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Background: In Australia, a sharp increase in syphilis cases among heterosexual men and women has been identified as a public health priority due to its association with congenital syphilis which is complicated by congenital defects, prematurity, low birth weight and stillbirth. Timely testing, diagnosis and treatment are important to prevent and control syphilis. The Melbourne Sexual Health Centre (MSHC) implemented an opt-out syphilis test for women in December 2017. We aimed to examine the differences in syphilis testing uptake among women after switching from an opt-in to an opt-out testing strategy. Methods: This was a retrospective study examining all women attending the MSHC for the first time in periods of opt-in (2015-2017) and opt-out (2018- 2020) syphilis testing. We calculated the proportion of women who tested for syphilis in each period. Additional analyses were performed among women with urogenital chlamydia testing as a proxy indicator of sexual risk. Multivariable logistic regression was performed to identify factors associated with syphilis testing in the opt-out period. Results: The mean age of the 27,481 women was 26.8 years (standard deviation=6.9). The proportion of women who were tested for chlamydia who were also tested for syphilis increased from 55.9% (6,676/11,949) in the opt-in period to 71.8% (9,515/13,254) in the opt-out period (p < 0.001). Syphilis positivity did not differ between the two periods (0.49% [33/6676] vs 0.73% [69/9515], p=0.070). The proportion of cases that were late latent increased significantly from 36.4% (12/33) in the opt-in to 60.9% (42/69) in the opt-out period (p=0.033); while the proportion of primary (p=0.342), secondary (p=0.766) and early latent (p=0.055) syphilis did not differ between the two periods. Women aged 16-24 years old (aOR=0.60, 95%CI: 0.46-0.77), and women who engaged in condomless sex (aOR=0.85, 95%CI: 0.75-0.97) were less likely to be tested for syphilis during the opt-out period. Conclusion: The opt-out testing strategy increased syphilis testing among women with increased detection of asymptomatic late latent syphilis. Further studies are required to understand why young women and those reporting condomless sex are more likely to opt out of syphilis testing. Health education and awareness may be required to improve syphilis testing uptake. [ABSTRACT FROM AUTHOR]

Background: Drug use, particularly sexualised drug use, has been associated with an increased risk of acquiring sexually transmitted infections (STI). Sexualised drugs generally refer to the drugs used to facilitate sex, including methamphetamine, mephedrone and gamma-hydroxybutyrate (GHB). Most research on sexualised drug use and STIs was conducted among adult men who have sex with men (MSM). There have been very limited studies on adolescent MSM, particularly young people who may be more susceptible to drug use. This study aimed to examine drug use and its association with STI diagnosis among adolescent MSM in Melbourne. Methods: The HYPER2 study was a cohort of MSM aged 16-20 years recruited in Melbourne, Australia, aimed at examining the prevalence of human papillomavirus (HPV) after gender-neutral, schoolbased HPV vaccination was implemented. As part of the study, data on drug use was collected and men received HIV/STI screening. We calculated the proportion of men who used any drugs, sexualised drugs, and polydrug (more than one drug). Univariable and multivariable logistic regression was performed to examine the association between sexualised drugs and STI. Results: Of the 179 men included in this analysis, 59% (n=105) had used any drug in the past 6 months, with the most common drug being marijuana (44%, n=78), followed by poppers (38%, n=68). 11% (n=20) used sexualised drugs (i.e., methamphetamine, mephedrone and GHB). Polydrug use was reported by 36% (n=65) of men with marijuana and poppers being the most common combination (18%, n=12). The prevalence of any STI (gonorrhoea, chlamydia and infectious syphilis) was 16% (n=28), and there was no new HIV diagnosis. Multivariable analyses showed that using sexualised drugs had higher odds of acquiring any STI (aOR=8.83; 95%CI: 1.03-75.90), after adjusting for education level, condomless sex and the number of partners; however, there was no significant association between any drug use and STI (aOR=1.62; 95%CI: 0.52-5.08). Conclusion: Sexualised drug use is common among adolescent MSM and is associated with an increased risk of STI. This suggests the need for interventions integrating both sexual health and substance use for adolescent MSM. [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: 537 participants were included in the final analysis with a median age of 33 years (IQR 28-42). The median number of male partners in the past 12 months was 10 (IQR 4-20). 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 an STI diagnosis (aOR=1.72; 95% CI: 1.09-2.70), and attended sex on premises venues (SOPV) (aOR=1.66; 95% CI: 1.05-2.62) in the past 12 months had higher odds of receiving mpox vaccine. To prevent mpox, half reported they would reduce having sex with casual partners (53.9%, 280/519), stop having chemsex (49.8%, 254/510), stop attending SOPV (49.3, 253/513), and stop having group sex (45.3%, 233/514) (Figure 1). A quarter (26.2%, 134/512) reported they would increase condom use for anal sex. 68.3% (213/312) of unvaccinated participants reported they intended to get vaccinated. Conclusions: One-third of high-risk participants and a substantial proportion of participants were willing to reduce or stop certain practices which may explain the large reduction in mpox cases. [ABSTRACT FROM AUTHOR]

Background: Recent studies have shown that Treponema pallidum can be detected from asymptomatic oral and anal sites by PCR in individuals with early syphilis. This study aimed to investigate T. pallidum PCR testing of oral, anal and vaginal sites among individuals reporting sexual contact with a partner with syphilis.Methods: This was a prospective, cross-sectional study of men and women who reported sexual contact with a partner with syphilis at the Melbourne Sexual Health Centre, Australia, from November 2018 to March 2020. All individuals had an oral rinse and oral swab collected for PCR. Additionally, MSM had an anal swab and women had a vaginal swab for PCR regardless of the presence of lesions. Any mucocutaneous lesions at other sites were also swabbed for PCR. Syphilis serology was performed. Results: 407 individuals (364 MSM, 22 heterosexual men, 21 women) provided 398 oral rinses, 363 oral swabs, 351 anal swabs, and 19 vaginal swabs. 42 contacts (10%) were diagnosed with early syphilis based on positive serology and/or positive PCR. Of these, 19 (45%) tested positive by PCR from any anatomical site, with all having positive serology. Among these 19 cases, there were 4 women and 5 men without symptoms or signs of syphilis (Table 1). Of the 4 women, 3 tested positive by PCR from the vagina with no vaginal symptoms and 3 had no prior serology. Of the 5 men, 3 tested positive by PCR from the anus with no anal symptoms. Five (2 women and 3 men) tested positive by PCR in the oral cavity with no oral symptoms. PCR detection at multiple sites occurred in one woman and one MSM. Conclusion: T. pallidum was detected at oral, anal and vaginal sites in the absence of symptoms at these sites among sexual contacts of syphilis. The asymptomatic PCR detection indicated early latent syphilis infection among the individuals, who would have been otherwise diagnosed with latent syphilis of unknown duration in some cases. The change in staging resulted in shortening the duration of treatment required from three injections given one week apart to single dose therapy. [ABSTRACT FROM AUTHOR]

Background: Most research focuses on individual selling sex but very few on paying for sex. This study aimed to determine the proportion of males and females who paid for sex and associated factors.Methods: We conducted a short survey at the Melbourne Sexual Health Centre between March and April 2019, which included a question on whether they had paid for sex in the past 3 months. The proportion of individuals who had paid for sex was calculated by sex and sexual orientation. Univariable and multivariable logistic regression models were conducted to identify individual's factors (e.g., demographics, sexual orientation, and HIV/sexually transmitted infection [STI] positivity) associated with paying for sex in the past 3 months.Results: The proportion who reported paying for sex in the past 3 months was 12.2% (42/345) among heterosexual males, followed by 6.4% (23/357) among men who have sex with men (MSM) and 0.2% (1/430) among females. HIV status, preexposure prophylaxis use, and sexual orientation were not associated with paying for sex among MSM. No MSM living with HIV reported paying for sex in the past 3 months. There was a significant association between paying for sex and gonorrhea (odds ratio, 2.84; 95% confidence interval, 1.05-7.71; P = 0.041) but not HIV, syphilis, and chlamydia among MSM. HIV/STI was not associated with paying for sex among heterosexual males.Conclusions: Paying for sex was more commonly reported among heterosexual males, followed by MSM. Females were very unlikely to pay for sex. There was a limited association between HIV/STI diagnosis and paying for sex among males. [ABSTRACT FROM AUTHOR]

Background: A second wave of COVID-19 began in late June in Victoria, Australia. Stage 3 then Stage 4 restrictions were introduced in July-August. This study aimed to compare the use of preexposure prophylaxis (PrEP) and sexual practices among men who have sex with men taking PrEP between May-June (post-first lockdown) and July-August (second lockdown). Methods: This was an online survey conducted among men who have sex with men who had their PrEP managed at the Melbourne Sexual Health Centre, Australia. A short message service with a link to the survey was sent to 503 PrEP clients who provided consent to receive a short message service from Melbourne Sexual Health Centre in August 2020. Results: Of the 192 participants completed the survey, 153 (80%) did not change how they took PrEP. Of the 136 daily PrEP users, 111 (82%) continued to take daily PrEP, 3 (2%) switched to ondemand PrEP, and 22 (16%) stopped PrEP in July-August. Men generally reported that they had no partners or decreased sexual activities during second lockdown compared with post-first lockdown; the number of casual sex partners (43% decreased vs. 3% increased) and the number of kissing partners (36% decreased vs. 3% increased). Most men reported no chemsex (79%) or group sex (77%) in May-August. 10% (13/127) of men had ever worn face masks during sex in May-August. Conclusion: During the second wave of COVID-19 in Victoria, most men did not change the way they used PrEP but the majority had no risks or reduced sexual practices while one in 10 men wore a face mask during sex. [ABSTRACT FROM AUTHOR]

Background: Sexual mixing between HIV-positive, HIV-negative, and pre-exposure prophylaxis (PrEP) users among men who have sex with men (MSM) is an important determinant of the incidence of infection. There have been very limited studies examining the patterns of sexual mixing in relation to HIV status and PrEP use in the era of PrEP. Setting: Melbourne Sexual Health Centre (MSHC), Australia. Methods: We included all MSM partnerships attending MSHC on the same day between 2011 and 2018. A chi-square trend test was used to examine the changes in the annual proportion of partnerships by HIV serostatus in 2011-2018 and by PrEP use in 2016-2018. Results: Of the 1765 MSM partnerships who attended MSHC between 2011 and 2018, 1.3% of the partnerships were concordant HIV-positive, 91.0% were concordant HIV-negative, and 7.6% were HIV-discordant. The proportion of HIV-discordant partnerships increased from 0% in 2011 to 12.5% in 2018 (ptrend, 0.001). In 2016-2018, only a small proportion (1.2%) of concordant HIVnegative partnerships involved both men taking PrEP, whereas 6.0% involved at least one man taking PrEP. Overall, 79.1% of concordant HIV-negative partnerships were not protected against HIV (ie, neither man taking PrEP), and this proportion declined significantly from 84.3% in 2016 to 74.0% in 2018 (ptrend = 0.001). Conclusions: The pattern of sexual mixing by HIV status and PrEP use among MSM partnerships has changed over time. PrEP use in both men within MSM partnerships is not common. About 79% of concordant HIV-negative partnerships were not protected against HIV as neither man taking PrEP. [ABSTRACT FROM AUTHOR]

Background: There have been very limited studies of oropharyngeal gonorrhea in heterosexuals. Routine screening of oropharyngeal gonorrhea is not recommended in heterosexual contacts of gonorrhea. This study aimed to examine oropharyngeal gonorrhea positivity among heterosexuals reporting contact with a partner with gonorrhea.Methods: At the Melbourne Sexual Health Centre (MSHC), all heterosexual individuals reporting contact with sexual partners with gonorrhea are tested for genital gonorrhea. In May 2017, MSHC also included screening for oropharyngeal gonorrhea in heterosexual contacts of gonorrhea. All contacts of gonorrhea among women and heterosexual men between May 2017 and November 2018 were reviewed. Site-specific gonorrhea positivity was also calculated.Results: One hundred ninety-one gonorrhea contacts (102 heterosexual men and 89 women) were reviewed. The median age was 28 (interquartile range, 24-33) years. The gonorrhea positivity in males was significantly higher at the oropharynx compared with urethra (18%; 95% confidence interval [CI], 11% to 26% vs 2%; 95% CI, 0% to 7%; P < 0.001); and higher at the oropharynx compared with cervicovaginal site in women (46%; 95% CI, 35% to 57% vs 36%; 95% CI, 26% to 47%; P = 0.056). Of the 100 men who did not have genital gonorrhea, 17 (18%; 95% CI, 10% to 26%) tested positive at the oropharynx. Of the 55 women who did not have genital gonorrhea, 21 (24%; 95% CI, 15% to 34%) tested positive at the oropharynx. Infection at both the oropharynx and genital sites was not associated with sex worker status in women. Overall, 89% and 40% of gonorrhea in heterosexual men and women were only in the oropharynx, respectively.Conclusions: Oropharyngeal gonorrhea testing among heterosexual contacts of gonorrhea may be indicated given a substantial proportion of gonorrhea contacts are only infected at this site. [ABSTRACT FROM AUTHOR]

Background: In August 2015, a nurse-led express human immunodeficiency virus (HIV)/sexually transmitted infection (STI) testing service "Test-And-Go" (TAG) for asymptomatic men who have sex with men (MSM) was implemented in a large public sexual health center in Melbourne, Australia. We aimed to compare the clients' characteristics between the TAG and routine walk-in service among asymptomatic MSM.Methods: This study was conducted at the Melbourne Sexual Health Centre, Australia, between August 5, 2015, and June 1, 2016. General estimating equation logistic regression models were constructed to examine the association between the use of TAG service and clients' demographic characteristics, sexual behaviors, and HIV/STI positivity. Clients' consultation and waiting times for both services were calculated.Results: Of the 3520 consultations, 784 (22.3%) were TAG services and 2736 (77.7%) were routine walk-in services for asymptomatic MSM. Asymptomatic MSM were more likely to use the TAG service if they were born in Australia (adjusted odds ratio, 1.29; 95% confidence interval, 1.07-1.56), and had more than 6 male partners in the last 12 months (adjusted odds ratio, 1.13; 95% confidence interval, 1.08-1.58). Age, HIV status, condomless anal sex and HIV/STI positivity did not differ between the two services. The TAG service had a shorter median waiting time (8.4 minutes vs 52.9 minutes; p < 0.001) and consultation time (8.9 minutes vs 17.6 minutes; p < 0.001) than the routine walk-in service.Conclusions: Although country of birth and sexual behaviors differed between clients attending the 2 services, there were no differences in HIV and STI positivity. Importantly, the TAG service required less waiting and consultation time and hence created additional clinic capacity at the general clinic to see clients who are at higher risk. [ABSTRACT FROM AUTHOR]

Objective: To help inform screening guidelines, we estimated the proportion of asymptomatic men who have sex with men (MSM) with oropharyngeal chlamydia.Study Design: An audit of asymptomatic MSM attending a sexual health service from March 2015 to April 2016 was conducted. They each had an oropharyngeal swab that was tested for Chlamydia trachomatis by transcription-mediated nucleic acid amplification. In addition, a random sample of 17 swabs that initially tested positive had confirmatory testing to determine the likelihood of true positivity.Results: We collected 4877 oropharyngeal swabs: 72 (1.5%; 95% confidence interval [CI], 1.2-1.9) were diagnosed positive for chlamydia. Most (n = 56 [78%]; 95% CI, 67-86) only had oropharyngeal chlamydia detected (i.e., no concurrent extraoropharyngeal chlamydia and/or gonorrhea). Of the 17 samples that underwent confirmation, all confirmed positive (100%; 95% CI, 82-100).Conclusions: Although oropharyngeal chlamydia prevalence was low among asymptomatic MSM, most oropharyngeal chlamydia cases had no chlamydia at other sites, and these cases would have been missed and not treated if routine oropharyngeal chlamydia testing was not done. [ABSTRACT FROM AUTHOR]

Background: This before-and-after study measured the impact of a change in testing methods from culture to nucleic acid amplification testing (NAAT) on the detection of pharyngeal and rectal gonorrhea in men who have sex with men (MSM) on a sexual health service level, including the effect on subgroups anticipated to have higher rates of gonorrhea.Methods: In March 2015, Melbourne Sexual Health Centre changed its laboratory method for gonococcal testing from culture to NAAT using the Aptima Combo 2 and Aptima GC tests. We compared the proportion of tests positive for rectal and pharyngeal gonorrhea in MSM using culture in 2014 with those using NAAT in 2015.Results: The proportion of tests positive for rectal gonorrhea by NAAT was double that obtained by culture (8% vs 3.9%; prevalence ratio [PR], 2.0; 95% confidence interval [CI], 1.8-2.4) and 5-fold for pharyngeal gonorrhea (8.3% vs 1.6%; PR, 5.2; 95% CI, 4.2-6.4). Similar increases in test positivity were observed in human immunodeficiency virus (HIV)-positive and HIV-negative men. By NAAT, test positivity for rectal gonorrhea was higher in HIV-positive compared with HIV-negative men (15.4% vs 7.3%; PR, 2.1; 95% CI, 1.7-2.6). Culture and NAAT had similar test positivity for rectal gonorrhea among men who reported contact with gonorrhea (24.9% vs 25.3%, PR 1.0, 95% CI 0.8-1.4) and men who presented with symptoms of proctitis (22.2% vs 27.9%, PR 1.3, 95% CI 0.8-2.0).Conclusions: A switch from culture to Aptima Combo 2 testing for extragenital gonorrhea in MSM increased detection and was most marked for pharyngeal infections. [ABSTRACT FROM AUTHOR]

Background: Use of alcohol-containing mouthwash has been found to have an inhibitory effect against pharyngeal gonorrhoea. The aim of this study was to investigate the association between self-reported mouthwash use and pharyngeal gonorrhoea detection among men who have sex with men (MSM).Methods: A cross-sectional survey was conducted between March 23, 2015, and June 30, 2015 among MSM attending the Melbourne Sexual Health Centre in Australia. Men who have sex with men were invited to complete a short questionnaire on mouthwash use and they were also tested for pharyngeal gonorrhoea by nucleic acid amplification test. Multivariate logistic regression was performed to examine the association between mouthwash use and pharyngeal gonorrhoea detection.Results: Of the 823 MSM, pharyngeal gonorrhoea detection decreased significantly with increasing age group (≤24 years, 14.5%; 25-34 years, 10.7%; ≥35 years, 6.0%; ptrend = 0.003). The proportion reporting daily use of mouthwash increased significantly with increasing age group (from 10.1% to 14.5% to 19.8%; ptrend = 0.005). However, there was no significant association between pharyngeal gonorrhoea detection and daily use of mouthwash after adjusting for age, number of male sexual partners, human immunodeficiency virus status, and type of mouthwash use.Conclusions: Although the proportion of daily use of mouthwash increased with age, and pharyngeal gonorrhoea detection decreased with age, the association between self-reported mouthwash use and pharyngeal gonorrhoea detection by nucleic acid amplification test was not statistically significant. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Backgroud: Antiretroviral (ARV) side effects are a critical determinant of adherence among people living with HIV (PLWH). Integrase strand transfer inhibitors (INSTIs), a commonly used ARV, have been reported to cause weight gain. We determined the relative importance of weight gain compared with other side effects from the perspective of PLWH. Setting: Melbourne Sexual Health Centre and the Alfred Hospital in Victoria, Australia. Methods: We conducted a discrete choice experiment survey to explore PLWH's preferences for 8 short-term side effects (eg, weight gain and depression) and 4 long-term side effects (eg, long-term weight gain and risks of heart attack). We sent an anonymous survey link through short message service (SMS) and postcards to PLWH attending both centers between July and August 2021. The choice data were analyzed using random parameter logit (RPL) and latent class (LCM) models. Results: Three hundred thirty-five respondents were included: most were male (88.1%). In the RPL analyses, weight gain was the second most important attribute after depression for short-term side effects and the third most important attribute after risk of heart attack and kidney problem for long-term side effects. In the LCM analyses, 23.9% were most sensitive to short-term weight gain, whereas 16.0% were most sensitive to long-term weight gain. Conclusions: Weight gain was the second most important short-term side effect and the third most important long-term side effect in a cohort of Australian PLWH. However, weight gain was the most important side effect of ARV for a significant minority. [ABSTRACT FROM AUTHOR]

Background: Bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC) are common vaginal infections that significantly impact a woman's quality of life. However, current treatments are inadequate for preventing recurrent infections. We aimed to determine the factors associated with BV and VVC to inform clinical care. Methods: We performed a retrospective audit of BV and VVC positivity and recurrence among women attending the Melbourne Sexual Health Centre between 1st January 2012 and 31st December 2021. The proportions of women with BV and VVC at their first-test during the study period were calculated with 95% confidence intervals(CI). Factors associated with having BV or VVC vs no BV/VVC detected at their first-test were determined using logistic regression, and factors associated with recurrence (defined as >1 infection within 12-months) were assessed using Poisson regression, which accounted for multiple visits. Factors associated with infection positivity or recurrence in univariable analyses were included in multivariable models. Results: Of 50,245 female attendees, 6,975/22,769 (31%) had BV and 6,587/22,987 (29%) had VVC detected at their first-test. Women reporting hormonal contraceptive-use (excluding intrauterinedevice use) were less likely to have BV than women using no hormonal contraception (adjusted-oddsratio[ AOR]=0.73, 95%CI:0.68-0.82, p< 0.0001). Women reporting ≥2 male or ≥1 female partners in the preceding 3 months had higher odds of BV (AOR=1.33, 95%CI:1.23-1.42,p < 0.0001; AOR=1.86, 95%CI:1.50-2.30,p < 0.0001, respectively). Younger women (AOR=1.02, 95%CI:1.02-1.03,p < 0.0001) and those with ≥2 male partners (AOR=1.17, 95%CI:1.09- 1.27,p=0.001) had higher odds of VVC. Overall, 1,406 women experienced recurrent BV, and risk of recurrence was higher among women with a regular sexual partner (adjusted-incidence-rateratio[ AIRR]=1.32,95%CI:1.16-1.50,p < 0.0001) and those using any intrauterine-device (AIRR=1.29, 95%CI:1.07-1.56, p=0.007). 1,169 women experienced recurrent VVC over the decade. Sex workers (AIRR=1.87,95%CI:1.52-2.30,p < 0.0001) and those with concurrent BV (AIRR=1.23,95%CI:1.04- 1.45,p=0.016) had a higher risk of recurrent VVC. Conclusion: BV and VVC were common. BV had a risk profile more commonly associated with STIs, with stronger associations observed between BV and sexual practices compared to VVC. Factors associated with BV or VVC at first-visit and recurrence differed, suggesting individualised therapeutic approaches may promote long-term cure for women. Understanding the key drivers behind these vaginal conditions is integral to improving clinical care and sexual health for women. [ABSTRACT FROM AUTHOR]

Background: Cervicitis is associated with serious gynaecologic and obstetric sequelae, including pelvic inflammatory disease and infertility. Cervicitis is usually caused by a sexually transmitted infection, however, more than 50% of cases are idiopathic i.e. no known causative pathogen is identified. This poses considerable challenges for the clinical management of women with cervicitis, and contributes to overuse of antibiotics. To provide new insights into the infectious causes of cervicitis, inform clinical care, reduce morbidity and improve antimicrobial prescribing, we compared the vaginal microbiota of women with and without idiopathic cervicitis. Methods: This was a nested case-control study of women with idiopathic cervicitis. Participants were derived from a cross-sectional study conducted at the Melbourne Sexual Health Centre between April 2017-April 2019 that investigated clinical indications for testing for Mycoplasma genitalium. Idiopathic cervicitis cases (n=64) comprised symptomatic women who had cervicitis on clinical examination and tested negative for known causes of cervicitis (Chlamydia trachomatis, M. genitalium, Trichomonas vaginalis, Neisseria gonorrhoeae). Controls were asymptomatic women (n=155) who tested negative for each of these organisms. The vaginal microbiota was characterised using 16S-rRNA gene sequencing. Community state types (CSTs) were defined using VALENCIA, and compared between women with and without cervicitis using logistic regression. Associations between bacterial taxa abundance and cervicitis were investigated using ANCOM-BC. Results: The vaginal microbiota was categorised into three broad CSTs: optimal Lactobacillus (non L.iners)- dominant microbiota (mostly reflecting L. crispatus dominant communities; present in 84/161 [52%] women), L. iners-dominant microbiota (present in 77/161 [48%] women), and non-optimal microbiota deficient in lactobacilli (present in 58/161 [36%] women). Women with a Lactobacillus-deficient nonoptimal microbiota were more likely to have cervicitis compared to women with an optimal Lactobacillus-dominant microbiota (Odds ratio [OR] = 2.98, 95%CI: 1.44, 6.16, p=0.003). The mean abundance of Fannyhessea vaginae, Coriobacteriales bacterium DNF00809 and Prevotella bivia were increased in women with cervicitis compared to women without cervicitis (p< 0.05). Conclusion: Our findings suggest that a vaginal microbiota deficient in Lactobacillus spp. may contribute to the development of cervicitis. Of note, specific anaerobic bacteria including F. vaginae, DNF00809 and P. bivia, may represent infectious causes of cervicitis. [ABSTRACT FROM AUTHOR]

Background: How often mpox causes asymptomatic infections, particularly among persons who have received the Modified Vaccinia Ankara (MVA) vaccine, is unknown. Methods: We performed mpox polymerase chain reaction testing on rectal and pharyngeal specimens collected from symptomatic and asymptomatic patients at a sexual health clinic in Seattle, WA, between May 2022 and May 2023. Analyses evaluated the prevalence of asymptomatic or subclinical infection and, among persons with polymerase chain reaction-positive tests, the association of MVAvaccination status with the symptomatic infection. Results: The study population included 1663 persons tested for mpox during 2353 clinic visits. Ninety-three percent of study participants were cisgender men and 96% were men who have sex with men. A total of 198 symptomatic patients (30%) had a first mpox-positive test during 664 visits. Eighteen patients (1.1%) tested during 1689 visits had asymptomatic or subclinical mpox based on a positive rectal or pharyngeal test done in the absence of testing done because of clinical suspicion for mpox. Fourteen (78%) of 18 persons with asymptomatic/subclinical mpox and 53 (26%) of 198 persons with symptomatic mpox had received at least 1 dose of the MVAvaccine (P < 0.0001). Controlling for calendar month, study subjects who received 1 and 2 doses of MVAvaccinewere 4.4 (95% confidence interval, 1.3-15) and 11.9 (3.6-40) times more likely to have asymptomatic versus symptomatic mpox, respectively, than persons who were unvaccinated. Conclusions: Asymptomatic mpox is uncommon. Modified Vaccinia Ankara vaccination is associated with an asymptomatic/subclinical infection among persons with mpox. [ABSTRACT FROM AUTHOR]

Background: Cervicitis is traditionally associated with Chlamydia trachomatis and Neisseria gonorrhoeae. There is evidence to indicate both Mycoplasma genitalium and bacterial vaginosis (BV) are associated with cervicitis, but international guidelines inconsistently recommend testing for these infections. We aimed to describe the contribution of, and trends in, genital infections to cervicitis over a decade, to inform testing and treatment practices. Methods: We conducted a retrospective case-series to determine the number of cervicitis cases diagnosed with genital infections among women attending the largest public sexual health service in Australia. Electronic medical records were extracted for all cervicitis cases attending the Melbourne Sexual Health Centre between 1st March 2011-1st March 2021. We determined the proportion of cervicitis cases with one or more genital infections detected, and trends in testing and detection of each infection over time. Results: Of 813 cervicitis cases diagnosed over a decade, 226/729 (31%, 95%CI:28%-35%) had BV, 163/809 (20%, 95%CI:17%-23%) C. trachomatis, 48/747 (6%, 95%CI:5%-8%) M. genitalium, and 13/793 (2%, 95%CI:1%-3%) N. gonorrhoeae. Of the 665 (81.8%) cases tested for all four infections, 268 (40.3%) had one infection detected and 73 (11.0%) had >1 infection detected; BV and C. trachomatis accounted for 58.9% of coinfections (n=43/73). M. genitalium and BV testing was slightly lower (90- 92%) compared to testing for C. trachomatis and N. gonorrhoeae (>97%). The proportion of cases tested for M. genitalium increased from 84% in 2011 to 96% in 2019 (Ptrend=0.006), with M. genitaliumdetection in cervicitis increasing from 3% to 7% (Ptrend=0.046). The proportion with cervicitis tested for BV (90%) did not change overtime, but detection increased from 32% to 45% (Ptrend< 0.001). Conclusion: Over the past decade, BV emerged as the most frequently detected infection in women with cervicitis in our clinic population, often as the sole infection detected. Whilst C. trachomatis remained common among cervicitis cases, M. genitalium was more commonly detected than N. gonorrhoeae. Understanding the evolving contribution of genital infections to cervicitis globally and regionally is essential to informing relevant testing and treatment practices, to create consistency across guidelines and reduce confusion for clinicians, and lastly to improve targeted treatment strategies and reduce antibiotic misuse. [ABSTRACT FROM AUTHOR]

Background: Electronic health records allow for inexpensive communication with patients. In March 2021, the Melbourne Sexual Health Centre implemented an automated email summary ("Sexual Health Automated Visit Email" [SHAVE]) of a client's visit. This study evaluates the proportion of attendees at a sexual health service who opted in or out of SHAVE. Methods: This study was conducted at the Melbourne Sexual Health Centre in Australia between March 2021 and June 2022. Univariable and multivariable logistic regression analyses were used to examine the client characteristics associated with consenting to SHAVE. Results: There were 18,528 clients (men, 12,700; women, 5828) included in the final analysis and 55.2% (n = 10,233) consented to receiving SHAVE. Comparing with those who did not have a new sexually transmitted infection diagnosis, clients with a new diagnosis of a sexually transmitted infection, but not HIV, had lower odds of consenting to receiving SHAVE (chlamydia: adjusted odds ratio [aOR], 0.64 [95% confidence interval {CI}, 0.57--0.72]; gonorrhea: aOR, 0.71 [95% CI, 0.62--0.82]; syphilis: aOR, 0.75 [95% CI, 0.59--0.96]). Men had lower odds of consenting when compared with women (men who have sex with women only: aOR, 0.77 [95% CI, 0.71--0.84]; men who have sex with men: aOR, 0.68 [95% CI, 0.62--0.75]). Comparingwith those born in Australia orOceania, clients born in Europe had lower odds of consenting (aOR, 0.81; 95% CI, 0.70--0.94), whereas those born in Latin America or Caribbean had higher odds of consenting (aOR, 1.25; 95% CI, 1.04--1.51). Conclusions: Email summaries may serve as a valuable strategy to improve health communication and record keeping for clients. Understanding the client characteristics associated with consenting SHAVE will allow for the implementation of strategies to better communicate with clients. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Background: Few studies have examined the types of sexual activities and condom use during group sex among men who have sex with men (MSM). This study aimed to examine sexual activities and condom use during group sex. Setting: A cross-sectional survey among MSM attending a sexual health clinic in Melbourne, Australia, between May 2019 and March 2020. Method: Participants were asked whether they had engaged in group sex (sex involving more than 2 participants) within the past 3 months, the number of people involved, the sexual activities they engaged in, and their condom use during the most recent group sex. Results: More than a quarter (26.8%, 287 of 1071) had engaged in group sex in the past 3 months, and the median number of people involved was 3 (interquartile range 3–4), including the participant. Fellatio was the most common activity in group sex (94.4%, 271 of 287), followed by kissing (85.7%, 246 of 287) and anal sex (79.8%, 229 of 287). The proportion of men who always used condoms and changed condoms between partners was 27.0% (48 of 178) for insertive and 32.3% (52 of 161) for receptive anal sex. Compared with men not taking pre-exposure prophylaxis (PrEP), men living with HIV (adjusted odds ratio [aOR]: 2.35; 95% confidence interval [CI]: 1.20 to 4.59) and men taking PrEP (aOR: 3.07; 95% CI: 2.21 to 4.26) had higher odds of engaging in group sex after adjusting for confounders. Conclusion: Two-thirds of MSM either did not use condoms or did not change condoms between partners during group sex, which may increase sexually transmitted infection transmission between partners. [ABSTRACT FROM AUTHOR]

This systematic review found evidence to suggest a possible association between kissing and oropharyngeal gonorrhea after controlling for other sexual practices, including fellatio and rimming. Background: Tongue kissing is a poorly studied risk factor for sexually transmitted infections (STIs). We undertook the first systematic review to assess whether kissing is a risk factor for gonorrhea or chlamydia of the oropharynx. Methods: Online databases (MEDLINE, EMBASE, CINAHL, Web of Science, Cochrane) and reference lists were searched until September 30, 2022. The eligibility criteria for studies included: any peer-reviewed study design in the English language; gonorrhea or chlamydia diagnosed by nucleic acid amplification test, or an infection self-reported by a patient; tongue kissing or its equivalent measured as an exposure. Studies were appraised using a quality scoring tool and qualitatively synthesized. Results: Of 8248 studies screened, 6 were eligible for review. All were conducted among men who have sex with men in Australia, including 3 prospective cohort studies, 2 cross-sectional studies, and 1 age-matched case-control study. In summary, all 5 studies examining gonorrhea found an unadjusted association between kissing and oropharyngeal gonorrhea. Two cross-sectional studies found that tongue kissing was an independent risk factor for oropharyngeal gonorrhea after adjusting for other confounders, such as participant demographic characteristics and other sexual practices. In contrast, a single eligible prospective cohort study found no association between kissing and oropharyngeal chlamydia. Conclusions: This systematic review summarized the existing evidence that suggests that tongue kissing may be a risk factor for oropharyngeal gonorrhea but not chlamydia. Reinforcing the message that oropharyngeal gonorrhea could be transmitted through kissing may inform the development of novel approaches to prevent and treat gonorrhea. [ABSTRACT FROM AUTHOR]

Background: Increasing the frequency of HIV testing among men who have sex with men (MSM) maximizes the preventive effect of antiretroviral therapy, by reducing time to diagnosis and treatment. Setting: Melbourne Sexual Health Centre, Australia. Methods: This randomized controlled trial evaluated whether access to testing, without seeing a clinician would increase testing frequency. MSM attending for HIV testing between July 2014 and April 2015 were randomized in 1:1 ratio to the intervention arm (access to HIV and syphilis testing at 300 pathology centers, without requiring consultations) or the control arm (consultation at every test), without blinding. The primary outcome was the incidence of HIV testing over 12 months. Results: Of 443 men referred, 422 were randomized, 3 HIV positives at baseline were excluded, and 419 were analyzed. Of 208 control, 202 (97.1%) and 200 (94.8%) of 211 intervention group members were followed to 12 months. The intervention group had 453 tests in 205.6 person-years, incidence rate was 2.2 (95% confidence interval [CI]: 2.0 to 2.4) tests per year. The control group had 432 tests during 204.0 person-years, incidence rate was 2.1 (95% CI: 1.9 to 2.3) tests per year, and incidence rate ratio was 1.04 (95% CI: 0.89 to 1.2; P = 0.63). The annual rate of consultations was as follows: intervention, 1.61 (95% CI: 1.44 to 1.79); controls, 2.12 (95% CI: 1.92 to 2.33); rate ratio, 0.76 (95% CI: 0.65 to 0.88; P = 0.0001). There was no difference in quality of life scores (P = 0.61). Conclusions: MSM permitted HIV and syphilis testing outside of clinical consultations did not test more frequently than controls but had 24% fewer consultations, reducing service demand. Trial registration: ACTRN12614000760673. [ABSTRACT FROM AUTHOR]

Background: Gonorrhoea notifications are rapidly rising in men who have sex with men (MSM). We developed a model to assess mouthwash as a novel intervention for gonorrhoea control.Methods: We developed a model of Neisseria gonorrhoeae (NG) transmission to explain anatomic site-specific prevalence of gonorrhoea among MSM. The model was calibrated to available epidemiological and behavioral data. We estimated the contribution of various sexual acts to gonorrhoea incidence and evaluate the potential impacts of screening scale-up and utilization of mouthwash on the gonorrhoea epidemic.Results: We calibrated the model to prevalence of oropharyngeal, anal, and urethral gonorrhoea of 8.6% (7.7-9.5%), 8.3% (7.4-9.1%), and 0.20% (0.04-0.35%), respectively, among MSM. Oropharynx to oropharynx transmission through kissing is estimated to account for nearly three quarters of all incident cases (71.6% [64.4-80.5%]) of gonorrhoea in MSM. Substantially increasing annual oropharynx screening for gonorrhoea from the current 40% to 100% may only halve the prevalence of gonorrhoea in MSM. In contrast, the use of mouthwash with moderate efficacy (additional 1% clearance per daily use) would further reduce the corresponding prevalence rates to 3.1% (2.2-4.4%), 3.8% (2.3-4.9%), and 0.10% (0.06-0.11%), and a high-efficacy mouthwash (additional 1.5% clearance per daily use) may further halve the gonorrhoea prevalence. Without oropharynx to oropharynx transmission, we could not replicate current prevalence data.Conclusions: Despite a dearth of empirical data, our model suggests that kissing could potentially play an important role in NG transmission among MSM. Control through sexually transmitted infection screening alone is unlikely to have a substantial impact on the gonorrhoea epidemic in MSM. [ABSTRACT FROM AUTHOR]

There is a strong assortative sexual mixing pattern by age and region of birth among male-female partnerships attending a sexual health service in Melbourne, Australia. Background: Patterns of sexual mixing may be influenced by demographic factors where individuals show a preference for partners with particular traits and may have different levels of risk for HIV and sexually transmitted infection transmission. We aimed to explore age differences and mixing by region of birth among male-female partnerships. Methods: Male-female partnerships who presented to Melbourne Sexual Health Centre in Australia between 2015 and 2019 were investigated. Age and country of birth of sexual partners were collected. We calculated the age differences between partners and created tables demonstrating partnership mixing by age groups and by international region of birth. Results: A total of 2112 male-female partnerships (i.e., 4224 individuals) were included. The median age was 27 years (interquartile range, 23–31 years). Between men and women in partnerships, the median age difference was 1 year. Nearly half of all individuals (49.1% [2072 of 4224]) were in a partnership with another individual in the same 5-year interval age group as their own, and a majority of individuals (58.5% [2334 of 3988]) were in a partnership with another individual from the same region of birth when compared with other regions. Conclusions: There is a strong assortative sexual mixing pattern by age and region of birth among male-female partnerships in Melbourne, Australia. These results may have applications in further research to understand sexually transmitted infection transmission among clients attending sexual health centers, particularly those born overseas. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: To determine if female partners of men with pathogen-negative non-gonococcal urethritis (NGU) are at risk of genital infection.Methods: Secondary data analysis using health records from a large sexually transmitted disease clinic in Melbourne of 1710 men and their female partners attending on the same day from January 2006 to April 2015. Proportions of female partners with symptoms suggesting genital infection or pelvic inflammatory disease (PID) were determined for: (1) men with NGU and no Chlamydia trachomatis or Mycoplasma genitalium (referred to as pathogen-negative NGU) (n = 91); 2) men with urethral C. trachomatis (n = 176); 3) men with urethral M. genitalium (n = 26); and 4) asymptomatic men (n = 652).Results: Female partners of men with pathogen-negative NGU experienced deep pelvic pain (adjusted odds ratio [AOR], 2.2; 95% confidence interval [CI], 1.1-4.4), post coital bleeding (AOR, 2.4; 95% CI, 1.2-4.9), and dysuria (AOR, 3.7; 95% CI, 1.6-8.6) more commonly and were diagnosed with PID more commonly (AOR, 4.8; 95% CI, 2.1-11.3) than the female partners of asymptomatic men. Pelvic inflammatory disease was not more likely to be diagnosed in the female partners of men with genital warts (AOR, 1.4; 95% CI, 0.5-4.4) or candidiasis (AOR, 1.2; 95% CI, 0.4-3.5) than the female partners of asymptomatic men. The female partners of men with chlamydia experienced post coital bleeding more (AOR, 1.9; 95% CI, 1.0-3.6) and were more likely to be diagnosed with PID (AOR, 3.6; 95% CI, 1.6-8.0).Conclusions: The female partners of men with pathogen-negative NGU may be at increased risk of genital infection, even if a recognised pathogen is not identified in the man. [ABSTRACT FROM AUTHOR]

Background: Although pediatric lower extremity sarcoma once was routinely treated with amputation, multiagent chemotherapy as well as the evolution of tumor resection and reconstruction techniques have enabled the wide adoption of limb salvage surgery (LSS). Even though infection and tumor recurrence are established risk factors for early amputation (< 5 years) after LSS, the frequency of and factors associated with late amputation (≥ 5 years from diagnosis) in children with sarcomas are not known. Additionally, the resulting psychosocial and physical outcomes of these patients compared with those treated with primary amputation or LSS that was not complicated by subsequent amputation are not well studied. Studying these outcomes is critical to enhancing the quality of life of patients with sarcomas. Questions/purposes: (1) How have treatments changed over time in patients with lower extremity sarcoma who are included in the Childhood Cancer Survivor Study (CCSS), and did primary treatment with amputation or LSS affect overall survival at 25 years among patients who had survived at least 5 years from diagnosis? (2) What is the cumulative incidence of amputation after LSS for patients diagnosed with pediatric lower extremity sarcomas 25 years after diagnosis? (3) What are the factors associated with time to late amputation (≥ 5 years after diagnosis) in patients initially treated with LSS for lower extremity sarcomas in the CCSS? (4) What are the comparative social, physical, and emotional health-related quality of life (HRQOL) outcomes among patients with sarcoma treated with primary amputation, LSS without amputation, or LSS complicated by late amputation, as assessed by CCSS follow-up questionnaires, the SF-36, and the Brief Symptom Inventory-18 at 20 years after cancer diagnosis? Methods: The CCSS is a long-term follow-up study that began in 1994 and is coordinated through St. Jude Children's Research Hospital. It is a retrospective study with longitudinal follow-up of more than 38,000 participants treated for childhood cancer when younger than 21 years at one of 31 collaborating institutions between 1970 and 1999 in the United States and Canada. Participants were eligible for enrollment in the CCSS after they had survived 5 years from diagnosis. Within the CCSS cohort, we included participants who had a diagnosis of lower extremity sarcoma treated with primary amputation (547 patients with a mean age at diagnosis of 13 ± 4 years) or primary LSS (510 patients with a mean age 14 ± 4 years). The LSS cohort was subdivided into LSS without amputation, defined as primary LSS without amputation at the time of latest follow-up; LSS with early amputation, defined as LSS complicated by amputation occurring less than 5 years from diagnosis; or LSS with late amputation, defined as primary LSS in study patients who subsequently underwent amputation 5 years or more from cancer diagnosis. The cumulative incidence of late amputation after primary LSS was estimated. Cox proportional hazards regression with time-varying covariates identified factors associated with late amputation. Modified Poisson regression models were used to compare psychosocial, physical, and HRQOL outcomes among patients treated with primary amputation, LSS without amputation, or LSS complicated by late amputation using validated surveys. Results: More study participants were treated with LSS than with primary amputation in more recent decades. The overall survival at 25 years in this population who survived 5 years from diagnosis was not different between those treated with primary amputation (87% [95% confidence interval [CI] 82% to 91%]) compared with LSS (88% [95% CI 85% to 91%]; p = 0.31). The cumulative incidence of amputation at 25 years after cancer diagnosis and primary LSS was 18% (95% CI 14% to 21%). With the numbers available, the cumulative incidence of late amputation was not different among study patients treated in the 1970s (27% [95% CI 15% to 38%]) versus the 1980s and 1990s (19% [95% CI 13% to 25%] and 15% [95% CI 10% to 19%], respectively; p = 0.15). After controlling for gender, medical and surgical treatment variables, cancer recurrence, and chronic health conditions, gender (hazard ratio [HR] 2.02 [95% CI 1.07 to 3.82]; p = 0.03) and history of prosthetic joint reconstruction (HR 2.58 [95% CI 1.37 to 4.84]; p = 0.003) were associated with an increased likelihood of late amputation. Study patients treated with a primary amputation (relative risk [RR] 2.04 [95% CI 1.15 to 3.64]) and LSS complicated by late amputation (relative risk [RR] 3.85 [95% CI 1.66 to 8.92]) were more likely to be unemployed or unable to attend school than patients treated with LSS without amputation to date. The CCSS cohort treated with primary amputation and those with LSS complicated by late amputation reported worse physical health scores than those without amputation to date, although mental and emotional health outcomes did not differ between the groups. Conclusion: There is a substantial risk of late amputation after LSS, and both primary and late amputation status are associated with decreased physical HRQOL outcomes. Children treated for sarcoma who survive into adulthood after primary amputation and those who undergo late amputation after LSS may benefit from interventions focused on improving physical function and reaching educational and employment milestones. Efforts to improve the physical function of people who have undergone amputation either through prosthetic design or integration into the residuum should be supported. Understanding factors associated with late amputation in the setting of more modern surgical approaches and implants will help surgeons more effectively manage patient expectations and adjust practice to mitigate these risks over the life of the patient. Level of Evidence: Level III, therapeutic study. [ABSTRACT FROM AUTHOR]

Background: Trichomonas vaginalis is not a notifiable disease in Australia in most states, resulting in limited Australian epidemiological studies. This study aimed to examine the positivity of T. vaginalis in women attending the Melbourne Sexual Health Centre (MSHC) and identify associated factors.Methods: All women 16 years or older who were tested for T. vaginalis at MSHC from 2006 to 2019 were included. The diagnostic method changed from culture to nucleic acid amplification test in August 2018. The annual positivity of T. vaginalis was calculated. Because of the data completeness, we performed a generalized estimating equations multivariable logistic regression using data from 2011 to 2019 to examine factors associated with T. vaginalis positivity.Results: From 2006 to 2019, 69,739 tests for T. vaginalis were conducted, and 294 tested positive (0.42%; 95% confidence interval [CI], 0.37%-0.47%). Approximately 60% of women tested reported symptoms. After adjusting for potential confounders including the change in diagnostic method, there was a 21% (95% CI, 12%-31%) annual increase in T. vaginalis positivity between 2011 and 2019. Women with concurrent syphilis had the highest odds of testing positive for T. vaginalis (adjusted odds ratio [aOR], 21.55; 95% CI, 6.96-66.78), followed by women who had injected drugs in the last 12 months (aOR, 6.99; 95% CI, 4.11-11.87), were 35 years or older (aOR, 3.47; 95% CI, 2.26-5.35), or had concurrent chlamydia (aOR, 1.77; 95% CI, 1.05-2.99).Conclusions: The rising positivity of T. vaginalis at MSHC irrespective of change in diagnostic method suggests a concurrent community-wide rise in Melbourne. Given the rising positivity, testing informed by risk factors should be considered. [ABSTRACT FROM AUTHOR]

Background: Earlier detection of syphilis is needed to reduce infectiousness and transmission and improve control. PCR for Treponema pallidum is highly sensitive for detecting primary syphilis but in many settings is not widely available or used. The aim of this systematic review was to investigate what proportion of PCR-positive primary syphilis infections are seronegative for syphilis, when serology is performed at clinical presentation for primary syphilis. Methods: We undertook a systematic review to identify studies of patients presenting with primary syphilis where PCR for T. pallidum was performed on the primary syphilis lesion and serology for syphilis on the same occasion. The review was conducted according to the PRISMA checklist. Three databases (Medline, Embase, PubMed) were searched from 1 January 2000 to 27 November 2022. Only studies published in English were included. The search terms used were: 'primary syphilis', 'Treponema pallidum', 'polymerase chain reaction', 'PCR', 'nucleic acid amplification test', 'NAAT'. Medical subject headings (MeSH) were used where possible. Results: Of 2,569 studies identified, 10 studies were included: 2 prospective, 7 retrospective and 1 mixed prospective and retrospective. All studies were conducted in clinical/sexual health settings (Canada, Australia, UK, France, Czechia, Cuba). Across the 10 studies, there were a total of 1084 individuals who had T. pallidum positive primary lesions. This included 867 men: gender was not specified in 2 studies. A total of 1043 individuals with T. pallidum positive primary lesions had serology performed. Among these, 14% (147/1043) (95% CI: 12-16%) were negative by serology, ranging between 4% (4/108) (95% CI 1-9%) and 50% (51/102) (95% CI: 40- 60%). Among studies where the anatomical site of the primary lesion was provided there were a total of 503 anogenital and 8 oral primary lesions that were T. pallidum PCR-positive. Conclusion: Among patients with primary syphilis, a proportion will have PCR-confirmed primary infection when serology is negative. This proportion may vary depending on a number of factors. More widespread availability and appropriate testing with PCR for T. pallidum may improve detection of primary syphilis, resulting in earlier diagnosis. [ABSTRACT FROM AUTHOR]

Background: Syphilis epidemics are worsening in many countries and earlier diagnosis is needed to reduce infectiousness and transmission. Better detection of primary syphilis is needed in primary care settings as this is where many syphilis cases present. The aim of this study was to evaluate whether the use of multiplex PCR testing of anogenital lesions for Treponema pallidum and herpes simplex virus (HSV) in general practice improves the detection of primary syphilis. Methods: Between September and December 2022, multiplex PlexPCR VHS (SpeeDx) testing for T. pallidum and HSV type-1 and -2 was performed on all clinical specimens received from general practitioners across Victoria using the Melbourne Pathology laboratory network if HSV PCR testing of anogenital lesions was requested in a patient aged ≥18, even if T. pallidum PCR was not requested. Multiplex PCR was also performed if testing for other STIs or T. pallidum PCR was requested. Clinics were made aware of this testing via a letter that included a link to an educational video on PCR testing for syphilis. Results: During the period,1,291 multiplex tests were performed, 882 in women and 398 in men, 18 of which were positive for T. pallidum. Of the positive T. pallidum samples, 6/18 (33%) (95%CI: 13-59%) were from patients where the practitioner had requested PCR for HSV but not T. pallidum: 2 female and 4 male. All 6 cases were negative for HSV on PCR. Among the 2 females, both swabs were from genital sites. Among the 4 males, 3 swabs were genital and one anal. Four individuals (2 women, 2 men) resided in more socioeconomically disadvantaged areas known to have higher rates of syphilis in women of reproductive age. Conclusion: Multiplex PCR testing for syphilis and herpes in primary care resulted in the detection of primary syphilis in male and female patients which may have otherwise not been identified. This is likely to have led to earlier diagnosis and treatment, potentially reducing infectiousness and progression of infection. [ABSTRACT FROM AUTHOR]

Project: Implementation of routine syphilis screening in later pregnancy at antenatal services across Victoria, Australia. Issue: Syphilis is increasing among women globally, leading to an increase in congenital syphilis in many countries. Screening for syphilis in later pregnancy could help prevent congenital syphilis but is generally only advised for women identified as being at high risk for infection. However, there are barriers to the identification of risk. This project adopted an implementation science approach to embed syphilis screening into the routine 28-week antenatal clinic visit undertaken by pregnant women across several antenatal services in Victoria with differing health service systems. Results: Data analysis from seven metropolitan and rural antenatal services informed the development of a low-cost implementation package to support practice change, with routine syphilis screening at the 28-week visit. The package comprises four core elements: (1) clinical guidelines recommending routine inclusion of syphilis serology with other blood tests taken for the 28-week visit; (2) automation of pathology ordering that includes syphilis testing with other tests; (3) clinician reminders within clinical records; and (4) training and resources for midwives and obstetricians including an educational video on screening and management for syphilis (Table 1). Use of a hybrid implementation framework identified contextual and behavioural barriers and facilitators that guided the development and integration of these elements to fit within existing clinical workflows and systems, including different systems for pathology ordering and electronic records. The Consolidated Framework for Implementation Research facilitated a deep contextual analysis of the intervention settings, informing tailored implementation strategies. The COM-B model for behaviour change assessed motivation, capability, and opportunity for change, which informed the development of training and resources. Lessons learned: Applying a change in process across varied health service settings required a deep contextual analysis of existing systems, local practices and resources within each setting. Meaningful engagement with clinical staff underpinned by implementation frameworks enabled identification of key elements for implementation that can be tailored according to local conditions. The resulting implementation package could be useful across a variety of healthcare settings to address the preventable epidemic of congenital syphilis. [ABSTRACT FROM AUTHOR]

Background: Mycoplasma genitalium is a sexually transmitted bacterium with an evolving resistance profile. Macrolide resistance in M. genitalium exceeds 50% in many regions, and fluoroquinolone resistance is rising. Current practice in Australia follows macrolide-resistance guided therapy. Patients with macrolide-resistant M. genitalium receive doxycycline followed by moxifloxacin as first-line treatment. At Melbourne Sexual Health Centre (MSHC), patients who fail moxifloxacin are treated second-line with a sitafloxacin-containing regimen. We conducted an audit to evaluate the efficacy of sitafloxacin-containing regimens for macrolideresistant M. genitalium. Methods: Patients with macrolide-resistant M. genitalium treated with sitafloxacin at MSHC between January 2017-February 2022 were included. Two sitafloxacin regimens were used during the study period: before October 2017 patients received sequential monotherapy (doxycycline followed by sitafloxacin); subsequently, patients received combination therapy (doxycycline followed by doxycycline+sitafloxacin). Microbial cure was defined as a negative test-of-cure 14-90 days after completing sitafloxacin. Proportions and 95% confidence intervals (CI) were calculated. Logistic regression was used to explore factors associated with sitafloxacin failure. Factors associated with treatment failure in univariable analyses were included in multivariable analysis. Results: 232 patients with M. genitalium (representing 235 infections) were treated with a sitafloxacin-containing regimen. Microbial cure following sitafloxacin was 80.4% (95%CI:74.8-85.3, 189/235). In analyses adjusted for age, gender, prior failure of moxifloxacin and M. genitalium test-of-cure assay, prior failure of moxifloxacin was the only factor associated with sitafloxacin failure (Adjusted- Odds-Ratio=7.93, 95%CI:2.49-25.23, pvs combination therapy among patients who had previously failed moxifloxacin (2/6 [33.3%] vs 87/122 [71.3%], p=0.069) or among those who had not previously failed moxifloxacin (87/92 [94.6%] vs 11/12 [91.7%], p=0.530), although small numbers limited comparisons. Conclusion: The overall cure following sitafloxacin was 80.4%. Failure was 8-fold higher among patients who had previously failed moxifloxacin, which is likely due to increases in specific fluoroquinolone resistance mutations (i.e. S83I) in Melbourne over this period. These data provide information about the efficacy of sitafloxacin for macrolide-resistant M. genitalium and highlight the need for nextgeneration resistance-guided therapy. [ABSTRACT FROM AUTHOR]

Background: In 2022, a global mpox (previously monkeypox) virus outbreak occurred, predominantly affecting gay, bisexual, and other men who have sex with men (GBM). We aimed to ascertain the infectiousness of mpox from oral and anal sites over time, relative to the resolution of mucocutaneous mpox lesions. Methods: This prospective cohort study recruited GBM with suspected, or contacts of, mpox, at Melbourne Sexual Health Centre, Australia, from June to October 2022. Men self-collected oral and anal swabs, and urine for mpox PCR and viral culture at first presentation (Day 0), with repeat testing weekly, when reviewed for clinical clearance, until lesion resolution. Results: 14/19 (74%) men had initial oral PCR detection with 6/14 (42%) still positive by oral PCR and culture (median 14.5, IQR: 10.5-17 days) at or after resolution of mpox lesions at other sites. Of the 14, one had oral mpox lesions at the initial visit. 16/19 (84%) men had initial anal PCR detection with 9/16 (64%) still positive by anal PCR (median 11, IQR: 9-16 days) and 6/16 (43%) by anal culture (median 10.5, IQR: 9-15.5 days) at or after resolution of mpox lesions elsewhere. Of the 16, nine had anal mpox lesions. Among 16 men who underwent serology, 8 (50%) had mpox antibodies detected, including four with positive serology while culture positive, and two negative on day 15. Conclusion: Australia had fewer mpox cases than the UK, Europe, and North America, thus our study had a limited sample size. Detection of mpox by culture suggests virus viability and potential infectiousness. Our data indicate that a proportion of men who had resolution of mpox lesions and who would be cleared by public health authorities and advised their mpox infection is no longer contagious, may still be infectious from oral and anal sites and should be advised to abstain from physical and sexual contact involving these sites for a longer period of time. Further longitudinal studies using culture are needed to define this period. [ABSTRACT FROM AUTHOR]

Background: The risk of HIV and sexually transmitted infections (STIs) varies substantially across diverse population groups in Australia. This study aims to measure the disparity in the distribution of HIV/STIs among attendees in a clinical setting using the Gini coefficient, a measure of inequality to describe the distribution of HIV/STIs. Methods: We used demographic and sexual behaviour data from attendees of Melbourne Sexual Health Centre, between 2015-2018. We applied a machine learning-based risk assessment tool, MySTIRisk, to determine the risk scores. Based on individuals' risk scores and HIV/STIs diagnoses, we calculated the Gini coefficients for HIV, syphilis, gonorrhoea, and chlamydia infections for different subgroups. Results: Among all clinic attendees, the Gini coefficients were highest for syphilis (0.60, (95% CIs, 0.57-0.64)) followed by HIV (0.57, 0.52-0.62), gonorrhoea (0.38, 0.36-0.42) and chlamydia (0.31, 0.28-0.35). Men who had sex with men (MSM) had lower Gini coefficients compared to heterosexual men or women; HIV (0.54 vs. 0.94 vs. 0.96), syphilis (0.50 vs. 0.86 vs. 0.93), gonorrhoea (0.24 vs. 0.57 vs. 0.57) and chlamydia (0.23 vs. 0.42 vs. 0.40), respectively. The Gini coefficient was lower among 25-34-year-olds than in other age groups for HIV (0.66 vs. 0.83-0.90), gonorrhoea (0.38 vs. 0.43-0.47) and for some age groups for chlamydia (0.31 vs. 0.39-0.47). For syphilis, the oldest age group (≥45 years) had a lower Gini coefficient than 18-24-yearolds (0.61 vs. 0.70). Conclusions: Our study finds that HIV/STIs are more evenly distributed in MSM populations suggesting interventions can be widely disseminated in MSM communities. In contrast, interventions in heterosexual men and women need to be more targeted at higher-risk individuals. [ABSTRACT FROM AUTHOR]

Background: Presumptive treatment in STI syndromes and among sexual contacts of an STI leads to antibiotic overuse and misuse. We aimed to determine if near-to-patient-testing for Neisseria gonorroheae, Chlamydia trachomatis and Mycoplasma genitalium (plus macrolide-resistancemutations) would improve appropriate prescribing and reduce antibiotic overuse in patients with nongonococcal urethritis (NGU), suspected proctitis or pelvic inflammatory disease (PID), patients attending as STI-contacts, and patients attending for M.genitalium test-of-cure (MG-TOC). Timely STIspecific partner-notification was measured. Methods: From March-December 2021, enrolled patients underwent testing for STIs by molecular near-to-patient-testing (SpeeDx; GeneXpertR System,Cepheid, Sunnyvale, CA, USA) and transcription-mediated-amplification standardof- care testing (Aptima, Hologic). We calculated the proportion with an STI detected among those who presented with an STI syndrome, as an STI-contact, or for MG-TOC. To estimate the benefit of near-topatient- testing on antimicrobial stewardship among those normally receiving syndromic therapy, we compared prescribing practices among patients undergoing near-to-patient-testing with a control group undergoing standard-of-care. Finally, patients received an SMS asking how many partners they had notified of the specific STI within 24h. Results: Among 870 patients (representing 975 consults) undergoing near-to-patient-testing, an STI was detected in 63/252 (25.0%) with NGU (12.3% C.trachomatis; 11.3% M.genitalium; 2.8% N.gonorrhoeae), 18/51 (35.3%) with proctitis (21.6% N.gonorrhoeae; 9.8% C.trachomatis; 11.8% M.genitalium) and 5/51 (9.8%) with pelvic pain (5.8% M.genitalium; 2.0% C.trachomatis; 2.0% N.gonorrhoeae). Near-to-patient-testing detected an STI among 183/527 (34.7%) STI-contacts, and M.genitalium among 35/161 (21.7%) MG-TOC presentations. Among patients with an STI syndrome, significantly more patients undergoing near-to-patient-testing vs standard-of care received etiologic therapy (72.6% vs 8.8%, respectively). This resulted in more patients undergoing near-to-patient-testing vs standard-of-care receiving precise treatment (correct drug/no drug appropriately; 80.5% vs 21.2%, respectively), and fewer patients undergoing nearto- patient-testing being mistreated (incorrect drug/no pathogen detected; 17.2% vs 66.0%, respectively). 173/276 with an STI detected reported partner-notification via reply-SMS; 95.4% notified all or some sexual partners and 85.9% of these notifications occurred < 24h post-result. Conclusion: The three bacterial STIs were detected in less than a third of patients, highlighting the need for timely etiologic strategies to mitigate antibiotic overuse and misuse as a result of presumptive therapy. Near-to-patient-testing resulted in improved antimicrobial stewardship, and rapid and high rates of STI-specific partner-notification. [ABSTRACT FROM AUTHOR]

Background: Changes in condom use and serosorting associated with HIV PrEP and treatment as prevention may be driving syphilis transmission in gay and bisexual men (GBM). We describe trends in syphilis testing and incidence among a large, national, retrospective cohort of GBM in Australia over a decade spanning PrEP implementation. Methods: Data were extracted from 55 sentinel clinics participating in the ACCESS project. GBM with ≥2 visits and ≥2 syphilis tests from Jan2012-Dec2021 were included in testing and incidence analyses, respectively. Annual rates of syphilis testing and diagnosis (primary, secondary, early-latent) per 100 person-years (py) were calculated disaggregated by HIV status and PrEP use (evidence of PrEP prescription; dichotomised as ever-PrEP vs never- PrEP). Poisson regression tested for trends from 2012-2021. Among those diagnosed with syphilis, rate of syphilis reinfection was calculated. Multivariable Cox regression explored risk factors for syphilis between 2016 (post-PrEP availability) to 2019 (pre-COVID). Results: 135,443 GBM (mean age=35.9 years; 7.8% with HIV; 31.0% ever-PrEP-users) had ≥2 visits and 93,918 GBM had ≥2 syphilis tests. There were 653,438 syphilis tests (median days between tests=119) over 610,996 person-years (testing rate=107.0/100py); testing was highest among GBM with HIV (152.2/100py). Between 2012-2021, testing increased from 68.3/100py to 132.7/100py (p< 0.001), mostly driven by increases among ever-PrEPusers [Figure]. There were 13,662 syphilis infections diagnosed in 9,546 (10.2%) GBM over 399,399 person-years (incidence rate=3.4/100py). Syphilis incidence was highest among GBM with HIV (6.7/100py), followed by ever-PrEP-users (3.7/100py) and never-PrEP-users (1.6/100py). Between 2012-2021, syphilis incidence increased among ever-PrEP-users from 1.4/100py to 5.0/100py (p< 0.001) and fluctuated between 5.8/100py and 7.4/100py among GBM with HIV. Rate of syphilis reinfection was 12.5/100py, and similar across groups. Ever previously diagnosed with syphilis (adjusted Hazard Ratio [HR]=2.63, 95%CI=2.45-2.82) was the strongest predictor of syphilis incidence, followed by recent (< 12m) syphilis diagnosis (aHR=2.04, 95%CI=1.89-2.20), living with HIV (aHR=2.07, 95%CI=1.94-2.23) and recently (< 12m) prescribed PrEP (aHR=1.91, 95%CI=1.77-2.06). Conclusions: Syphilis trends between GBM with HIV and GBM with evidence of PrEP use have been converging over the past decade. Previous syphilis infection was the strongest predictor of subsequent infection, highlighting the importance of including prior diagnosis as an indication for new targeted strategies (e.g., doxy-PEP). [ABSTRACT FROM AUTHOR]

Background: Mycoplasma genitalium is increasingly difficult to treat. Macrolide-resistance exceeds 50% in many regions, and the prevalence of fluoroquinolone resistance mutations is upwards of 20% in some regions of the Asia-Pacific, including Melbourne, Australia. Minocycline is an alternative treatment for patients with macrolide-resistant M. genitalium infections that have failed moxifloxacin and those with contraindications to fluoroquinolones. Data around the efficacy of minocycline for M. genitalium are limited to case reports and small series. Methods: We conducted a retrospective review of patients with macrolide-resistant M. genitalium who were treated with minocycline 100mg BID for 14 days at Melbourne Sexual Health Centre (MSHC) between February 2020 and May 2022. Microbial cure was defined as a negative test-of-cure within 14-90 days after completing minocycline. The proportion cured with 95% confidence intervals (CI) were calculated and logistic regression was used to explore factors associated with treatment failure. To provide greater precision around microbial cure for minocycline, we pooled data from the current study with a prior juxtaposed case series of patients with M. genitalium who had received minocycline 100mg BID for 14 days at MSHC between May 2018, February 2020. Results: Data from 90 patients with macrolideresistant M. genitalium who were treated with 14 days of minocycline were analysed; 60 patients (66.7% [95% CI 56.0%-76.3%]) experienced microbial cure within 14-90 days of completing minocycline. Adherence to minocycline was high; 86/90 patients (96%) reported taking all minocycline doses. Sideeffects were mild and self-limiting, with dizziness/light-headedness being the most common side-effect reported (8/90, 8.9%). No demographic or clinical characteristics were associated with minocycline failure in regression analyses. In pooled analyses of 123 patients, 83 [67.5% (95% CI 58.4%- 75.6%)] were cured following 14 days of minocycline. Conclusion: Minocycline cured 68% of macrolideresistant M. genitalium infections. These data provide tighter precision around the efficacy of minocycline for macrolide-resistant M. genitalium, and show that it is a well-tolerated regimen. With high levels of macrolide-resistance, increasing fluoroquinolone resistance, and the high cost of moxifloxacin, access to non-quinolone options such as minocycline is increasingly important for the clinical management of M. genitalium. [ABSTRACT FROM AUTHOR]

Background: Bacterial vaginosis (BV) is a common vaginal condition that is characterised by a nonoptimal, lactobacillus-deficient vaginal microbiota. BV recurrence following first-line antibiotics is common. Studies exploring the contribution of the vaginal microbiota to recurrence are limited and conflicting. We investigated if the vaginal microbiota composition pre-treatment or immediately posttreatment was associated with BV recurrence within one-month of treatment. Methods: This was a secondary analysis of vaginal samples collected from women who participated in three clinical trials that evaluated new interventions for improving BV cure, including concurrent antibiotic treatment of regular sexual partners (RSP). Women attending Melbourne Sexual Health Centre who were diagnosed with BV (≥3 Amsel criteria and Nugent Score=4-10) received first-line BV-treatment, and self-collected vaginal swabs pre-treatment and immediately post-treatment. 16S-rRNA gene sequencing was used to characterise the vaginal microbiota. Differences in the pre- and posttreatment microbiota composition between women who experienced recurrence within one-month of enrolment and women who remained cured were examined using ANOSIM. Logistic regression, adjusted for confounders, was performed to explore the association between BV recurrence and 1) bacterial diversity and 2) centre-log-ratio transformed abundance of individual bacterial taxa before and after treatment. Results: Data from 121 women were analysed; 16 women (13%; 95%CI:8-21%) recurred within onemonth of enrolment. Women with an untreated RSP were more likely to recur than women with no RSP (9/28 vs 3/44; P=0.008) or women with a RSP who received partner treatment through two of the parent trials (4/49; P=0.011). Neither the diversity nor composition of the microbiota pre-treatment (adjusted odds ratio [AOR]=1.99, 95%CI:0.77,6.71, p=0.203 and ANOSIM-R=0.070, p=0.166, respectively) or immediately post-treatment (AOR=1.37, 95%CI:0.60,2.97, p=0.435 and ANOSIMR= 0.037, p=0.318, respectively) differed between recurrence and cure cases. However, a higher abundance of Prevotella spp. pre-treatment (AOR=1.35, 95%CI:1.05,1.91, p=0.041) and Gardnerella spp. immediately post-treatment (AOR=1.23, 95%CI:1.03,1.49, p=0.026) were both associated with increased odds of BV recurrence after adjusting for partner type and treatment status. Conclusion: Our findings suggest that specific taxa may play a role in the high rates of treatment failure following recommended BV therapy. Further work should prioritise understanding the contribution of Prevotella and Gardnerella species to BV recurrence. [ABSTRACT FROM AUTHOR]

Abstract: This analysis of notified syphilis cases in Victoria, Australia between 2015 and 2018 shows that the syphilis epidemic in Victoria has become more generalized, with increases among heterosexual men and women residing in outer Melbourne suburbs-areas that differ from those of gay men. [ABSTRACT FROM AUTHOR]

Background: The clinical role of non-lesion mpox testing is ill-defined, and how often mpox causes asymptomatic infections is uncertain. Methods: We performed mpox PCR testing on rectal and pharyngeal specimens collected from two crosssectional samples of MSM sexual health clinic (SHC) patients in Seattle, WA, May-September 2022. One sample included participants in a prospective study. The second included randomly selected MSM. We evaluated the sensitivity of lesion, pharyngeal and rectal specimens in detecting mpox in symptomatic MSM and contacts to mpox. We also estimated the incidence of asymptomatic mpox in MSM based on the prevalence of asymptomatic mpox in our clinic, published data on duration of infection (20 days), and an estimate of the number of local MSM with a risk profile comparable to SHC patients (20% MSM). We used our incidence estimate and mpox surveillance data to estimate the proportion of all mpox cases that were asymptomatic. Results: The study population included 704 MSM. Forty-six men had symptoms prompting mpox testing, 20 (44%) of whom had PCR+ lesions. Six additional symptomatic men had PCR+ tests from only rectal and/or pharyngeal specimens. Among 23 symptomatic men with PCR+ mpox and specimens from all 3 anatomic sites, lesion, rectal, and pharyngeal specimens were 83%, 100%, and 56% sensitive, respectively. Among 6 contacts to mpox, 3 had PCR+ lesions, 4 had PCR+ pharyngeal specimens, and 6 had PCR+ rectal specimens. Eight (1.2%) of 658 asymptomatic men had a positive rectal and/or pharyngeal mpox PCR. We estimate that 71% of all mpox cases in the population were asymptomatic. This estimate decreases if the mean duration of infection is longer, the size of the at-risk population is smaller, or the number of symptomatic cases is greater (i.e., symptomatic cases went undiagnosed or unreported) (figure). At least onethird of cases were asymptomatic under all modelled scenarios. Conclusions: Although asymptomatic mpox was rare in our SHC, our findings suggest that asymptomatic infections likely account for a large proportion of all infections at the population-level. Rectal testing can identify infections in symptomatic patients missed by testing lesions alone and may be useful in evaluating contacts to mpox. [ABSTRACT FROM AUTHOR]

Background: There are limited data on HIV/sexually transmitted infection (STI) positivity and sexual practices among male sex workers (MSWs) both globally and particularly in Australia. This study aimed to explore demographic characteristics, sexual practices, and HIV/STI positivity among MSWs attending a sexual health clinic in Melbourne.Methods: We analyzed computerized medical records of all first-visit consultations with men 18 years or older who self-identified as current sex workers and attended the Melbourne Sexual Health Centre (MSHC) between 2010 and 2018. Demographic data, sexual behavior data, and laboratory results for HIV, syphilis, chlamydia, and gonorrhea were collected as part of routine clinical care at Melbourne Sexual Health Centre.Results: Of the 190 MSWs included in the analysis, the median age was 28 years (interquartile range, 23-30 years), 30.4% (52/171) reported having condomless penile-anal sex with their clients, and 59.6% (102/171) reported having condomless penile-oral sex with their clients since their last STI screening. Most (85.6%) MSWs had noncommercial sex partners, including 56.5% with male partners only, 30.6% with female partners only, and 12.9% with both. Approximately half of MSWs used condoms consistently with noncommercial sex partners (regardless of partner gender). The positivity for incident HIV was 1.7% (95% confidence interval [CI], 0.0%-5.0%), that for syphilis was 6.1% (95% CI, 2.6%-10.5%), that for chlamydia was 9.6% (95% CI, 5.6%-14.9%), and that for gonorrhea was 10.8% (95% CI, 4.4%-20.9%). Male sex workers who exclusively had sex with women had a lower any HIV/STI positivity (0%) compared with MSW who had sex with men (15.7%; P = 0.013).Conclusions: Male sex workers fall into 2 groups: those who had male clients and/or noncommercial partners who have a relatively high HIV/STI positivity and those who only had female partners or clients whose HIV/STI positivity is low. Both have a high proportion of condomless sex with clients and noncommercial sex partners. Strategies to increase condom use during sex work are needed. [ABSTRACT FROM AUTHOR]

Background: Group sex has been commonly reported among gay and bisexual men who have sex with men (GBMSM); however, there are limited studies on the factors associated with participating in group sex. Setting: A cross-sectional study among GBMSM attending a sexual health clinic in Melbourne, Australia. Methods: Univariable and multivariable logistic regression were performed to examine the association between GBMSM participating in group sex in the previous 3 months and their demographic characteristics, including age, pre-exposure prophylaxis (PrEP) use, HIV status, any STI (gonorrhea, chlamydia, syphilis) diagnosis on the day, and method of seeking partners. Results: There were 357 GBMSM who participated in the survey and their mean age was 32.9 years (SD = 10.9). Almost a third (n = 115; 32.2%) had participated in group sex in the previous 3 months. GBMSM who sought sex partners at sex on premises venues (SOPVs) [aOR 5.83; 95% confidence interval (CI): 3.23 to 10.53] had the highest odds of group sex participation after adjusting for other potential confounders. Compared with GBMSM not living with HIV and not taking PrEP, GBMSM taking PrEP had higher odds of group sex participation (aOR 2.09; 95% CI: 1.05 to 4.15) but GBMSM living with HIV did not (aOR 0.93; 95% CI: 0.23 to 3.68). Recent group sex participation was not associated with being diagnosed with any STI (chlamydia, syphilis, or gonorrhea) on the day in the adjusted analyses. Conclusion: PrEP users and MSM attending SOPVs are more likely to participate in group sex. SOPV could be important venues for future public health campaigns. [ABSTRACT FROM AUTHOR]

Background: There are limited data on the extent of use of online services that support partner notification for sexually transmitted infections. The online partner notification service Let Them Know was implemented in 2008 to support partner messaging for chlamydia in Australia. In 2010, the service was expanded to include gonorrhea, syphilis, Mycoplasma genitalium, and Trichomonas vaginalis. We aimed to determine usage of Let Them Know between 2011 and 2019.Methods: The number of text messages sent via Let Them Know for each infection between 2011 and 2019 was extracted by using Microsoft SQL Server Management Studio. Users who sent a text message were asked "Were you more likely to let a partner know because of this website?"Results: The number of text messages sent for each infection increased over the evaluation period with a total of 148,256 text messages sent from the service. Sixty-nine percent (103,026) of users indicated that they were more likely to let a partner know because of the website. The number of text messages increased between 2011 and 2019 from 4,666 to 17,889 (283%) for chlamydia, from 2101 to 6328 (201%) for gonorrhea, from 1895 to 4908 (159%) for syphilis, from 703 to 1953 (178%) for M. genitalium, and from 173 to 629 (264%) for trichomonas.Conclusions: This fully automated partner messaging service showed high and increasing use with data suggesting it helped most users contact partners. [ABSTRACT FROM AUTHOR]

Background: Men who have sex with men living with human immunodeficiency virus have a high risk of anal cancer. We estimate the likely benefit of human papillomavirus (HPV) vaccination among participants of the Anal Cancer Examination study.Methods: Anal swabs were collected for the detection and genotyping of anal HPV DNA by linear array (Roche Diagnostics) in this 2-year multicenter prospective cohort. We calculated the proportion of men, stratified by age, without detectable vaccine type-specific DNA.Results: Overall, 255 men, with a median age of 50 years (interquartile range, 44-56 years) contributed 488.9 person-years of follow-up. After 2 years of follow-up, 149 (58%; 95% confidence interval [CI], 52-65) had at least 1 high-risk HPV (HRHPV), and 71 (28%, 95% CI, 22-34) had HPV types 16/18 detected. Assuming that DNA-negative men would receive vaccine protection, vaccination at baseline could potentially prevent HRHPV infection in 10.2% of men (95% CI, 6.8-14.6, 26 of 255) 2 years later from incident HRHPV covered by the bivalent and quadrivalent vaccine, and 29.4% of men (95% CI, 23.9-35.4, 75/255) from incident HRHPV covered by the nonavalent vaccine.Conclusion: Though there is high prevalence of anal HPV in men who have sex with men living with human immunodeficiency virus, there was also a high incidence of HRHPV vaccine types in the 2-year follow-up, indicating potential for prevention if these men were not previously infected with HPV vaccine types and were vaccinated at their baseline visit. [ABSTRACT FROM AUTHOR]

Background: We report clinical characteristics of proctitis caused solely by Mycoplasma genitalium (MG) compared with chlamydia and gonococcus. We determined the proportions cured with first-line (azithromycin) and second-line antimicrobials (moxifloxacin, pristinamycin).Methods: A total of 166 patients attending Melbourne Sexual Health Centre from 2012 to 2016 with symptoms of proctitis were tested for MG, Chlamydia trachomatis, and Neisseria gonorrhoeae. Demographic characteristics, sexual behaviors, clinical symptoms, and signs were recorded. Multinomial multivariable logistic regression was used to test for significant differences in symptoms and signs for the pathogens detected.Results: Seventeen percent of men had MG (95% confidence interval, 12-24), 21% had chlamydia (15-27), and 40% had gonococcal monoinfection (32-48), whereas 22% had MG coinfection (16-29). Relative to men with MG monoinfection, those with chlamydial monoinfection reported more anal pain (adjusted prevalence odds ratio (aPOR), 4.68 [1.41-14.19]), whereas men with gonococcal monoinfection reported more anal pain (aPOR, 6.75 [2.21-20.55]) and tenesmus (aPOR, 15.44 [1.62-146.90]), but less anal itch (aPOR, 0.32 [0.11-0.93]). The microbiological cure for MG using azithromycin was low at 35% (22-50), whereas moxifloxacin subsequently cured 92% (64-100) and pristinamycin cured 79% (54-94) of infections.Conclusions: M. genitalium was almost as common as chlamydia in men presenting to a sexual health center with symptoms of proctitis. Men with anorectal MG monoinfection were less likely to have symptoms and signs compared with those with chlamydia or gonococcus monoinfection. Cure for men with symptomatic anorectal MG by azithromycin was low. We suggest routine testing for MG in cases of proctitis, with test of cure after treatment being essential. [ABSTRACT FROM AUTHOR]

Background: Receptive condomless anal sex is a known risk factor for anorectal chlamydia, but it remains unclear whether oroanal sex practices also contribute. We aimed to determine whether oroanal sex ("rimming"), fingering, or the use of saliva as anal lubricant are risk factors for anorectal chlamydia among men who have sex with men (MSM).Methods: This cross-sectional study was conducted at Melbourne Sexual Health Centre from July 2014 to June 2015. Routinely collected computer-assisted self-interview data included demographics, number of sexual partners, and condom use. We added questions on receptive rimming, receptive fingering or penis "dipping," and the use of a partner's saliva as anal lubricant.Results: A total of 1691 MSM completed the questionnaire and tested for anorectal chlamydia. In univariable analyses, anorectal chlamydia was associated with using a partner's saliva as lubricant (odds ratio [OR] 1.97, 95% confidence interval [CI] 1.26-3.09), receptive rimming (OR 1.59; 95% CI 1.04-2.45), and receptive fingering or dipping (OR 1.90; 95% CI 1.06-3.43). In multivariable analysis, anorectal chlamydia was not associated with these sexual practices, after adjusting for number of sexual partners, HIV status, known contact with chlamydia, and condom use. However, collinearity between sexual practices likely obscured associations with anorectal chlamydia, and further analyses suggested weak associations between these sexual practices and anorectal chlamydia.Conclusions: The use of a partner's saliva during receptive anal sex practices such as rimming, fingering, or penis dipping were weak risk factor for anorectal chlamydia in MSM. This contrasts with our previously reported findings that the use of saliva as anal lubricant is more strongly associated with anorectal gonorrhea. [ABSTRACT FROM AUTHOR]

Background: Female sex workers in Australia have achieved some of the lowest documented prevalences of human immunodeficiency virus (HIV) and other sexually transmissible infections globally but rates overall are increasing in Australia and warrant closer investigation.Methods: We constructed a retrospective cohort using repeat testing data extracted from a network of 42 sexual health clinics. Poisson and Cox regression were used to determined trends in incidence and risk factors for HIV, chlamydia, gonorrhoea, and infectious syphilis among female sex workers.Results: From 2009 to 2015, 18,475 women reporting sex work attended a participating service. The overall incidence of urogenital chlamydia was 7.7/100 person years (PY), declining by 38% from 2009 to 2013 before increasing by 43% to 2015 (P < 0.001); anorectal chlamydia incidence was 0.6/100 PY, and pharyngeal was 1.9/100 PY, which increased significantly during the study period (P < 0.001, both). For gonorrhoea, the urogenital incidence was 1.4/100 PY, anorectal incidence was 0.3/100 PY, P < 0.001), and 3.6/100 PY for pharyngeal; urogenital incidence doubled during the study period, anorectal increased fivefold, and pharyngeal more than tripled (P < 0.001, all). Incidence of infectious syphilis was 0.4/100 PY, which remained stable from 2009 to 2015 (P = 0.09). There were seven incident infections of HIV among female sex workers (0.1/100 PY). Inconsistent condom use with private partners, higher number of private partner numbers, recent injecting drug use, younger age, and country of birth variously predicted sexually transmissible infections among female sex workers.Conclusions: Although infectious syphilis and HIV remain uncommon in female sex workers attending Australian sexual health clinics, the increasing incidence of gonorrhoea across anatomical sites and increasing chlamydia after a period of decline demands enhanced health promotion initiatives. [ABSTRACT FROM AUTHOR]