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Evidence of autoimmune disease associated with hepatitis C virus (HCV)-infection has important clinical implications. A systematic profile of these autoantibodies in relevant clinical cohorts relative to healthy controls is needed to better inform current standard of care for chronic hepatitis C. Samples from an Australian cohort of chronic HCV-infected subjects (n=127) were tested for the presence of 19 diagnostic autoantibodies and compared with data available from a control cohort representing a general Caucasian population (n=198). Chronic HCV-infected individuals had a greater number of autoantibodies than controls (p

Background: Community reintegration from prison is typically stressful, with several health and social outcomes impacting psychiatric well-being during this time, often exacerbated among individuals with histories of drug use. Longitudinal data was used to assess change in psychiatric well-being over 2 years following release from prison among men who reported a recent history of injecting drug use. Methods: Data for this study come from the Prison and Transition Health cohort study of 400 men recruited in prison prior to release and followed up over three time points. Psychiatric well-being was assessed using the 12-item General Health Questionnaire. We calculated change in individual General Health Questionnaire scores between interviews and identified covariates associated with General Health Questionnaire score using linear mixed-effects regression. Results: Data from 690 follow-up interviews among 326 participants were included in analyses. There was considerable variation in individuals’ General Health Questionnaire scores. Moving accommodation frequently and frequent illicit drug injections were associated with an increase in General Health Questionnaire score (i.e. decline in psychiatric well-being). Two or more prior adult imprisonment episodes, social supports and past month primary healthcare attendance were associated with a decrease in General Health Questionnaire score. Conclusion: Our findings identify health, social and structural influences on psychiatric well-being after release from prison that can inform re-entry programmes to support community reintegration.

Background People who inject drugs are overrepresented in prison and have diverse and complex health needs. However, outcomes after release from prison are poorly understood, limiting effective interventions supporting community reintegration. We describe the prevalence of socio-demographics, physical and mental health, alcohol and other drug use, and crime characteristics of men with histories of injecting drug use after their release from prison in Victoria, Australia. Methods Data come from the Prison and Transition Health (PATH) prospective cohort study. Interviews were undertaken approximately three, 12, and 24 months after release from their index prison episode and were completed in the community, or in prison for those reimprisoned during the study. We present cross-sectional descriptive statistics for each follow-up wave of the PATH study. Results Among 400 men recruited into PATH, 85 % (n = 336) completed at least one follow-up interview; 162 (42 %) completed all three interviews. Participants reported social disadvantage and health inequity, including high rates of unemployment, homelessness, and physical and mental health morbidities at each follow-up time point. Rapid return to illicit substance use was common, as was overdose (ranging 9 %–13 %), receptive syringe sharing (ranging 20 %–29 %), involvement in crime-related activities (ranging 49 %–58 %), and reimprisonment (ranging 22 %–50 %) over the duration of follow-up. Conclusion Men in this study experienced substantial health and social challenges across a 24-month prospective follow-up period. Improved understanding of characteristics and experiences of this group after release from prison can inform more coordinated and continued care between prison and the community.

Background Although HIV self-tests can support frequent HIV testing, their impact on attending clinics for other sexually transmissible infection (STI) testing and sexual health care is largely unknown. We explored intentions to use HIV self-tests and how this might affect patterns of attending sexual health services among gay, bisexual, and other men who have sex with men (GBM) in Victoria, Australia. Methods Gay, bisexual, and other men who have sex with men self-completed an online survey between March 10 and June 10, 2019. Among GBM reporting lifetime HIV testing and intentions to self-test at least once annually, we used logistic regression to identify correlates of intending to replace clinic-based HIV testing with self-tests. Qualitative interviews with purposively selected survey participants undertaken between May and June 2019 explored the implications of self-testing on clinic-based sexual health care. Results Of the 279 survey participants, 79 (29%) reported they would replace most or all clinic-based HIV tests with self-tests, with longer time since last testing for HIV and younger age associated with reporting this outcome in the multivariate analysis. Qualitative interviews revealed different perceived roles for self-tests and clinic-based testing, and the importance of integrating HIV self-tests within broader sexual health routines. Conclusions Although GBM see a distinct role for HIV self-testing, its rollout will likely result in missed opportunities for clinic-based STI testing and education for some GBM, particularly among younger and less-recently tested GBM. Convenient, non-clinic-based approaches to STI testing are needed alongside support platforms to maximize the benefits of HIV self-testing within comprehensive sexual health routines.

Background Reliably measuring drug use by gay, bisexual and other men who have sex with men (GBM) in the context of sex can inform sexual health service responses. We report changing drug use patterns among GBM testing for HIV at a community-based service in Melbourne in response to behavioural survey modifications. Methods Surveys were completed by GBM prior to all HIV tests. Survey one asked about use of "party drugs for the purpose of sex" and survey two asked about specific drug use (alcohol, amyl nitrate, methamphetamine, cocaine, ecstasy, GHB, Viagra ® /Cialis ® ) before or during sex. Differences in drug use prevalence and demographic and sexual risk correlates are reported. Results Reported drug use increased from 16.9% in survey one to 54.0% in survey two. Among GBM completing both surveys, 45% who reported no drug use in survey one reported drug use in survey two. Drug use was associated with high HIV risk behaviours across both surveys. Conclusion Survey modification improved ascertainment of drug use in the context of sex among GBM. Continued monitoring of drug use in this setting will improve our understanding the relationship between use of specific drugs and sexual health and help inform client focused health promotion.

Background The 2012 regulatory approval of HIV rapid point of care (RPOC) tests in Australia and a national strategic focus on HIV testing provided a catalyst for implementation of non-clinical HIV testing service models. PRONTO! opened in 2013 as a two-year trial delivering peer-led community-based HIV RPOC tests targeting gay, bisexual and other men who have sex with men (GBM), with the aim of increasing HIV testing frequency. Initial data suggested this aim was not achieved and, as part of a broader service evaluation, we sought to explore client acceptability and barriers to testing at PRONTO! to refine the service model. Methods We present descriptive and thematic analyses of data from two in-depth evaluation surveys and four focus groups with PRONTO! clients focused on service acceptability, client testing history, intentions to test and barriers to testing for HIV and other sexually transmitted infections (STIs). Results The three novel aspects of the PRONTO! model, testing environment, rapid-testing, peer-staff, were reported to be highly acceptable among survey and focus group participants. Focus group discussions revealed that the PRONTO! model reduced anxiety associated with HIV testing and created a comfortable environment conducive to discussing sexual risk and health. However, an absence of STI testing at PRONTO!, driven by restrictions on medical subsidies for STI testing and limited funds available at the service level created a barrier to HIV testing. An overwhelming majority of PRONTO! clients reported usually testing for STIs alongside HIV and most reported plans to seek STI testing after testing for HIV at PRONTO!. When deciding where, when and what to test for, clients reported balancing convenience and relative risk and consequences for each infection as guiding their decision-making. Conclusions A community-based and peer-led HIV testing model reduced previously reported barriers to HIV testing, while introducing new barriers. The absence of STI testing at PRONTO! and the need to access multiple services for comprehensive sexual health screening, created a significant service engagement barrier for some clients. Understanding client motivations to access testing and ensuring novel service models meet client needs is crucial for developing acceptable sexual health services for high-risk populations.

Frequent HIV testing among gay, bisexual and other men who have sex with men (GBM) is a strategic priority for HIV prevention in Australia. To overcome barriers to testing in conventional clinical services, Australia recently introduced peer HIV rapid point of care (RPOC) testing services for GBM. This mixed methods evaluation describes client acceptability and HIV prevention benefits of a peer HIV testing model. Most aspects of the service model were overwhelmingly acceptable to clients. Two-thirds of survey participants reported preferring testing with peers rather than doctors or nurses and over half reported learning something new about reducing HIV risk. Focus group findings suggested peer-delivered HIV RPOC testing reduced stigma-related barriers to frequent testing and provided novel opportunities for GBM to openly discuss HIV prevention and sexual practices, enhancing their HIV risk-reduction knowledge. Analysis of survey data suggested knowledge transfer occurred particularly among younger and less gay community-attached GBM.

New combination human acquired deficiency (HIV) prevention strategies that include biomedical and primary prevention approaches add complexity to the task of measuring sexual risk. Latent transition models are beneficial for understanding complex phenomena; therefore, we trialed the application of latent class and latent transition models to HIV surveillance data. Our aims were to identify sexual risk states and model individuals' transitions between states. A total of 4,685 HIV-negative men who have sex with men (MSM) completed behavioral questionnaires alongside tests for HIV and sexually transmissible infections at one of 2 Melbourne, Victoria, Australia, general practices (2007-2013). We found 4 distinct classes of sexual risk, which we labeled "monogamous" (n = 1,224), "risk minimizer" (n = 1,443), "risk potential" (n = 1,335), and "risk taker" (n = 683). A positive syphilis, gonorrhea, or chlamydia test was significantly associated with class membership. Among a subset of 516 MSM who had at least 3 clinic visits, there was general stability across risk classes; MSM had on average a 0.70 (i.e., 70%) probability of remaining in the same class between visits 1 and 2 and between visits 2 and 3. Monogamous MSM were one exception; the probability of remaining in the monogamous class was 0.51 between visits 1 and 2. Latent transition analyses identified unobserved risk patterns in surveillance data, characterized high-risk MSM, and quantified transitions over time.

Introduction Achieving the virtual elimination of HIV requires equitable access to HIV prevention tools for all priority populations. Restricted access to healthcare means migrants face particular barriers to HIV prevention services. In February 2016, a peer‐led rapid HIV testing service for gay, bisexual and other men who have sex with men (gay and bisexual men, GBM) in Melbourne, Australia, introduced free sexually transmissible infection (STI) testing funded through Medicare (Australia's universal healthcare system). Medicare ineligible migrant clients were required to pay up to $158AUD for STI tests. We determined the uptake of STI testing and assessed the impact on repeat HIV testing among Medicare eligible and ineligible clients. Methods All HIV tests conducted between August 2014 and March 2018 were included. We describe client characteristics, STI testing uptake and HIV/STI positivity among Medicare eligible and ineligible clients. Repeat HIV testing, assessed as the percentage of HIV tests with a return test within six months, was compared pre‐integration (August 2014‐June 2016) and post‐integration(July 2016‐March 2018) of STI testing using segmented linear regression of monthly aggregate data for Medicare eligible and ineligible clients. Results Analyses included 9134 HIV tests among 4753 individuals. Medicare ineligible clients were younger (p

Objective: PRONTO!, a peer‐led rapid HIV‐testing service in Melbourne, Australia, opened to improve HIV testing among gay and bisexual men (GBM). We compared client characteristics and return testing among GBM testing at PRONTO! with GBM testing at Melbourne Sexual Health Centre (MSHC). Methods: All GBM attending PRONTO! and MSHC for HIV testing between August 2013 and April 2016 were included. We describe the number of tests, percentage of clients who returned during follow‐up, the mean number of tests and median time between tests at the two services. Results: At PRONTO!, 33% of 3,102 GBM and at MSHC 50% of 9,836 GBM returned for a further HIV test at least once. The mean number of tests per client was 1.7 and 2.5 at PRONTO! and MSHC (p

HIV-negative and untested gay and bisexual men from Victoria, Australia (n = 771) were surveyed during August–September 2016 about their comfort having condomless sex with casual male partners in scenarios in which pre-exposure prophylaxis (PrEP) or treatment as prevention were used. Men not using PrEP were most comfortable with the idea of condomless sex with HIV-negative partners (31%), followed by partners using PrEP (23%). PrEP users were more comfortable with the idea of condomless sex with these partner types (64 and 72%, respectively). Very few men not taking PrEP were comfortable with condomless sex with HIV-positive partners (3%), even with undetectable viral loads (6%). PrEP users were more comfortable with condomless sex with HIV-positive partners (29%), and those with undetectable viral loads (48%). Being on PrEP, having recent condomless sex with casual partners or a HIV-positive regular partner were independently associated with comfort having condomless sex.

Background Chlamydia (Chlamydia trachomatis) continues to be a public health challenge in Australia, with some contention as to the best screening approach. In the present study we examined chlamydia testing, positivity and sexual behaviour among women with the aim of informing targeted testing among women aged ≥30 years. Methods: A longitudinal analysis was conducted on retrospective surveillance data collected among women attending general practice, family planning and sexual health clinics participating in sentinel surveillance in Melbourne, Australia. Women were aged ≥16 years and underwent urogenital testing for C. trachomatis (chlamydia) at participating clinics between 2007 and 2014. Chlamydia incidence was calculated as positive chlamydia tests over person-years (PY) among women and reported by 5-year age groups. A Cox regression model examined correlates of a positive chlamydia test among women aged ≥30 years. Results: In all, 36 770 women contributed 46 432 PY and 52 395 chlamydia tests, of which 2895 were positive. The overall chlamydia incidence rate was 6.2 per 100 PY (95% confidence interval (CI) 6.0–6.5). Chlamydia incidence declined with age, plateauing to

Background In response to increasing HIV and other sexually transmissible infection (HIV/STI) notifications in Australia, a social marketing campaign Drama Downunder (DDU) was launched in 2008 to promote HIV/STI testing among men who have sex with men (MSM). We analyzed prospective data from (1) an online cohort of MSM and (2) clinic-level HIV/STI testing to evaluate the impact of DDU on HIV, syphilis, gonorrhea, and chlamydia testing. Materials and methods (1) Cohort participants who completed 3 surveys (2010-2014) contributed to a Poisson regression model examining predictors of recent HIV testing.(2) HIV, syphilis, gonorrhea, and chlamydia tests among MSM attending high caseload primary care clinics (2007-2013) were included in an interrupted time series analysis. Results (1) Although campaign awareness was high among 242 MSM completing 726 prospective surveys, campaign recall was not associated with self-reported HIV testing. Reporting previous regular HIV testing (adjusted incidence rate ratio, 2.4; 95% confidence interval, 1.3-4.4) and more than 10 partners in the previous 6 months (adjusted incidence rate ratio, 1.2; 95% confidence interval, 1.1-1.4) was associated with recent HIV testing. (2) Analysis of 257,023 tests showed increasing monthly HIV, syphilis, gonorrhea, and chlamydia tests pre-DDU. Post-DDU, gonorrhea test rates increased significantly among HIV-negative MSM, with modest and nonsignificant increasing rates of HIV, syphilis, and chlamydia testing. Among HIV-positive MSM, no change in gonorrhea or chlamydia testing occurred and syphilis testing declined significantly. Conclusions Increasing HIV/STI testing trends among MSM occurred pre- and post-DDU, coinciding with other plausible drivers of testing. Modest changes in HIV testing post-DDU suggest that structural changes to improve testing access may need to occur alongside health promotion to increase testing frequency.

Background International non-occupational post-exposure prophylaxis (NPEP) guidelines recommend routine use of three drug NPEP regimens, despite absence of evidence for greater prevention efficacy compared with two drug regimens. This study examines the potential for excess HIV seroconversions among high-risk men who have sex with men (MSM) reporting receptive anal intercourse with a source of unknown HIV serostatus (RAIU) following a two-drug versus a three-drug NPEP regimen. Methods: Data for MSM in the Victorian NPEP service database between 10 August 2005 and 31 December 2012 were linked with all Victorian HIV notifications up to 31 December 2013. The primary outcome was NPEP failure following NPEP presentation among MSM reporting RAIU, stratified by the number of drugs prescribed. Results: Among 1482 MSM reporting 2002 episodes of RAIU and prescribed two- or three-drug NPEP, 70 seroconverted to HIV, but only 19 were considered possible NPEP failures. HIV diagnosis incidence among men reporting RAIU was 1.2/100 person years (PY) (95%CI = 1.0–1.6); 1.1/100 PY (95%CI = 0.8–1.4) among MSM prescribed two drugs and 2.2/100 PY (95%CI = 1.4–3.7) among MSM prescribed three drugs (P

Objectives To examine whether rectal gonorrhoea (RG; Neisseria gonorrhoeae) can be used as a lead indicator of trends in HIV diagnosis in men who have sex with men (MSM). Methods: Data from a metropolitan sexual health centre in Victoria, Australia, on RG and HIV tests in HIV-negative MSM from January 2006 to December 2011 were examined. Results: Allowing RG a 12-month lead over HIV showed no concordance in proportion positive (r = 0.27; P-value = 0.28). Conclusions: The data do not support use of RG trends as a lead indicator of trends in HIV among MSM.

Background Chlamydia is the most commonly notified sexually transmitted infection (STI) in Australia. Incidence studies of chlamydia in men who have sex with men (MSM) are rare and offer important public health information. Objective To determine chlamydia incidence in MSM presenting at high caseload clinics and describe predictors of infection. Methods The Victorian Primary Care Network for Sentinel Surveillance of bloodborne viruses and STIs (VPCNSS) links testing, demographic and behavioural data from individual testers at participating clinics. Data from MSM with more than one chlamydia test at the VPCNSS site between April 2006 and June 2010 were included. Chlamydia incidence per 100 person-years (PY) was calculated and Cox regression used to examine predictors of incidence. Results 1206 positive tests for chlamydia were detected among 6333 MSM across 11 409 PY of follow-up. Overall chlamydia incidence was 10.6/100 PY (95% CI 10.0 to 11.2) and was highest among MSM aged 16–29 years (12.9/100 PY, 95% CI 11.7 to 14.1), presenting with STI symptoms (16.0/100 PY, 95% CI 14.2 to 18.0), HIV positive (18.5/100 PY, 95% CI 16.6 to 20.6) and self-identified sex workers (14.3/100 PY, 95% CI 10.0 to 20.6). Significant predictors of chlamydia infection among MSM were younger age (adjusted hazard ratio (aHR)=1.9, 95% CI 1.5 to 2.3), self-identifying as a sex worker (aHR=1.6, 95% CI 1.0 to 2.6), being HIV positive (aHR=2.6, 95% CI 1.8 to 3.8), presenting with STI symptoms (aHR=1.7, 95% CI 1.4 to 2.1) and reporting >10 sex partners in the past 6 months (aHR=2.5 95% CI 1.4 to 4.6). Conclusion These results show that MSM represent a key risk population for chlamydia in Australia and identify a number of high-risk MSM subpopulations for whom clinical and public health interventions are warranted.

Background: HIV rapid point-of-care (RPOC) testing was approved in Australia in 2012 prompting new testing models. We describe gay, bisexual and other men who have sex with men (GBM) testing in the first year of operations at Australia’s first shop-front, community-based RPOC testing service, PRONTO!, and characterise return testers and first-time testers. Methods: Univariable and multivariable logistic regression using data collected at clients’ first test at PRONTO! from 15 August 2013 to 14 August 2014 examined correlates of: 1) return-testing within 6 months of GBMs first test at PRONTO!; and 2) reporting a first ever HIV test at PRONTO!. Results: In the first year, 1226 GBM tested at PRONTO! (median age = 30.4 years, 60.2% Australian born). Condomless anal sex with casual or regular partners was reported by 45% and 66% of GBM, respectively. Almost one-quarter (23%) of GBM returned within 6 months of their first test. Return-testing was associated with being born overseas (adjusted odds ratio (AOR) = 1.48, 95% confidence interval (CI) = 1.10–2.0), reporting a regular check-up as reason to test (AOR = 1.53, 95% CI = 1.01–2.30) and reporting a HIV test in the 6 months before first testing at PRONTO! (AOR = 1.73, 95% CI = 1.09–2.73). Reporting first testing at PRONTO! (17.9%) was positively associated with younger age (

Introduction Treatment as prevention (TAP) has become a key part of HIV control strategies in Australia. Ending HIV was launched in September 2013 as a combination prevention campaign with three messages: HIV testing, HIV treatment, and condom-reinforcement. The Burnet Institute has maintained a HIV prevention evaluation online cohort of men who have sex with men. We compare pre- and post-campaign evaluation surveys to assess Ending HIV campaign awareness and changes in campaign-related attitudes and beliefs. Methods Participants were surveyed in August 2013 (S1, pre- Ending HIV implementation) and July 2014 (S2, post- Ending HIV implementation). Campaign recall and message recognition were assessed at S2, alongside S1 to S2 changes in attitudes and beliefs regarding a range of prevention topics, including TaP. Results There were 353 respondents at S1 and 328 at S2; 193 completed both surveys. 158 respondents (48%) were aware of Ending HIV at S2, of who 87 (55%) correctly recalled at least one campaign message. Most commonly recalled messages referenced HIV testing (58%), followed by HIV treatment (37%) and condom-reinforcement (29%). Significant increases were seen in the proportion of HIV-negative men reporting positive changes in attitudes/beliefs in 7 out of 9 statements about TaP (p < 0.05). Proportional increases ranged from 5.0–17.0%, and highest for agreeing that PrEP is effective for HIV prevention (17%) and disagreeing that people should delay treatment until absolutely necessary (12%). Changes in attitudes and beliefs did not differ significantly by campaign awareness at S2. Conclusion While awareness of Ending HIV is encouraging, comprehension of different combination prevention messages was inconsistent and modest for some messages. Predominant shifts in beliefs about TAP are likely to be driven by influences beyond campaign exposure. Future implementation of Ending HIV and associated prevention campaigns should ensure sufficient emphasis on primary prevention and early treatment messages as a part of combination prevention. Disclosure of interest statement All authors have no conflicts to declare. The Victorian Department of Health funds the implementation of the Ending HIV campaign by the Victorian AIDS Council, and the evaluation of HIV prevention campaigns by the Burnet Institute. The authors would like to acknowledge the NHMRC who provide funding to Margaret Hellard as a Senior Research Fellow, Anna Wilkinson as a public health scholarship recipient, Alisa Pedrana through the Sidney Sax Post-Doctoral Fellowship and Mark Stoove through a Career Development Fellowship. The authors gratefully acknowledge the contribution to this work of Victorian Operational Infrastructure Support Program received by the Burnet Institute.

Background Condom promotion is a key component of combination HIV prevention globally. There is evidence from clinical settings that intense interventions successfully increase condom use. However it is unknown if routine sexual health clinical encounters, including encounters potentially prompted by concern relating to particularly high risk events, have the same impact on reducing HIV risk behaviours. We compared self-reported condom use among MSM before and after receiving standard care non-post exposure prophylaxis. Methods Data from MSM accessing the Victorian NPEP Service (VNPEPS) was linked to HIV/STI testing data from Victorian Primary Care Network for sentinel surveillance (VPCNSS) clinics between 2007–2013. Analysis included data from MSM who accessed NPEP and reported condom use at their most recent HIV/STI test prior to NPEP (baseline) and two tests following NPEP (follow-up one and two). Only the first NPEP episode was included. Proportion of MSM reporting inconsistent condom use at baseline (test immediately prior to NPEP) and follow-up one and two were compared using a two sample test of proportions. Results Among 1199 MSM presenting for NPEP on 2094 occasions, 6329 test and risk behaviour records were obtained from VPCNSS sites pre-and post-NPEP. A total of 303 MSM had data on condom use at baseline and two follow ups. Inconsistent condom use was reported by 146 (48.2%) of MSM at baseline, 138 (45.5%) at follow-up one (p = 0.60) and 146 (48.2%) at follow-up two (p = 1.0). Follow-up two occurred a median of 15 months (IQR = 10–23) after NPEP presentation. Conclusion In this study we found no change in condom use following NPEP among MSM with pre- and post-NPEP VPCNSS testing histories. Though generalisability to all MSM is limited, this analysis offers insight into a key risk population and highlights the potential need for tailored strategies to promote primary prevention during risk event-prompted clinical presentations. Disclosure of interest statement The Victorian Department of Health funds the VNPEPS and ongoing surveillance projects within the Burnet Institute. The authors would like to acknowledge the NHMRC who provide funding to Margaret Hellard as a Senior Research Fellow, Mark Stoove as a Career Development Fellow and Anna Wilkinson as a public health scholarship recipient. Edwina Wright receives funding from a research grant from NIH, research funding from the Victorian Department of Health and unrestricted research funds from Gilead, Abbott, Janssen Cilag, MSD and Boehringer Ingelheim. She has also received funding that has been used for research purposes only from ViiV, Merck, Gilead, and Abbott for consultancy work, payment for lectures from ViiV and payment for developing educational resources for ViiV, MSD and Gilead. The study drug for the VicPrEP study has been donated by Gilead Sciences. The authors gratefully acknowledge the contribution to this work of Victorian Operational Infrastructure Support Program received by the Burnet Institute.

Introduction Sexually transmissible infection (STI) screening and treatment is a health priority for gay, bisexual and other men who have sex with men (GBM). Current Australian guidelines recommend frequent syphilis serology and screening for pharyngeal, anorectal and urogenital chlamydia and gonorrhoea infection, in addition to routine HIV testing. However, evidence from recent community surveys that many Australian GBM access only some of these tests suggests concurrent infections may remain undetected. Methods To better understand the epidemiology of co-occurring curative STIs, we calculated the proportion of positive tests for one or more STI among GBM attending two sexual health services and two gay-friendly high-caseload general practices in Victoria between 2007 and 2013. Among positive tests for chlamydia or gonorrhoea, we calculated the proportion positive at multiple anatomical sites. We examined demographic and risk behaviour associations with co-occurring STIs and positivity at multiple anatomical sites using adjusted logistic regression. Results There were 70977 test events between 2007 and 2013; 8316 (11.7%) were positive for at least one STI and of these, 792 (9.5%) were positive for more than one STI. Younger age (16–29 years) (aOR = 1.7, 95% CI = 1.1–2.7), being HIV-positive (aOR = 2.2, 95% CI = 1.5–3.1) and reporting inconsistent condom use (aOR = 1.3, 95% CI = 1.0–1.6) were associated with testing positive for co-occurring infections. Of 7584 test events positive for chlamydia or gonorrhoea, 1028 (13.6%) were positive for either infection at multiple sites. Being aged 16–29 (aOR = 2.9, 95% CI = 1.8–4.6) or 30–39 (aOR = 2.4, 95% CI = 1.5–3.9) was associated with testing positive for either infection at multiple sites. Conclusion The high prevalence of co-occurring STIs and infection at multiple anatomical sites supports national guidelines for frequent comprehensive testing for GBM. These results support the promotion of comprehensive STI testing for GBM, including in lower-caseload settings alongside taking appropriate sexual histories, and underline the importance of structural efforts to maximise access to comprehensive testing for GBM. Disclosure of interest statement All authors have no conflicts to declare. The authors gratefully acknowledge patients and participating clinics and laboratories for the ongoing data contribution. The authors acknowledge Drs Norm Roth and BK Tee for their ongoing support of surveillance work at the Burnet Institute. The Victorian Department of Health funds ongoing surveillance projects within the Burnet Institute. The authors would like to acknowledge the NHMRC who provide funding to Anna Wilkinson as a public health scholarship recipient. Mark Stoove is supported by an NHMRC Career Development Fellowship. The authors gratefully acknowledge the contribution to this work of Victorian Operational Infrastructure Support Program received by the Burnet Institute.