137 research outputs found

    The epidemiology of cervictis in sexually transmitted infection clinic populations in Sydney, Australia

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    Infectious and non-infectious associations of cervicitis were explored in a prospective cross-sectional study of 550 women at three STI services in Sydney, 2006 to 2010. Associations were compared using three cervicitis case definitions: >30 polymorphonuclear leucocytes/high powered field of cervical Gram stain, yellow discharge or mucopurulent discharge (MCP). Women underwent testing for multiple infections. A prospective observational sub-study assessed the effect of Azithromycin treatment of all cervicitis and non-specific cervicitis (NSC) (cervicitis in the absence of Chlamydia trachomatis (CT), Neisseria gonorrhoea (NG) Mycoplasma genitalium (MG), Trichomonas vaginalis (TV)) CT, MG and TV were significantly associated with increased cervicitis risk on multivariate analysis, strongest associations with MCP: CT adjusted Relative Risk (ARR) =2.61 (95% CI 1.57-4.35) p=0.0002, MG ARR =2.25 (95% CI 1.12-4.54) p=0.003, TV ARR=2.86 (95% CI 1.61-5.09) p=0.0003. NG increased cervicitis risk on univariate analysis (RR=3.66 (95% CI 2.02-6.62) p<0.0001). Condom use reduced cervicitis risk by the yellow discharge definition (ARR=0.68 (95% CI 0.50-0.92) p=0.013). Population Attributable Risk% of significant pathogens explained only 23.4% of cervicitis and were: CT 8.5%, NG 3.6%, MG 4.5%, TV 6.7%. Azithromycin treatment showed non-significant reductions in cervicitis persistence for all cervicitis, RR=0.74 (95% CI 0.46-1.21) p=0.235 and NSC, RR=0.60 (95% CI 0.35-1.02) P=0.05

    Travel-related sexually transmitted infections

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    Sexually transmitted infections (STIs) are among the most common notifiable health problems worldwide, with particularly high rates in developing countries. Men and women with multiple sexual partners at home or a previous history of STIs are more likely to have casual sexual exposure (CSE) while travelling. Over the last several decades 5% to even 50% of short-term travellers engaged in CSE during foreign trips. It is estimated that only 50% of travellers use condoms during casual sex abroad. Sexual contact with commercial sex workers is an exceptionally high-risk behaviour. The common risk factor is also young age. Adolescents and young adults constitute 25% of the sexually active population, but represent almost 50% of all new acquired STIs. Many STIs are asymptomatic and therefore can be difficult to identify and control. The clinical manifestation of STIs can be grouped into a number of syndromes, such as genital ulcer or erosion, urethral or vaginal discharge, pelvic inflammatory disease. STIs are divided into curable infections caused by bacteria (gonorrhoea, chlamydiasis, syphilis, chancroid, lymphogranuloma venereum, granuloma inguinale) or protozoa (trichomoniasis) and incurable viral infections (genital herpes, genital warts, HIV). STIs are not only a cause of acute morbidity, but may result in complications including male and female infertility, ectopic pregnancy, cervical cancer, premature mortality or miscarriage. Monogamous sex with a stable, uninfected partner or sexual abstinence remains the only way to avoid the risk of becoming infected with STIs.

    Sexually transmitted infections: challenges ahead.

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    : WHO estimated that nearly 1 million people become infected every day with any of four curable sexually transmitted infections (STIs): chlamydia, gonorrhoea, syphilis, and trichomoniasis. Despite their high global incidence, STIs remain a neglected area of research. In this Commission, we have prioritised five areas that represent particular challenges in STI treatment and control. Chlamydia remains the most commonly diagnosed bacterial STI in high-income countries despite widespread testing recommendations, sensitive and specific non-invasive testing techniques, and cheap effective therapy. We discuss the challenges for chlamydia control and evidence to support a shift from the current focus on infection-based screening to improved management of diagnosed cases and of chlamydial morbidity, such as pelvic inflammatory disease. The emergence and spread of antimicrobial resistance in Neisseria gonorrhoeae is globally recognised. We review current and potential future control and treatment strategies, with a focus on novel antimicrobials. Bacterial vaginosis is the most common vaginal disorder in women, but current treatments are associated with frequent recurrence. Recurrence after treatment might relate to evidence that suggests sexual transmission is integral to the pathogenesis of bacterial vaginosis, which has substantial implications for the development of effective management approaches. STIs disproportionately affect low-income and middle-income countries. We review strategies for case management, focusing on point-of-care tests that hold considerable potential for improving STI control. Lastly, STIs in men who have sex with men have increased since the late 1990s. We discuss the contribution of new biomedical HIV prevention strategies and risk compensation. Overall, this Commission aims to enhance the understanding of some of the key challenges facing the field of STIs, and outlines new approaches to improve the clinical management of STIs and public health.<br/

    Global Estimates of the Prevalence and Incidence of Four Curable Sexually Transmitted Infections in 2012 Based on Systematic Review and Global Reporting

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    Background: Quantifying sexually transmitted infection (STI) prevalence and incidence is important for planning interventions and advocating for resources. The World Health Organization (WHO) periodically estimates global and regional prevalence and incidence of four curable STIs: chlamydia, gonorrhoea, trichomoniasis and syphilis. Methods and Findings: WHO’s 2012 estimates were based upon literature reviews of prevalence data from 2005 through 2012 among general populations for genitourinary infection with chlamydia, gonorrhoea, and trichomoniasis, and nationally reported data on syphilis seroprevalence among antenatal care attendees. Data were standardized for laboratory test type, geography, age, and high risk subpopulations, and combined using a Bayesian meta-analytic approach. Regional incidence estimates were generated from prevalence estimates by adjusting for average duration of infection. In 2012, among women aged 15–49 years, the estimated global prevalence of chlamydia was 4.2% (95% uncertainty interval (UI): 3.7–4.7%), gonorrhoea 0.8% (0.6–1.0%), trichomoniasis 5.0% (4.0–6.4%), and syphilis 0.5% (0.4–0.6%); among men, estimated chlamydia prevalence was 2.7% (2.0–3.6%), gonorrhoea 0.6% (0.4–0.9%), trichomoniasis 0.6% (0.4–0.8%), and syphilis 0.48% (0.3–0.7%). These figures correspond to an estimated 131 million new cases of chlamydia (100–166 million), 78 million of gonorrhoea (53–110 million), 143 million of trichomoniasis (98–202 million), and 6 million of syphilis (4–8 million). Prevalence and incidence estimates varied by region and sex. Conclusions: Estimates of the global prevalence and incidence of chlamydia, gonorrhoea, trichomoniasis, and syphilis in adult women and men remain high, with nearly one million new infections with curable STI each day. The estimates highlight the urgent need for the public health community to ensure that well-recognized effective interventions for STI prevention, screening, diagnosis, and treatment are made more widely available. Improved estimation methods are needed to allow use of more varied data and generation of estimates at the national level

    Sexually transmitted infections: challenges ahead.

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    WHO estimated that nearly 1 million people become infected every day with any of four curable sexually transmitted infections (STIs): chlamydia, gonorrhoea, syphilis, and trichomoniasis. Despite their high global incidence, STIs remain a neglected area of research. In this Commission, we have prioritised five areas that represent particular challenges in STI treatment and control. Chlamydia remains the most commonly diagnosed bacterial STI in high-income countries despite widespread testing recommendations, sensitive and specific non-invasive testing techniques, and cheap effective therapy. We discuss the challenges for chlamydia control and evidence to support a shift from the current focus on infection-based screening to improved management of diagnosed cases and of chlamydial morbidity, such as pelvic inflammatory disease. The emergence and spread of antimicrobial resistance in Neisseria gonorrhoeae is globally recognised. We review current and potential future control and treatment strategies, with a focus on novel antimicrobials. Bacterial vaginosis is the most common vaginal disorder in women, but current treatments are associated with frequent recurrence. Recurrence after treatment might relate to evidence that suggests sexual transmission is integral to the pathogenesis of bacterial vaginosis, which has substantial implications for the development of effective management approaches. STIs disproportionately affect low-income and middle-income countries. We review strategies for case management, focusing on point-of-care tests that hold considerable potential for improving STI control. Lastly, STIs in men who have sex with men have increased since the late 1990s. We discuss the contribution of new biomedical HIV prevention strategies and risk compensation. Overall, this Commission aims to enhance the understanding of some of the key challenges facing the field of STIs, and outlines new approaches to improve the clinical management of STIs and public health

    A Gonococcal Vaccine Has the Potential to Rapidly Reduce the Incidence of Neisseria gonorrhoeae Infection among Urban Men Who Have Sex with Men

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    Background: A gonococcal vaccine is urgently needed due to increasing gonorrhea incidence and emerging multidrug-resistant gonococcal strains worldwide. Men who have sex with men (MSM) have among the highest incidences of gonorrhea and may be a key target population for vaccination when available. Methods: An individual-based, anatomical site-specific mathematical model was used to simulate Neisseria gonorrhoeae transmission in a population of 10000 MSM. The impact of vaccination on gonorrhea prevalence was assessed. Results: With a gonococcal vaccine of 100% or 50% protective efficacy, gonorrhea prevalence could be reduced by 94% or 62%, respectively, within 2 years if 30% of MSM are vaccinated on presentation for sexually transmitted infection (STI) testing. Elimination of gonorrhea is possible within 8 years with vaccines of≥50% efficacy lasting 2 years, providing a booster vaccination is available every 3 years on average. A vaccine's impact may be reduced if it is not effective at all anatomical sites. Conclusions: Our study indicates that with a vaccine of modest efficacy and an immunization strategy that targets MSM presenting for STI screening, the prevalence of gonorrhea in this population could be rapidly and substantially reduced

    Remote Aboriginal-led primary care services integrate testing for sexually transmitted infections into comprehensive annual preventive health assessments in regions with highest prevalence

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    Top Abstracts of the Joint Australasian Sexual Health and HIV & AIDS Conferences, Held 29 August-1 September 2022 at the Sunshine Coast Convention Centre

    Point of care (POC) tests for diagnosis of sexually transmissible infections (STIs) in Australia

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    Sexually transmissible infections (STIs) are responsible for a huge health, economic and social burden globally with an estimated almost 360 million new infections in 15–49 year olds annually due to curable microbial STIs. Access to accurate diagnostic testing is a key control strategy, yet in many settings laboratory infrastructure is inadequate or as is the case in remote Australia, significant physical distances and highly mobile patient populations are barriers. Point-of-care (POC) tests have the potential to provide timely testing and treatment for STIs, yet their poor accuracy or in the case of syphilis, their inability to differentiate current from past/treated infection, has limited their use. New POC tests, which overcome these limitations, need rigorous laboratory and field-based evaluations before being introduced programmatically. The research presented in this thesis provides new information from evaluations of novel POC tests for STIs. The first evaluation was a multi-site laboratory-based assessment of one new and three traditional POC test for syphilis; more than 1000 sera were tested. The new test identified >93% of active syphilis infections, whereas just over half of past infections were diagnosed as past or not syphilis, thereby avoiding unnecessary treatment compared with traditional POC tests. Its sensitivity (89.8%) was lower than traditional tests, possibly limiting its usefulness. The second evaluation was field-based in two remote Aboriginal communities and included two traditional tests and one new molecular-based POC test for chlamydia (CT) and gonorrhoea (NG); this followed a laboratory-based investigation which already confirmed test accuracy. The new test was easy-to-use and exceptionally more sensitive (CT:100%; NG:100%) than traditional tests (CT:27.3%; NG:66.7%), and was subsequently included in a large cluster-randomised controlled trial involving 12 remote Aboriginal health services to evaluate clinical benefit and accuracy in the hands of health care staff. Over 2500 POC tests were performed, demonstrating very high concordance (CT:99.4%; NG:99.9%) with laboratory results. The findings presented here contribute new knowledge to the field of STI POC testing and highlight the importance of the evaluation pathway. The research has already informed the direction of further STI POC program implementation in Australia. These findings are also likely to be applicable more broadly in similar settings globally

    STI in remote communities: improved and enhanced primary health care (STRIVE) study protocol: a cluster randomised controlled trial comparing 'usual practice' STI care to enhanced care in remote primary health care services in Australia

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    BACKGROUND Despite two decades of interventions, rates of sexually transmissible infections (STI) in remote Australian Aboriginal communities remain unacceptably high. Routine notifications data from 2011 indicate rates of chlamydia and gonorrhoea among Aboriginal people in remote settings were 8 and 61 times higher respectively than in the non-Indigenous population. METHODS/DESIGN STRIVE is a stepped-wedge cluster randomised trial designed to compare a sexual health quality improvement program (SHQIP) to usual STI clinical care delivered in remote primary health care services. The SHQIP is a multifaceted intervention comprising annual assessments of sexual health service delivery, implementation of a sexual health action plan, six-monthly clinical service activity data reports, regular feedback meetings with a regional coordinator, training and financial incentive payments. The trial clusters comprise either a single community or several communities grouped together based on geographic proximity and cultural ties. The primary outcomes are: prevalence of chlamydia, gonorrhoea and trichomonas in Aboriginal residents aged 16–34 years, and performance in clinical management of STIs based on best practice indicators. STRIVE will be conducted over five years comprising one and a half years of trial initiation and community consultation, three years of trial conditions, and a half year of data analysis. The trial was initiated in 68 remote Aboriginal health services in the Northern Territory, Queensland and Western Australia. DISCUSSION STRIVE is the first cluster randomised trial in STI care in remote Aboriginal health services. The trial will provide evidence to inform future culturally appropriate STI clinical care and control strategies in communities with high STI rates. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12610000358044James Ward, Skye McGregor, Rebecca J Guy, Alice R Rumbold, Linda Garton, Bronwyn J Silver, Debbie Taylor-Thomson, Belinda Hengel, Janet Knox, Amalie Dyda, Matthew G Law, Handan Wand, Basil Donovan, Christopher K Fairley, Steven Skov, Donna Ah Chee, John Boffa, David Glance, Robyn McDermott, Lisa Maher and John M Kaldo

    Health service implications of the introduction of STI point-of-care testing in Australia

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    Chlamydia trachomatis (CT) and Neisseria gonorrhoea (NG) are curable sexually transmissible infections (STIs) which represent a significant public health burden, particularly in young Australia Aboriginal people in remote communities. Prompt testing and treatment is fundamental to STI control yet distance to urban laboratories is a significant barrier. CT/NG point-of-care (POC) testing offers an ideal solution, but until recently had been unavailable. This thesis aims to identify settings where POC testing could be beneficial, benefits and barriers to implementation and health service staff acceptability. The thesis was based on two sets of qualitative interviews. The first occurred with 18 Australian key informants with remote, sexual health and laboratory expertise, and generated three discrete studies. The second occurred with 16 trained nurses and Aboriginal health workers (AHWs) from the first 12 remote primary care services internationally to use GeneXpert CT/NG POC testing and resulted in study four. Study one focused on settings where the technology would have greatest benefit, with remote Aboriginal communities most commonly identified, as well as juvenile justice and outreach services to highly mobile or marginalised populations. In study two, informants identified the benefits of POC use for clinical practice including improved management of STIs- more timely and targeted treatment, earlier commencement of partner notification, and reduced effort associated with client recall, but noted it will result in changes to the STI management pathway, and policy and clinical guidelines may need to be altered. Study three focused on the public health implications; with the key perceived benefit being STI control, and barriers including the potential to negatively impact on disease notification and NG antibiotic sensitivity surveillance. In study four, most nurses and AHWs found the test easy to use and useful, and reported improved management of STIs consistent with the key informant’s perceived benefits. In conclusion, this thesis has provided information to inform implementation of CT/NG POC testing, including selection of appropriate settings, and the need to review clinical guidelines and establish systems to avoid adverse impact on public health surveillance. Importantly the research demonstrated the new technology was highly acceptable to staff working in remote primary care
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