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Sydney, Australia

Ali H.,University of New South Wales | Donovan B.,University of New South Wales | Donovan B.,Sydney Sexual Health Center | Wand H.,University of New South Wales | And 7 more authors.
BMJ (Online) | Year: 2013

Objective To measure the effect on genital warts of the national human papillomavirus vaccination programme in Australia, which started in mid-2007. Design Trend analysis of national surveillance data. Setting Data collated from eight sexual health services from 2004 to 2011; the two largest clinics also collected self reported human papillomavirus vaccination status from 2009. Participants Between 2004 and 2011, 85 770 Australian born patients were seen for the first time; 7686 (9.0%) were found to have genital warts. Main outcome measure Rate ratios comparing trends in proportion of new patients diagnosed as having genital warts in the pre-vaccination period (2004 to mid-2007) and vaccination period (mid-2007 to the end of 2011). Results Large declines occurred in the proportions of under 21 year old (92.6%) and 21-30 year old (72.6%) women diagnosed as having genital warts in the vaccination period-from 11.5% in 2007 to 0.85% in 2011 (P<0.001) and from 11.3% in 2007 to 3.1% in 2011 (P<0.001), respectively. No significant decline in wart diagnoses was seen in women over 30 years of age. Significant declines occurred in proportions of under 21 year old (81.8%) and 21-30 year old (51.1%) heterosexual men diagnosed as having genital warts in the vaccination period-from 12.1% in 2007 to 2.2% in 2011 (P<0.001) and from 18.2% in 2007 to 8.9% in 2011 (P<0.001), respectively. No significant decline in genital wart diagnoses was seen in heterosexual men over 30 years of age. In 2011 no genital wart diagnoses were made among 235 women under 21 years of age who reported prior human papillomavirus vaccination. Conclusions The significant declines in the proportion of young women found to have genital warts and the absence of genital warts in vaccinated women in 2011 suggests that the human papillomavirus vaccine has a high efficacy outside of the trial setting. Large declines in diagnoses of genital warts in heterosexual men are probably due to herd immunity. Source

Read P.,Kirketon Road Center | Read P.,University of New South Wales | Jeoffreys N.,University of Western Sydney | Tagg K.,University of Western Sydney | And 4 more authors.
Journal of Clinical Microbiology | Year: 2014

Azithromycin has shown high efficacy in randomized trials when used for treating infectious syphilis in Africa. However, its use in clinical practice has been limited by the development of antimicrobial drug resistance. Resistance has not previously been reported from Australasia. The aim of this study was to determine the prevalence of and risk factors for azithromycin-resistant syphilis-causing strains in Sydney, Australia. We evaluated 409 samples that were PCR positive for Treponema pallidum DNA collected between 2004 and 2011 for the presence of the A2058G mutation, which confers resistance to macrolide antibiotics such as azithromycin. Overall, 84% of samples harbored the mutation. The prevalence of the mutation increased during the study period (P trend, 0.003). We also collected clinical and demographic data on 220 patients from whom these samples had been collected to determine factors associated with the A2058G mutation; 97% were from men who have sex with men. Reporting sex in countries other than Australia was associated with less macrolide resistance (adjusted odds ratio, 0.25; 95% confidence interval, 0.09 to 0.66; P = 0.005), with other study factors showing no association (age, HIV status, recent macrolide use, stage of syphilis, or history of prior syphilis). Azithromycin cannot be recommended as an alternative treatment for syphilis in Sydney. Copyright © 2014, American Society for Microbiology. All Rights Reserved. Source

Liu B.,University of New South Wales | Guy R.,University of New South Wales | Donovan B.,University of New South Wales | Donovan B.,Sydney Sexual Health Center | Kaldor J.M.,University of New South Wales
Sexually Transmitted Infections | Year: 2013

Objectives Re-infection with chlamydia may increase subsequent reproductive morbidity in women. The authors sought to identify characteristics associated with re-infection. Methods A cohort of all women aged 10e49 years with a notification of genital chlamydia in the Australian state of New South Wales during 1999e2008 was defined. Probabilistic linkage was used to identify women with repeat notifications in the same period. The risk of repeat notification was examined according to age and other characteristics using proportional hazards regression. Results Among 40 936 women in the cohort, 3236 had at least one repeat chlamydia notification over an average of 3.5 years of follow-up. The incidence of repeat notification was greatest in the first year after index notification (4.5 per 100 person-years) and decreased thereafter. The RR of repeat notification increased by 8% (95% CI 7% to 9%) for each year decrease in age. Compared with women aged 20e21 years at index chlamydia notification, women aged <16 years were twice as likely to have a repeat notification (adjusted HR 2.12, 95% CI 1.75 to 2.56), while women aged 26e27 years were half as likely (adjusted HR 0.53, 95% CI 0.43 to 0.66). Year of index notification, parity and concurrent or past gonorrhoeal infection were also significantly associated with the risk of repeat notification, but socioeconomic status and area of residence were not. Conclusions Younger age is a strong predictor of chlamydia re-infection in women. The results support targeting interventions to prevent re-infections to very young women. Source

Brotherton J.M.L.,VCS Inc. | Brotherton J.M.L.,University of Sydney | Brotherton J.M.L.,University of Melbourne | Liu B.,University of New South Wales | And 4 more authors.
Vaccine | Year: 2014

Background: Accurate estimates of coverage are essential for estimating the population effectiveness of human papillomavirus (HPV) vaccination. Australia has a purpose built National HPV Vaccination Program Register for monitoring coverage, however notification of doses administered to young women in the community during the national catch-up program (2007-2009) was not compulsory. In 2011, we undertook a population-based mobile phone survey of young women to independently estimate HPV vaccination coverage. Methods: Randomly generated mobile phone numbers were dialed to recruit women aged 22-30 (age eligible for HPV vaccination) to complete a computer assisted telephone interview. Consent was sought to validate self reported HPV vaccination status against the national register. Coverage rates were calculated based on self report and weighted to the age and state of residence structure of the Australian female population. These were compared with coverage estimates from the register using Australian Bureau of Statistics estimated resident populations as the denominator. Results: Among the 1379 participants, the national estimate for self reported HPV vaccination coverage for doses 1/2/3, respectively, weighted for age and state of residence, was 64/59/53%. This compares with coverage of 55/45/32% and 49/40/28% based on register records, using 2007 and 2011 population data as the denominators respectively. Some significant differences in coverage between the states were identified. 20% (223) of women returned a consent form allowing validation of doses against the register and provider records: among these women 85.6% (538) of self reported doses were confirmed. Conclusions: We confirmed that coverage rates for young women vaccinated in the community (at age 18-26 years) are underestimated by the national register and that under-notification is greater for second and third doses. Using 2011 population estimates, rather than estimates contemporaneous with the program rollout, reduces register-based coverage estimates further because of large population increases due to immigration since the program. © 2013 Elsevier Ltd. Source

Shields M.,Taylor Square Private Clinic | Guy R.J.,University of New South Wales | Jeoffreys N.J.,Institute of Clinical Pathology and Medical Research ICPMR | Finlayson R.J.,Taylor Square Private Clinic | And 2 more authors.
BMC Infectious Diseases | Year: 2012

Background: Syphilis is a growing public health problem among men who have sex with men (MSM) globally. Rapid and accurate detection of syphilis is vital to ensure patients and their contacts receive timely treatment and reduce ongoing transmission.Methods: We evaluated a PCR assay for the diagnosis of Treponema pallidum using swabs of suspected early syphilis lesions in longitudinally assessed MSM. Results: We tested 260 MSM for T pallidum by PCR on 288 occasions: 77 (26.7%) had early syphilis that was serologically confirmed at baseline or within six weeks, and 211 (73.3%) remained seronegative for syphilis. Of 55 men with primary syphilis, 49 were PCR positive, giving a sensitivity of 89.1% (95% CI: 77.8%-95.9%) and a specificity of 99.1% (95% CI: 96.5%-99.9%). Of 22 men with secondary syphilis, 11 were PCR positive, giving a sensitivity of 50% (95% CI: 28.2%-71.8%) and a specificity of 100% (95% CI: 66.4%-71.8%). Of the 77 syphilis cases, 43 (56%) were HIV positive and the sensitivity and specificity of the PCR test did not vary by HIV status. The PCR test was able to detect up to five (10%) primary infections that were initially seronegative, including one HIV positive man with delayed seroconversion to syphilis (72 to 140 days) and one HIV positive man who did not seroconvert to syphilis over 14 months follow-up. Both men had been treated for syphilis within a week of the PCR test. Conclusions: T pallidum PCR is a potentially powerful tool for the early diagnosis of primary syphilis, particularly where a serological response has yet to develop. © 2012 Shields et al.; licensee BioMed Central Ltd. Source

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