Investigating the impact of the current issues affecting the sexual health of Australian young people

Background Although new technologies bring many benefits, there is also concern that sexting, internet pornography, meeting partners online and new contraceptive technologies may be fuelling the spread of sexually transmitted infections (STIs) and unintended pregnancies. This thesis considers several current issues affecting Australians' sexual and reproductive health, focusing on young people. Methods Drawing on data collected during a national health survey conducted in 2012–13 among 20 091 participants aged 16–69, I investigate these topics using a whole population epidemiological approach. I also undertake a systematic review and meta-analysis of the relationship between sexual behaviours and exposure to sexually explicit websites (SEW) and sexting among young people. Results The systematic review included 14 cross-sectional studies; pooled findings linked some STI risk behaviours with exposure to SEW and sexting. However, several variables suggestive of being more sexually active or having a pre-existing interest in sexual activity also correlated with SEW and sexting exposure. Similarly, the strongest correlate of meeting a sexual partner online was higher sexual partner numbers. Analysis of contraception and condom use found that almost all (95%) of the women used a form of contraception at their last vaginal intercourse; however, only half (49%) were protected from STIs by condoms or dual contraception. Conclusions Interpreted collectively, the studies in this thesis tend to support the argument that individuals use new media platforms to satisfy their pre-existing interests. These findings underscore the nuanced and potentially nonlinear relationships between new technologies, STIs and unintended pregnancies among young people

“I see it everywhere...” young people’s exposure to sexual content in social media: a qualitative study of Australian adolescents’ social media use

Background: Surveys suggest over 40% of young people 13-16 years have seen some form of sexual content online in the past 12 months. There is little research exploring the pathways through which exposure occurs or descriptions of such content. While there is much public concern regarding exposure to sexual content, Australian students receive little or no education on mitigating the impact of sexual content online. Methods: We conducted focus groups with high school students in an aim to discover young people’s experience of exposure to sexual content in social media. In this paper we describe these pathways to sexual content exposure, the nature of the sexual content young people are exposed to and their views about this exposure. Results: Focus groups found that exposure to sexual content through social media occurred through networks of ‘friends’ or followers, or paid-for advertising. Content ranged from subtle messages/photos to explicit pornographic pictures/videos. Young people described much of their exposure was unwanted. Conclusions: Exposure to sexual content, no matter the scope and intensity, is almost unavoidable among young people who use social media. Utilising this information to educate young people on mitigating the impact of sexual content, rather than trying to prevent young people from viewing it, could be a more effective approach

Increasing hepatitis A immunity in men who have sex with men in Sydney, 1996-2012

We examined the hepatitis A virus status of all MSM seen at a large sexual health clinic in inner Sydney between 1996 and 2012. Overall, the proportion of MSM susceptible to hepatitis A decreased from 68.1% in 1996 to 36.2% in 2012; most of this reduction was attributable to vaccination

Do new media affect adolescent sexual attitudes and behaviours? A systematic review

Introduction: There is considerable public concern that new media (including the Internet and mobile phones) could be exposing young people to high levels of sexual content and may impact risky behaviour and/or risk for sexually transmissible infections. Methods: The review was conducted in accordance with the PRISMA guidelines. Medline, EMBASE and PsychINFO were searched to the end of August 2012. Articles were included if they described the statistical association between exposure to sexual content in new media (viewing or engaging) and sexual attitudes or behaviours in young people (defined as 1 partner in last 3 months, multiple lifetime partners, unprotected sex at last sex, drug and alcohol use at last sex, acceptance of casual sexual relationships, having casual sexual relationships, notions of women as sex objects, and approval of extra-marital sex. “Sexting” (sending or receiving sexual texts) was the exposure in the fifth study and was associated with ever having unprotected sex. Conclusion: The relationship between SEW and sexual behaviours and attitudes was inconsistent. Engagement with sexual media appeared to be associated with markers of higher sexual interest and/or activity, but study size, methodological approach and inconsistencies in outcome measures prevented us from drawing conclusions regarding causality. No study explored associations with positive aspects of sexual development (e.g. sexual communication, sexual assertiveness, relationship quality). Further research in this emerging area is needed.2 page(s

Point-of-care tests for the diagnosis of Neisseria gonorrhoeae infection: a systematic review of operational and performance characteristics

Objectives Systematic review of the performance and operational characteristics of point-of-care (POC) tests for the diagnosis of Neisseria gonorrhoeae.Methods We searched PubMed and Embase until August 2010 using variations of the terms: 'rapid test', 'Neisseria gonorrhoeae' and 'evaluation'.Results We identified 100 papers, 14 studies were included; nine evaluated leucocyte esterase (LE) dipsticks and three immunochromatographic strips, and two clinical audits of microscopy were identified. Of the field evaluations the gold standard was nucleic acid amplification technology in six studies and bacterial culture in the other six. In four studies, 50% or more of the patients were symptomatic. The median sensitivity of LE dipsticks was 71% (range 23-85%), median specificity was 70% (33-99%), median positive predictive value (PPV) was 19% (5-40%) and median negative predictive value (NPV) was 95% (56-99%). One LE study found a sensitivity of 23% overall, increasing to 75% in symptomatic women. LE dipsticks mostly involved three steps and took under 2 min. The median sensitivity of immunochromatographic tests (ICT) was 70% (60-94%), median specificity was 96% (89-97%), median PPV was 56% (55-97%) and median NPV was 93% (92-99%). Immunochromatic strips involved five to seven steps and took 15-30 min. Specificity of microscopy ranged from 38% to 89%.Conclusions ICT and LE tests had similar sensitivities, but sensitivity results may be overestimated as largely symptomatic patients were included in some studies. ICT had a higher specificity in women than LE tests. The findings highlight the need for improved POC tests for diagnosis of N gonorrhoeae and more standardised evaluations