59. PATIENT DELIVERED PARTNER THERAPY FOR CHLAMYDIAL INFECTION: WHAT WOULD BE MISSED?

Sexual Health ◽  
2007 ◽  
Vol 4 (4) ◽  
pp. 307
Author(s):  
A. M. McNulty ◽  
M. F. Teh ◽  
E. F. Freedman
Keyword(s):  
Chlamydial Infection ◽  
Health Centre ◽  
Gonococcal Infection ◽  
Centre Database ◽  
Number Of Sexual Partners ◽  
Associated Conditions ◽  
Sex With Men ◽  
Time Of Presentation ◽  
Missed Opportunity ◽  
Missed Diagnoses

The number of contacts of STIs who are tested and treated is generally low. Patient delivered partner therapy ( PDPT) has been proposed in order to increase the number of sexual partners of the index case that are treated. PDPT does not require the contact to be clinically assessed and tested. We sought to determine whether PDPT for chlamydial infection would result in missed diagnoses of other STIs or of the complications of chlamydial infection. The Sydney Sexual Health Centre database was accessed to identify patients who presented as contacts of chlamydia and chlamydia associated conditions and to determine whether other STIs were diagnosed at the time of presentation. Those who were contacts of more than one bacterial STI or HIV were excluded. In the 3 years from June 2003 to June 2006, 626 individuals presented as contacts of chlamydia, NGU or PID. Of these, 212 (34%) tested positive for Chlamydia trachomatis by PCR. Of the 442 heterosexual patients, 36% had chlamydial infection diagnosed. Of the 184 men who had sex with men (MSM), 29% had chlamydial infection diagnosed. Of the heterosexuals who presented as contacts, 13 were diagnosed with other bacterial STIs or complications of chlamydia. Of these, 2 women and 2 men had gonococcal infection (0.9%), 1 woman had syphilis of unknown duration, 6 women (3%) were diagnosed with PID and 2 men (0.8%) with epididymitis. Of the MSM, 9 (5%), were newly diagnosed with HIV infection, 15 (8%) with gonococcal infection and none with syphilis. PDPT would result in a missed opportunity to diagnose other STIs in MSM. In heterosexuals a small number of cases of PID and epididymitis would be inadequately treated and a small number of gonococcal infections would be missed.

Only recent sexual partners contribute to oropharyngeal gonorrhoea positivity: the number of sexual partners over different time periods as an indicator of gonorrhoea and chlamydia infection duration among men who have sex with men

Sexual Health ◽  
2018 ◽  
Vol 15 (4) ◽  
pp. 342 ◽  
Author(s):  
David Priest ◽  
Tim R. H. Read ◽  
Marcus Y. Chen ◽  
Catriona S. Bradshaw ◽  
Christopher K. Fairley ◽  
...  
Keyword(s):  
Health Centre ◽  
Sexual Partners ◽  
Chlamydia Infection ◽  
Gonococcal Infection ◽  
The Past ◽  
Retrospective Data Analysis ◽  
Number Of Sexual Partners ◽  
Time Periods ◽  
Sex With Men ◽  
Generalised Estimating Equations

Background Mathematical models have demonstrated that the majority of gonococcal transmission is from oropharynx to oropharynx (i.e. kissing) among men who have sex with men (MSM). The aim of this study is to investigate the association between the number of partners within specific time periods and gonorrhoea and chlamydia positivity. Methods: This was a retrospective data analysis of MSM attending the Melbourne Sexual Health Centre between 2007 and 2016. Univariable and multivariable logistic regression analyses, with generalised estimating equations (GEE), were performed to determine if the number of partners within specified time periods was associated with site-specific gonorrhoea and chlamydia positivity. Results: There were 45933 consultations which included 15197 MSM. Oropharyngeal gonorrhoea positivity was associated with the number of partners in the past 3 months, but not the number of partners 4–12 months ago; men who had ≥6 partners in the past 3 months had significantly higher odds of acquiring oropharyngeal gonorrhoea (aOR 1.93; 95% CI 1.61–2.31), but this was not the case for men who had ≥6 partners 4–12 months ago. Anorectal gonorrhoea and chlamydia and urethral chlamydia were associated with the number of partners in both time periods after adjusting for age and condom use. Conclusions: The association of oropharyngeal gonorrhoea with the number of recent partners, but not partners from an earlier period, unlike anorectal gonorrhoea and anorectal and urethral chlamydia, could be explained by a shorter duration of oropharyngeal gonococcal infection. Annual screening for gonorrhoea may be insufficient to materially reduce oropharyngeal prevalence.

scholarly journals Trends and differences in sexual practices and sexually transmitted infections in men who have sex with men only (MSMO) and men who have sex with men and women (MSMW): a repeated cross-sectional study in Melbourne, Australia

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e037608
Author(s):  
Mario Martín-Sánchez ◽  
Richard Case ◽  
Christopher Fairley ◽  
Jane S Hocking ◽  
Catriona Bradshaw ◽  
...  
Keyword(s):  
Health Centre ◽  
Cross Sectional Study ◽  
Sexual Practices ◽  
Sectional Study ◽  
Anal Sex ◽  
Cross Sectional ◽  
Men And Women ◽  
Sexually Transmitted ◽  
Receptive Anal Sex ◽  
Sex With Men

ObjectivesIn the 2010s, there has been an increase in sexually transmitted infections (STI) in men who have sex with men (MSM) in Australia, and since 2015 also in urban heterosexuals. Men who have sex with both men and women (MSMW) have characteristics that may differ from both men who have sex with men only (MSMO) and heterosexual men. We aimed to compare the sexual practices and the trends in HIV/STI positivity between MSMO and MSMW.DesignRepeated cross-sectional study.SettingA sexual health centre in Melbourne, Australia.ParticipantsMSM aged 18 years and above who attended the Melbourne Sexual Health Centre for the first time between 2011 and 2018. This includes 12 795 MSMO and 1979 MSMW.Primary outcome measuresDemographic characterics, sexual practices and HIV/STI positivity.ResultsCompared with MSMW, MSMO were more likely to practice anal sex and to have condomless receptive anal sex with casual male partners, and less likely to have a current regular relationship. Over the 8-year period, there was an increase in condomless receptive anal sex with casual male partners for both groups (MSMO: from 46.2% to 63.3%, ptrend <0.001; MSMW: from 41.3% to 57.9%, ptrend=0.011). Syphilis positivity increased in MSMO (from 5.5% to 7.9%, ptrend=0.012) and MSMW (from 0.9% to 6.4%, ptrend=0.004) and HIV remained stable. Gonorrhoea increased among MSMO from 2011 to 2014 (from 6.7% to 9.6%, ptrend=0.002), and remained stable from 2015 to 2018. MSMO had higher odds of testing positive for gonorrhoea (adjusted OR (aOR) 1.36, 95% CI 1.13 to 1.64), chlamydia (aOR 1.39, 95% CI 1.16 to 1.67), syphilis (aOR 1.74, 95% CI 1.37 to 2.22) and HIV (aOR 4.60, 95% CI 2.43 to 8.70) than MSMW.ConclusionsMSMW have overall lower condomless sex and lower HIV/STI positivity. In the last years, changes in sexual practices in MSM have affected both MSMW and MSMO leading to an increased STI risk.

Comparison of the patterns of chlamydia and gonorrhoea at the oropharynx, anorectum and urethra among men who have sex with men

2021 ◽  
pp. sextrans-2020-054632
Author(s):  
Marjan Tabesh ◽  
Christopher K Fairley ◽  
Jane S Hocking ◽  
Deborah A Williamson ◽  
Lei Zhang ◽  
...  
Keyword(s):  
Health Centre ◽  
Single Site ◽  
Chlamydia Infection ◽  
Similar Proportion ◽  
Anatomical Site ◽  
Site Infection ◽  
Site Specific ◽  
Sexually Transmitted ◽  
Sex With Men ◽  
First Time

ObjectiveChlamydia and gonorrhoea are common sexually transmitted infections that infect the oropharynx, anorectum and urethra in men who have sex with men (MSM). This study aimed to examine the pattern of infection at more than one site (multisite) for chlamydia and gonorrhoea among MSM.MethodsThis was a retrospective study of MSM attending the Melbourne Sexual Health Centre for the first time between 2018 and 2019. We included MSM aged ≥16 years who had tested for Neisseria gonorrhoeae and Chlamydia trachomatis at all three sites (oropharynx, anorectum and urethra). We compared infections that occurred at a single site (termed single-site infection) and those that occurred at more than one site (termed multisite infections).ResultsOf the 3938 men who were tested for chlamydia and gonorrhoea, 498/3938 men (12.6%, 95% CI 11.5% to 13.6%) had chlamydia at any site, of whom 400/498 (80.3%, 95% CI 78.9% to 81.2%) had single-site chlamydia infection, and 98/498 (19.7%, 95% CI 16.2% to 23.1%) had multisite infections. A similar proportion of men had gonorrhoea at any site (447/3938, 11.4%, 95% CI 10.3% to 12.2%), but among these 447 men, single-site infection was less common (256/447, 57.3%, 95% CI 52.6% to 61.7%, p<0.001) and multisite infection (191/447, 42.7%, 95% CI 38.2% to 47.3%, p<0.001) was more common than chlamydia. There were also marked differences by anatomical site. Urethral infection commonly occurred as single sites (75/122, 61.5%, 95% CI 52.8% to 70.1%) for chlamydia but uncommonly occurred for gonorrhoea (12/100, 12.0%, 95% CI 5.6% to 18.3%, p<0.001). In contrast, anorectal infection uncommonly occurred as multisite infection for chlamydia (98/394, 24.9%, 95% CI 20.6% to 29.1%) but was common (184/309, 59.5%, 95% CI 54.0% to 64.9%, p<0.001) for gonorrhoea.ConclusionsThe markedly different pattern of site-specific infection for chlamydia and gonorrhoea infections among the same MSM suggests significant differences in the transmissibility between anatomical sites and the duration of each infection at each site.

Neisseria gonorrhoeae

2020 ◽  
pp. 1025-1032
Author(s):  
Jackie Sherrard ◽  
Magnus Unemo
Keyword(s):  
Neisseria Gonorrhoeae ◽  
Sexual Activity ◽  
Antimicrobial Therapy ◽  
Genital Tract ◽  
Systemic Disease ◽  
Gonococcal Infection ◽  
Gram Negative ◽  
Lower Genital Tract ◽  
Direct Inoculation ◽  
Sex With Men

Neisseria gonorrhoeae is a Gram-negative, intracellular diplococcus that is transmitted by direct inoculation of infected secretion from one mucosa to another. It primarily colonizes the columnar epithelium of lower genital tract, only occasionally spreading to the upper genital tract or causing systemic disease. Oropharyngeal and rectal infections are common in men who have sex with men but also occur in women. N. gonorrhoeae is almost exclusively transmitted by sexual activity. Oropharyngeal and rectal infections usually produce no symptoms; disseminated gonococcal infection is a comparatively benign bacteraemia affecting joints (particularly shoulder and knee) and skin; traditionally more common in women than men. The gonococcus has adapted rapidly to prevalent antimicrobial usage, leading to resistance to all antibiotics used for treatment, notably penicillins, fluoroquinolones, macrolides, tetracycline, and cephalosporins. This development has resulted in major concerns internationally and the introduction of international and national action/response plans as well as dual antimicrobial therapy.

Prevalence of rectal Mycoplasma genitalium and macrolide resistance in men who have sex with men attending Sydney Sexual Health Centre

Sexual Health ◽  
2020 ◽  
Vol 17 (2) ◽  
pp. 114
Author(s):  
Isabella Bradley ◽  
Rick Varma ◽  
Vickie Knight ◽  
Dimitra Iliakis ◽  
Leon McNally ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Sexual Health ◽  
Rectal Swab ◽  
Health Centre ◽  
Mycoplasma Genitalium ◽  
Macrolide Resistance ◽  
Cross Sectional ◽  
Screening Guidelines ◽  
Sexually Transmissible Infections ◽  
Sex With Men

Background Sexually transmissible infections (STIs) have been increasing in men who have sex with men (MSM) in recent years; however, few studies have investigated the prevalence or antimicrobial resistance in rectal Mycoplasma genitalium in this group. This study aimed to determine the prevalence and predictors of rectal M. genitalium in MSM attending an urban sexual health service in Sydney, Australia, namely the Sydney Sexual Health Centre (SSHC), as well as estimate the rate of macrolide resistance. Methods: A prospective cross-sectional analysis was conducted of rectally asymptomatic MSM having a rectal swab collected as part of their routine care. Participants self-collected a rectal swab to be tested for M. genitalium and completed a 14-item questionnaire that provided information on behavioural risk factors. The prevalence of rectal M. genitalium was determined and multivariate analysis was performed to assess the associations for this infection. Positive specimens then underwent testing for macrolide-resistant mutations (MRMs) using the ResistancePlus MG assay (SpeeDx, Eveleigh, NSW, Australia). Results: In all, 742 patients were consecutively enrolled in the study. The median age was 31 years (interquartile range 27–39 years), with 43.0% born in Australia. Overall, 19.0% of men were bisexual, 22.9% were taking pre-exposure prophylaxis (PrEP) and 4.3% were HIV positive. The prevalence of rectal M. genitalium was 7.0% (95% confidence interval (CI) 5.3–9.1) overall and 11.8% in those taking PrEP. On multivariate analysis, PrEP use was significantly associated with having rectal M. genitalium (odds ratio 2.01; 95% CI 1.09–3.73; P = 0.01). MRMs were detected in 75.0% (36/48; 95% CI 60.4–86.4%) of infections. Conclusion: Rates of rectal M. genitalium infection were high among asymptomatic MSM attending SSHC and MRMs were detected in 75% of infections. PrEP use was found to be significantly associated with rectal M. genitalium infection. These data contribute to the evidence base for screening guidelines in MSM.

Getting to the Bottom of It: Sexual Positioning and Stage of Syphilis at Diagnosis, and Implications for Syphilis Screening

2019 ◽  
Vol 71 (2) ◽  
pp. 318-322
Author(s):  
Vincent J Cornelisse ◽  
Eric P F Chow ◽  
Rosie L Latimer ◽  
Janet Towns ◽  
Marcus Chen ◽  
...  
Keyword(s):  
Health Centre ◽  
Anal Intercourse ◽  
Human Immunodeficiency Virus Status ◽  
Secondary Syphilis ◽  
Multivariable Logistic Regression Analysis ◽  
Computer Assisted ◽  
Receptive Anal Intercourse ◽  
Primary Stage ◽  
Primary Syphilis ◽  
Sex With Men

Abstract Background Syphilis control among men who have sex with men (MSM) would be improved if we could increase the proportion of cases who present for treatment at the primary stage rather than at a later stage, as this would reduce their duration of infectivity. We hypothesized that MSM who practiced receptive anal intercourse were more likely to present with secondary syphilis, compared to MSM who did not practice receptive anal intercourse. Methods In this retrospective analysis of MSM diagnosed with primary or secondary syphilis at Melbourne Sexual Health Centre between 2008 and 2017, we analyzed associations between the stage of syphilis (primary vs secondary) and behavioral data collected by computer-assisted self-interviews. Results There were 559 MSM diagnosed with primary (n = 338) or secondary (n = 221) syphilis. Of these, 134 (24%) men reported not practicing receptive anal sex. In multivariable logistic regression analysis, MSM were more likely to present with secondary rather than primary syphilis if they reported practicing receptive anal intercourse (adjusted odds ratio 3.90; P &lt; .001) after adjusting for age, human immunodeficiency virus status, and condom use. MSM with primary syphilis who did not practice receptive anal intercourse almost always (92%) had their primary syphilis lesion on their penis. Conclusions The finding that MSM who practiced receptive anal intercourse more commonly presented with secondary syphilis—and hence, had undetected syphilis during the primary stage—implies that anorectal syphilis chancres are less noticeable than penile chancres. These men may need additional strategies to improve early detection of anorectal chancres, to reduce their duration of infectivity and, hence, reduce onward transmission. Men who practiced receptive anal intercourse (AI) were more likely to present with secondary syphilis, compared to men who exclusively practiced insertive AI. Hence, men who practice receptive AI may need additional strategies to detect anal chancres, to reduce transmission.

scholarly journals Duration of gargling and rinsing among frequent mouthwash users: a cross-sectional study

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e040754 ◽  
Author(s):  
Tiffany Renee Phillips ◽  
Christopher Fairley ◽  
Kate Maddaford ◽  
Sabrina Trumpour ◽  
Rebecca Wigan ◽  
...  
Keyword(s):  
Sex Workers ◽  
Health Centre ◽  
Randomised Trial ◽  
Total Duration ◽  
Cross Sectional Study ◽  
Secondary Outcome ◽  
Sectional Study ◽  
Cross Sectional ◽  
Patient Groups ◽  
Sex With Men

ObjectiveTo examine the rinsing and gargling mouthwash practices among frequent mouthwash users to determine if there are differences in use between gender, sexual orientation and sex work status.DesignCross-sectional study.SettingData obtained from patients attending a sexual health centre located in Melbourne, Australia.Participants200 frequent mouthwash users (four or more times per week), 50 for each of the following patient groups: men who have sex with men (MSM), female sex workers (FSW), females who are not sex workers and men who have sex with women only (MSW). Participants were observed and audio recorded using mouthwash.Primary and secondary outcome measuresDescriptive analyses were conducted to calculate the median age, time rinsing and gargling, amount of mouthwash used and proportion of participants who rinsed, gargled or both, as determined from the audio files. Kruskal-Wallis H test and χ2 test were used to examine differences between the patient groups.ResultsMedian age was 28 years (IQR: 24–33). During the study, most (n=127; 63.5%) rinsed and gargled, but 70 (35.0%) rinsed only and three (1.5%) gargled only. Median time rinsing was 13.5 s (IQR: 8.5–22.0 s), gargling was 4.0 s (IQR: 2.5–6.0 s) and the median total duration was 17.0 s (IQR: 11.5–25.8 s). Median duration of mouthwash did not differ significantly between the groups (females not sex workers: 18.8 s (IQR: 12.5–24.5 s); FSW: 14.0 s (9.0–22.0 s); MSM: 22.3 s (13.0–26.5 s); MSW: 15.8 s (12.0–25.0 s); p=0.070) but males used mouthwash longer than females (median 20.3 s compared with 15.5 s; p=0.034). The median volume of mouthwash used was 20 mL (IQR: 15–27 mL). And most (n=198; 99.0%) did not dilute mouthwash with water.ConclusionOver a quarter of frequent users do not gargle mouthwash at all (35%) and used it for a substantially shorter period of time than it was used in the randomised trial (1 min) where it was shown to be effective at inhibiting Neisseria gonorrhoeae growth. Our findings suggest that many frequent mouthwash users do not follow the manufacturer instructions for using mouthwash and may not use mouthwash in a way that was shown to reduce the growth of oropharyngeal gonorrhoea.

Sites in the oropharynx reached by different methods of using mouthwash: clinical implication for oropharyngeal gonorrhoea prevention

2019 ◽  
Vol 96 (5) ◽  
pp. 358-360 ◽  
Author(s):  
Kate Maddaford ◽  
Christopher K Fairley ◽  
Sabrina Trumpour ◽  
Mark Chung ◽  
Eric P F Chow
Keyword(s):  
Soft Palate ◽  
Clinical Implication ◽  
Health Centre ◽  
Posterior Pharyngeal Wall ◽  
Pharyngeal Wall ◽  
Oral Rinse ◽  
Food Dye ◽  
The Mean ◽  
Application Methods ◽  
Sex With Men

ObjectivesOropharyngeal gonorrhoea is increasing among men who have sex with men and is commonly found in the tonsils and at the posterior pharyngeal wall. To address this rise, investigators are currently trialling mouthwash to prevent oropharyngeal gonorrhoea. We aimed to determine which parts of the oropharynx were reached by different methods of mouthwash use (oral rinse, oral gargle and oral spray).MethodsTwenty staff at Melbourne Sexual Health Centre participated in the study from March to May 2018. Participants were asked to use mouthwash mixed with food dye, by three application methods on three separate days: oral rinse (15 s and 60 s), oral gargle (15 s and 60 s) and oral spray (10 and 20 times). Photographs were taken after using each method. Three authors assessed the photographs of seven anatomical areas (tongue base, soft palate, uvula, anterior tonsillar pillar, posterior tonsillar pillar, tonsil, posterior pharyngeal wall) independently and scored the dye coverage from 0% to 100%. Scores were then averaged.ResultsThe mean coverage at the sites ranged from 2 to 100. At the posterior pharyngeal wall, spraying 10 times had the highest mean coverage (29%) and was higher than a 15 s rinse (2%, p=0.001) or a 15 s gargle (8%, p=0.016). At the tonsils, there was no difference in mean coverage between spray and gargle at any dosage, but spraying 20 times had a higher mean coverage than a 15 s rinse (42% vs 12%, p=0.012).ConclusionOverall, spray is more effective at reaching the tonsils and posterior pharyngeal wall compared with rinse and gargle. If mouthwash is effective in preventing oropharyngeal gonorrhoea, application methods that have greater coverage may be more efficacious.

Introduction of screening guidelines for men who have sex with men at an STD clinic, the Melbourne Sexual Health Centre, Australia

Sexual Health ◽  
2005 ◽  
Vol 2 (4) ◽  
pp. 241 ◽  
Author(s):  
Nichole A. Lister ◽  
Anthony Smith ◽  
Christopher K. Fairley
Keyword(s):  
Sexual Health ◽  
Health Centre ◽  
Health Clinic ◽  
Chlamydia Screening ◽  
Screening Guidelines ◽  
Computer Reminder ◽  
Sex With Men ◽  
New Guidelines ◽  
One Year ◽  
The Impact

Background: A recent audit indicated that a substantial proportion of men who have sex with men (MSM) were not screened for rectal gonorrhoea and chlamydia at the Melbourne Sexual Health Clinic, Melbourne, Australia. In response, screening guidelines for MSM were introduced at the clinic using a computer reminder. The aim of this study was to evaluate the impact of the guidelines and alert on screening MSM for gonorrhoea and chlamydia. Methods: The medical records of MSM were reviewed for gonorrhoea and chlamydia screening by site (pharyngeal, urethral and rectal), four months before the implementation of the guidelines and alert (July to October 2002), and one year thereafter (beginning November 2002). Results: After the introduction of the guidelines there was a significant increase in rectal chlamydia testing (55% to 67%, P < 0.001), and significant reduction in pharyngeal chlamydia and gonorrhoea testing (65% to 28%, P < 0.001, and 83% to 76%, P = 0.015 respectively). The proportion of tests that were positive by any site did not change (7% to 7%). Conclusions: The introduction of a computer reminder for new guidelines was temporally associated with screening that conformed more closely to clinical guidelines.

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