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Background. In Australia, syphilis notifications increased 2.5-fold during 2013-2022 and 83 congenital syphilis cases were reported. Timely diagnosis and management are crucial. We developed a tool to promote syphilis testing into our existing 'Future Health Today' (FHT) software and explored its acceptability in general practice. Methods. Our tool (FHT-syphilis) scans electronic medical record data to identify and prompt testing for pregnant women, and, people recently tested for sexually transmissible infection (STI) or HIV, but not syphilis. It links to relevant guidelines and patient resources. We implemented FHT-syphilis in 52 general practices using FHT for other conditions and interviewed practice clinicians (n = 9) to explore it's acceptability. Data were analysed deductively guided by the Theoretical Framework of Acceptability. Results. Interviewees considered syphilis an important infection to focus on and broadly viewed FHT-syphilis as acceptable for identifying patients and giving clinicians authority to discuss syphilis testing. Time constraints and unrelated reasons for a patient's visit were barriers to initiating syphilis testing discussions. Australian STI guidelines were considered appropriate to link to. Some interviewees considered prompts should be based on sexual behaviour, however this is not well captured in the electonic medical record. Two interviewees were alerted to updated Australian STI guidelines via their interaction with FHT-syphilis and expanded their syphilis testing practices. Expertise to initiate discussions about syphilis and risk was deemed important. Conclusions. A digital tool for prompting syphilis testing was acceptable to clinicians already using FHT. Linkage to STI guidelines alerted some end-users to updated guidelines, informing STI testing practices. [ABSTRACT FROM AUTHOR]

Background: There are limited studies examining the early experiences of adolescent men who have sex with men (MSM), and the magnitude of changes in sexual practice among adolescent MSM is unclear. Therefore, we compared the sexual practice and trajectory among adolescent men who are MSM aged 16–20 years in two cohorts, 5 years apart in Melbourne, Australia. Methods: A total of 200 self-identified same-sex attracted men aged 16–20 years were recruited in each of HYPER1 (2010–2012) and HYPER2 (2017–2018) using similar methodology. Men completed a questionnaire about their sexual practices. Men were also asked to report the age of first sex with different sexual activities with men and women. Results: Compared to HYPER1, the median age at first sex with men was slightly increased in HYPER2: receiving oral sex (17.2 years in HYPER2 vs 16.5 years in HYPER1), performing oral sex (17.3 years vs 16.4 years), receptive anal sex (18 years vs 17.0 years) and insertive anal sex (18 years vs 17.3 years). Similar patterns were also observed in sexual practice with women: performing oral sex (17.0 years in HYPER2 vs 16.8 years in HYPER1), receiving oral sex (17.0 years vs 16.3 years) and vaginal sex (17.0 years vs 16.7 years). Conclusions: In general, there was a small delay in first-sex activity among adolescent MSM between two cohorts 5 years apart. Most adolescent MSM started their sexual practices before the age of 18 years and have engaged in activities that are at risk of HIV and STI. Health education and promotion, including regular sexual health check-ups, are important for HIV and STI prevention and intervention in this population. This study documents adolescent men who have sex with men aged between 16 and 20 years and assesses the magnitude of change in sexual practice and trajectory in this population. Compared to an earlier study cohort, the median age at first sex was slightly increased in this cohort and there was a small delay in first-sex activity. This study elicits evidence of changes in sexual practice which could translate into targeted sexually transmitted infections prevention strategies. [ABSTRACT FROM AUTHOR]

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 45 years 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. Women living with HIV are a minority in Australia. They present unique healthcare challenges, particularly relating to sexual and reproductive health. Evidence shows higher rates of unplanned pregnancy and lower rates of long-acting-reversible contraception use among women living with HIV. We highlight gaps in care at an Australian metropolitan centre and suggest contraceptive options used by women living with HIV may be changing in the era of modern HIV treatment. We suggest changes in care provision to meet demand, including use of 'women-centred' models of care. [ABSTRACT FROM AUTHOR]

Background: The first mpox case was reported in May 2022 in Australia. Most cases have been diagnosed in men who have sex with men (MSM). This study aimed to examine community understanding of mpox, attitudes towards vaccination, and potential changes in sexual practices surrounding the mpox outbreak among MSM and transgender people in Victoria, Australia. Methods: Participants were recruited from sexual health clinics and communities in Victoria, Australia, in August–October 2022. Participants were asked about their understanding and knowledge of mpox, vaccination uptake and intentions to change sexual practices. Univariable and multivariable logistic regression was performed to examine the factors associated with mpox vaccine uptake. Results: Most participants (97.8%, 525/537) had heard about mpox and 10.5% (55/525) knew someone who had had mpox. Of the 12 mpox knowledge questions, the median score of correct answers was 10 (IQR = 8–11) out of a maximum of 12. More than a third (36.6%, 191/522) had been vaccinated against mpox. MSM who had a good knowledge of mpox had the highest odds of receiving mpox vaccine compared with those who had poor knowledge (aOR = 4.05; 95% CI: 1.54–10.61). To prevent mpox, half reported they would reduce having sex with casual partners, stop having chemsex (used drugs for the purpose of sex), stop attending sex-on-premises-venues, and stop having group sex. A quarter reported they would increase condom use for anal sex. Conclusions: One-third of high-risk participants and a substantial proportion of participants intended to reduce or stop certain practices, which may explain the large reduction in mpox cases. We conducted a cross-sectional survey among gay, bisexual and other men who have sex with men and transgender people across Victoria in Australia to understand community understanding of mpox, attitudes towards vaccination, and potential changes in sexual practices due to the mpox outbreak. Most people were willing to reduce or stop high-risk sexual practices to prevent mpox. Individuals who were at higher risk of acquiring mpox were likely to have received their mpox vaccine. [ABSTRACT FROM AUTHOR]

Background: Despite the increase in the proportion of HIV notifications attributed to heterosexuals in Australia, little is known about their HIV testing behaviours. We investigated the trends and factors associated with HIV testing behaviours among heterosexuals. Methods: We analysed the trend and proportion of heterosexuals attending the centre for the first time between 2011 and 2020, who had ever tested and tested for HIV in the past 12 months and the median number of months since their last HIV test. We identified factors associated with HIV testing behaviours using univariable and multivariable logistic regressions. Results: Of the 78 652 heterosexuals included, 53.1% were men and 46.9% were women. Overall, the proportion of heterosexuals who had ever tested for HIV was 40.8%, with a declining testing trend from 40.2% in 2011 to 36.5% in 2020 (P trend < 0.001). Overall, the proportion of heterosexuals tested for HIV in the past 12 months was 15.7%, with no significant change from 15.3% in 2011 to 14.7% in 2020 (P trend = 0.489). The median number of months since the last HIV test decreased from 18.0 (IQR 6.9–37.3) in 2011 to 15.0 (IQR 6.4–32.5) in 2020 (P trend < 0.001). Individuals who had condomless sex with casual partners (aOR 0.92, 95% CI 0.88–0.96) and who were diagnosed with a sexually transmitted infection (aOR 0.88, 95% CI 0.84–0.93) were less likely to have ever tested for HIV. Conclusions: HIV testing was low among heterosexuals, and individuals who engaged in condomless sex and had another sexually transmitted infection were less likely to be tested. To reduce HIV transmission, strategies to improve HIV testing among heterosexuals are needed. Despite the increase in the proportion of HIV notifications attributed to heterosexuals in Australia, little is known about their HIV testing practices. Among heterosexuals attending the Melbourne Sexual Health Centre for the first time between 2011 and 2020, the odds of ever HIV testing werelow (40.8%), and individuals who engaged in condomless sex and had another STI were less likely to be tested. To reduce HIV transmission, strategies to improve HIV testing among heterosexuals are needed. [ABSTRACT FROM AUTHOR]

Background: Few studies investigate group sex among heterosexuals. The aim of this study was to provide an exploration of characteristics and practices among heterosexual men and women who engage in group sex.Method: We conducted a cross-sectional survey between May 2019 and March 2020 among heterosexual men and women attending a sexual health clinic in Melbourne, Australia. Participants were asked whether they had participated in group sex (sex involving more than two participants) in the past 3months, the size of the most recent event, sexual activities in which they engaged, and condom use.Results: Of 3277 heterosexuals surveyed (1509 women and 1768 men), the mean age was 29.9years (s.d. 8.8) and more than half (56.0%, n=1834) were born outside Australia. One in 20 participants (5.4%) had engaged in group sex in the past 3months with the number of events ranging 1-10times. Kissing was the most common activity in group sex, and women were significantly more likely to kiss a same-sex partner than men. Overall, of 165 participants who engaged in vaginal sex, 57 (34.5%) reported always using condoms and changing condoms between consecutive partners. Of the 100 men and women who had condomless vaginal sex, 79 (79.0%) received or performed fellatio after condomless vaginal sex.Conclusion: About two-thirds of heterosexuals who engaged in group sex neither used condoms nor changed condoms between partners in the most recent group sex event. Safe sex messages on changing condoms between partners and between sexual activities should be reinforced for sexually transmitted infections prevention. [ABSTRACT FROM AUTHOR]

Background: With a rise in sexually transmitted infections in Australia, it is important to evaluate and optimise current sexual health services to reduce barriers to access and increase testing. We aimed to describe the range of sexual health services in Australia, focusing on strategies to improve testing among priority populations, and any future strategies participants believed would improve service delivery.Methods: We conducted 20 semi-structured interviews with key informants working in Australian sexual health services from July to December 2020, and collected data on service characteristics and strategies to improve access. We used content analysis, then coded and categorised the data into recurring themes and sub-themes.Results: We identified two major themes: 'Expanding Traditional Service Delivery' and 'Thinking Outside the Box'. The first theme outlines strategies that build upon pre-existing service delivery models, such as express clinics and an increased focus on confidentiality. The second theme outlines new strategies introduced to fill gaps in service delivery, such as self-testing and outreach.Conclusions: To improve access to HIV/STI testing, there is a need for multiple access points to cater for a range of populations and their preferences. Establishing strategies to accomplish this involves utilising a combination of expanding traditional service models and implementing new approaches to service delivery. [ABSTRACT FROM AUTHOR]

Background: This study aimed to examine the positivity of urethral Trichomonas vaginalis in men attending an urban sexual health clinic in Melbourne, Australia.Methods: We conducted a retrospective analysis of men who were tested for T. vaginalis using nucleic acid amplification test at the Melbourne Sexual Health Centre between August 2018 and May 2021, and calculated the positivity.Results: Of the 893 men who were tested for T. vaginalis , 12 (1.3%; 95% CI 0.7-2.3) tested positive for T. vaginalis . The positivity of T. vaginalis among men who reported sexual contact with a female partner with T. vaginalis was significantly higher than men who were not contacts (18.6% [8/43] vs 0.5% [4/850], P <0.001).Conclusions: The positivity of T. vaginalis was low at our clinic. The high positivity among contacts highlights the importance of partner notification, testing and management. [ABSTRACT FROM AUTHOR]

Background Patient-delivered partner therapy (PDPT) is a method for an index patient to give treatment for genital chlamydia to their sexual partner(s) directly. In Australia, PDPT is considered suitable for heterosexual partners of men and women, but is not uniformly endorsed. We explored the policy environment for PDPT in Australia and considered how PDPT might become a routine option.Methods: Structured interviews were conducted with 10 key informants (KIs) representing six of eight Australian jurisdictions and documents relevant to PDPT were appraised. Interview transcripts and documents were analysed together, drawing on KIs' understanding of their jurisdiction to explore our research topics, namely the current context for PDPT, challenges, and actions needed for PDPT to become routine.Results: PDPT was allowable in three jurisdictions (Victoria, New South Wales, Northern Territory) where State governments have formally supported PDPT. In three jurisdictions (Western Australia, Australian Capital Territory, Tasmania), KIs viewed PDPT as potentially allowable under relevant prescribing regulations; however, no guidance was available. Concern about antimicrobial stewardship precluded PDPT inclusion in the South Australian strategy. For Queensland, KIs viewed PDPT as not allowable under current prescribing regulations and, although a Medicine and Poisons Act was passed in 2019, it is unclear if PDPT will be possible under new regulations. Clarifying the doctor-partner treating relationship and clinical guidance within a care standard were viewed as crucial for PDPT uptake, irrespective of regulatory contexts.Conclusion: Endorsement and guidance are essential so doctors can confidently and routinely offer PDPT in respect to professional standards and regulatory requirements. [ABSTRACT FROM AUTHOR]

Background Sexually transmissible infections (STIs) are rising among female sex workers (FSW) in Australia. The rise might be explained by changes in sexual practices; however, there is limited behavioural data available. This study aimed to explore the current sexual practices among FSW in Melbourne.Methods: This cross-sectional study was conducted among FSW at Melbourne Sexual Health Centre between September 2017 and March 2018. Participants were asked about current sexual practices with male clients in an average working week. The frequency and proportion of each sexual practice was calculated.Results: There were 180 questionnaires included in the analysis. The median age of the FSW was 28 years (interquartile range [IQR]: 25-34). Most FSW (80.6%) worked in brothels. In an average working week, FSW had a median of 10 (IQR: 7-20) male clients. The most common sexual practices included: vaginal sex (98.3%), fellatio (97.2%), cunnilingus (92.2%) and tongue-kissing (83.7%). FSW had a median number of 10 (IQR: 6-18) vaginal, 10 (IQR: 5-18) fellatio, 7 (IQR: 2-10) cunnilingus and 6 (IQR: 2-10) tongue-kissing clients. Consistent condom use with all clients was highest for vaginal sex (97.1%), followed by anal sex (92.3%), then fellatio (78.9%). Only 3.1% used dental dams consistently for cunnilingus.Conclusion: Consistent condom use with all clients was high among FSWs, especially for vaginal and anal sex. However, one-fifth of FSW had condomless fellatio during an average working week. Tongue-kissing was more common than previously published. Peer-led sexual health education on safe sex practice for FSW is of high importance. [ABSTRACT FROM AUTHOR]

Background Since 2014 there has been an increase in gonorrhoea among heterosexuals in Australia. Sex with a partner from a country with high gonorrhoea prevalence has been identified as a risk factor for gonorrhoea in heterosexual females, but risk factors for heterosexual males remain unclear. This study determined risk factors for gonorrhoea among heterosexual males.Methods: Retrospective analysis was performed among heterosexual males attending Melbourne Sexual Health Centre (MSHC) between 1 January 2007 and 31 December 2017. Countries for overseas sexual partners were stratified as high-prevalence countries (HPC) or low-prevalence countries (LPC) based on the incidence of gonorrhoea.Results: The annual gonorrhoea positivity increased from 0.72% in 2007 to 1.33% in 2017 (Ptrend <0.001). Males attending MSHC as a contact of gonorrhoea had the highest odds of testing positive (adjusted odds ratio (aOR) 7.46; 95% confidence interval (CI) 4.46-12.49), followed by males identifying as Aboriginal and Torres Strait Islander (aOR 2.57; 95% CI 1.30-5.09), males who had injected drugs in the past 12 months (aOR 2.44; 95% CI 1.39-4.30) and males who had sex with a female from an HPC (aOR 2.18; 95% CI 1.77-2.68). Males aged ≥35 were at higher risk than those aged ≤24 years (aOR 1.44; 95% CI 1.14-1.82). Gonorrhoea positivity increased among males who had sex with females from an LPC (from 0.60% to 1.33%; Ptrend = 0.004) but remained the same over time among males who had sex with females from an HPC (2.14%; Ptrend = 0.143).Conclusions: There was an 80% increase in urethral gonorrhoea among heterosexual males between 2007 and 2017. Having sex with a female from an HPC is a significant risk factor for gonorrhoea. Gonorrhoea positivity among men having sex with a female from an HPC did not change over time, suggesting this risk factor has become less important. [ABSTRACT FROM AUTHOR]

Background Gonorrhoea notifications continue to rise among gay and bisexual men in Australia and around the world. More information is needed on infection trends, accounting for testing and complimented by demographics and risk practices.Methods: A retrospective cohort analysis was undertaken using repeat gonorrhoea testing data among gay and bisexual men from 2010 to 2017, which was extracted from a network of 47 sexual health clinics across Australia. Poisson and Cox regression analyses were used to determine temporal trends in gonorrhoea incidence rates, as well as associated demographic and behavioural factors.Results: The present analysis included 46904 gay and bisexual men. Gonorrhoea incidence at any anatomical site increased from 14.1/100 person years (PY) in 2010 to 24.6/100 PY in 2017 (P<0.001), with the greatest increase in infections of the pharynx (5.6-15.9/100 PY, P<0.001) and rectum (6.6-14.8/100 PY, P<0.001). After adjusting for symptomatic and contact-driven presentations, the strongest predictors of infection were having more than 20 sexual partners in a year (hazard ratio (HR)=1.9, 95% confidence interval (CI): 1.7-2.2), using injecting drugs (HR=1.7, 95%CI: 1.4-2.0), being HIV positive (HR=1.4, 95%CI: 1.2-1.6) and being aged less than 30 years old (HR=1.4, 95%CI: 1.2-1.6).Conclusions: Gonorrhoea has increased dramatically among gay and bisexual men in Australia. Enhanced prevention efforts, as well as more detailed, network-driven research are required to combat gonorrhoea among young men, those with HIV and those who use injecting drugs. [ABSTRACT FROM AUTHOR]

Background A 2006 Australian sexual health clinic audit of pelvic inflammatory disease (PID) diagnosis rates found variability between doctors. Doctors were given audit feedback towards increasing diagnosis and reducing variability. The clinic implemented other improvements to increase capacity. This study investigated PID diagnosis time trends before and after feedback.Methods: Yearly PID diagnosis rates for women aged 16-49 years attending the clinic (2002-16) were calculated. Using multivariable generalised linear mixed models, adjusted for patient risk and lower genital infection (any of chlamydia, gonorrhoea, Mycoplasma genitalium, bacterial vaginosis) and stratified by before (2002-June 2007) and after (July 2007-2016) feedback, we assessed if PID rates changed over time, accounting for between-doctor variability.Results: During 2002-16, 144 doctors undertook 84476 female consultations and diagnosed 1755 (2.1%, 95% confidence interval (CI) 2.0-2.2) with PID. Comparing 2002-03 to 2015-16, the yearly PID rate increased; 0.8% (37/4836) to 2.9% (209/7088). Comparing before and after feedback more women reported any symptoms at triage (35.1%-47.2%) or had a lower genital infection diagnosed (10.1%-14.9%). After feedback, PID rates increased by 8% yearly (incidence rate ratio (IRR) 1.08, 95% CI 1.06-1.11), but were unchanged (adjusted IRR (aIRR) 1.01, 95% CI 0.98-1.03) after adjustment for patient characteristics. Factors associated with PID were self-reported symptoms, younger age and a lower genital infection. Lower variability in doctor-specific rates was observed after feedback.Conclusions: Increasing PID diagnosis rates appeared to be driven by a greater female patient risk profile, influenced by increased capacity following service improvements. [ABSTRACT FROM AUTHOR]

Background On 26 July 2016, Victoria began a large study of HIV pre-exposure prophylaxis, called PrEPX, that involved the creation of around 2600 appointments over 3 months across multiple sites in Melbourne, Australia. At this time, the Melbourne Sexual Health Centre (MSHC) appeared to have a larger demand on its services. The aim of the present study was to determine whether this apparent increase in demand was substantially different from other demand fluctuations.Methods: Patients presenting to the MSHC from 2014 to 2016 were reviewed. Demographic characteristics, sexual risks and sexually transmitted infection diagnoses were extracted from the clinical database.Results: There were 115522 walk-in presentations for care and a rise in presentations in the week following the launch of the PrEPX study, but at least six similar peaks occurred that year. The peak coinciding with the launch of PrEPX was only apparent for men who have sex with men. There was a substantial increase in the proportion of patients who could not be seen (i.e. triaged out), from 10% in the week before PrEPX to 22.2% in the second week after, but this was primarily due to staff absences. At the time of the PrEPX study, data were collected on the duration of symptoms for common conditions and found no significant (P>0.29) change in the average duration of symptoms compared with that seen before the PrEPX launch.Conclusions: The increase in the number of medical consultations required for the PrEPX study did not result in excessive demand for public sexual health services. [ABSTRACT FROM AUTHOR]

Background The number of sexual partners is one of the most important risk factors for sexually transmissible infections (STIs), including HIV. The aim of the present study was to examine the association between declining to report the number of partners using computer-assisted self-interviewing (CASI) and HIV or STI positivity at a public sexual health centre in Melbourne, Australia, in 2016.Methods: Individuals were categorised into three risk populations: women, men who have sex with women only (MSW) and men who have sex with men (MSM). Logistic regression analysis was used to examine the association between declining to report the number of sexual partners in the past 12 months and HIV or STI positivity for women and MSW, with generalised estimating equations (GEE) used for estimation in MSM to address repeated-measures within individuals.Results: In all, 18085 individuals (5579 women, 6013 MSW, 6493 MSM) were included in the final analysis. There was no association between chlamydia positivity and declining to respond among women and MSW. MSM who declined to respond were more likely to be chlamydia positive (adjusted odds ratio1.21; 95% confidence interval (CI) 1.01-1.43). Known HIV-positive MSM and MSM newly diagnosed with HIV had 3.31-fold (95% CI 2.48-4.42) and 2.82-fold (95% CI 1.84-4.32) greater odds respectively of declining to respond compared with HIV-negative MSM. Gonorrhoea and syphilis positivity in MSM were not associated with declining to respond.Conclusions: There was no association between declining to report the number of partners and chlamydia positivity among women and MSW. However, MSM who declined to report the number of partners were slightly more likely to have chlamydia and substantially more likely to be HIV positive. [ABSTRACT FROM AUTHOR]

Background Mathematical models have demonstrated that the majority of gonococcal transmission is from oropharynx to oropharynx (i.e. kissing) among men who have sex with men (MSM). The aim of this study is to investigate the association between the number of partners within specific time periods and gonorrhoea and chlamydia positivity.Methods: This was a retrospective data analysis of MSM attending the Melbourne Sexual Health Centre between 2007 and 2016. Univariable and multivariable logistic regression analyses, with generalised estimating equations (GEE), were performed to determine if the number of partners within specified time periods was associated with site-specific gonorrhoea and chlamydia positivity.Results: There were 45933 consultations which included 15197 MSM. Oropharyngeal gonorrhoea positivity was associated with the number of partners in the past 3 months, but not the number of partners 4-12 months ago; men who had ≥6 partners in the past 3 months had significantly higher odds of acquiring oropharyngeal gonorrhoea (aOR 1.93; 95% CI 1.61-2.31), but this was not the case for men who had ≥6 partners 4-12 months ago. Anorectal gonorrhoea and chlamydia and urethral chlamydia were associated with the number of partners in both time periods after adjusting for age and condom use.Conclusions: The association of oropharyngeal gonorrhoea with the number of recent partners, but not partners from an earlier period, unlike anorectal gonorrhoea and anorectal and urethral chlamydia, could be explained by a shorter duration of oropharyngeal gonococcal infection. Annual screening for gonorrhoea may be insufficient to materially reduce oropharyngeal prevalence. [ABSTRACT FROM AUTHOR]

Background Regular testing of individuals at higher-risk of HIV is central to current prevention strategies. The aim of the present study was to examine the extent to which confidence in one's perceived ability to undertake various aspects of HIV testing and self-testing (self-efficacy) affected HIV testing outcomes. We assessed factors, including self-efficacy, associated with HIV testing frequency and the likelihood to self-test among gay and bisexual men (GBM).Methods: Participants were HIV-negative GBM at an increased risk of HIV (more than five partners or condomless anal intercourse in the previous 3 months) enrolled in a randomised controlled trial of HIV self-testing. The baseline questionnaire captured data regarding sociodemographic characteristics, HIV and/or sexually transmissible infection testing history, sexual behaviour, beliefs and attitudes towards HIV and eight items capturing confidence in HIV testing ability that were combined as a single broad measure of HIV testing self-efficacy (α=0.81). Factors associated with three or more HIV tests in the past year and the likelihood of self-testing in the future were determined using logistic regression.Results: Of 354 GBM, 34% reported three or more HIV tests in the past year, and 64% reported being 'very likely' to self-test. Factors independently associated with three or more HIV tests in the past year were: higher self-efficacy (adjusted odds ratio (aOR) 1.08 per unit increase; 95% confidence interval (CI) 1.02-1.14; P=0.004); >10 male partners in the past 6 months (aOR 1.79; 95% CI 1.05-3.04; P=0.031) and higher optimism regarding the effects of HIV treatments on HIV transmission (aOR 1.14; 95% CI 1.00-1.29; P=0.044). Only higher self-efficacy was independently associated with reporting a greater likelihood to self-test in the future (aOR 1.10; 95% CI 1.05-1.15; P < 0.001).Conclusions: Improving self-efficacy by enhancing GBM's knowledge and experience may lead to higher testing frequency. The self-efficacy measure used in the present study could be useful in identifying GBM likely to face difficulties with HIV testing and self-testing. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Assortative mixing patterns have become a new and important focus in HIV/sexually transmissible infection (STI) research in recent years. There are very limited data on sexual mixing patterns, particularly in an Australian population.Methods: Male-female and male-male partnerships attending the Melbourne Sexual Health Centre (MSHC) between 2011 and 2014 were included. Correlation of age between two individuals within a partnership was examined by using Spearman's rank correlation. The Newman's assortativity coefficient was used as an aggregate quantitative measurement of sexual mixing for number of partners and condom use.Results: 1165 male-female and 610 male-male partnerships were included in the analysis. There was a strong positive correlation of age in both male-female (rho=0.709; P<0.001) and male-male partnerships (rho=0.553; P<0.001). The assortative mixing pattern for number of partners was similar in male-female (r=0.255; 95% CI: 0.221-0.289) and male-male partnerships (r=0.264; 95% CI: 0.218-0.309). There was a stronger assortative mixing pattern for condom use in male-male (r=0.517, 95% CI: 0.465-0.569) compared with male-female (r=0.382; 95% CI: 0.353-0.412) partnerships.Conclusion: Male-female and male-male partnerships have a high assortativity mixing pattern for age, number of partners and condom use. The sexual mixing pattern is not purely assortative, and hence it may lead to increased HIV and STI transmission in certain risk groups. [ABSTRACT FROM AUTHOR]

Background: Pre-exposure prophylaxis (PrEP) may be an effective option for HIV prevention among heterosexual serodiscordant couples. However, there are knowledge gaps in social research about PrEP in heterosexual serodiscordant relationships, including motivations and barriers to its use and possible impacts of PrEP uptake on the sexual practices of these couples. The aim of this study was to explore the views of HIV-negative men and women in stable serodiscordant heterosexual relationships about the possible use of PrEP. Methods: Semi-structured interviews were used to understand participants' views on the use of PrEP. Interviews were conducted face-to-face or by telephone and transcribed verbatim for thematic analysis. Results: In total, 13 HIV-negative partners were interviewed; six men and seven women. Participants demonstrated a high interest in the use of PrEP for conception. PrEP was also considered an option for general HIV prevention, although men saw more benefits for this use than women. Participants' main concerns around PrEP usage were about cost, efficacy, daily adherence and side-effects. HIV-positive partner support is likely to play a central role for PrEP uptake and adherence. Conclusions: This study is one of the first studies to explore the views of HIV-negative heterosexual partners in serodiscordant relationships around the use of PrEP while trying to conceive, as well as for general HIV prevention. These study results provide new insights for the further development of guidelines governing the use of PrEP for serodiscordant couples. [ABSTRACT FROM AUTHOR]

Unlabelled: Background Chlamydia and gonorrhoea are the two most common sexually transmissible infections (STI) among men who have sex with men (MSM) worldwide. Infections at the pharynx and rectum are usually asymptomatic; however, the natural history of these infections remains unknown. The aim of this study is to estimate the duration of both infections at the extragenital sites from published epidemiological cohort studies.Methods: English peer-reviewed articles were searched from 1 January 2000 to 12 March 2015 in three electronic databases (MEDLINE, EMBASE and Cochrane Central). The prevalence-to-incidence ratio from each study was calculated to reflect the duration of each infection. This review followed the PRISMA guidelines and was registered in PROSPERO (CRD42014007087).Results: There were 2585 records identified, with 1721 abstracts and 52 full-text articles screened, resulting in four studies fulfilling the inclusion criteria. Pharyngeal gonorrhoea (114-138 days) had a shorter duration of infection than rectal gonorrhoea (346 days). In addition, chlamydia had a longer duration of infection at the pharynx (667 days) and rectum (579 days) compared with gonorrhoea infection.Conclusions: Gonorrhoea has a shorter duration of infection than chlamydia, suggesting that annual STI screening will be more effective at diagnosing chlamydia than gonorrhoea. The current STI guidelines recommend screening gonorrhoea and chlamydia at least once a year in MSM; it would only detect ~30% of incident pharyngeal gonorrhoea cases, with a mean duration of 4 months. [ABSTRACT FROM AUTHOR]

Unlabelled: Background Sexually transmissible infections (STIs) have increased rapidly among men who have sex with men (MSM). One of the most effective strategies to control STIs is partner notification. Inadequate partner notification may be associated with high rates of repeat diagnoses with STIs. The aim of this study is to estimate and compare the rate of chlamydia and gonorrhoea infection following primary infection to the overall clinic rate.Methods: A retrospective cohort analysis of MSM attending the Melbourne Sexual Health Clinic was conducted. For both infections, the overall incidence and that following diagnosis and treatment was calculated.Results: Of the 13053 MSM, the incidence of diagnoses for chlamydia and gonorrhoea was 8.5 (95% CI: 8.2-8.9) and 6.2 (95% CI: 5.9-6.5) per 100 person-years, respectively. Seventy per cent of chlamydia and 64% of gonorrhoea cases were retested at 10-365 days after diagnosis and treatment. Following diagnosis and treatment of chlamydia, the rate ratio in these individuals in the first quarter was 16- and 8-fold higher for chlamydia and gonorrhoea, respectively, compared with the background incidence of diagnoses. Similarly, following diagnosis and treatment of gonorrhoea, the rate ratio in these individuals in the first quarter was 18- and 10-fold higher for gonorrhoea and chlamydia, respectively.Conclusions: These data suggest that approximately half of MSM who test positive for chlamydia or gonorrhoea within 90 days after an initial infection represent contact with either a previous sexual partner or member of the same sexual network, the remainder representing the particularly high STI risk for these MSM. [ABSTRACT FROM AUTHOR]

Unlabelled: Background Increasing the frequency of HIV testing in men who have sex with men (MSM) will reduce the incidence of HIV. Trends in HIV testing among MSM in Melbourne, Australia over the last 11 years have been investigated.Methods: A retrospective study was conducted using electronic medical records of the first presentation of MSM who attended the Melbourne Sexual Health Centre between 2003 and 2013. Factors associated with HIV testing (year, demographic characteristics and sexual practices) were examined in multivariable logistic regression analyses. Jonckheere-Terpstra tests were used to examine the significance of trends in the mean time since the last HIV test.Results: Of 17578 MSM seen; 13489 attended for the first time during the study period. The proportion of first attendances who had previously tested and reported a HIV test in the last 12 months increased from 43.6% in 2003 to 56.9% in 2013 (adjusted ptrend=0.030), with a corresponding decrease in median time since the last HIV test from 19 months [interquartile range (IQR) 6-42] in 2003 to 10 months (IQR4-24) in 2013 (ptrend <0.001). The proportion of high-risk MSM (who reported unprotected anal intercourse and/or >20 partners in 12 months) who reported an HIV test in the last 12 months was unchanged (ptrend = 0.242).Conclusions: Despite HIV testing becoming more frequent, the magnitude of change over the last decade is insufficient to substantially reduce HIV incidence. A paradigm shift is required to remove barriers to testing through strategies such as point-of-care rapid testing or access to testing without seeing a clinician. [ABSTRACT FROM AUTHOR]

With reports of increasing syphilis rates among men who have sex with men in various countries and complications such as ocular syphilis and neurosyphilis, greater efforts for promoting frequent syphilis screening of higher risk men are required. This should include serological testing for syphilis every time HIV testing is undertaken and each time HIV viral load testing is performed in HIV-positive men who have sex with men. Systems-based approaches tailored to particular contexts should be explored, evaluated and, if shown to be effective, implemented. [ABSTRACT FROM AUTHOR]

To answer a key question ('Are Australian sexual health clinics attracting priority populations?'), we used data from 44 Australian sexual health clinics between 2004 and 2011. We assessed the proportion of patients that were from priority populations (deemed to be at risk of sexually transmissible infections) and compared this to their proportions in the general population using data from Australian Bureau of Statistics and the Australian Study of Health and Relationships. A X²-test was used. A total of 278 154 new patients attended during 2004-2011. The proportions from each priority population were significantly higher (P < 0.01 for all) than for the general population: young people aged 15-29 years (58.1% v. 20.1%), men who have sex with men (26.0% v. 6.0%), female sex workers (10.8% v. 0.5%), and Aboriginal and Torres Strait Islander people (4.2% v. 2.3%). This study confirms that Australian sexual health clinics attract higher proportions of priority populations and are thus meeting their mandate as defined in the 2010-2013 National Sexually Transmissible Infections Strategy. [ABSTRACT FROM AUTHOR]

The article discusses a study that compared the proportion of female sex workers (FSW) with sexually transmitted infections (STIs) from countries with high prevalence (HPC) of STI and compared this to other FSW. It aims to determines the proportion of FSWs from the Western Pacific and South-east Asian region where STI rates are generally higher. Melbourne, Australia Sexual Health Centre (MSHC) is Victoria's largest sexual health clinic that provides free sexual health consultations a year to the general public including consultations to FSWs for monthly STI screening. Data shows that FSWs, regardless of their origin have very low rate of STIs than nonFSW women attending MSHC.

The article discusses a study on the effectiveness of advertising for the TESTme sexually transmissible infection (STI) screening service for young people in rural areas in Victoria. Websites, a page on the social networking site Facebook and business cards were among the advertising used. Advertisements in newspapers, student diaries and short messages to mobile telephones were also used. The study showed that 20 young people found out about the service with the help of health professionals while six knew about it through the Melbourne Sexual Health Centre (MSHC) web page. The centre incurred 20,850 Australian dollars in total direct costs for advertising. The authors note that advertising STI health services should focus on referrals from other health services or health care websites.

The article discusses a study that aimed to describe the frequency of the three-month test for re-infection among sexual health service patients in Australia. Re-testing rates were assessed at 30-120 days after chlamydia infection in men who have sex with men (MSM), and heterosexual males and females attending sexual health services in Australia between 2004 and 2008. Chlamydia re-testing rates were found to be lower among MSM above 30 years old and travelers and migrants than non-travelers. Rates were also lower in heterosexual men in regional and rural areas. The need for innovative strategies to increase re-testing rates is also discussed.

The article discusses a study that aimed to describe the use of and response to the self-management web site Health Map, which was created to address the key chronic health issues of people with HIV. Health issues were assessed against recommendations for factors such as treatment adherence, vaccination, alcohol consumption and body mass index. The majority of people who completed the full Health Map program were male Australians, including men who have sex with men (MSM). The results indicated that HIV and more general health care is suboptimal for a significant proportion of respondents.

The article discusses a study which reported chlamydia testing and positivity rates in a sexual health service in the inner west of Sydney, New South Wales between 2004 and 2008 and compared these to published national data from the Australian Collaboration for Chlamydia Enhanced Sentinel Surveillance (ACCESS) Project in sexual health services. Retrospective de-identified line-listed demographic and chlamydia testing data on all patients were extracted from patient management systems using a standardised extraction program. The study revealed that 5145 new patients attended the inner-west sexual health service over the 5-year period. It also observed that testing rates were similar and positivity rates for Chlamydia were higher in this sexual health service than national trends.

The article discusses the results of a chlamydia testing program undertaken among 16-29 years old from the Loddon Mallee region of Victoria. Chlamydia prevalence was noted to be high in the study population that use an illicit drug and has a low condom usage. Many participants were found to have poor knowledge on STIs and low condom use. The study concluded that the findings highlight the need for intervention programs that combine both sexually transmissible infections (STI) testing and prevention programs.

We investigated whether men who have sex with men (MSM) would use mouthwash daily to prevent pharyngeal gonorrhoea. Ten MSM attending the Melbourne Sexual Health Centre were asked to use a Listerine® alcohol-containing mouthwash daily for 14 days in August 2015. Mouthwash was used at least once daily for 133 of 140 person-days (95% of days; 95% confidence interval 90-98%). All 10 men were willing to use mouthwash on a daily basis, and nine men were willing to use mouthwash after oral sex. This study showed that daily use of mouthwash is an acceptable intervention to prevent pharyngeal gonorrhoea in MSM. [ABSTRACT FROM AUTHOR]

Background: The present study aimed to determine the sexual risk profile of people using an automated, internet-based service that allows internet users to receive recommendations on sexually transmissible infection screening ('Check your risk' (CYR), http://www.checkyourrisk.org.au/), and to compare this with that of patients attending the Melbourne Sexual Health Centre (MSHC) for the first time over the same 6-month period: January-June 2006.Methods: The characteristics of those who used CYR and those who attended MSHC were compared using a chi(2)-test for categorical variables and the Mann-Whitney U-test for non-parametric data.Results: There were 2492 users who accessed CYR and 2735 who attended MSHC over the period. The age of CYR users was similar to that of MSHC patients when compared according to risk groups. The median number of recent sexual partners reported by CYR users was similar to and not significantly lower than that reported by MSHC patients. Of the 309 CYR users who provided a rating for the CYR site, 215 (70%) rated it as being 'useful' to 'very useful'.Conclusions: Individuals who accessed an automated, internet-based sexual risk assessment service were at substantial risk for sexually transmitted infections, similar to those attending a sexual health service. [ABSTRACT FROM AUTHOR]

Syphilis remains a pressing public health problem globally across different populations including men who have sex with men and pregnant women. It is timely to review what international surveillance data tell us and the evidence behind public health interventions aimed at controlling syphilis. A reinvigorated response to the re-emergence of syphilis is required. [ABSTRACT FROM AUTHOR]

The article discusses a study on the incidence of induced abortion (IA) in Australian women aged 16 to 25. The 12-month longitudinal study was conducted in 2008 and it evaluated data on demographic, sexual behaviour, conceived pregnancies, IA and use of contraceptives. It found that 22 of the 76 pregnancies conceived during the study period resulted in an IA. According to the authors, the study found no demographic or behavioural characteristics that will serve as significant predictors for IA.

The article supports the use of nucleic acid amplification tests (NAAT) over the common practice of using tissue culture as a better alternative in detecting gonorrhea at pharyngeal and rectal sites among men who have sex with men (MSM) in Australia and other countries. Based on several studies, the limited sensitivity of culture could be contributing to the higher prevalence of gonorrhea and higher rates of transmitting the human immunodeficiency virus (HIV). It recommends shifting from culture to NAAT to lower the basic reproductive rate of infection to less than one site. However, it says that individuals with positive-NAAT specimens should have pretreatment culture samples for surveillance of antibiotic resistance and should have supplemental NAAT assays.

The article discusses a study on whether rectal gonorrhoea can be used as a lead indicator of trends in HIV diagnosis in men who have sex with men. It notes that gonorrhoea is prevalent among males in Australia and cites an increasing diagnoses of rectal gonorrhoea (RG) with the great majority of infections occurring among men who have sex with men (MSM). RG and HIV tests were conducted during the study period with the highest annual proportion positive was in 2009 for HIV and 2006 for RG. It suggests the need for further research at an individual level to test the surveillance hypothesis presented in the study since establishing a temporal relationship between RG and HIV diagnoses can inform clinical and public health practice.

The article focuses on the need for new approaches and guidelines for the testing and treatment of sexual partners of patients diagnosed with treatable sexually-transmissible infection (STI), a process known as partner notification or contact tracing. It discusses the problems faced by STI patients in informing their partners about the need for treatment which include their unwillingness to involve their partners and the lack of guidelines in handling such matters. It discusses the benefits of an innovative approach known as patient-delivered partner therapy (PDPT) where the patient is allowed by a clinician to administer STI medication to his partner without requiring a physical examination and mentions Internet-based partner notification services that provide support to STI patients.

The article discusses a study which determined whether pelvic examinations change clinical management of women with asymptomatic chlamydia infection. The study analyzed records for women with asymptomatic chlamydia who underwent a pelvic examination at a sexual health clinic in Melbourne, Victoria from January 2006 to June 2007. Findings showed that of the 91 cases examined, 31 warranted examination, one woman had muco-purulent cervicitis and mild tenderness, and was treated for possible pelvic inflammatory disease. The study also suggested that pelvic examination will lead to changes in treatment for very few women diagnosed with asymptomatic chlamydia infection.

The article discusses research on the views of rural youth on an Australian sexual health telemedicine service piloted for the youth. It is noted that the service was launched to enhance health service access of rural youth in the country. It reports on details including the administration of questionnaires and interviews to subjects. It is concluded that online video consultations for sexual health-related issues are not yet widely accepted by young people in rural areas.