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Background: A review of historical trends in gonococcal diagnoses made at the Adelaide Sexual Health Clinic (ASHC), South Australia, identified a substantial rise in diagnoses among heterosexuals between 2006 and 2010. Sex work is illegal in South Australia, regulated in Victoria and legal in New South Wales. This and other factors that could have influenced the epidemic were explored in this analysis.Methods: Retrospective analyses of gonorrhoea diagnoses made by sexual health services between 1990 and 2012 in three Australian state capitals, Melbourne (Victoria) and Sydney (New South Wales) were undertaken.Results: At the ASHC the proportion of gonorrhoea diagnoses was higher between 2006 and 2010 among heterosexual men (5.34% vs 0.84%, p<0.001), non-sex worker women (0.64% vs 0.28%, p<0.001) and female sex workers (FSWs) (1.75% vs 0.24%, p<0.001) compared with other years. This relationship was not seen at the Melbourne Sexual Health Clinic and corresponding data from the Sydney Sexual Health Centre showed that FSWs were less likely to have gonorrhoea between 2006 and 2010 than the other groups (p=0.746, p=0.522, p=0.024, respectively). At ASHC FSWs were significantly more likely to be diagnosed between 2006 and 2010 (OR 2.8, 95% CI 1.48 to 5.27, p=0.002). Charges against sex workers peaked in 2007/2008.Conclusions: A substantial, self-limiting rise in diagnoses of heterosexual gonorrhoea was seen in Adelaide FSWs between 2006 and 2010. Removing barriers to condom use is vital to the prevention of HIV and STI transmission. [ABSTRACT FROM AUTHOR]

Background. We have undertaken a cross-sectional study that investigates the association between bacterial vaginosis (BV) and sexual practices in sexually experienced and inexperienced women. Methods. Participants were 17-21-year-old females who attend Melbourne University, Australia. Study kits that contained an information and consent form, questionnaire, swab, and slide were distributed. Information regarding demographic characteristics and a broad range of sexual practices were collected. Gram-stained, selfcollected vaginal smears were scored with the Nugent method. Associations between BV and behaviors were examined by univariate and multivariate analysis. Results. BV was diagnosed in 25 (4.7%) of 528 women (95% confidence interval [CI], 3.1%-6.9%). Importantly, BV was not detected in women (n=83) without a history of coital or noncoital sexual contact (0%; 95% CI, 0%-4.3%). BV was detected in 3 (3.8%) of 78 women (95% CI, 0.8%-10.8%) with noncoital sexual experience only and in 22 (6.0%) of 367 women (95% CI, 3.8%-8.9%) who reported penile-vaginal sex. BV was associated with a history of any genital contact with a sexual partner (P=.02). BV was strongly associated with >3 penilevaginal sex partners in the prior year (adjusted odds ratio, 7.1; 95% CI, 2.7-18.4) by multivariable analysis. Conclusions. This study shows a strong association between BV and penile-vaginal sex with multiple partners but found no BV in sexually inexperienced women, once a history of noncoital sexual practices was elicited. Our findings indicate that BV is not present in truly sexually inexperienced women. [ABSTRACT FROM AUTHOR]

Objectives: To examine whether the rapid increase of gonorrhoea notifications in Victoria, Australia, identified by nucleic acid amplification test (NAAT) is supported by similar changes in diagnoses by culture, which has higher specificity, and to determine the proportion of tests positive among women tested., Design, Setting and Participants: Retrospective analysis of Medicare reporting of dual NAATs in Victoria, Victorian Department of Health gonorrhoea notifications, and gonorrhoea culture data at the Melbourne Sexual Health Centre (MSHC), among women, 2008 to 2013., Main Outcome Measures: Gonorrhoea notifications and testing methods., Results: Gonorrhoea cases identified by NAAT increased from 98 to 343 cases over the study period. Notifications by culture alone decreased from 19 to five cases. The proportion of NAATs positive for gonorrhoea in Victoria was low (0.2%-0.3%) and did not change over time (P for trend, 0.66). Similarly, the proportion of women tested at the MSHC for gonorrhoea who tested positive (0.4%-0.6%) did not change over time (P for trend, 0.70). Of untreated women who had a positive NAAT result for gonorrhoea and were referred to the MSHC, 10/25 were confirmed by culture., Conclusions: The positivity of gonorrhoea in women identified by culture remains stable over time. Using NAAT for gonorrhoea screening in low-prevalence populations will result in many false positives. Positive NAAT results among low-risk women should be regarded as doubtful, and confirmatory cultures should be performed.

Background: The frequency of testing sex workers for sexually transmitted infections (STIs) in Victoria, Australia, was changed from monthly to quarterly on 6 October 2012. Our aim was to determine the impact of this change to the clients seen at the Melbourne Sexual Health Centre (MHSC)., Methods: Computerised medical records of all clients attending at MHSC from 7 October 2011 to 7 October 2013 were analysed., Results: Comparing between the monthly and quarterly testing periods, the number of consultations at MSHC with female sex workers (FSW) halved from 6146 to 3453 (p<0.001) and the consultation time spent on FSW reduced by 40.6% (1942 h to 1153 h). More heterosexual men (p<0.001), and women (p<0.001) were seen in the quarterly testing period. The number of STIs diagnosed in the clinic increased from 2243 to 2589 from the monthly to quarterly period, respectively [15.4% increase (p<0.001)]. Up to AU$247,000 was saved on FSW testing after the shift to quarterly testing., Conclusions: The change to STIs screening frequency for sex workers from monthly to quarterly resulted in a 15% increase in STI diagnoses in the clinic and approximate a quarter of a million dollars was diverted from FSW testing to other clients. Overall the change in frequency is likely to have had a beneficial effect on STI control in Victoria.

Background: We investigated the detection of chlamydia at different stages of the menstrual cycle., Methods: Electronic medical records for women attending Melbourne Sexual Health Centre between March 2011 and 31(st) December 2012, who were tested for chlamydia by nucleic acid amplification of high vaginal, cervical, or urinary samples, and who recorded a date of last normal menstrual period (LNMP) between 0-28 days were included in the analysis. Logistic regression was used to calculate adjusted odds ratio (aOR) and 95% confidence intervals (CI) for the association of chlamydia with menstrual cycle adjusted by demographics and behavioural variables. Chlamydia and beta globin load were determined on those with stored samples., Results: Of the 10,017 consultations that included a test for chlamydia and a valid LNMP, there were 417 in which chlamydia was detected. The proportion of samples with chlamydia was greater in the luteal phase (4.8%, 184/3831) than in the follicular phase (3.4%, 233/6816) both in the crude (OR 1.29 95%CI 1.1-1.6, p = 0.01) and adjusted odds ratio (aOR) 1.4 (95%CI 1.1-1.8, p = 0.004). Among women using hormonal contraception, there was no significant association with the luteal phase of the menstrual cycle (aOR 1.3, 95%CI 0.9, 1.8, p = 0.18). Among women not using hormonal contraception, there was a significant association with the luteal phase (aOR 1.6, (95% CI 1.1-2.3, p = 0.007). The chlamydia load was not significantly different in the 329 positive stored samples in weeks 3 and 4 vs weeks 1 and 2 for any site (P>0.12)., Conclusions: The higher detection of chlamydia detection in the luteal phase of the menstrual cycle in only those not taking hormonal contraception suggest that hormonal factors influence chlamydia detection. The absence of a significantly highly chlamydia load in women during the luteal phase raises questions about the mechanism.

Objectives: To assess the proportion of female sex workers (FSWs) from low-prevalence ('other') and high-prevalence countries (HPCs) for sexually transmissible infections (STIs) in Melbourne., Methods: Retrospective data analysis from the Melbourne Sexual Health Centre database for February 2002-May 2011., Results: Some 1702 HPC FSWs, 2594 other FSWs and 13?644 nonFSW women were included, with 12?891 and 21?611 consultations, respectively, for HPC FSWs and other FSWs. Proportions of HPC FSWs with chlamydia (Chlamydia trachomatis) (4.2% v. 3.3%, P=0.14), gonorrhoea (Neisseria gonorrhoeae) (0.24% v. 0.31%, P=0.66) or trichomonas (0.65 v. 0.46, P=0.42) at first visit were similar to those of other FSWs, but nonFSWs had a higher prevalence of chlamydia and gonorrhoea (P<0.01). On return visits, chlamydia (1.2% v. 0.92%, P<0.05) and gonorrhoea (0.29% v. 0.10%, P=<0.05) were more common in HPC FSWs than other FSWs. The presence of any of these STIs among FSWs was predicted by having private nonpaying partners in the last year (adjusted odds ratio (AOR): 1.99 (95% confidence interval (CI): 1.52-2.61)), having private partners from overseas (AOR: 1.69 (95% CI: 1.33-2.16)) and being a HPC FSW (AOR: 1.38 (95% CI: 1.12-1.72)). Injecting drug use was less common in HPC FSWs than in other FSWs (0.82% v. 16.54%, P<0.0001)., Conclusions: STI prevalence was low among FSWs from countries with high and low background STI. Among FSWs having private sex partners and private partners from overseas were the primary predictors for STIs.