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Summary: The aim of this study was to ascertain how sexual health physicians in Australia and New Zealand manage men with chlamydia-negative non-gonococcal urethritis (NGU), particularly in relation to the notification of their female sexual partners. In July 2006, a cross-section survey was sent out to all the members of the Australasian Chapter of Sexual Health Medicine. Seventy-three percent of sexual health physicians believed that female partners of men who present with chlamydia-negative NGU were at risk of adverse reproductive health outcomes. At least 62% usually initiated some form of partner notification of female partners of men with chlamydia-negative NGU. However, only 19% (21/111) of sexual health physicians routinely tested for, and only 65% sometimes tested for, pathogens other than Neisseria gonorrhoeae and Chlamydia trachomatis in men presenting with NGU. These included Mycoplasma genitalium, herpes simplex virus, ureaplasma species, Trichomonas vaginalis and adenoviruses.

The proportion of clinically important diagnoses in a low-risk, asymptomatic population who use a computer-assisted self-interview (CASI) to assess risk was needed to determine optimal health service delivery. Medical records were retrospectively analysed between July 2008 and June 2009 for risk characteristics and diagnoses. A total of 7733 new patients completed a CASI, of whom 1060 were asymptomatic heterosexuals. From this low-risk group, 26 diagnoses were made on the day of presentation, including 22 cases of genital warts (2.08% [95% confidence interval (CI) 1.22–2.93]), three cases of genital herpes (0.28% [95% CI 0.055–0.82]) and one case of unintended pregnancy (0.094% [95% CI 0.0061–0.52]). Additionally, there were 54 cases of chlamydia detected (5.09% [95% CI 3.77–6.42]). As chlamydia is effectively diagnosed and managed from self-collected samples, patient review is not always required. This study provides evidence for an express testing service for chlamydia to streamline the screening of low-risk, asymptomatic heterosexual patients as identified by CASI without the need to for a traditional face-to-face consultation.

The aim of this study was to determine the experience and views of female patients when they were offered a chaperone by a male sexual health practitioner for a genital examination. Between November 2007 and January 2008, an anonymous survey was administered to female patients seen by male practitioners at Melbourne Sexual Health Centre. None of the 79 (95% CI 0–5%) patients who were offered a chaperone and declined one reported that they were uncomfortable declining the offer. The qualitative analysis showed that some participants appreciated being offered the option of a chaperone even if they did not want one and that the professional attributes of the practitioner influenced their decision not to have a chaperone. Only 8% (95%CI 4–15%) felt uncomfortable when asked if they would like a chaperone. The results reassure that when a female patient declines the offer of a chaperone within a sexual health clinic, the male practitioner can feel confident that this is the expression of the patient's wish.

Background One effective way of reducing the prevalence of sexually transmissible infections (STIs) in a population is ensuring easy access to clinical services and screening of populations at high risk of STIs, including HIV. We aimed to describe the features of clients using the express testing service (ETS) and the overall impact on the service. Methods: This retrospective cross-sectional study involved all clients attending the walk-in triage service at Melbourne Sexual Health Centre before the introduction of ETS in 2009 and after ETS (2011 and 2012). Results: There were 32 720 and 82 265 consultations before and after ETS respectively. The ETS saw 4387 (9%) of 55 648 consultations (excluding appointments and results), giving rise to a fall in the proportion of lower-risk clients having full consultations (from 53% to 50% of consultations; P

Objective Despite substantial investment in Electronic Medical Record (EMR) systems there has been little research to evaluate them. Our aim was to evaluate changes in efficiency and quality of services after the introduction of a purpose built EMR system, and to assess its acceptability by the doctors, nurses and patients using it. Methods We compared a nine month period before and after the introduction of an EMR system in a large sexual health service, audited a sample of records in both periods and undertook anonymous surveys of both staff and patients. Results There were 9,752 doctor consultations (in 5,512 consulting hours) in the Paper Medical Record (PMR) period and 9,145 doctor consultations (in 5,176 consulting hours in the EMR period eligible for inclusion in the analysis. There were 5% more consultations per hour seen by doctors in the EMR period compared to the PMR period (rate ratio = 1.05; 95% confidence interval, 1.02, 1.08) after adjusting for type of consultation. The qualitative evaluation of 300 records for each period showed no difference in quality (P>0.17). A survey of clinicians demonstrated that doctors and nurses preferred the EMR system (P

Background The study objective was to investigate the effect of the introduction of a sexual health practice nurse on HIV and STI testing in a general practice that specialized in gay men’s health. Methods This observational study compared the proportion of gay and other men who have sex with men (MSM) tested for HIV, syphilis, chlamydia (urethral and anal) and gonorrhoea (anal), or all of the above (defined as a complete set of tests at a single visit), two years before and one year after the nurse was introduced (Clinic A). Clinic B, a general practice which also specialized in gay men’s health, but with no sexual health nurse, was used as a control. Results In Clinic A, amongst HIV negative MSM the proportion of men who had a complete set of HIV and STI tests increased from 41% to 47% (p

Background Given the high rate of sexually transmissible infections among young people and limited rural access to specialist healthcare, an Australian telemedicine service was piloted. Clients’ views were investigated. Methods: All clients aged 15–24 were given a questionnaire. A sub-sample was interviewed. Results: The service was used by 25 rural youths aged 15–24; 18 returned the questionnaire, 4 were interviewed. All had a telephone consultation. They reported being satisfied with the service; most preferred the telemedicine service to consulting a doctor in person. Conclusions: Online video consultations for sexual health may not yet be accep to young people in Australia.

Background Computer assisted self interviewing (CASI) has been used at the Melbourne Sexual Health Centre (MSHC) since 2008 for obtaining sexual history and identifying patients' risk factors for sexually transmitted infections (STIs). We aimed to evaluate the impact of CASI operating at MSHC. Methodology/Principal Findings The proportion of patients who decline to answer questions using CASI was determined. We then compared consultation times and STI-testing rates during comparable CASI and non-CASI operating periods. Patients and staff completed anonymous questionnaires about their experience with CASI. 14,190 patients completed CASI during the audit period. Men were more likely than women to decline questions about the number of partners they had of the opposite sex (4.4% v 3.6%, p = 0.05) and same sex (8.9% v 0%, p

Introduction Previous studies have examined sex workers' attitudes to work but not their levels of job satisfaction compared with other occupations. Aim The job satisfaction levels and standards of living of sex workers in licensed brothels in Victoria were compared with Australian women. Main Outcome Measures Responses to a questionnaire that included questions about sex work and their “most likely alternative job.” Survey data was compared with identical questions from the Households, Income and Labour Dynamics in Australia Survey. Methods A structured survey was undertaken with sex workers in Victoria attending a a sexual health service. Results Of the 112 sex workers who agreed to participate in the study, 85 (76%) completed the survey. The median years women had been working as sex workers was three (range 0.1–18). The main reasons women started sex work was because “they needed the money” (69%), were attracted to the flexible hours (44%) or had a particular goal in mind (43%). The two biggest concerns women had about sex work were their safety (65%) and the risk of sexually transmitted infections (65%). When compared with the median job satisfaction scores of Australian women working in sex workers' “most likely alternative jobs,” 50% of sex workers reported a higher median satisfaction score for sex work in relation to hours worked, 47% in relation to flexibility, 43% in relation to total pay, 26% in relation to job security, 19% in relation to the work itself, and 25% in relation to overall job satisfaction. Conclusions Women reported that they primarily do sex work for financial gain although a significant minority prefer it to other work they would be likely to do. These results should be interpreted in the context that the presence of personality disorders that are common among sex workers were not measured in this study. Bilardi JE, Miller A, Hocking JS, Keogh L, Cummings R, Chen MY, Bradshaw CS, and Fairley CK. The job satisfaction of female sex workers working in licensed brothels in Victoria, Australia.

This study examined the views of 172 community-based Australian men who have sex with men (MSM) on the acceptability and potential uptake of rapid oral testing for HIV in clinic and home-based settings. Men were asked to complete a questionnaire that sought their views on rapid testing for HIV. When asked about which HIV test they would prefer in a clinic setting, 64% indicated a preference for rapid oral HIV testing and 74% indicated that if rapid oral HIV testing was available at a clinic they would test for HIV more frequently. If rapid oral HIV testing was available for home testing, 63% of men indicated it would be likely they would test themselves for HIV and 61% indicated they would test more frequently. Overall, MSM expressed a preference for rapid oral HIV testing and would test more frequently if testing was available for clinic or home use in Australia.

Background: Our aim was to describe the use of and responses to a self-management website, ‘Health Map’, established to address the key chronic health issues of HIV-positive people. Methods: Health Map assessed health issues against current recommendations for: treatment adherence, monitoring CD4 counts and viral load, psychological health and physical activity, vaccination, cholesterol, fasting blood sugar, blood pressure, alcohol consumption, smoking, body mass index, and cervical screening for women and sexually transmissible infection (STI) screening for men who have sex with men (MSM). Results: A total of 552 people, with a mean age of 37 years, completed the full ‘Health Map’ program, of whom 536 (97%) were Australian, 425 (77%) were male, including 268 (63%) MSM. Online responses to several health indices were of concern: 49% missed at least one dose of antiretroviral therapy per month and only 41% had had an HIV viral load test in the 4 months prior. Only 43% reported regular physical activity, and 49% and 61% reported vaccination for hepatitis A and B. The proportion tested within the recommended periods for fasting cholesterol (40%), fasting blood sugar (35%) and cervical screening (43%) in women or STI screening for MSM (53%) were low. Conclusions: A substantial proportion of individuals completing the online survey reported information that would suggest their HIV and more general health care is suboptimal. These data are consistent with community surveys and indicate the need for improvement in the chronic management of HIV.

We therefore reviewed the medical records of clients attending MSHC who had tested HIV-negative and who subsequently tested HIV-positive at MSHC within 1 year of their last negative test. We reviewed all new HIV-positive cases over a 3-year period from 1January 2004. We extracted epidemiological data and clinical notes relating to risk, interventions and discussions held during consultations. Quantitative data was analysed using SPSS software (SPSS Inc, Chicago, IL, USA). Annotated records were examined and transcribed by two researchers (SP, RC), independently. A process of qualitative thematic analysis then occurred in order to generate common themes. All 20 clients who fulfilled the inclusion criteria were men who have sex with men (MSM) and had a mean age of 32 years. At their last HIV-negative consultation before testing HIVpositive, 16 reported inconsistent condom use for anal sex among 23median male partners (range 1 to 200) over the previous 12 months. Over half (13) clients had at least one documented sexually transmissible infection (chlamydia/ gonococcal/herpes simplex virus) diagnosed at the Centre in the year before HIV positive diagnosis. In the medical records of the HIV-negative consultations, qualitative themes generated relating to their risk of acquiring HIV included drug and alcohol use (n=1), depression (n=6), serodiscordant relationships (n=6) and history of sexual abuse (n=2). Post HIV diagnosis, the medical records indicated the same themes at higher rates and, in particular, drug and alcohol use during high-risk events (n=9). Depression was slightly higher (n=7), as was a history of sexual abuse (n=3). Despite reporting considerable levels of risk for HIV transmission at the last HIV-negative consultation, only seven records documented an offer of counselling and in only five of these cases were the clients referred for counselling or other services to assess risk. Two records indicated that referral to these services had been declined. We found that while these clients often reported unsafe sex, the full context of the sexual encounter was often not documented in the medical record at the time of the negative test but was documented later. Of particular note only one client had drug or alcohol use documented initially, but after the HIV diagnosis, nine had this documented. While we acknowledge medical records may not fully reflect the extent of discussions held during a consultation, these findings indicate that documentation needs to be improved in medical records and also that a more proactive process of referral for counselling should be implemented in the Centre. We are, therefore, implementing a quality improvement process to ensure enhanced documentation of contributing factors that predispose to unsafe sex and for the offer of referral to counselling services and the outcome of that offer. The recommendation is that HIV-negative MSM are asked questions relating to the context of high-risk events and that the offer of appropriate services be made if these co-contributors are acknowledged during sexual history taking. Wepropose that seroconversion to HIV among clients seen at a sexual health service could be used as an important quality marker that should be regularly audited. Given the current rises in HIV seen in Australia, fine-tuning services for MSM is one way of reducing future HIV cases. 1

Background: The present study aimed to determine the sexual risk profile of people using an automated, internet-based service that allows internet users to receive recommendations on sexually transmissible infection screening (‘Check your risk’ (CYR), http://www.checkyourrisk.org.au/), and to compare this with that of patients attending the Melbourne Sexual Health Centre (MSHC) for the first time over the same 6-month period: January–June 2006. Methods: The characteristics of those who used CYR and those who attended MSHC were compared using a χ2-test for categorical variables and the Mann–Whitney U-test for non-parametric data. Results: There were 2492 users who accessed CYR and 2735 who attended MSHC over the period. The age of CYR users was similar to that of MSHC patients when compared according to risk groups. The median number of recent sexual partners reported by CYR users was similar to and not significantly lower than that reported by MSHC patients. Of the 309 CYR users who provided a rating for the CYR site, 215 (70%) rated it as being ‘useful’ to ‘very useful’. Conclusions: Individuals who accessed an automated, internet-based sexual risk assessment service were at substantial risk for sexually transmitted infections, similar to those attending a sexual health service.

Most Australian men who have sex with men who underwent rapid testing for syphilis using the Determine Syphilis TP immunoassay indicated a preference for rapid testing over conventional serology. Most also indicated that they would test for syphilis more frequently if rapid syphilis testing was available in a clinic setting.

Access to sexual health services, by those at highest risk of sexually transmitted infections (STI) is critical to effective STI control. Access to services is determined by the systems that clinics use to prioritize clients. However, despite there being thousands of sexual health services world wide, only three published studies in the last 25 years have specifically assessed changes in the process of access to STI clinics in which a control period was used. These studies indicate that appointments booked in advance provide the least access for higher risk clients, whereas both triage systems and systems with a significant proportion of same day appointments improve access. It is likely, however, that many services have changed their practices and evaluation of these changes could provide valuable data to improve the efficiency and hence improve STI control.

Background ‘TESTme’ is a sexually transmissible infection (STI) screening service for Victorian young people living in rural areas. We evaluated the effectiveness of advertising for this service over an 11-month pilot period. Methods: The advertising that was used included websites, a Facebook page, posters, flyers, business cards, wrist bands and professional development sessions for health nurses that occurred throughout the pilot period. We also used once-off methods including advertisements in newspapers, student diaries and short messages to mobile phones. Results: Twenty-eight clients had a consultation through TESTme. Twenty found the service through health professionals, six through the Melbourne Sexual Health Centre (MSHC) web page, one through the Facebook page and one through the student diary. The total direct costs incurred by the centre for advertising were $20 850. The advertising cost per client reached for each advertising method was $26 for health professionals, $80 for the MSHC web advertisement, $1408 for Facebook and $790 for the student diary. Other advertising methods cost $12 248 and did not attract any clients. Conclusion: Advertising STI health services for rural young people would be best to focus on referrals from other health services or health care websites.

Objective: It may be difficult for young people to know if they need testing for sexually transmitted infections and some primary care physicians may be unsure about what tests to order for patients with different risk profiles. Our aim was to help overcome these barriers by implementing an automated, internet based service that allowed internet users to receive specific recommendations for STI screening based on their online responses to a series of questions relating to their recent sexual practices ('Check Your Risk' (CYR), available at: www.mshc.org.au). This study evaluated this service and compared the risk profile of individuals using CYR with that of patients attending a sexual health centre in the same city over the same time period. Methods: An automated and individualised web based algorithm was developed using current recommendations for STI testing. The characteristics of individuals visiting CYR were compared to those attending the Melbourne Sexual Health Centre (MSHC) for the first time over the same 6 month period, from January to June 2006. Results: There were 2492 (59% men, 41% women) who visited the CYR online service and 2735 (59% men, 41% women) who attended the MSHC over the period. 513 (22%) of the men visiting CYR and 467 (18%) of the men visiting MSHC reported sex with other men, with a median of 6 (SD 26.4) and 6 (SD 29.4) partners in the previous 12 months respectively (p�=�0.9). 43 (1.8%) of the women visiting CYR and 54 (2.1%) of the women visiting MSHC reported sex with other women, with a median of 1 (SD 9.3) and 1 (SD 2.1) partners in the previous 12 months respectively (p�=�0.5). Among men reporting sex with women only, the median number of female sex partners in the preceding 12 months was 2 (SD 10.6) and 3 (SD 5.8) for those visiting CYR and MSHC respectively (p�=�0.8). For women reporting sex with men only, the median number of male partners was 2 (SD 11.1) and 2 (SD 4) for those visiting CYR and MSHC respectively (p�=�0.03). Participants responded favourably to the CYR online service, with 70% rating it as 'useful'; or 'very useful'. Conclusions: This internet based sexual risk assessment tool was accessed frequently by individuals with a high risk profile that was similar to those who attended the sexual health service in the same city. The CYR service cost A$4000 to set up. CYR effectively increased the outreach of the centre's services substantially, via the internet and was given a positive rating by the majority of its users.

Objective: In clinical practice, chlamydia-negative non-gonococcal urethritis (NGU) is a common but poorly understood condition. The purpose of this study was to determine how Australian sexual health physicians manage men with this condition. Methods: In July 2006, a survey was mailed to all members of the Australasian Chapter of Sexual Health Medicine. Results: Of 166 surveys mailed out, 111 (67%) were returned completed. The majority of sexual health physicians (73%, n�=�81) indicated that they believed that female partners of men with acute chlamydia-negative NGU were at risk of adverse reproductive health outcomes. However, only 19% (n�=�21) routinely tested men with acute NGU for pathogens other than Neisseria gonorrhoeae and Chlamydia trachomatis. Most commonly, this was for M. genitalium (n�=�16). While 68% of respondents believed that M. genitalium was a cause of acute NGU, only 27% had access to testing for this organism. Other pathogens that were sometimes tested for included herpes simplex virus, Trichomonas vaginalis and adenovirus. Over half of sexual health physicians indicated that they would usually initiate notification of female sexual partners of men presenting with acute NGU, even before confirmatory test results were available. Conclusion: There are substantial differences in how acute, chlamydia-negative NGU is managed by Australian sexual health physicians. In part, these may relate to differences in beliefs around which pathogens are responsible for this condition and the availability of testing for particular pathogens. Notification of female partners is commonplace, even though the underlying cause of urethritis in affected men appears to be poorly defined.