monk B, Mirza M, Coleman R, Ray-Coquard I, Pothuri B, Marth C, Demars L, Bradshaw C, Dicristo C, Mosher R, Drapkin R. 3P NaPi2b expression in high grade serous ovarian cancer: Results from combined data sets. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.100857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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Lu M, Shaw P, Richardson D, Hamilton E, Bernardo P, Bradshaw C, Tolcher A, Mosher R. Archival vs fresh tumor samples for assessing the gene expression of NaPi2b and immune-related genes in the Phase 1b study of Upifitamab Rilsodotin (UpRi) in platinum-resistant ovarian cancer. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01033-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Cunningham J, Bradshaw C, Damani A, Kettley C, Duguid J, Cudiamat E, Santos L, Billings L, Henke C, Higton A, Orchard C, Samarasinghe Y. P181 The effects of linagliptin in patients with a diagnosis of Cystic Fibrosis-Related Diabetes. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00511-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bhojwani D, Kapuge L, Dewar G, Bradshaw C. 278 The Paediatric Major Trauma Tertiary Survey: Are We Missing the Mark on Missed Injuries? Br J Surg 2022. [DOI: 10.1093/bjs/znac039.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
The tertiary survey is an integral part of assessment in major trauma. This has been shown to reduce missed injuries resulting in better patient care and favourable medico-legal outcomes. A formal tertiary survey should be carried out for all paediatric major trauma patients.
The primary aim of this audit was to assess completion rates of the tertiary survey proforma for major trauma admissions under the paediatric surgery team at the Bristol Royal Hospital for Children. The secondary aim was to evaluate the adequacy of the current proforma and detect areas for improvement.
Paediatric surgery major trauma admissions were audited over a 7-month period and data was collected retrospectively from patient notes on Evolve (n = 20).
A formal tertiary survey was completed for 6 patients which equated to a completion rate of 30%. A total of 1 missed injury was identified (lip laceration) which required no further treatment. Head-to-toe examination was documented in all of the completed surveys but lacked detail. Documentation of gait was absent in 85% and a body map was not filled in for any of the patients.
The audit was presented at a departmental meeting to increase awareness about the tertiary survey and requirements for completion. An MDT of doctors, nurses and trauma co-ordinators was consulted to design a more thorough proforma which included specific sections for review of bloods and imaging.
Re-audit of the new proforma is ongoing and it is hoped that, in combination with educational initiatives, this will lead to increased identification of missed injuries.
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Affiliation(s)
- D. Bhojwani
- Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - L. Kapuge
- Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - G. Dewar
- Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - C. Bradshaw
- Bristol Royal Hospital for Children, Bristol, United Kingdom
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Suarez-Trujillo A, Luecke SM, Logan L, Bradshaw C, Stewart KR, Minor RC, Ramires Ferreira C, Casey TM. Changes in sow milk lipidome across lactation occur in fatty acyl residues of triacylglycerol and phosphatidylglycerol lipids, but not in plasma membrane phospholipids. Animal 2021; 15:100280. [PMID: 34252722 DOI: 10.1016/j.animal.2021.100280] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/10/2021] [Accepted: 05/17/2021] [Indexed: 12/26/2022] Open
Abstract
Milk fats are vital to neonate survival and development, but vary highly by diet, maternal metabolic state and stage of lactation. To gain a better understanding of changes in lipid composition of sow milk across lactation, milk was collected from nine multiparous sows on days 0, 3, 7, and 14, relative to birth and lipids were profiled using multiple reaction monitoring (MRM) profiling. Percent fat was determined by creamatocrit, and found to be different (P < 0.05) between day 0 (12.36 ± 5.90%) and day 3 (16.22 ± 3.65%) but not between day 7 (13.13 ± 2.19%) and day 14 (12.13 ± 2.45%). Fat was extracted from milk (n = 6/day) using the Bligh-Dyer method and profiled using tandem mass spectrometry MRM to determine the abundance of lipids defined by class and fatty acyl residue composition. Lipid species relative concentration was calculated from internal standards, and data analysis was performed using Metaboanalyst 4.0. Concentration of phosphatidyl-choline, -serine, -ethanolamine, -inositol, cholesteryl ester and sphingomyelin did not vary across lactation days, nor did the distribution of associated fatty acyl residues. The total abundance of triacylglycerides (TGs) and phosphatidylglycerols (PGs) increased (P < 0.05) from colostrum (day 0) to transitional (days 3 and 7) and mature milk (day 14). As lactation days increased from day 0 to day 14, the number of carbons and unsaturation within fatty acyl residues decreased (P < 0.05) in both TGs and PGs. The proportion of TGs and PGs increased (P < 0.05) relative to other lipid classes. Changes in composition of milk triglycerides and phosphatidylglycerols likely reflect the metabolic activity of the mammary gland and developmental needs of neonates.
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Affiliation(s)
- A Suarez-Trujillo
- Department of Animal Sciences, Purdue University, West Lafayette, IN 47907, United States
| | - S M Luecke
- Department of Animal Sciences, Purdue University, West Lafayette, IN 47907, United States
| | - L Logan
- Department of Animal Sciences, Purdue University, West Lafayette, IN 47907, United States
| | - C Bradshaw
- Department of Animal Sciences, North Carolina A&T University, Greensboro, NC 27411, United States
| | - K R Stewart
- Department of Animal Sciences, Purdue University, West Lafayette, IN 47907, United States
| | - R C Minor
- Department of Animal Sciences, North Carolina A&T University, Greensboro, NC 27411, United States
| | - C Ramires Ferreira
- Metabolomics Core, Bindley Science Center, Purdue University, West Lafayette, IN 47907, United States
| | - T M Casey
- Department of Animal Sciences, Purdue University, West Lafayette, IN 47907, United States.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Rosie L Latimer
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia .,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Lenka A Vodstrcil
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Erica L Plummer
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Michelle Doyle
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Gerald L Murray
- Molecular Microbiology Research Group, Murdoch Children's Research institute, Parkville, Victoria, Australia.,Centre for Women's Infectious Diseases, Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Kaveesha Bodiyabadu
- Molecular Microbiology Research Group, Murdoch Children's Research institute, Parkville, Victoria, Australia.,Centre for Women's Infectious Diseases, Royal Women's Hospital, Parkville, Victoria, Australia.,SpeeDx Pty Ltd, Sydney, New South Wales, Australia
| | - Tim R H Read
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Marti Kaiser
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Elisa Mokany
- SpeeDx Pty Ltd, Sydney, New South Wales, Australia
| | - Rebecca Guy
- Sexual Health Program, The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Catriona Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
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9
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Shilling HS, Garland SM, Costa AM, Marceglia A, Fethers K, Danielewski J, Murray G, Bradshaw C, Vodstrcil L, Hocking JS, Kaldor J, Guy R, Machalek DA. Chlamydia trachomatis and Mycoplasma genitalium prevalence and associated factors among women presenting to a pregnancy termination and contraception clinic, 2009-2019. Sex Transm Infect 2021; 98:115-120. [PMID: 33782146 DOI: 10.1136/sextrans-2020-054695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/05/2020] [Accepted: 02/27/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Risk of pelvic inflammatory disease associated with Chlamydia trachomatis and Mycoplasma genitalium is increased after termination of pregnancy (TOP) and may be increased after insertion of intrauterine devices (IUDs). Screening prior to these procedures is recommended only for C. trachomatis. We examined C. trachomatis and M. genitalium prevalence and associated factors among women presenting to a pregnancy termination and contraception service over 10 years. METHODS Retrospective analysis of clinical data collected from 17 573 women aged 15-45 years in 2009-2019 and for 266 M. genitalium positive women tested for macrolide resistance-associated mutations in 2016-2019. RESULTS C. trachomatis and M. genitalium prevalence was 3.7% and 3.4%, respectively. In multivariable analyses, shared risk factors were younger age (p<0.001, for both C. trachomatis and M. genitalium), socioeconomic disadvantage (p=0.045 and p=0.008, respectively) and coinfection (p<0.001, for both sexually transmitted infections), with 10.1% of C. trachomatis positive women also positive for M. genitalium. Additional risk factors were earlier year of visit (p=0.001) for C. trachomatis and for M. genitalium residing outside a major city (p=0.013). The proportion of M. genitalium infections tested between 2016 and 2019 with macrolide resistance-associated mutations was 32.7%. CONCLUSIONS Given the high level of antimicrobial resistance and the prevalence of coinfection, testing C. trachomatis positive women for M. genitalium could be considered in this setting to prevent further spread of resistant infections. Further research is required into the causal link between M. genitalium and pelvic inflammatory disease in women undergoing TOP and IUD insertion.
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Affiliation(s)
- Hannah S Shilling
- Centre for Women's Infectious Diseases, Royal Women's Hospital, Parkville, Victoria, Australia.,Molecular Microbiology group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Suzanne M Garland
- Centre for Women's Infectious Diseases, Royal Women's Hospital, Parkville, Victoria, Australia.,Molecular Microbiology group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Anna-Maria Costa
- Laboratory Services, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Alex Marceglia
- Sexual Health and Rapid Access Service, Royal Women's Hospital, Parkville, Victoria, Australia.,Melbourne Sexual Health Centre, Carlton, Victoria, Australia
| | - Katherine Fethers
- Sexual Health and Rapid Access Service, Royal Women's Hospital, Parkville, Victoria, Australia.,Melbourne Sexual Health Centre, Carlton, Victoria, Australia
| | - Jennifer Danielewski
- Centre for Women's Infectious Diseases, Royal Women's Hospital, Parkville, Victoria, Australia.,Molecular Microbiology group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Gerald Murray
- Centre for Women's Infectious Diseases, Royal Women's Hospital, Parkville, Victoria, Australia.,Molecular Microbiology group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Catriona Bradshaw
- Melbourne Sexual Health Centre, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Clayton, Victoria, Australia
| | - Lenka Vodstrcil
- Melbourne Sexual Health Centre, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Clayton, Victoria, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - John Kaldor
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Dorothy A Machalek
- Centre for Women's Infectious Diseases, Royal Women's Hospital, Parkville, Victoria, Australia .,The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
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Martín-Sánchez M, Case R, Fairley C, Hocking JS, Bradshaw C, Ong J, Chen MY, Chow EPF. Trends and differences in sexual practices and sexually transmitted infections in men who have sex with men only (MSMO) and men who have sex with men and women (MSMW): a repeated cross-sectional study in Melbourne, Australia. BMJ Open 2020; 10:e037608. [PMID: 33234617 PMCID: PMC7689083 DOI: 10.1136/bmjopen-2020-037608] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 10/19/2020] [Accepted: 10/29/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES In the 2010s, there has been an increase in sexually transmitted infections (STI) in men who have sex with men (MSM) in Australia, and since 2015 also in urban heterosexuals. Men who have sex with both men and women (MSMW) have characteristics that may differ from both men who have sex with men only (MSMO) and heterosexual men. We aimed to compare the sexual practices and the trends in HIV/STI positivity between MSMO and MSMW. DESIGN Repeated cross-sectional study. SETTING A sexual health centre in Melbourne, Australia. PARTICIPANTS MSM aged 18 years and above who attended the Melbourne Sexual Health Centre for the first time between 2011 and 2018. This includes 12 795 MSMO and 1979 MSMW. PRIMARY OUTCOME MEASURES Demographic characterics, sexual practices and HIV/STI positivity. RESULTS Compared with MSMW, MSMO were more likely to practice anal sex and to have condomless receptive anal sex with casual male partners, and less likely to have a current regular relationship. Over the 8-year period, there was an increase in condomless receptive anal sex with casual male partners for both groups (MSMO: from 46.2% to 63.3%, ptrend <0.001; MSMW: from 41.3% to 57.9%, ptrend=0.011). Syphilis positivity increased in MSMO (from 5.5% to 7.9%, ptrend=0.012) and MSMW (from 0.9% to 6.4%, ptrend=0.004) and HIV remained stable. Gonorrhoea increased among MSMO from 2011 to 2014 (from 6.7% to 9.6%, ptrend=0.002), and remained stable from 2015 to 2018. MSMO had higher odds of testing positive for gonorrhoea (adjusted OR (aOR) 1.36, 95% CI 1.13 to 1.64), chlamydia (aOR 1.39, 95% CI 1.16 to 1.67), syphilis (aOR 1.74, 95% CI 1.37 to 2.22) and HIV (aOR 4.60, 95% CI 2.43 to 8.70) than MSMW. CONCLUSIONS MSMW have overall lower condomless sex and lower HIV/STI positivity. In the last years, changes in sexual practices in MSM have affected both MSMW and MSMO leading to an increased STI risk.
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Affiliation(s)
- Mario Martín-Sánchez
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Preventive Medicine and Public Health Training Unit, Parc de Salut Mar - Pompeu Fabra University - Agència de Salut Pública de Barcelona (PSMar-UPF-ASPB), Barcelona, Spain
| | - Richard Case
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Christopher Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jane S Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Catriona Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jason Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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11
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Abstract
Mycoplasma genitalium has emerged over the last 30 years as a sexually transmitted infection (STI). As data have accumulated, our understanding of this pathogen and its role in disease continues to evolve. This in turn creates new challenges and complexities. Questions remain regarding the natural history of M. genitalium, its contribution to disease and long-term sequelae. A decline in cure rates for first-line anti-microbials has been observed. This is likely in part due to high usage of single-dose azithromycin in the sexual health field but also due to the intrinsic ability of M. genitalium to rapidly acquire anti-microbial resistance. Consequently, the term 'the new STI superbug' is not infrequently used by the media to describe this pathogen. Currently available antibiotics have side effects that, though rare, are potentially serious. This leads to inherent questions regarding the benefit of testing for and treating M. genitalium, particularly in asymptomatic individuals or in genital syndromes where the benefit of treatment is not well established. In this review, we summarize the most recent evidence and literature regarding M. genitalium and explore areas of research where disparities exist. We discuss the contribution of M. genitalium to genital syndromes, particularly those where data are conflicting, in order to inform indications for testing and treatment. Avoidance of increasing anti-microbial resistance with astute anti-microbial stewardship is paramount if we are to successfully manage M. genitalium infection. We examine the state of play regarding anti-microbial resistance and how to combat this, including currently available anti-microbials, resistance-guided therapy and novel therapeutic approaches. We aim to provide an overview of the current understanding of M. genitalium and the implications for current clinical practise and suggestions for future research.
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Affiliation(s)
- Joanne Peel
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Ei Aung
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Stephanie Bond
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Catriona Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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12
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Abstract
OBJECTIVE To examine the rinsing and gargling mouthwash practices among frequent mouthwash users to determine if there are differences in use between gender, sexual orientation and sex work status. DESIGN Cross-sectional study. SETTING Data obtained from patients attending a sexual health centre located in Melbourne, Australia. PARTICIPANTS 200 frequent mouthwash users (four or more times per week), 50 for each of the following patient groups: men who have sex with men (MSM), female sex workers (FSW), females who are not sex workers and men who have sex with women only (MSW). Participants were observed and audio recorded using mouthwash. PRIMARY AND SECONDARY OUTCOME MEASURES Descriptive analyses were conducted to calculate the median age, time rinsing and gargling, amount of mouthwash used and proportion of participants who rinsed, gargled or both, as determined from the audio files. Kruskal-Wallis H test and χ2 test were used to examine differences between the patient groups. RESULTS Median age was 28 years (IQR: 24-33). During the study, most (n=127; 63.5%) rinsed and gargled, but 70 (35.0%) rinsed only and three (1.5%) gargled only. Median time rinsing was 13.5 s (IQR: 8.5-22.0 s), gargling was 4.0 s (IQR: 2.5-6.0 s) and the median total duration was 17.0 s (IQR: 11.5-25.8 s). Median duration of mouthwash did not differ significantly between the groups (females not sex workers: 18.8 s (IQR: 12.5-24.5 s); FSW: 14.0 s (9.0-22.0 s); MSM: 22.3 s (13.0-26.5 s); MSW: 15.8 s (12.0-25.0 s); p=0.070) but males used mouthwash longer than females (median 20.3 s compared with 15.5 s; p=0.034). The median volume of mouthwash used was 20 mL (IQR: 15-27 mL). And most (n=198; 99.0%) did not dilute mouthwash with water. CONCLUSION Over a quarter of frequent users do not gargle mouthwash at all (35%) and used it for a substantially shorter period of time than it was used in the randomised trial (1 min) where it was shown to be effective at inhibiting Neisseria gonorrhoeae growth. Our findings suggest that many frequent mouthwash users do not follow the manufacturer instructions for using mouthwash and may not use mouthwash in a way that was shown to reduce the growth of oropharyngeal gonorrhoea.
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Affiliation(s)
- Tiffany Renee Phillips
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
- Central Clinical School, Monash University, Carlton, Victoria, Australia
| | - Christopher Fairley
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
- Central Clinical School, Monash University, Carlton, Victoria, Australia
| | - Kate Maddaford
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Sabrina Trumpour
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Rebecca Wigan
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Catriona Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
- Central Clinical School, Monash University, Carlton, Victoria, Australia
| | - Jane S Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
- Central Clinical School, Monash University, Carlton, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
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13
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Carr M, Stocks A, Mallett R, Konkoly K, Freegard M, Hicks A, Crawford M, Pigeon W, Schredl M, Bradshaw C. 0112 Lucid Dreaming Associated with Positive Waking Mood. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Lucid dreaming (being aware that one is dreaming) is typically a positive experience that may enhance positive mood even after waking. There is concern, however, that lucid dreaming may interfere with sleep quality. In the current experiment, participants practiced common lucid dream induction techniques over the course of a week, and kept a daily sleep and dream diary. The study objective was to assess relationships between dream lucidity and subjective sleep quality, dream emotional content, and subsequent waking mood.
Methods
There were 32 participants aged 19–33 in this open label, single arm study (mean=22.63±3.48; 6 males, 24 females). All participants completed a sleep and dream diary for 7 days that included scaled items (1–7 scale) concerning subjective sleep quality, negative and positive emotional intensity of a dream (if recalled). Participants also completed a 19-item lucidity questionnaire, and the Positive and Negative Affect Schedule. Average scores for the week were computed for all measures and Pearson’s correlations conducted between lucidity and all other measures. Participants with no dream recall (n=5) were excluded. Within-subjects analyses were undertaken by selecting each participant’s highest and lowest lucidity night (n=22; 5 participants with only minimum lucidity excluded).
Results
Positive correlations were found between lucidity and dream positive emotion (r=.490, n=27, p=.009) and positive waking mood (r=.638, n=27, p<.001); there were no other significant correlations (all p>.1). Higher lucidity was associated with more positive dream content (t(21)= -3.214, p=.004) and positive waking mood (t(25)=-4.568, p<.001); no other significant differences were observed.
Conclusion
These data indicate that lucidity is associated with positive dreams and waking mood, with no detriment to self-reported sleep quality. The findings provide preliminary support of lucid dreaming as an intervention to improve wellbeing and mood in the short term.
Support
N/A
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Affiliation(s)
- M Carr
- University of Rochester, Rochester, NY
| | - A Stocks
- Swansea University, Swansea, UNITED KINGDOM
| | - R Mallett
- University of Texas at Austin, Austin, TX
| | - K Konkoly
- Northwestern University, Evanston, IL
| | - M Freegard
- Swansea University, Swansea, UNITED KINGDOM
| | - A Hicks
- Swansea University, Swansea, UNITED KINGDOM
| | - M Crawford
- Swansea University, Swansea, UNITED KINGDOM
| | - W Pigeon
- University of Rochester, Rochester, NY
| | - M Schredl
- Central Institute of Mental Health, Mannehim, GERMANY
| | - C Bradshaw
- Swansea University, Swansea, UNITED KINGDOM
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14
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Abstract
Abstract
Introduction
THC (the main psychoactive component of cannabis) has been shown to suppress REM sleep and decrease sleep latency, although this is not consistently replicated. Increased dream vividness is reported to occur in abstinent cannabis users, although dream quality in active users is unstudied. The current study aimed to assess the effects of cannabis use compared to non-use on objective sleep measures, dream reports, and self-reported anxiety, memory, and sleep quality. To collect objective sleep data we piloted the use of a portable PSG headband that allows EEG and EOG recording at home.
Methods
12 regular cannabis users (> 3 days per week) & 9 non-users (aged 19 - 27; 43% female) participated; participants used no other drugs or alcohol on study nights. The most common form of cannabis use was smoking in joints with tobacco (range = 1 - 15 per day). Participants wore the PSG headband (the Hypnodyne ZMax) over 2 nights at home (2nd night used for analysis), and were instructed to awaken 4 times across the night to fill out brief dream reports. Objective sleep measures included TST, Sleep latency, REM latency, and REM percent. Self-report measures included the Pittsburgh Sleep Quality Index, Everyday Memory Questionnaire, and State-Trait Anxiety Index. Dream measures included recall frequency, word length, and three attributes rated on a 1–7 Likert scale - sensory vividness, emotional intensity, and bizarreness.
Results
There were no group differences on self-report measures. Cannabis users showed longer REM latency (t=2.23, p=.04) and lower REM% (U=22, p=.02); there were no other objective group differences. Cannabis users reported higher bizarreness in their dreams (t=2.07, p=.05); there were no other dream differences.
Conclusion
The study presents a novel approach to assess sleep at home and cannabis use. Significant differences emerged between users and non-users on REM latency, REM%, and dream bizarreness.
Support
N/A
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Affiliation(s)
- M Carr
- University of Rochester, Rochester, NY
| | - R Borcsok
- Swansea University, Swansea, UNITED KINGDOM
| | - M Taylor
- Swansea University, Swansea, UNITED KINGDOM
| | - S Segust
- Swansea University, Swansea, UNITED KINGDOM
| | - W Pigeon
- University of Rochester, Rochester, NY
| | - C Bradshaw
- Swansea University, Swansea, UNITED KINGDOM
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15
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Lecomte-Pradines C, Adam-Guillermin C, Gashchak S, Bradshaw C, Copplestone D, Beresford NA. More than thirty years after the Chernobyl accident: What do we know about the effects of radiation on the environment? J Environ Radioact 2020; 211:106108. [PMID: 31753471 DOI: 10.1016/j.jenvrad.2019.106108] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
| | | | - S Gashchak
- Chornobyl Centre for Nuclear Safety, Radioactive Waste and Radioecology, International Radioecology Laboratory, 77th Gvardiiska Dyviiya Str.11, P.O. Box 151, 07100, Slavutych, Kiev Region, Ukraine
| | - C Bradshaw
- Department of Ecology, Environment and Plant Sciences, Stockholm University, SE-10691, Stockholm, Sweden
| | - D Copplestone
- Faculty of Natural Sciences, University of Stirling, Stirling, FK9 4LA, United Kingdom
| | - N A Beresford
- UK Centre for Ecology & Hydrology, CEH Lancaster, Lancaster Environment Centre, Library Av., Bailrigg, Lancaster, LA1 4AP, United Kingdom
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16
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Crawford M, Salanitro M, Vallières A, Carr M, Rees H, Norris E, Bradshaw C, Blagrove M. Both good and poor sleepers overestimate wakefulness after waking from a nap: impact of sleep inertia. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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17
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Latimer RL, Vodstrcil L, De Petra V, Fairley CK, Read TR, Williamson D, Doyle M, Chow EP, Bradshaw C. Extragenital Mycoplasma genitalium infections among men who have sex with men. Sex Transm Infect 2019; 96:10-18. [PMID: 31217322 DOI: 10.1136/sextrans-2019-054058] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/24/2019] [Accepted: 06/02/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES There are limited data on the prevalence of Mycoplasma genitalium (Mgen) coinfection with rectal chlamydia (Chlamydia trachomatis (CT)) and rectal gonorrhoea (Neisseria gonorrhoeae (NG)) infections and few studies examining the prevalence of pharyngeal Mgen in men who have sex with men (MSM). Using transcription-mediated amplification assay, this study aimed to determine the proportion of rectal CT and rectal NG infections in MSM who are coinfected with rectal Mgen, and the proportion of MSM with Mgen detected in the pharynx in order to inform clinical practice. METHODS This was a cross-sectional study conducted at Melbourne Sexual Health Centre in Australia. Consecutively collected rectal swabs from MSM that tested positive for CT (n=212) or NG (n=212), and consecutively collected pharyngeal samples (n=480) from MSM were tested for Mgen using the Aptima Mycoplasma genitalium Assay (Hologic, San Diego). Samples were linked to demographic data and symptom status. RESULTS Rectal Mgen was codetected in 27 of 212 rectal CT (13%, 95% CI 9 to 18) and in 29 of 212 rectal NG (14%, 95% CI 9 to 19) samples, with no difference in the proportion positive for Mgen. MSM with rectal CT/Mgen coinfection had more sexual partners than those with rectal CT monoinfection (mean 6 vs 11, p=0.06). MSM with rectal NG/Mgen coinfection were more likely to be HIV-positive than those with rectal NG monoinfection (OR=2.96, 95% CI 1.21 to 7.26, p=0.023). MSM with rectal CT/Mgen coinfection were more likely to be using pre-exposure prophylaxis than MSM with rectal NG/Mgen coinfection (OR 0.25, 95% CI 0.10 to 0.65, p=0.002). Pharyngeal Mgen was uncommon and detected in 8 of 464 samples (2%, 95% CI 1% to 3%). Pharyngeal Mgen was associated with having a rectal STI (OR=10.61, 95% CI 2.30 to 48.87, p=0.002), and there was a borderline association with being HIV-positive (p=0.079). CONCLUSION These data indicate one in seven MSM treated for rectal CT or rectal NG will have undiagnosed Mgen that is potentially exposed to azithromycin during treatment of these STIs. Rectal Mgen coinfection was associated with specific risk factors which may inform testing practices. Pharyngeal Mgen was uncommon.
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Affiliation(s)
- Rosie Louise Latimer
- Central Clinical School, Monash University, Clayton, Victoria, Australia .,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Lenka Vodstrcil
- Central Clinical School, Monash University, Clayton, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Vesna De Petra
- Doherty Institute, Microbiological Diagnostic Unit Public Health Laboratory, University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Central Clinical School, Monash University, Clayton, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Tim Rh Read
- Central Clinical School, Monash University, Clayton, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Deborah Williamson
- Doherty Institute, Microbiological Diagnostic Unit Public Health Laboratory, University of Melbourne, Melbourne, Victoria, Australia
| | - Michelle Doyle
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Eric Pf Chow
- Central Clinical School, Monash University, Clayton, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Catriona Bradshaw
- Central Clinical School, Monash University, Clayton, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
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18
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Ryan KE, Wilkinson AL, Chow E, Read T, Chen M, Locke P, Leitinger D, Bradshaw C, Pedrana A, Hellard M, Fairley CK, Stoové M. A comparative, retrospective analysis of HIV testing among gay, bisexual and other men who have sex with men in Melbourne, Australia. Aust N Z J Public Health 2019; 43:419-423. [PMID: 31141274 DOI: 10.1111/1753-6405.12903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 03/01/2019] [Accepted: 03/01/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE PRONTO!, a peer-led rapid HIV-testing service in Melbourne, Australia, opened to improve HIV testing among gay and bisexual men (GBM). We compared client characteristics and return testing among GBM testing at PRONTO! with GBM testing at Melbourne Sexual Health Centre (MSHC). METHODS All GBM attending PRONTO! and MSHC for HIV testing between August 2013 and April 2016 were included. We describe the number of tests, percentage of clients who returned during follow-up, the mean number of tests and median time between tests at the two services. RESULTS At PRONTO!, 33% of 3,102 GBM and at MSHC 50% of 9,836 GBM returned for a further HIV test at least once. The mean number of tests per client was 1.7 and 2.5 at PRONTO! and MSHC (p<0.01), respectively. A majority of clients at both services reported behaviours that would recommend up to quarterly testing, however, the median time between tests was 20.0 and 17.0 weeks at PRONTO! and MSHC (p<0.01), respectively. CONCLUSIONS A greater proportion of clients returned and returned frequently at MSHC compared to PRONTO!, however, at both services HIV testing frequency was suboptimal. Implications for public health: Novel HIV testing services should provide convenient and comprehensive sexual health services.
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Affiliation(s)
- Kathleen E Ryan
- Public Health Discipline, Burnet Institute, Melbourne, Victoria.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
| | | | - Eric Chow
- Melbourne Sexual Health Centre, Melbourne, Victoria.,Central Clinical School, Monash University, Melbourne, Victoria
| | - Tim Read
- Melbourne Sexual Health Centre, Melbourne, Victoria
| | - Marcus Chen
- Melbourne Sexual Health Centre, Melbourne, Victoria.,Central Clinical School, Monash University, Melbourne, Victoria
| | - Peter Locke
- PRONTO!, Victorian AIDS Council, Melbourne, Victoria
| | | | | | - Alisa Pedrana
- Public Health Discipline, Burnet Institute, Melbourne, Victoria.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
| | - Margaret Hellard
- Public Health Discipline, Burnet Institute, Melbourne, Victoria.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Melbourne, Victoria.,Central Clinical School, Monash University, Melbourne, Victoria
| | - Mark Stoové
- Public Health Discipline, Burnet Institute, Melbourne, Victoria.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
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19
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Cornelisse VJ, Williamson D, Zhang L, Chen MY, Bradshaw C, Hocking JS, Hoy J, Howden BP, Chow EPF, Fairley CK. Evidence for a new paradigm of gonorrhoea transmission: cross-sectional analysis of Neisseria gonorrhoeae infections by anatomical site in both partners in 60 male couples. Sex Transm Infect 2019; 95:437-442. [PMID: 30996106 DOI: 10.1136/sextrans-2018-053803] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 02/12/2019] [Accepted: 03/03/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Gonorrhoea transmission between men is currently thought to occur primarily to and from the urethra. Transmission without urethral involvement, from throat-to-throat and throat-to-anus, is considered to be uncommon. Using gonorrhoea results from male couples, we aimed to investigate the transmission dynamics of gonorrhoea. If current medical consensus is correct, then most throat and anal infections should be explained by the partner's urethral infection. METHODS This is a cross-sectional analysis of gonorrhoea diagnosed by nucleic acid amplification tests in both partners in male couples who attended Melbourne Sexual Health Centre together between March 2015 and June 2017. Isolates obtained from culture-positive infections underwent whole genome sequencing to assess phylogenetic relatedness between partners. RESULTS In all 60 couples (120 men) at least one partner had gonorrhoea, and isolates had very high phylogenetic relatedness between partners. After excluding men with urethral gonorrhoea, among 32 men with anal gonorrhoea, 34% (95% CI 19% to 53 %) had a partner with throat gonorrhoea. After excluding couples where either man had urethral gonorrhoea, among 48 couples in which at least one man had throat gonorrhoea, in 23% (95% CI 12% to 37 %) of couples both men had throat gonorrhoea. CONCLUSIONS The observed gonorrhoea positivity when urethral infection is absent supports a new paradigm of gonorrhoea transmission, where the throat is a major source of gonorrhoea transmission between men, through tongue kissing, oroanal sex and saliva use as anal lubricant. Public health messages may need to address the risk of saliva exposure during sex.
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Affiliation(s)
- Vincent Jasper Cornelisse
- Melbourne Sexual Health Centre, Carlton, Victoria, Australia .,Prahran Market Clinic, Prahran, Victoria, Australia.,Central Clinical School, Monash University, Prahran, Victoria, Australia.,Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Deborah Williamson
- Melbourne Diagnostic Unit Public Health Laboratory, Peter Doherty Institute, University of Melbourne, Melbourne, Sydney, Australia
| | - Lei Zhang
- Melbourne Sexual Health Centre, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Prahran, Victoria, Australia.,The Kirby Institute, UNSW Australia, Kensington, New South Wales, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Prahran, Victoria, Australia
| | - Catriona Bradshaw
- Melbourne Sexual Health Centre, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Prahran, Victoria, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Jennifer Hoy
- Central Clinical School, Monash University, Prahran, Victoria, Australia.,Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Benjamin P Howden
- Melbourne Diagnostic Unit Public Health Laboratory, Peter Doherty Institute, University of Melbourne, Melbourne, Sydney, Australia.,Doherty Applied Microbial Genomics, Peter Doherty Institute, Department of Microbiology and Immunology, University of Melbourne, Melbourne, Sydney, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Prahran, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Prahran, Victoria, Australia
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20
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Ong JJ, Walker S, Grulich A, Hoy J, Read TRH, Bradshaw C, Chen M, Garland SM, Hillman R, Templeton DJ, Hocking J, Eu B, Tee BK, Chow EPF, Fairley CK. Incorporating digital anorectal examinations for anal cancer screening into routine HIV care for men who have sex with men living with HIV: a prospective cohort study. J Int AIDS Soc 2018; 21:e25192. [PMID: 30516346 PMCID: PMC6280647 DOI: 10.1002/jia2.25192] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/11/2018] [Accepted: 09/18/2018] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Men who have sex with men (MSM) living with HIV have a high risk of anal cancer, which is often detected at late stages, when morbidity and mortality are high. The objective of this study was to describe the feasibility and challenges to incorporating regular digital anorectal examination (DARE) into routine HIV care for MSM living with HIV, from the perspective of patients, physicians and the health service. METHODS In 2014, we recruited 327 MSM living with HIV, aged 35 and above from one major sexual health centre (n = 187), two high HIV caseload general practices (n = 118) and one tertiary hospital (n = 22) in Melbourne, Australia. Men were followed up for two years and DARE was recommended at baseline, year 1 and year 2. Data were collected regarding patient and physician experience, and health service use. An ordered logit model was used to assess the relationship between sociodemographic factors and the number of DAREs performed. RESULTS Mean age of men was 51 (SD ± 9) years, 69% were Australian born, 32% current smokers, and mean CD4 was 630 (SD ± 265) cells per mm3 , with no significant differences between clinical sites. Overall, 232 (71%) men received all three DAREs, 71 (22%) received two DAREs, and 24 (7%) had one DARE. Adverse outcomes were rarely reported: anal pain (1.2% of total DAREs), bleeding (0.8%) and not feeling in control of their body during the examination (1.6%). Of 862 DAREs performed, 33 (3.8%) examinations resulted in a referral to a colorectal surgeon. One Stage 1 anal cancer was detected. CONCLUSION Incorporation of an early anal cancer detection programme into routine HIV clinical care for MSM living with HIV showed high patient acceptability, uncommon adverse outcomes and specialist referral patterns similar to other cancer screening programmes.
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Affiliation(s)
- Jason J Ong
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- London School of Hygiene and Tropical MedicineLondonUK
- Melbourne Sexual Health CentreAlfred HealthCarltonVictoriaAustralia
| | - Sandra Walker
- Melbourne Sexual Health CentreAlfred HealthCarltonVictoriaAustralia
| | - Andrew Grulich
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Jennifer Hoy
- Department of Infectious DiseasesAlfred Hospital and Monash UniversityMelbourneVictoriaAustralia
| | - Tim RH Read
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Melbourne Sexual Health CentreAlfred HealthCarltonVictoriaAustralia
| | - Catriona Bradshaw
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Melbourne Sexual Health CentreAlfred HealthCarltonVictoriaAustralia
| | - Marcus Chen
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Melbourne Sexual Health CentreAlfred HealthCarltonVictoriaAustralia
| | - Suzanne M Garland
- Department of Obstetrics and GynaecologyDepartment of Microbiology in Infectious DiseasesUniversity of MelbourneRoyal Women's HospitalMurdoch Children's Research InstituteParkvilleVictoriaAustralia
| | - Richard Hillman
- HIV, Immunology and Infectious DiseaseSt Vincent's HospitalDarlinghurstNew South WalesAustralia
| | - David J Templeton
- Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
- RPA Sexual HealthSydney Local Health DistrictSydney Medical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Jane Hocking
- Melbourne School of Population and Global HealthUniversity of MelbourneParkvilleVictoriaAustralia
| | - Beng Eu
- Prahran Market ClinicPrahranVictoriaAustralia
| | - Bian Kiem Tee
- The Centre ClinicVictorian AIDS CouncilSt KildaVictoriaAustralia
| | - Eric P F Chow
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Melbourne Sexual Health CentreAlfred HealthCarltonVictoriaAustralia
| | - Christopher K Fairley
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Melbourne Sexual Health CentreAlfred HealthCarltonVictoriaAustralia
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21
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Vandenhove H, Bradshaw C, Beresford NA, Vives I Batlle J, Real A, Garnier-Laplace J. ALLIANCE perspectives on integration of humans and the environment into the system of radiological protection. Ann ICRP 2018; 47:285-297. [PMID: 29671613 DOI: 10.1177/0146645318756831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Risks posed by the presence of radionuclides in the environment require an efficient, balanced, and adaptable assessment for protecting exposed humans and wildlife, and managing the associated radiological risk. Exposure of humans and wildlife originate from the same sources releasing radionuclides to the environment. Environmental concentrations of radionuclides serve as inputs to estimate the dose to man, fauna, and flora, with transfer processes being, in essence, similar, which calls for a common use of transport models. Dose estimates are compared with the radiological protection criteria for humans and wildlife, such as those developed by the International Commission on Radiological Protection. This indicates a similarity in the approaches for impact assessment in humans and wildlife, although some elements are different (e.g. the protection endpoint for humans is stochastic effects on individuals, whereas for wildlife, it is deterministic effects on species and ecosystems). Human and environmental assessments are consistent and complementary in terms of how they are conducted and in terms of the underlying databases (where appropriate). Not having an integrated approach may cause difficulties for operators and regulators, for communication to stakeholders, and may even hamper decision making. For optimised risk assessment and management, the impact from non-radiation contaminants and stressors should also be considered. Both in terms of the underlying philosophy and the application via appropriate tools, the European Radioecology Alliance (ALLIANCE) upholds that integration of human and ecological impact and risk assessment is recommended from several perspectives (e.g. chemical/radiological risks).
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Affiliation(s)
- H Vandenhove
- a SCK•CEN, Belgian Nuclear Research Centre, Environment Health and Safety, Boeretang 200, 2400 Mol, Belgium
| | | | - N A Beresford
- c NERC Centre for Ecology and Hydrology, Lancaster Environment Centre, UK
| | - J Vives I Batlle
- a SCK•CEN, Belgian Nuclear Research Centre, Environment Health and Safety, Boeretang 200, 2400 Mol, Belgium
| | - A Real
- d CIEMAT Centre for Research in Energy, Environment and Technology, Spain
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22
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Ong JJ, Landika A, Fairley CK, Bradshaw C, Chen M, Read TRH, Chow EPF. Characteristics, sexual practices and sexually transmissible infections diagnoses of men who have sex with men and use non-occupational HIV post-exposure prophylaxis in Victoria, Australia. Sex Health 2018; 13:555-559. [PMID: 27537936 DOI: 10.1071/sh16092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 07/15/2016] [Indexed: 11/23/2022]
Abstract
Background Non-occupational post-exposure prophylaxis (NPEP) is available to people with a potential risk for HIV exposure within the preceding 72h. We sought to determine if men who have sex with men (MSM) and receive NPEP had a significantly different risk profile (before the preceding 72h) from MSM not receiving NPEP. If this is the case, NPEP consultations may act as a cue for also discussing pre-exposure prophylaxis. METHODS We conducted a retrospective analysis to compare the demographic characteristics, sexual practices and clinical diagnoses of MSM who were NPEP users and those who were non-NPEP users attending Melbourne Sexual Health Centre from January 2008 to December 2014. Univariate and multivariate logistic regression models were used to examine the association between NPEP use and risk practices. Generalised estimating equations were used to adjust for within-individual correlations related to multiple visits of the same individual. RESULTS Of the 40395 MSM consultations included in the study, 1776 consultations (4%) were related to NPEP prescription. NPEP prescribing was associated with ever having injected drugs (adjusted odds ratio (AOR) 1.8, 95% confidence interval (CI): 1.4-2.3), sex with males only (AOR 1.9, 95% CI: 1.6-2.3), more than three male partners in the past 3 months (AOR 1.5, 95% CI: 1.4-1.7) and inconsistent condom use with these partners within the past 3 months (AOR 2.1, 95% CI: 1.9-2.4). Sex workers (AOR 0.6, 95% CI: 0.3-0.9), and men reporting sex overseas within the past 12 months (AOR 0.7, 95% CI: 0.6-0.8) were less likely to receive NPEP. MSM who used NPEP were more likely to test positive for any sexually transmissible infection (AOR 1.2, 95% CI: 1.0-1.4). CONCLUSIONS MSM receiving NPEP generally had a higher risk profile than MSM not requesting NPEP, indicating that NPEP was used by MSM at higher risk for HIV. Therefore, consultations for NPEP may be an opportune time for also discussing pre-exposure prophylaxis for HIV.
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Affiliation(s)
- Jason J Ong
- Melbourne Sexual Health Centre, 580 Swanston Street, Carlton, Vic. 3053, Australia
| | - Andre Landika
- Central Clinical School, Monash University, Clayton, Vic. 3168, Australia
| | | | - Catriona Bradshaw
- Melbourne Sexual Health Centre, 580 Swanston Street, Carlton, Vic. 3053, Australia
| | - Marcus Chen
- Melbourne Sexual Health Centre, 580 Swanston Street, Carlton, Vic. 3053, Australia
| | - Tim R H Read
- Melbourne Sexual Health Centre, 580 Swanston Street, Carlton, Vic. 3053, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, 580 Swanston Street, Carlton, Vic. 3053, Australia
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Vives I Batlle J, Aoyama M, Bradshaw C, Brown J, Buesseler KO, Casacuberta N, Christl M, Duffa C, Impens NREN, Iosjpe M, Masqué P, Nishikawa J. Marine radioecology after the Fukushima Dai-ichi nuclear accident: Are we better positioned to understand the impact of radionuclides in marine ecosystems? Sci Total Environ 2018; 618:80-92. [PMID: 29127871 DOI: 10.1016/j.scitotenv.2017.11.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/01/2017] [Accepted: 11/01/2017] [Indexed: 06/07/2023]
Abstract
This paper focuses on how a community of researchers under the COMET (CO-ordination and iMplementation of a pan European projecT for radioecology) project has improved the capacity of marine radioecology to understand at the process level the behaviour of radionuclides in the marine environment, uptake by organisms and the resulting doses after the Fukushima Dai-ichi nuclear accident occurred in 2011. We present new radioecological understanding of the processes involved, such as the interaction of waterborne radionuclides with suspended particles and sediments or the biological uptake and turnover of radionuclides, which have been better quantified and mathematically described. We demonstrate that biokinetic models can better represent radionuclide transfer to biota in non-equilibrium situations, bringing more realism to predictions, especially when combining physical, chemical and biological interactions that occur in such an open and dynamic environment as the ocean. As a result, we are readier now than we were before the FDNPP accident in terms of having models that can be applied to dynamic situations. The paper concludes with our vision for marine radioecology as a fundamental research discipline and we present a strategy for our discipline at the European and international levels. The lessons learned are presented along with their possible applicability to assess/reduce the environmental consequences of future accidents to the marine environment and guidance for future research, as well as to assure the sustainability of marine radioecology. This guidance necessarily reflects on why and where further research funding is needed, signalling the way for future investigations.
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Affiliation(s)
- J Vives I Batlle
- Belgian Nuclear Research Centre (SCK•CEN), Boeretang 200, 2400 Mol, Belgium.
| | - M Aoyama
- Institute of Environmental Radioactivity, Fukushima University, Fukushima 960-1296, Japan
| | - C Bradshaw
- Department of Ecology, Environment, and Plant Sciences, Stockholm University, 10691 Stockholm, Sweden
| | - J Brown
- Norwegian Radiation Protection Authority (NRPA), Department of Emergency Preparedness and Environmental Radioactivity, Grini Næringspark 13, Postbox 55, NO-1332, Østerås, Norway
| | - K O Buesseler
- Woods Hole Oceanographic Institution, Woods Hole, MA 02543, United States
| | - N Casacuberta
- Laboratory of Ion Beam Physics, ETH-Zurich, Otto Stern Weg 5, 8093 Zurich, Switzerland; Institute of Biogeochemistry and Pollutant Dynamics, Environmental Physics, ETH-Zurich, Universitätstrasse 16, 8092 Zurich, Switzerland
| | - M Christl
- Laboratory of Ion Beam Physics, ETH-Zurich, Otto Stern Weg 5, 8093 Zurich, Switzerland
| | - C Duffa
- Institut de Radioprotection et de Sureté Nucléaire (IRSN), Centre de Cadarache, 13115 St Paul Lez Durance, France
| | - N R E N Impens
- Belgian Nuclear Research Centre (SCK•CEN), Boeretang 200, 2400 Mol, Belgium
| | - M Iosjpe
- Norwegian Radiation Protection Authority (NRPA), Department of Emergency Preparedness and Environmental Radioactivity, Grini Næringspark 13, Postbox 55, NO-1332, Østerås, Norway
| | - P Masqué
- School of Science and Centre for Marine Ecosystems Research, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027, Australia; Departament de Física & Institut de Ciència i Tecnologia Ambientals, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - J Nishikawa
- School of Marine Science and Technology, Tokai University, Shizuoka 424-8610, Japan
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Rane V, Tomnay J, Fairley C, Read T, Bradshaw C, Carter T, Chen M. Opt-Out Referral of Men Who Have Sex With Men Newly Diagnosed With HIV to Partner Notification Officers: Results and Yield of Sexual Partners Being Contacted. Sex Transm Dis 2017; 43:341-5. [PMID: 27200517 DOI: 10.1097/olq.0000000000000449] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Given its potential for reducing the proportion of people with human immunodeficiency virus (HIV) unaware of their diagnosis, partner notification for HIV has been underutilized. This study aimed to determine if the implementation of opt-out referral of men who have sex with men, newly diagnosed with HIV, to partner notification officers (PNO) increased the proportion of sexual partners notified. METHODS In April 2013, all individuals newly diagnosed with HIV at the Melbourne Sexual Health Centre, Australia were referred to Department of Health PNO to facilitate partner notification. The number of sexual partners reported by men and the proportion contacted in the 12 months before (opt-in period) and after (opt-out period) this policy change were determined through review of the clinical PNO records. RESULTS Overall, 111 men were diagnosed with HIV during the study period. Compared with men in the opt-in period (n = 51), men in the opt-out period (n = 60) were significantly more likely to accept assistance from the PNO (12 [24%] vs 51 [85%]; P < 0.001). A significantly higher proportion of reported partners were notified with opt-out referral (85/185, 45.9%; 95% confidence interval, 38.6-53.4) compared with opt-in referral (31/252, 12.3%; 95% confidence interval, 8.5-17.0) (P < 0.001). DISCUSSION Opt-out referral to PNO was associated with a substantially higher proportion of partners at risk of HIV being contacted.
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Affiliation(s)
- Vinita Rane
- From the *Melbourne Sexual Health Centre, Alfred Hospital; †Centre for Excellence in Rural Sexual Health, Melbourne Medical School, University of Melbourne, Melbourne; ‡Central Clinical School, Monash University, Clayton; and §Department of Health, Melbourne, Victoria, Australia
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Leeyaphan C, Ong JJ, Chow EPF, Dimovski K, Kong FYS, Hocking JS, Howden B, Bissessor M, Fairley CK, Bradshaw C, Read T, Chen M. Treatment Outcomes for Rectal Lymphogranuloma Venereum in Men Who Have Sex with Men Using Doxycycline, Azithromycin, or Both: A Review of Clinical Cases. Sex Transm Dis 2017; 44:245-248. [PMID: 28282652 DOI: 10.1097/olq.0000000000000578] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Treatment for rectal lymphogranuloma venereum where doxycycline 100 mg twice daily for 21 days was used-either alone or together with azithromycin 1 g single dose-resulted in microbiological cure of 97%. These data support doxycycline 100 mg twice daily for 21 days as the preferred treatment for rectal lymphogranuloma venereum.
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Affiliation(s)
- Charussri Leeyaphan
- From the *Melbourne Sexual Health Centre, Alfred Health, Carlton, Melbourne, Victoria, Australia; †Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; ‡Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne; §Microbiological Diagnostic Unit Public Health Laboratory, University of Melbourne, Parkville; and ¶Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Bradshaw C, Murray G, Vodstrcil L, Garland S, Plummer E, Tan A, Twin J, Law M, Hocking J, Bulach D, Phillips G, Fairley C, Tabrizi S. P2.08 Microbiological factors that contribute to the development of bacterial vaginosis:a longitudinal study. Clin Sci (Lond) 2017. [DOI: 10.1136/sextrans-2017-053264.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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27
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Bilardi J, Walker S, Temple-Smith M, Mcnair R, Mooney-Somers J, Vodstrcil L, Bellhouse C, Fairley C, Bradshaw C. Women View Key Sexual Behaviours As the Trigger for the Onset and Recurrence of Bacterial Vaginosis. J Sex Med 2017. [DOI: 10.1016/j.jsxm.2017.04.425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chow E, Priest D, Walker S, Cornelisse V, Chen M, Bradshaw C, Phillips T, Fairley C. Kissing Is Association With the Source for Meeting Casual Partners in Men Who Have Sex With Men. J Sex Med 2017. [DOI: 10.1016/j.jsxm.2017.04.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Chow E, Chen M, Bradshaw C, Fairley C. Vaccinating Against Human Papillomavirus Is not Associated With Risky Sexual Behaviours Among Men Who Have Sex With Men. J Sex Med 2017. [DOI: 10.1016/j.jsxm.2017.04.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Konovalenko L, Bradshaw C, Andersson E, Kautsky U. Application of an ecosystem model to evaluate the importance of different processes and food web structure for transfer of 13 elements in a shallow lake. J Environ Radioact 2017; 169-170:85-97. [PMID: 28110115 DOI: 10.1016/j.jenvrad.2016.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 12/25/2016] [Accepted: 12/29/2016] [Indexed: 06/06/2023]
Abstract
In environmental risk assessments of nuclear waste, there is need to estimate the potential risks of a large number of radionuclides over a long time period during which the environment is likely to change. Usually concentration ratios (CRs) are used to calculate the activity concentrations in organisms. However, CRs are not available for all radionuclides and they are not easily scalable to the varying environment. Here, an ecosystem transport model of elements, which estimates concentrations in organisms using carbon flows and food transfer instead of CR is presented. It is a stochastic compartment model developed for Lake Eckarfjärden at Forsmark in Sweden. The model was based on available data on carbon circulation, physical and biological processes from the site and identifies 11 functional groups of organisms. The ecosystem model was used to estimate the environmental transfer of 13 elements (Al, Ca, Cd, Cl, Cs, I, Ni, Nb, Pb, Se, Sr, Th, U) to various aquatic organisms, using element-specific distribution coefficients for suspended particles (Kd PM) and upper sediment (Kd sed), and subsequent transfer in the foodweb. The modelled CRs for different organism groups were compared with measured CRs from the lake and literature data, and showed good agreement for many elements and organisms, particularly for lower trophic levels. The model is, therefore, proposed as an alternative to measured CR, though it is suggested to further explore active uptake, assimilation and elimination processes to get better correspondence for some of the elements. The benthic organisms (i.e. bacteria, microphytobenthos and macroalgae) were identified as more important than pelagic organisms for transfer of elements to top predators. The element transfer model revealed that most of the radionuclides were channelled through the microbial loop, despite the fact that macroalgae dominated the carbon fluxes in this lake. Thus, element-specific adsorption of elements to the surface of aquatic species, that may be food sources for organisms at higher trophic levels, needs to be considered in combination with generic processes described by carbon fluxes.
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Affiliation(s)
- L Konovalenko
- Department of Ecology, Environment and Plant Sciences, (DEEP), Stockholm University, 10691 Stockholm, Sweden.
| | - C Bradshaw
- Department of Ecology, Environment and Plant Sciences, (DEEP), Stockholm University, 10691 Stockholm, Sweden.
| | - E Andersson
- Swedish Nuclear Fuel and Waste Management Co, (SKB), Box 250, 10124 Stockholm, Sweden.
| | - U Kautsky
- Swedish Nuclear Fuel and Waste Management Co, (SKB), Box 250, 10124 Stockholm, Sweden.
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Lau A, Kong F, Fairley CK, Donovan B, Chen M, Bradshaw C, Boyd M, Amin J, Timms P, Tabrizi S, Regan DG, Lewis DA, McNulty A, Hocking JS. Treatment efficacy of azithromycin 1 g single dose versus doxycycline 100 mg twice daily for 7 days for the treatment of rectal chlamydia among men who have sex with men - a double-blind randomised controlled trial protocol. BMC Infect Dis 2017; 17:35. [PMID: 28061753 PMCID: PMC5217553 DOI: 10.1186/s12879-016-2125-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 12/14/2016] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Rectal infection with Chlamydia trachomatis is one of the most common bacterial sexually transmissible infections among men who have sex with men (MSM) with diagnosis rates continuing to rise. Current treatment guidelines recommend either azithromycin 1 g single dose or doxycycline 100 mg twice daily for 7 days. However, there are increasing concerns about treatment failure with azithromycin. We are conducting the first randomised controlled trial (RCT) to compare treatment efficacy of azithromycin versus doxycycline for the treatment of rectal chlamydia in MSM. METHODS/DESIGN The Rectal Treatment Study will recruit 700 MSM attending Australian sexual health clinics for the treatment of rectal chlamydia. Participants will be asked to provide rectal swabs and will be randomised to either azithromycin 1 g single dose or doxycycline 100 mg twice daily for 7 days. Participants will be asked to complete questionnaires about adverse drug reactions, sexual behaviour and drug adherence via short message service and online survey. The primary outcome is the treatment efficacy as determined by a negative chlamydia nucleic acid amplification test at 4 weeks post treatment. Secondary outcomes will utilise whole genome sequencing and mRNA assay to differentiate between treatment failure, reinfection or false positive results. DISCUSSION Rectal chlamydia is an increasing public health concern as use of pre-exposure prophylaxis against HIV becomes commonplace. Optimal, evidence-based treatment is critical to halting ongoing transmission. This study will provide the first RCT evidence comparing azithromycin and doxycycline for the treatment of rectal chlamydia. The results of this trial will establish which treatment is more efficacious and inform international management guidelines. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12614001125617.
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Affiliation(s)
- Andrew Lau
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Carlton, 3053 VIC Australia
| | - Fabian Kong
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Carlton, 3053 VIC Australia
| | - Christopher K. Fairley
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston St, Carlton, 3053 VIC Australia
- Central Clinical School, Monash University, Clayton, 3800 VIC Australia
| | - Basil Donovan
- The Kirby Institute, UNSW Australia, Kensington, 2052 NSW Australia
| | - Marcus Chen
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston St, Carlton, 3053 VIC Australia
- Central Clinical School, Monash University, Clayton, 3800 VIC Australia
| | - Catriona Bradshaw
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Carlton, 3053 VIC Australia
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston St, Carlton, 3053 VIC Australia
- Central Clinical School, Monash University, Clayton, 3800 VIC Australia
| | - Mark Boyd
- The Kirby Institute, UNSW Australia, Kensington, 2052 NSW Australia
| | - Janaki Amin
- The Kirby Institute, UNSW Australia, Kensington, 2052 NSW Australia
| | - Peter Timms
- University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, 4556 QLD Australia
| | - Sepehr Tabrizi
- Division of Laboratory Services, Department of Microbiology, University of Melbourne, Carlton, 3053 VIC Australia
| | - David G. Regan
- The Kirby Institute, UNSW Australia, Kensington, 2052 NSW Australia
| | - David A. Lewis
- Western Sydney Sexual Health Centre, 162 Marsden St, Parramatta, 2150 NSW Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity & Sydney Medical School-Westmead, University of Sydney, Sydney, 2000 NSW Australia
| | - Anna McNulty
- Sydney Sexual Health Centre, Level 3 Nightingale Wing, Sydney Hospital, Macquarie St, Sydney, 2000 NSW Australia
| | - Jane S. Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Carlton, 3053 VIC Australia
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston St, Carlton, 3053 VIC Australia
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Read T, Bradshaw C. Managing Mycoplasma genitalium infections during a rapid upsurge in antibiotic resistance. MLO Med Lab Obs 2016; 48:28-30. [PMID: 30047665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Konovalenko L, Bradshaw C, Andersson E, Lindqvist D, Kautsky U. Evaluation of factors influencing accumulation of stable Sr and Cs in lake and coastal fish. J Environ Radioact 2016; 160:64-79. [PMID: 27153476 DOI: 10.1016/j.jenvrad.2016.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 04/06/2016] [Accepted: 04/18/2016] [Indexed: 06/05/2023]
Abstract
As a result of nuclear accidents and weapons tests, the radionuclides Cs-137 and Sr-90 are common contaminants in aquatic ecosystems. Concentration ratios (CR) based on concentrations of stable Cs and Sr in biota and media are used for the estimation of transfer of their radioisotopes for radiation dose calculations in environmental and human safety assessments. Available element-specific CRs vary by over an order of magnitude for similar organisms, thus affecting the dose estimates proportionally. The variation could be reduced if they were based on a better understanding of the influence of the underlying data and how that affects accumulation and potential biomagnification of stable Cs and Sr in aquatic organisms. For fish, relationships have been identified between water concentrations of K and CR of Cs-137, and between water concentrations of Ca and CR of Sr-90. This has not been confirmed for stable Cs and Sr in European waters. In this study, we analysed an existing dataset for stable Cs and Sr, as well as K and Ca, in four Swedish lakes and three Baltic Sea coastal areas, in order to understand the behaviour of these elements and their radioisotopes in these ecosystems. We found significant seasonal variations in the water concentrations of Cs, Sr, K and Ca, and in electrical conductivity (EC), especially in the lakes. CR values based on measurements taken at single or few time points may, therefore, be inaccurate or introduce unnecessarily large variation into risk assessments. Instead, we recommend incorporating information about the underlying variation in water concentrations into the CR calculations, for example by using the variation of the mean. The inverse relationships between fish CR(Cs)-[K]water and fish CR(Sr)-[Ca]water, confirmed that stable Cs and Sr follow the same trends as their radioisotopes. Thus, they can be used as proxies when radioisotope data are lacking. EC was also strongly correlated with K and Ca concentrations in the water and could potentially be used as a quick and cost-effective method to estimate water chemistry to obtain less variable CR. We also recommend some simple improvements to data collection that would greatly enhance our ability to understand Cs and Sr uptake by fish.
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Affiliation(s)
- L Konovalenko
- Department of Ecology, Environment and Plant Sciences, (DEEP), Stockholm University, 10691 Stockholm, Sweden.
| | - C Bradshaw
- Department of Ecology, Environment and Plant Sciences, (DEEP), Stockholm University, 10691 Stockholm, Sweden.
| | - E Andersson
- Swedish Nuclear Fuel and Waste Management Co, (SKB), Box 250, 10124 Stockholm, Sweden.
| | - D Lindqvist
- Department of Environmental Science and Analytical Chemistry, (ACES), Stockholm University, 10691 Stockholm, Sweden.
| | - U Kautsky
- Swedish Nuclear Fuel and Waste Management Co, (SKB), Box 250, 10124 Stockholm, Sweden.
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Sunderland T, Tan LY, Walker S, Su J, Bradshaw C, Fairley C, Garland S, Mokany E, Tabrizi S. O033 A qPCR assay that simultaneously detects Mycoplasma genitaliumand mutations associated with macrolide resistance has the potential to improve patient management. Br J Vener Dis 2016. [DOI: 10.1136/sextrans-2016-052718.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chow E, Howden B, Stevens K, Walker S, Lee D, Snow A, Cook S, Fehler G, Bradshaw C, Chen M, Fairley C. O004 Inhibitory effect of an antiseptic mouthwash against Neisseria gonorrhoeaein the pharynx (GONE) among men who have sex with men: a randomised control trial. Br J Vener Dis 2016. [DOI: 10.1136/sextrans-2016-052718.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bilardi J, Walker S, Mooney-Somers J, McNair R, Temple-Smith M, Bellhouse C, Fairley C, Chen M, Bradshaw C. P088 Sexual contact is the trigger! Women’s views and experiences of the triggers for the onset of bacterial vaginosis and exacerbating factors associated with recurrence. Br J Vener Dis 2016. [DOI: 10.1136/sextrans-2016-052718.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chow E, Machalek D, Tabrizi S, Danielewski J, Fehler G, Bradshaw C, Garland S, Chen M, Fairley C, Walker S. O027 Rapid fall in quadrivalent vaccine targeted human papillomavirus genotypes in heterosexual men following the Australian female HPV vaccination programme: an observational study from 2004 to 2015. Br J Vener Dis 2016. [DOI: 10.1136/sextrans-2016-052718.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Cornelisse V, Sherman C, Zhang L, Chen M, Bradshaw C, Bellhouse C, Fairley C, Chow E. P096 Concordance of chlamydia infections of the rectum and urethra in same-sex male partnerships: A cross-sectional analysis: Abstract P096 Table 1. Br J Vener Dis 2016. [DOI: 10.1136/sextrans-2016-052718.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ong J, Morton A, Henzel H, Berzins K, Druce J, Fairley C, Bradshaw C, Hocking J, Chen M. P024 Clinical characteristics of herpes simplex virus urethritis compaerd with chlamydia urethritis among men: a case control study. Br J Vener Dis 2016. [DOI: 10.1136/sextrans-2016-052718.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chow E, Tabrizi S, Phillips S, Lee D, Bradshaw C, Chen M, Fairley C. P089 Detection of Neisseria gonorrhoeaebacterial loads in the pharynx and saliva among men who have sex with men. Br J Vener Dis 2016. [DOI: 10.1136/sextrans-2016-052718.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bellhouse C, Walker S, Fairley C, Vodstrcil L, Bradshaw C, Chen M, Chow E. P149 Patterns of sexual behaviour among transgender individuals in Melbourne, Australia 2011–2014. Br J Vener Dis 2016. [DOI: 10.1136/sextrans-2016-052718.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chow E, Read T, Law M, Chen M, Bradshaw C, Fairley C. P090 Assortative sexual mixing patterns in male-female and male-male partnerships in Melbourne, Australia: implications for HIV and STI transmission. Br J Vener Dis 2016. [DOI: 10.1136/sextrans-2016-052718.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Cornelisse V, Fairley C, Walker S, Young T, Lee D, Chen M, Bradshaw C, Chow E. P098 Adherence to and acceptability of mouthwash as a potential preventive intervention for pharyngeal gonorrhoea among men who have sex with men in Australia – an observational study. Br J Vener Dis 2016. [DOI: 10.1136/sextrans-2016-052718.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bilardi J, Walker S, McNair R, Mooney-Somers J, Temple-Smith M, Bellhouse C, Fairley C, Chen M, Bradshaw C. Women's Management of Recurrent Bacterial Vaginosis and Experiences of Clinical Care: A Qualitative Study. PLoS One 2016; 11:e0151794. [PMID: 27010725 PMCID: PMC4807032 DOI: 10.1371/journal.pone.0151794] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 02/17/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Few data are available on how women manage recurring bacterial vaginosis (BV) and their experiences of the clinical care of this condition. This study aimed to explore women's recurrent BV management approaches and clinical care experiences, with a view to informing and improving the clinical management of BV. METHODS A descriptive, social constructionist approach was chosen as the framework for the study. Thirty-five women of varying sexual orientation who had experienced recurrent BV in the past 5 years took part in semi-structured interviews. RESULTS The majority of women reported frustration and dissatisfaction with current treatment regimens and low levels of satisfaction with the clinical management of BV. Overall, women disliked taking antibiotics regularly, commonly experienced adverse side effects from treatment and felt frustrated at having symptoms recur quite quickly after treatment. Issues in clinical care included inconsistency in advice, misdiagnosis and inappropriate diagnostic approaches and insensitive or dismissive attitudes. Women were more inclined to report positive clinical experiences with sexual health physicians than primary care providers. Women's frustrations led most to try their own self-help remedies and lifestyle modifications in an attempt to treat symptoms and prevent recurrences, including well-known risk practices such as douching. CONCLUSION In the face of considerable uncertainty about the cause of BV, high rates of recurrence, unacceptable treatment options and often insensitive and inconsistent clinical management, women are trying their own self-help remedies and lifestyle modifications to prevent recurrences, often with little effect. Clinical management of BV could be improved through the use of standardised diagnostic approaches, increased sensitivity and understanding of the impact of BV, and the provision of evidence based advice about known BV related risk factors.
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Affiliation(s)
- Jade Bilardi
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Victoria, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sandra Walker
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Ruth McNair
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Julie Mooney-Somers
- Centre for Values, Ethics and the Law in Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Meredith Temple-Smith
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Clare Bellhouse
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Christopher Fairley
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Marcus Chen
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Catriona Bradshaw
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Bilardi J, Walker S, Mooney-Somers J, Temple-Smith M, McNair R, Bellhouse C, Fairley C, Chen M, Bradshaw C. Women's Views and Experiences of the Triggers for Onset of Bacterial Vaginosis and Exacerbating Factors Associated with Recurrence. PLoS One 2016; 11:e0150272. [PMID: 26930414 PMCID: PMC4773144 DOI: 10.1371/journal.pone.0150272] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 02/11/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Bacterial vaginosis (BV) is the most common vaginal infection affecting women of childbearing age. While the aetiology and transmissibility of BV remain unclear, there is strong evidence to suggest an association between BV and sexual activity. This study explored women's views and experiences of the triggers for BV onset and factors associated with recurrence. METHODS A descriptive, social constructionist approach was chosen as the framework for the study. Thirty five women of varying sexual orientation who had experienced recurrent BV in the past five years took part in semi-structured interviews. RESULTS The majority of women predominantly reported sexual contact triggered the onset of BV and sexual and non-sexual factors precipitated recurrence. Recurrence was most commonly referred to in terms of a 'flare-up' of symptoms. The majority of women did not think BV was a sexually transmitted infection however many reported being informed this by their clinician. Single women who attributed BV onset to sex with casual partners were most likely to display self-blame tendencies and to consider changing their future sexual behaviour. Women who have sex with women (WSW) were more inclined to believe their partner was responsible for the transmission of or reinfection with BV and seek partner treatment or change their sexual practices. CONCLUSION Findings from this study strongly suggest women believe that BV onset is associated with sexual activity, concurring with epidemiological data which increasingly suggest BV may be sexually transmitted. Exacerbating factors associated with recurrence were largely heterogeneous and may reflect the fact it is difficult to determine whether recurrence is due to persistent BV or a new infection in women. There was however evidence to suggest possible transmission and reinfection among WSW, reinforcing the need for new approaches to treatment and management strategies including male and female partner treatment trials.
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Affiliation(s)
- Jade Bilardi
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Sandra Walker
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Julie Mooney-Somers
- Centre for Values, Ethics and the Law in Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Meredith Temple-Smith
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ruth McNair
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Clare Bellhouse
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Christopher Fairley
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Marcus Chen
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Catriona Bradshaw
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Ong JJ, Grulich A, Walker S, Hoy J, Read T, Bradshaw C, Garland SM, Hillman R, Templeton D, Hocking J, Eu B, Tee BK, Fairley CK. Baseline findings from the Anal Cancer Examination (ACE) study: screening using digital ano-rectal examination in HIV-positive men who have sex with men. J Med Screen 2015; 23:70-6. [PMID: 26462726 DOI: 10.1177/0969141315604658] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 08/10/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Cytological screening for anal cancer precursors is not always possible. We investigated digital ano-rectal examination (DARE) as a means of early anal cancer detection in HIV-positive men who have sex with men (MSM). METHODS We recruited 327 HIV-positive MSM aged 35 and over from clinics with HIV physicians in Melbourne, Australia, to receive an annual DARE. We analyzed baseline data from patient questionnaires regarding general, anal and sexual health, adverse effects from the anal examination, cancer worry, and quality of life. RESULTS The majority of men (82%, 95% CI:78-87) felt relaxed during the DARE, 1% (95% CI:0-3) complained of pain, and 1% (95% CI:0-4) reported bleeding after the examination. Nearly all men (99%, 95% CI:96-100) were willing to continue with an annual DARE. Quality of life was unaffected with utility scores of 0.76 before examination vs. 0.77 two weeks after examination, (p = 0.41). An anal abnormality was detected in 86 men (27%, 95% CI:22-31), with one anal cancer identified. The specialist referral rate following DARE was 5% (95% CI:3-8). Recruitment rates were significantly associated with the clinic setting (sexual health centre 78%, general practice 13%, hospital 14%, p = 0.002) and specialty (sexual health physician 67%, general practitioner 20%, infectious disease physician 14%, p = 0.031). CONCLUSION Annual DARE to detect anal cancer in HIV-positive MSM was acceptable for patients, with minimal side effects. Strategies to increase HIV physician's patient recruitment would be needed if DARE were to be implemented in anal cancer screening.
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Affiliation(s)
- Jason J Ong
- Melbourne School of Population and Global Health, University of Melbourne, Australia Melbourne Sexual Health Centre, Alfred Health, Australia
| | - Andrew Grulich
- Kirby Institute, University of New South Wales, Australia
| | - Sandra Walker
- Melbourne Sexual Health Centre, Alfred Health, Australia
| | - Jennifer Hoy
- Department of Infectious Diseases, Alfred Hospital and Monash University, Australia
| | - Tim Read
- Melbourne Sexual Health Centre, Alfred Health, Australia
| | - Catriona Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Australia Central Clinical School, Monash University, Australia
| | - Suzanne M Garland
- Department of Obstetrics and Gynaecology, University of Melbourne, Australia
| | | | | | - Jane Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Beng Eu
- Prahran Market Clinic, Melbourne Australia
| | - B K Tee
- The Centre Clinic, Victorian AIDS Council, Melbourne Australia
| | - Christopher K Fairley
- Melbourne School of Population and Global Health, University of Melbourne, Australia Melbourne Sexual Health Centre, Alfred Health, Australia Central Clinical School, Monash University, Australia
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Hocking JS, Vodstrcil L, Huston W, Timms P, Chen M, Bradshaw C, Worthington K, Lawrence A, McIver R, Phillips S, Tabrizi SN. O15.4 Azithromycin treatment failure in women infected with genital chlamydia infection. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ong J, Fairley CK, Carroll S, Walker S, Chen M, Read T, Bradshaw C, Grulich A, Kaldor J, Clarke P. P10.05 Cost-effectiveness of screening for anal cancer using regular digital ano-rectal examinations in hiv-positive men who have sex with men. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Zou H, Tabrizi S, Grulich A, Hocking J, Garland S, Bradshaw C, Fairley C, Chen M. P10.11 Serum antibody responses following anal and penile infection with human papillomavirus in teenage men who have sex with men. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bilardi J, Walker S, Temple-Smith M, McNair R, Mooney-Somers J, Bellhouse C, Fairley C, Chen M, Bradshaw C. P14.05 Sexual contact is the trigger! women’s views and experience of the causes and triggers of bacterial vaginosis. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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