scholarly journals High prevalence and incidence of HIV, sexually transmissible infections and penile foreskin cutting among sexual health clinic attendees in Papua New Guinea

Sexual Health ◽  
2014 ◽  
Vol 11 (1) ◽  
pp. 58 ◽  
Author(s):  
Andrew Vallely ◽  
Claire E. Ryan ◽  
Joyce Allen ◽  
Joyce C. Sauk ◽  
Cassey S. Simbiken ◽  
...  
Keyword(s):  
Sexual Health ◽  
Papua New Guinea ◽  
Trichomonas Vaginalis ◽  
New Guinea ◽  
Asia Pacific ◽  
Health Clinic ◽  
Multiple Infections ◽  
Specimen Collection ◽  
Sexually Transmissible Infections ◽  
Sexual Health Clinics

Background Papua New Guinea (PNG) has one of the highest prevalences of HIV and sexually transmissible infections (STIs) in the Asia-Pacific region, and one of the highest burdens of maternal syphilis and cervical cancer globally. Despite this disease burden, only limited clinical research in sexual and reproductive health has been conducted in PNG. Methods: A longitudinal clinical cohort study was conducted at two sexual health clinics. Participants completed a behavioural interview, clinical assessment and genital examination at baseline, and at 12, 24 and 50 weeks, including specimen collection for STI diagnostics. Results: In total, 154 people attended a screening visit. Reattendance at 12, 24 and 50-weeks was 87%, 78% and 80% respectively. At baseline, HIV prevalence was 3.3%; chlamydia (Chlamydia trachomatis), 29.2%; gonorrhoea (Neisseria gonorrhoeae), 22.1%; Trichomonas vaginalis 15.6%; herpes simplex type-2 (HSV-2), 46.1%; active syphilis, 11.7%. Multiple infections were common particularly among women. The incidence of chlamydia was 27 per 100 person-years (PY); gonorrhoea, 15 out of 100 PY; T. vaginalis, 29 out of 100 PY; HSV-2, 12 out of 100 PY; syphilis, 8 out of 100 PY. No incident HIV cases were recorded. At baseline, 39% of men in Mt Hagen and 65% in Port Moresby had a penile foreskin cut, with a dorsal slit being the most common. Two men underwent penile cutting during the follow-up period. Conclusions: The prevalence and incidence of STIs, HIV and penile cutting were high among sexual health clinic attendees. High retention figures suggest that this population may be suitable for future interventions research and clinical trials.

Prevalence and risk factors of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and other sexually transmissible infections among women attending antenatal clinics in three provinces in Papua New Guinea: a cross-sectional survey

Sexual Health ◽  
2016 ◽  
Vol 13 (5) ◽  
pp. 420 ◽  
Author(s):  
Lisa M. Vallely ◽  
Pamela Toliman ◽  
Claire Ryan ◽  
Glennis Rai ◽  
Johanna Wapling ◽  
...  
Keyword(s):  
Chlamydia Trachomatis ◽  
Neisseria Gonorrhoeae ◽  
Pregnant Women ◽  
Papua New Guinea ◽  
Trichomonas Vaginalis ◽  
New Guinea ◽  
Antenatal Clinic ◽  
Asia Pacific ◽  
Cross Sectional ◽  
Sexually Transmissible Infections

Background Papua New Guinea (PNG) is estimated to have among the highest prevalences of HIV and sexually transmissible infections (STIs) of any Asia-Pacific country, and one of the highest burdens of maternal syphilis globally. The prevalence of curable STIs, such as Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV), among pregnant women in PNG is relatively unknown. Methods: A cross-sectional bio-behavioural survey to investigate the epidemiology of CT, NG, TV and other STIs among pregnant women in three provinces of PNG was undertaken. Women aged 18–35 years attending their first antenatal clinic visit were invited to participate. Participants completed a short interview and provided self-collected vaginal specimens for CT, NG and TV laboratory-based nucleic acid amplification tests and a venepuncture specimen for laboratory testing for syphilis and Herpes simplex virus type-2 (HSV-2) serology. Routine antenatal assessment was conducted according to national guidelines, including HIV counselling and testing and point-of-care syphilis screening. Results: A total of 765 women were enrolled. Overall, 43% (95% confidence interval (CI): 39.2–46.4) had one or more of CT, NG or TV infection. CT was the most prevalent STI (22.9%, 175/765; 95% CI: 19.9–25.9), followed by TV (22.4%, 171/765; 95% CI: 19.4–25.4), and NG (14.2%, 109/765; 95% CI: 11.7–16.7). The prevalence of active syphilis was 2.2% (17/765; 95% CI: 1.2–3.3), HSV-2 was 28.0% (214/765; 95% CI: 24.8–31.2) and HIV, 0.8% (6/765; 95% CI: 0.2–1.4). Prevalences were highest among primigravid women, women aged <25 years, and among those in Central Province. Conclusion: High prevalences of curable genital STIs were observed among women attending routine antenatal clinic services in PNG. These infections have been associated with adverse pregnancy outcomes and could be important contributors to poor maternal and neonatal health in this setting.

Cervicitis: limited clinical utility for the detection of Mycoplasma genitalium in a cross-sectional study of women attending a New Zealand sexual health clinic

Sexual Health ◽  
2013 ◽  
Vol 10 (3) ◽  
pp. 263 ◽  
Author(s):  
Jeannie Oliphant ◽  
Sunita Azariah
Keyword(s):  
Sexual Health ◽  
Trichomonas Vaginalis ◽  
Clinical Utility ◽  
Clinical Symptoms ◽  
Mycoplasma Genitalium ◽  
Cross Sectional Study ◽  
Health Clinic ◽  
Sectional Study ◽  
Cross Sectional ◽  
Sexually Transmissible Infections

Background Although multiple studies have confirmed Mycoplasma genitalium as a cause of nongonococcal urethritis in men, there is less evidence of its pathogenicity in women. Our aims were to determine the prevalence of M. genitalium in a sample of women attending a sexual health clinic and to assess whether there was any association between the detection of M. genitalium and a diagnosis of cervicitis in this population. Methods: A cross-sectional study recruited women who required screening for sexually transmissible infections. Endocervical swabs to detect the presence of M. genitalium were taken in addition to routine testing for Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis. Data were collected on demographics, sexual behaviour, clinical symptoms and the presence of clinical or microscopic cervicitis. Results: The prevalence of M. genitalium was 8.4% (n = 22, 95% confidence interval (CI): 5.4–12.5%) in the study sample of 261 women. There was an association between the finding of cervical contact bleeding (odds ratio OR): 5.45; 95% CI: 1.93–15.42, P = 0.001) and microscopic cervicitis (OR: 2.64; 95% CI: 0.95–7.34, P = 0.06) and the presence of M. genitalium when compared with women with no diagnosed infection; however, the latter finding was not statistically significant. Conclusions: Although the prevalence of M. genitalium was high at 8.4%, the overall lack of any association between the findings of cervicitis and the detection of M. genitalium support the conclusion that cervicitis has poor clinical utility as an indicator for the presence of M. genitalium infection.

scholarly journals Performance of syndromic management for the detection and treatment of genitalChlamydia trachomatis,Neisseria gonorrhoeaeandTrichomonas vaginalisamong women attending antenatal, well woman and sexual health clinics in Papua New Guinea: a cross-sectional study

BMJ Open ◽  
2017 ◽  
Vol 7 (12) ◽  
pp. e018630 ◽  
Author(s):  
Lisa M Vallely ◽  
Pamela Toliman ◽  
Claire Ryan ◽  
Glennis Rai ◽  
Johanna Wapling ◽  
...  
Keyword(s):  
Sexual Health ◽  
Papua New Guinea ◽  
Predictive Value ◽  
Lower Abdominal Pain ◽  
High Sensitivity ◽  
New Guinea ◽  
Asia Pacific ◽  
Clinical Settings ◽  
Syndromic Management ◽  
Low Sensitivity

ObjectivePapua New Guinea (PNG) has among the highest estimated prevalences of genitalChlamydia trachomatis(CT),Neisseria gonorrhoeae(NG) andTrichomonas vaginalis(TV) of any country in the Asia-Pacific region. Diagnosis and treatment of these infections have relied on the WHO-endorsed syndromic management strategy that uses clinical presentation without laboratory confirmation to make treatment decisions. We evaluated the performance of this strategy in clinical settings in PNG.DesignWomen attending antenatal (ANC), well woman (WWC) and sexual health (SHC) clinics in four provinces were invited to participate, completed a face-to-face interview and clinical examination, and provided genital specimens for laboratory testing. We estimated the performance characteristics of syndromic diagnoses against combined laboratory diagnoses.Results1764 women were enrolled (ANC=765; WWC=614; SHC=385). The prevalences of CT, NG and TV were highest among women attending ANC and SHC. Among antenatal women, syndromic diagnosis of sexually transmitted infection had low sensitivity (9%–21%) and positive predictive value (PPV) (7%–37%), but high specificity (76%–89%) and moderate negative predictive value (NPV) (55%–86%) for the combined endpoint of laboratory-confirmed CT, NG or TV. Among women attending WWC and SHC, ‘vaginal discharge syndrome’ had moderate to high sensitivity (72%–78%) and NPV (62%–94%), but low specificity (26%–33%) and PPV (8%–38%). ‘Lower abdominal pain syndrome’ had low sensitivity (26%–41%) and PPV (8%–23%) but moderate specificity (66%–68%) and high NPV (74%–93%) among women attending WWC, and moderate-high sensitivity (67%–79%) and NPV (62%–86%) but low specificity (26%–28%) and PPV (14%–33%) among SHC attendees.ConclusionThe performance of syndromic management for the detection and treatment of genital chlamydia, gonorrhoea and trichomonas was poor among women in different clinical settings in PNG. New diagnostic strategies are needed to control these infections and to prevent their adverse health outcomes in PNG and other high-burden countries.

Epididymitis and its aetiologies in a central London sexual health clinic

2020 ◽  
pp. 095646242096387
Author(s):  
Venkateshwaran Sivaraj ◽  
Azraan Ahamed ◽  
Ruslan Artykov ◽  
Anatole Menon-Johansson
Keyword(s):  
Sexual Health ◽  
Trichomonas Vaginalis ◽  
Health Clinic ◽  
Study Cohort ◽  
Scrotal Pain ◽  
Sexually Transmitted ◽  
Health Clinics ◽  
Results Management ◽  
Sexual Health Clinics

Epididymitis is a common cause of scrotal pain presentation in sexual health clinics; however, it is unclear what fraction is attributable to transmissible infections. We, therefore, reviewed the aetiologies causing epididymitis. A retrospective data analysis of all cases of epididymitis diagnosed from January 2018 to December 2018 in three sexual health clinics was conducted, collecting demographics, results, management and symptom resolution at two weeks follow up. A total of 127 cases of epididymitis (mean age 32 years, heterosexual 97, MSM 30) were included. Among them 14 cases (11%) were caused by sexual transmitted infections (<35 years n = 9; >35 years n = 5): seven cases of chlamydia, six gonorrhoea, one syphilis and one trichomonas vaginalis. There were three cases of urinary tract infection diagnosed. All cases were treated with antibiotics recommended by the British Association for Sexual Health and HIV (BASHH). At two weeks follow up post-treatment 10 (7%) were symptomatic; 91% did not attend for follow up. Sexually transmitted infections were associated with acute epididymitis in 11% of this study cohort.

Low yield of anogenital examination among asymptomatic clients of an urban sexual health clinic

Sexual Health ◽  
2011 ◽  
Vol 8 (1) ◽  
pp. 90 ◽  
Author(s):  
Jun Yong Ma ◽  
Nathan Ryder ◽  
Lynne Wray ◽  
Anna McNulty
Keyword(s):  
Sexual Health ◽  
Physical Examination ◽  
Diagnostic Yield ◽  
Health Centre ◽  
Cross Sectional Study ◽  
Health Clinic ◽  
Cross Sectional ◽  
Heterosexual Women ◽  
Sexually Transmissible Infections ◽  
Sexual Health Clinics

Background: The use of self-collected specimens to test for sexually transmissible infections (STI) has reduced the opportunity for physical examination. Physical examination has been found to be of limited value in asymptomatic heterosexual women and men; however, prior studies have excluded higher risk populations. We performed a retrospective cross-sectional study to determine the diagnostic yield of physical examination among all clients attending our sexual health service. Methods: The Sydney Sexual Health Centre database was used to identify asymptomatic clients attending for the first time between January and June 2009. Demographic and behavioural data were extracted from the database for all clients. Medical records were then manually reviewed to determine the number and nature of diagnoses related to the examination and whether this varied by sex and sex of sexual partners. Results: Of the 590 clients included, 450 (76%) received anogenital examinations. Ten (2.2%; 95% confidence interval 1.1–4.1%) STI were found, including four cases of cervicitis, four of anogenital warts and two of molluscum. Nineteen (4.2%) other non-STI conditions were detected, mostly in heterosexual women and men who have sex with men (MSM). Conclusion: Physical examination of asymptomatic clients attending our sexual health clinic was of limited value, even among higher risk individuals such as MSM. Sexual health clinics should direct resources currently used to examine clients towards increasing the STI testing rate.

Triage in a public outpatient sexual health clinic

Sexual Health ◽  
2006 ◽  
Vol 3 (2) ◽  
pp. 87 ◽  
Author(s):  
Vickie Knight ◽  
Anna McNulty
Keyword(s):  
Sexual Health ◽  
Waiting Times ◽  
Health Centre ◽  
Wait Time ◽  
Health Clinic ◽  
Average Wait Time ◽  
Survey Tool ◽  
Time Flow ◽  
Sexually Transmissible Infections ◽  
Nurse Triage

Background:The increasing prevalence of sexually transmissible infections in Australia, coupled with a NSW Health Department requirement to target services to those most in need, has led many services to investigate patient triage as a way of better using scarce resources.2 In October 1997, a Triage Nurse position was trialled that aimed to facilitate the optimal flow of patients through the Sydney Sexual Health Centre (SSHC) clinic in an efficient and patient-focussed manner. A pre and post implementation time-flow study was conducted to analyse the effect. A staff survey was also completed to ascertain staff acceptance of the Nurse Triage system. Methods:A time-flow data survey tool was developed and placed in the medical record of every person attending the SSHC in one month in 1997 and again in 1999. The staff survey was an 11-item likert scale questionnaire administered to all centre staff. Data were analysed and average visit and waiting times were generated. Results:When comparing 1997 with 1999 data, the main results of note were that the length of consultation had been stable or decreased, the average wait time had remained stable or decreased and the wait time in the medical and nursing unbooked clinic had decreased. The average wait time for the unbooked clinic had decreased from ~24 minutes in 1997 to ~12 minutes in 1999. Conclusions:Since the introduction of Nurse Triage, the average overall waiting times for those who attend without an appointment has halved and the wait to see a doctor and a nurse has decreased. The majority of staff felt that the triage process had improved patient flow.

scholarly journals Anorectal swabs as a marker of male-to-male sexual exposure in STI surveillance systems

2017 ◽  
Vol 145 (12) ◽  
pp. 2530-2535 ◽  
Author(s):  
F. H. AMPT ◽  
C. EL HAYEK ◽  
P. A. AGIUS ◽  
A. L. BOWRING ◽  
N. BARTNIK ◽  
...  
Keyword(s):  
Sexual Health ◽  
Predictive Value ◽  
Area Under The Curve ◽  
Risk Behaviour ◽  
Health Clinic ◽  
Surveillance Systems ◽  
Internal Validation ◽  
Sexually Transmitted ◽  
Sex With Men ◽  
Sexual Health Clinics

SUMMARYIdentification of priority populations such as men who have sex with men (MSM) is important in surveillance systems to monitor trends of sexually transmitted infections (STIs). We explored using routinely collected non-behavioural data as a means to establish MSM status in surveillance by assessing anorectal swab as a marker of male-to-male sexual exposure. We used chlamydia testing data from a sexual health clinic, 2007–2012. Men reporting any male sexual partner(s) in the previous 12 months were considered MSM. The dataset was split into development and validation samples to develop a univariate predictive model and assess the model fit. The dataset included 30 358 individual men and 48 554 episodes of STI testing; 45% were among reported MSM and an anorectal swab was performed in 40% of testing episodes. Anorectal swabbing had good diagnostic performance as a marker for MSM status (sensitivity = 87%, specificity = 99%, positive predictive value = 98·6%, negative predictive value = 90·3%). The model showed good fit against the internal validation sample (area under the curve = 0·93). Anorectal swabs are a valid marker of MSM behaviour in surveillance data from sexual health clinics, and they are likely to be particularly useful for monitoring STI trends among MSM with higher risk behaviour.

Papua New Guinea may encounter 'resource curse'

2018 ◽  
Keyword(s):  
Papua New Guinea ◽  
Prime Minister ◽  
Resource Curse ◽  
New Guinea ◽  
Business Environment ◽  
Asia Pacific ◽  
Gdp Growth ◽  
Content Type ◽  
Recent Policy ◽  
Economic Outlook

Subject The economic outlook for Papua New Guinea. Significance Rating agency Moody’s on March 23 shifted Papua New Guinea (PNG) to 'negative watch', a further indication of the economic challenges facing the re-elected Peter O’Neill government as it prepares to host the Asia-Pacific Economic Cooperation (APEC) summit in November this year. PNG in February suffered its largest earthquake for nearly a century in areas surrounding the largest resource projects in the country. Impacts Despite a planned major expansion in LNG production, recent policy decisions suggest a troubled business environment. Reversals in economic policy, combined with the earthquake, will further depress GDP growth. Prime Minister Peter O’Neill is weaving together a large coalition which should cement his position until at least after APEC. Foreign exchange shortages will harm growth and discourage investment, due to fears that firms cannot pay dividends to foreign shareholders.

A retrospective case note review of sex worker attendees at sexual health clinics in the western suburbs of Sydney

Sexual Health ◽  
2010 ◽  
Vol 7 (1) ◽  
pp. 3 ◽  
Author(s):  
Sheena Rajesh Kakar ◽  
Karen Biggs ◽  
Charles Chung ◽  
Shailendra Sawleshwarkar ◽  
Adrian Mindel ◽  
...  
Keyword(s):  
Sexual Health ◽  
Case Note ◽  
Published Data ◽  
Common Symptom ◽  
Care Needs ◽  
Health Clinics ◽  
Sexually Transmissible Infections ◽  
English Speaking ◽  
Sexual Health Clinics ◽  
Case Note Review

Background: Sex workers (SWs) are globally recognised to be at high risk for the acquisition and transmission of sexually transmissible infections (STIs). There is a paucity of published data concerning SWs from the western suburbs of Sydney, with the last published study conducted in 1988. Therefore, we conducted a study to determine the demographics, sexual practices and health care needs of SWs attending Sexual Health Clinics (SHCs) in the region. Methods: Self-identified SWs presenting to SHCs in western Sydney between April 2007 and March 2008 were identified using clinic databases. A case note review was then undertaken. Results: One hundred and eighty-five female SWs were included in the analysis. Ninety-eight (54.5%) were born overseas (predominantly China) and 82 (45.6%) were born in Australia. One hundred and seventeen (68%) were English speaking backgrounds (ESB), while 55 (32%) were from non-English speaking backgrounds (NESB). Seventy-two (38.9%) were symptomatic on attendance, with vaginal discharge the most common symptom. Chlamydia was the most commonly reported STI in the previous 12 months with 28 cases (15.1%). SWs from NESB were significantly more likely to be older, symptomatic, have a hepatitis B diagnosis in the previous year and work more shifts per week, compared with SWs from ESB. SWs born overseas were more likely to be symptomatic than Australian born SWs who, in turn, were more likely to have a hepatitis C diagnosis in the previous year. Conclusion: SWs from NESB would potentially benefit from evidenced-based, culturally and linguistically appropriate interventions and targeted health promotion.

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