P355 The performance of laboratory-based diagnostic assays to diagnose primary syphilis cases at Western Sydney Sexual Health Centre, 2015–2019

We evaluated the ResistancePlus® MG assay in providing macrolide resistance-guided treatment (RGT) for Mycoplasma genitalium infection at a UK sexual health centre. M. genitalium–positive samples from men with urethritis and women with pelvic inflammatory disease (PID) were tested for macrolide resistance–mediating mutations (MRMMs). MRMM-positive infections were given moxifloxacin 400 mg; otherwise 2 g azithromycin (1 g single dose and then 500 mg OD) was given. Among 57 M. genitalium–positive patients (32 men and 25 women), MRMMs were detected in 41/57 (72% [95% confidence interval (95% CI) 58–83%). Thirty-two of 43 patients given RGT attended for test of cure. Treatment failure rate was significantly lower at 1/32 (3%) than 10/37 (27%) before RGT ( n = 37 [men = 23 and women = 17]; p = 0.008). Treatment failure was lower in male urethritis (0/15 vs. 7/21 p = 0.027) but not in female PID. There was a trend of a shorter time to negative test of cure (TOC) in male urethritis (55.1 [95% 43.7–66.4] vs. 85.1 [95% CI CI 64.1–106.0] days, p = 0.077) but not in female PID. Macrolide resistance is higher than previous UK reports and higher than expected. RGT reduces overall treatment failure and is particularly beneficial in M. genitalium urethritis. Fluoroquinolone resistance will continue to rise with increasing fluoroquinolone use, and RGT is critical to direct appropriate azithromycin use and prevent overuse of moxifloxacin.

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Mycoplasma genitalium: test positivity in syndromic presentations and clinicians’ adherence with treatment guidelines at Sydney Sexual Health Centre

International Journal of STD & AIDS ◽

10.1177/09564624211022583 ◽

2021 ◽

pp. 095646242110225

Author(s):

Calvin Cheung ◽

Christopher Bourne ◽

Rick Varma

Keyword(s):

Decision Making ◽

Antimicrobial Resistance ◽

Sexual Health ◽

Treatment Guidelines ◽

Health Centre ◽

Diagnostic Testing ◽

Mycoplasma Genitalium ◽

Macrolide Resistance ◽

Adherence To Treatment ◽

Real World Data

Mycoplasma genitalium ( M.genitalium) is associated with urethritis, cervicitis, pelvic inflammatory disease, proctitis and epididymitis. Its treatment is complicated by antimicrobial resistance. To assess clinicians’ adherence to M.genitalium diagnostic testing recommendations for syndromic presentations, as well as resistance-guided management of M.genitalium at Sydney Sexual Health Centre, we reviewed patients presenting between August and December 2018. 349/372 (94%) syndromic presentations were tested for M.genitalium with 16% M.genitalium test positivity and 81% macrolide resistance. 16/27 (59%) macrolide-sensitive infections and 65/77 (84%) macrolide-resistant infections received resistance-guided treatment. Tests of cure (TOCs) were unnecessarily ordered for 82% macrolide-sensitive cases, while 88% macrolide-resistant cases were correctly ordered TOCs. Co-existing STIs at the time of macrolide-sensitive ( p = 0.30) or macrolide-resistant M.genitalium ( p = 0.94) diagnosis did not significantly affect adherence to treatment guidelines. This study confirms the expected prevalence of M.genitalium and macrolide resistance in syndromic presentations while our real-world data highlight the decision-making challenges involved with managing M.genitalium, offering insights for further research.

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Use of the Delphi sorting technique to establish a core sexual history

International Journal of STD & AIDS ◽

10.1258/095646206775809114 ◽

2006 ◽

Vol 17 (3) ◽

pp. 170-172 ◽

Cited By ~ 7

Author(s):

Robin Tideman ◽

Marian Pitts ◽

Christopher K Fairley

Keyword(s):

New Zealand ◽

Sexual Health ◽

Delphi Technique ◽

Health Centre ◽

Sexual History ◽

Men And Women ◽

The Core ◽

Current State ◽

Sorting Technique ◽

History Of

The objective of this study was to develop a core sexual history to be used as a supplementary tool to assist sexual health physicians assess new clients attending a sexual health centre. Eight experts in sexual health medicine employed the Delphi technique and sexual history items from a previous study to generate a core sexual history. The core history contained 15 questions for men and women, with three additional specific questions for men and five for women. The current state of the clients' sexual health was explored (rather than a client's history of sexual behaviour) and three months (compared with 12 months and lifetime) came out strongly as the preferred timeframe for asking clients' behavioural questions. This core history may be useful in many clinics in Australia and New Zealand as its development was based on expert clinical experience of respected authorities within the field of sexual health medicine.

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Culture obtained from urethral swab of asymptomatic men who screen positive for Neisseria gonorrhoeae by urine nucleic acid amplification testing

Sexually Transmitted Infections ◽

10.1136/sextrans-2020-054690 ◽

2021 ◽

pp. sextrans-2020-054690

Author(s):

Ayoma Ratnappuli ◽

Melanie Bissessor ◽

Shehara Arumugam ◽

Deborah A Williamson ◽

Eric P F Chow ◽

...

Keyword(s):

Nucleic Acid ◽

Neisseria Gonorrhoeae ◽

Sexual Health ◽

Health Centre ◽

Antibiotic Use ◽

Nucleic Acid Amplification ◽

Return Visit ◽

Nucleic Acid Amplification Testing ◽

Culture Positive ◽

Asymptomatic Men

BackgroundIn a previous study of men attending Melbourne Sexual Health Centre who had Neisseria gonorrhoeae detected by urine Aptima Combo 2 (AC2) testing, 11% were asymptomatic. This study aimed to determine whether N. gonorrhoeae can be cultured from asymptomatic men screening positive for N. gonorrhoeae by nucleic acid amplification testing (NAAT) of urine.MethodsBetween 1 July 2017 and 31 March 2019, all men attending Melbourne Sexual Health Centre were tested for N. gonorrhoeae by AC2 testing of urine whether urethral symptoms were reported or not. NAAT-positive men were recalled and a urethral swab performed for gonococcal culture using modified Thayer-Martin media with determination of minimum inhibitory concentrations (MICs) by agar dilution.ResultsThere were 1001 cases (860 individuals) positive for N. gonorrhoeae by urine AC2: 892 (89%) reported urethral symptoms; 109 (11%) did not. Twenty-five asymptomatic cases were excluded because of antibiotic use at or following screening. Of the remaining 84 asymptomatic men, 41 (49%) had a urethral swab performed a median of 5 days after screening. Twenty-one men had urethral discharge at the return visit, 11 of whom reported the discharge at the return visit. Of the 41 men who were swabbed, 31 (76%; 95% CI 60% to 88%) were culture positive for N. gonorrhoeae. Among the 21 men who subsequently developed discharge, 19 (90%; 95% CI 70% to 99%) were culture positive. Among the 20 men who remained asymptomatic, 12 (60%; 95% CI 36% to 81%) were culture positive. MIC profiles were obtained from all isolates.ConclusionsGonorrhoea was isolated in most but not all asymptomatic men screening positive for N. gonorrhoeae by urine NAAT. Clinicians should consider performing urethral culture in such men to ensure optimal surveillance for antimicrobial resistance. Isolation of N. gonorrhoeae by culture in men without discharge indicates these are true infections with viable organisms.

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

Sexual Health ◽

10.1071/sh18221 ◽

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.

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

Clinical Infectious Diseases ◽

10.1093/cid/ciz802 ◽

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 < .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.

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11. SEX AND SPORT: A COMMUNITY BASED PROJECT OF CHLAMYDIA TESTING AND TREATMENT IN RURAL AND REGIONAL VICTORIA

Sexual Health ◽

10.1071/shv4n4ab11 ◽

2007 ◽

Vol 4 (4) ◽

pp. 288

Author(s):

F. Kong ◽

C. Kyle-Link ◽

J. Hocking ◽

M. Hellard

Keyword(s):

Health Services ◽

Sexual Health ◽

Treatment Program ◽

Health Centre ◽

Community Setting ◽

Sexual Risk Behaviour ◽

Local Health ◽

Community Based ◽

Telephone Consultation ◽

Chlamydia Testing

Chlamydia is the most common notifiable infectious disease in Australia with the number of notifications increasing 92% over the past 5 years. The "Sex and Sport" Project is piloting a community based chlamydia testing and treatment program reaching young people in a specific community setting, sporting clubs. This multifaceted approach utilises health education, population screening and collection of data on risk taking behaviour as the first steps in enhancing health and shaping future service provisions. The project's primary aim is to assess the feasibility of an outreach testing and treatment program. Secondary aims are to measure the prevalence of chlamydia and assess sexual risk behaviour in this population. Strong community collaborations and integration into local health services through the Primary Care Partnerships is important in the project's sustainability; in particular key community members respected by sporting clubs needed to be identified, capacity developed to deliver effective health promotion messages and improve young people's access to sexual health services. Additionally, local knowledge has guided overall program implementation and provides opportunities for capacity building to regionally based services. For example, poor access to sexual health services is being addressed by the participants being able to access services via telephone consultation with Melbourne Sexual Health Centre. Approximately 1000 Victorians aged 16-25 years from the Loddon Mallee region of Victoria will be tested between June and September 2007. This paper will report on the feasibility, challenges and possible solutions in establishing a community based outreach testing and treatment program.

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Men, bodily change and urethritis: a qualitative study

Sexual Health ◽

10.1071/sh04018 ◽

2005 ◽

Vol 2 (1) ◽

pp. 25 ◽

Cited By ~ 3

Author(s):

M. K. Pitts ◽

A. M. A Smith ◽

A. Mischewski ◽

C. Fairley

Keyword(s):

Qualitative Study ◽

Sexual Health ◽

Visual Cues ◽

Health Centre ◽

Urban Setting ◽

Ability To Act ◽

Sexually Transmissible Infection ◽

Transmissible Infection ◽

Visual Changes ◽

The Way

Objectives: To describe how men narrate the process of bodily change as a trigger to presentation for a suspected sexually transmissible infection. Methods: The study was qualitative with 18 men presenting at a specialist sexual health centre in an urban setting. Results: All men gave narratives that included accounts of bodily changes prior to presentation. The nature, severity and persistence of those changes were unrelated to subsequent diagnosis. Men responded particularly to visual changes as cues to action. Conclusions: The men exhibited limited skills in understanding the significance and the specifics of bodily change as they may relate to a sexually transmissible infection. While these men identified a broad range of changes as potentially indicative of a sexually transmissible infection, their ability to act on visceral rather than visual cues appears constrained in that they were less able to respond to the feel of their body than the way that it looked.

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49. SYPHILIS SCREENING PROFILE AT SEXUAL HEALTH CLINIC, ST GEORGE HOSPITAL & SUTHERLAND HOSPITAL

Sexual Health ◽

10.1071/shv4n4ab49 ◽

2007 ◽

Vol 4 (4) ◽

pp. 303

Author(s):

H. Tran ◽

P. Konecny ◽

C. Carmody

Keyword(s):

Sexual Health ◽

Health Centre ◽

Health Clinic ◽

Sexual Health Information ◽

Presenting Symptoms ◽

Information Program ◽

Syphilis Screening ◽

Behavioural Factors ◽

Syphilis Serology

A retrospective analysis was conducted to describe the cases of Syphilis identified and managed at Short Street Centre and The Sutherland Sexual Health Centre, in South Eastern Sydney and Illawarra Area, from January 2000 to June 2007. Syphilis serology is routinely offered as part of an STI screen to new and follow-up patients as appropriate. Information on the diagnoses, demographic and other variables was extracted from the clinical database Sexual Health Information Program (SHIP) and analysed in SPSS v11. Information on age, gender, relationship status, country of birth, presenting symptoms, stage of Syphilis, type of treatment and subsequent RPR levels were confirmed from patient records. An analysis of the relative frequency of the stages of Syphilis from over 130 patients will be presented and their relationship to a number of demographic and behavioural factors.

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Triage in a public outpatient sexual health clinic

Sexual Health ◽

10.1071/sh05046 ◽

2006 ◽

Vol 3 (2) ◽

pp. 87 ◽

Cited By ~ 9

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.

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