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Guy R.,University of New South Wales | Ward J.,Baker IDI Central Australia | Wand H.,University of New South Wales | Rumbold A.,University of Adelaide | And 12 more authors.
Sexually Transmitted Infections | Year: 2015

Objectives To determine the co-occurrence and epidemiological relationships of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) in a high-prevalence setting in Australia. Methods In the context of a cluster randomised trial in 68 remote Aboriginal communities, we obtained laboratory reports on simultaneous testing for CT, NG and TV by nucleic acid amplification tests in individuals aged ≤16 years and examined relationships between age and sex and the coinfection positivity. ORs were used to determine which infections were more likely to co-occur by demographic category. Results Of 13 480 patients (median age: 30 years; men: 37%) tested for all three infections during the study period, 33.3% of women and 21.3% of men had at least one of them, highest in patients aged 16-19 years (48.9% in women, 33.4% in men). The most frequent combination was CT/NG (2.0% of women, 4.1% of men), and 1.8% of women and 0.5% of men had all three. In all co-combinations, coinfection positivity was highest in patients aged 16-19 years. CT and NG were highly predictive of each other's presence, and TV was associated with each of the other two infections, but much more so with NG than CT, and its associations were much stronger in women than in men. Conclusions In this remote high-prevalence area, nearly half the patients aged 16-19 years had one or more sexually transmitted infections. CT and NG were more common dual infections. TV was more strongly associated with NG coinfections than with CT. These findings confirm the need for increased simultaneous screening for CT, NG and TV, and enhanced control strategies.


Silver B.J.,University of New South Wales | Guy R.J.,University of New South Wales | Wand H.,University of New South Wales | Ward J.,Baker IDI Central Australia | And 13 more authors.
Sexually Transmitted Infections | Year: 2015

Objectives: To undertake the first comprehensive analysis of the incidence of three curable sexually transmissible infections (STIs) within remote Australian Aboriginal populations and provide a basis for developing new control initiatives. Methods: We obtained all results for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) testing conducted during 2009-2011 in individuals aged ≥16 years attending 65 primary health services across central and northern Australia. Baseline prevalence and incidence of all three infections was calculated by sex and age group. Results: A total of 17 849 individuals were tested over 35 months. Baseline prevalence was 11.1%, 9.5% and 17.6% for CT, NG and TV, respectively. During the study period, 7171, 7439 and 4946 initially negative individuals had a repeat test for CT, NG and TV, respectively; these were followed for 6852, 6981 and 6621 person-years and 651 CT, 609 NG and 486 TV incident cases were detected. Incidence of all three STIs was highest in 16-year-olds to 19-year-olds compared with 35+ year olds (incident rate ratio: CT 10.9; NG 11.9; TV 2.5). In the youngest age group there were 23.4 new CT infections per 100 person-years for men and 29.2 for women; and 26.1 and 23.4 new NG infections per 100 person-years in men and women, respectively. TV incidence in this age group for women was also high, at 19.8 per 100 person-years but was much lower in men at 3.6 per 100 person-years. Conclusions: This study, the largest ever reported on the age and sex specific incidence of any one of these three curable infections, has identi fied extremely high rates of new infection in young people. Sexual health is a priority for remote communities, but will clearly need new approaches, at least intensification of existing approaches, if a reduction in rates is to be achieved. © 2015, BMJ Publishing Group. All rights reserved.


Ryder N.,Sexual Health and Blood Borne Virus Unit | Woods H.,Far Western and Western New South Wales Local Health Districts | McKay K.,Far Western and Western New South Wales Local Health Districts | Giddings N.,Far Western and Western New South Wales Local Health Districts | And 5 more authors.
Sexually Transmitted Diseases | Year: 2012

Background: Trichomonas has been reported to be rare in Australia's major cities while remaining very common in some extremely remote Aboriginal communities. This study examined the Trichomonas prevalence and relationship to remoteness among patients attending sexual health clinics in rural and remote areas of New South Wales, Australia. Methods: During the period 2009 to June 2010, all women attending sexual health clinics in the Western and Far Western Local Health Districts of New South Wales who agreed to sexually transmitted infection testing were offered Trichomonas testing using an in-house polymerase chain reaction test. Overall prevalence was calculated, and logistic regression was used to determine association with remoteness of residency. Results: Of the 506 women attending during the study period, 356 (70%) were tested. Thirty women (8.4%) tested positive to Trichomonas. Trichomonas infection was independently associated with increasing age, being symptomatic, never having had a previous Papanicolaou smear, and remote residency. Conclusions: The prevalence of Trichomonas was relatively high among women attending sexual health clinics in rural and remote western New South Wales. Trichomonas was more common among women living more remotely, which may reflect population-level health service use. Testing for Trichomonas should be considered for all women requesting testing for sexually transmitted infections in rural and remote Australia. © 2012 American Sexually Transmitted Diseases Association.All rights reserved.


PubMed | Melbourne Sexual Health Center, Sexual Health and Blood Borne Virus Unit, Health Diagnostic Laboratory, Darwin Lab and 8 more.
Type: Journal Article | Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America | Year: 2016

Antimicrobial resistance (AMR) by Neisseria gonorrhoeae is considered a serious global threat.In this nationwide study, we used MassARRAY iPLEX genotyping technology to examine the epidemiology of N. gonorrhoeae and associated AMR in the Australian population. All available N. gonorrhoeae isolates (n = 2452) received from Australian reference laboratories from January to June 2012 were included in the study. Genotypic data were combined with phenotypic AMR information to define strain types.A total of 270 distinct strain types were observed. The 40 most common strain types accounted for over 80% of isolates, and the 10 most common strain types accounted for almost half of all isolates. The high male to female ratios (>94% male) suggested that at least 22 of the top 40 strain types were primarily circulating within networks of men who have sex with men (MSM). Particular strain types were also concentrated among females: two strain types accounted for 37.5% of all isolates from females. Isolates harbouring the mosaic penicillin binding protein 2 (PBP2)-considered a key mechanism for cephalosporin resistance-comprised 8.9% of all N. gonorrhoeae isolates and were primarily observed in males (95%).This large scale epidemiological investigation demonstrated that N. gonorrhoeae infections are dominated by relatively few strain types. The commonest strain types were concentrated in MSM in urban areas and Indigenous heterosexuals in remote areas, and we were able to confirm a resurgent epidemic in heterosexual networks in urban areas. The prevalence of mosaic PBP2 harboring N. gonorrhoeae strains highlight the ability for new N. gonorrhoeae strains to spread and become established across populations.


Knight V.,Sydney Sexual Health Center | Knight V.,University of New South Wales | Ryder N.,Sexual Health and Blood Borne Virus Unit | Bourne C.,Sydney Sexual Health Center | And 4 more authors.
Sexually Transmitted Infections | Year: 2014

Objectives: To investigate the methods used by patients diagnosed with a sexually transmissible infection (STI) to inform their partners during contact tracing. Methods At a large Australian sexual health clinic between March and May 2010, we undertook a retrospective, cross sectional analysis of the methods used by patients diagnosed with a bacterial STI to inform their partners.Results: Of the 172 index patients contacted 1 week after treatment, 163 (95%) chose patient referral, 3 (2%) provider referral and 6 (3%) could not contact any partners. Index patients nominated 1010 sexual partners of whom 494 (49%) were reported as contactable. A total of 447/494 (91%) of these partners were successfully informed; telephone (37%) and face to face (22%) were the most used methods. After multivariate analysis, predictors of using face to face contact methods were age <30 years (AOR: 2.8; 95% CI 1.4 to 5.7), fewer than 2 sexual partners (AOR 3.6; 95% CI 1.7 to 7.6) and speaking a language other than English (adjusted OR (AOR) 3.1; 95% CI 1.3 to 7.2). The single predictor of using interactive contact methods (face to face+telephone) was reporting fewer than 2 sexual partners (AOR 2.7; 95% CI 1.3 to 5.5). People diagnosed with syphilis were significantly less likely to use an interactive contact tracing method (AOR 0.24; 95% CI 0.09 to 0.67).Conclusions: Most patients diagnosed with a bacterial STI at our sexual health clinic report informing their contactable partners directly either face to face or by telephone. Electronic communications methods were more popular for people with more sexual partners and those with syphilis. Effective contact tracing requires access to a range of methods for patients to inform their partners.


Knight V.,Sydney Sexual Health Center | Ryder N.,Sexual Health and Blood Borne Virus Unit | Guy R.,University of New South Wales | Lu H.,Sydney Sexual Health Center | And 3 more authors.
Sexually Transmitted Diseases | Year: 2013

INTRODUCTION: In December 2010, a new "express" testing service (Xpress) was implemented alongside routine clinics at a large sexual health clinic. Xpress involved a computer-assisted self-interview, self-collected samples and enrolled nurse staffing. We evaluated the impact of the service on patient journey, staff costs, and clinical capacity. METHODS: In the first 5 months of Xpress, we calculated the median waiting time and length of stay, staff hours and costs, and utilization. We compared these attributes to the same months in the previous year. RESULTS: In the Xpress period, 5335 patients were seen (705 in the Xpress clinic, 4630 in routine clinic), 11% more than the 4804 in the before period. Staff hours were 13% greater in the Xpress period compared with the before period (3567 vs. 3151). The cost per patient seen in the Xpress period was lower compared with the before period ($26.79 compared with $28.48). The median waiting time in the Xpress period was 19 minutes (interquartile range, 8-36; 10 in Xpress clinic and 17 in routine clinics) compared with 23 in the before period (P < 0.01). The median length of stay in the Xpress period was 40 minutes (interquartile range, 27-58; 21 in Xpress clinic and 40 in routine clinics) compared with 43 in the before period (P < 0.01). The utilization rates were 67% in the Xpress period (40% in the Xpress clinic and 74% in routine clinics) compared with 76% in the before period (P < 0.01). CONCLUSION: The Xpress clinic improved the patient journey, and although not fully used, more patients were seen overall in the clinic with minimal additional costs. Marketing of the Xpress clinic is underway. Copyright © 2012 American Sexually Transmitted Diseases Association.


Kwan B.,University of New South Wales | Ryder N.,Sexual Health and Blood Borne Virus Unit | Knight V.,Sydney Sexual Health Center | Kenigsberg A.,Sydney Sexual Health Center | And 5 more authors.
Sexually Transmitted Diseases | Year: 2012

Background: Men are recommended to not urinate for at least 1 hour before urine testing for Chlamydia trachomatis, but some studies have shown that recent urination does not impact test sensitivity for nucleic acid amplification tests. The objective of this study was to estimate the sensitivity of chlamydia testing using samples obtained 20-minutes post void. Methods: We recruited men returning to Sydney Sexual Health Centre for treatment of urethral Chlamydia trachomatis infection between July 2009 and February 2011. A short questionnaire was used to elicit symptoms, and 2 first-void urine samples were collected-the first after the standard 1 hour minimum and the second 20 minutes later. Men with clinical or microbiologic evidence of urethritis, men receiving antibiotic treatment, and those who had urinated within the last hour were excluded. Samples were tested using Roche COBAS Amplicor PCR. The proportion of samples testing positive at 20 minutes post void was determined using the 1-hour post void sample as a gold standard. Results: Thirty-one men with confirmed chlamydia infection were included in the analysis. Of these, 29 of 31 (93.5%) were positive at 20 minutes (95% CI: 78.6%-99.2%). Conclusions: The sensitivity of 20-minute voiding intervals in asymptomatic men remains reasonably high relative to standard voiding intervals. Removing the barrier of a 1-hour voiding interval should be considered during opportunistic screening. © 2012 American Sexually Transmitted Diseases Association All rights reserved.


Martin L.,Sydney Sexual Health Center | Knight V.,Sydney Sexual Health Center | Ryder N.,Sexual Health and Blood Borne Virus Unit | Lu H.,Sydney Sexual Health Center | And 4 more authors.
Sexually Transmitted Diseases | Year: 2013

BACKGROUND: Sydney Sexual Health Centre (SSHC) commenced a fast-track sexually transmissible infection clinic, the Xpress Clinic (Xpress) pilot for asymptomatic clients in March 2010, using a computer-assisted self-interview and self-collected samples. This study examines client satisfaction and changes in intended screening frequency among clients of Xpress. METHODS: This was a cross-sectional study of all clients attending Xpress clinics during the initial 6 months. All clients were requested to complete a survey based on a previously validated questionnaire. Results were stratified by sex, sex of sexual partners, age, and sex work status. RESULTS: Of the 243 clients who attended Xpress, 145 (60%) returned questionnaires. The 2 most common reasons for choosing Xpress clinic were reduced waiting time (n = 42/138 [30%]; 95% confidence interval [CI], 23%-38%) and reduced length of consultation (n = 16/138 [12%]; 95% CI, 7%-17%).When asked if they would have come to SSHC anyway if Xpress was not an option, men who have sex with men (MSM) were more likely than non-MSM to say that they would come for screening anyway (77% MSM vs. 59% non-MSM, P = 0.034). Youth younger than 25 were less likely than those 25 years and older to have come for screening anyway (53% vs. 79%, P = 0.012).Most (n = 101/138 [73%]; 95% CI, 65%-80%) considered that they would test for sexually transmissible infections more frequently in the future using the Xpress model. Client satisfaction levels were high, with most respondents reporting that they would return to Xpress (n = 119/142 [83%]; 95% CI, 77%-89%) and would recommend it to friends (n = 122/142 [86%]; 95% CI, 79%-90%). CONCLUSIONS: Most clients were highly satisfied with all aspects of Xpress and reported intentions to retest using this model of care. Copyright © 2012 American Sexually Transmitted Diseases Association.


Drummond F.,University of Sydney | Drummond F.,Sydney Hospital | Ryder N.,Sexual Health and Blood Borne Virus Unit | Wand H.,University of Sydney | And 9 more authors.
International Journal of STD and AIDS | Year: 2011

Rectal chlamydia is a common sexually transmissible infection (STI) in men who have sex with men (MSM) that is predominantly asymptomatic. The recommended treatment of azithromycin 1 g as a single oral dose has not been subject to randomized trials and so its efficacy is unknown. We conducted a retrospective case-note review of all MSM diagnosed at the Sydney Sexual Health Centre with asymptomatic rectal chlamydia in 2009. We identified 116 MSM who received azithromycin; 85 (73%) attended for the recommended re-test at varying times (median 78 days, range 21-372 days). Of the men who returned, 11 (13%) had a persistently positive result; we reviewed behavioural data to classify these men as probable re-infections (6/11) or possible treatment failures (5/11), suggesting an efficacy of 94%. Until a randomized controlled trial (RCT) is conducted, patients with rectal chlamydia should be encouraged to attend for a re-test at 6-12 weeks.


PubMed | Sydney Sexual Health Center, University of New South Wales, Sexual Health and Blood Borne Virus Unit and Australia The Kirby Institute
Type: Journal Article | Journal: Sexually transmitted infections | Year: 2014

To investigate the methods used by patients diagnosed with a sexually transmissible infection (STI) to inform their partners during contact tracing.At a large Australian sexual health clinic between March and May 2010, we undertook a retrospective, cross sectional analysis of the methods used by patients diagnosed with a bacterial STI to inform their partners.Of the 172 index patients contacted 1week after treatment, 163 (95%) chose patient referral, 3 (2%) provider referral and 6 (3%) could not contact any partners. Index patients nominated 1010 sexual partners of whom 494 (49%) were reported as contactable. A total of 447/494 (91%) of these partners were successfully informed; telephone (37%) and face to face (22%) were the most used methods. After multivariate analysis, predictors of using face to face contact methods were age <30years (AOR: 2.8; 95% CI 1.4 to 5.7), fewer than 2 sexual partners (AOR 3.6; 95% CI 1.7 to 7.6) and speaking a language other than English (adjusted OR (AOR) 3.1; 95% CI 1.3 to 7.2). The single predictor of using interactive contact methods (face to face+telephone) was reporting fewer than 2 sexual partners (AOR 2.7; 95% CI 1.3 to 5.5). People diagnosed with syphilis were significantly less likely to use an interactive contact tracing method (AOR 0.24; 95% CI 0.09 to 0.67).Most patients diagnosed with a bacterial STI at our sexual health clinic report informing their contactable partners directly either face to face or by telephone. Electronic communications methods were more popular for people with more sexual partners and those with syphilis. Effective contact tracing requires access to a range of methods for patients to inform their partners.

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