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The transition to parenthood is a high-risk time in a person's mental health and requires significant psychological adaptation to incorporate the parental role and creates a unique opportunity for intervention. This period has critical significance for infant development and for the emerging attachment relationship. The aim of this review was to identify and describe the effects of psychological interventions delivered in pregnancy which support the transition to parenthood and prepare parents for early parenting. A search of four key databases for papers published since 2000 identified only 13 eligible publications describing seven interventions. The included interventions involved variable treatment approaches, target outcomes and measures, and while they showed important applications of theoretical knowledge in empirical form, the results were highly mixed and aside from one intervention, were not replicated with a variety of samples over time. There are only a limited number of studies available despite strong theoretical and clinical knowledge which suggests these types of interventions would likely to beneficial and extremely important in preventing significant long-term issues. Significantly more research is needed to determine effective interventions which can be implemented in the antenatal period to prepare first-time parents for parenting and to avoid early relational trauma and attachment difficulties., Author(s): Clare Bellhouse [sup.1] , Louise Newman [sup.1] , Jade E. Bilardi [sup.2] [sup.3] [sup.4] , Meredith Temple-Smith [sup.2] [sup.3] Author Affiliations: (1) grid.1008.9, 0000 0001 2179 088X, Department of [...]

Background: Earlier detection of syphilis is needed to reduce infectiousness and transmission and improve control. PCR for Treponema pallidum is highly sensitive for detecting primary syphilis but in many settings is not widely available or used. The aim of this systematic review was to investigate what proportion of PCR-positive primary syphilis infections are seronegative for syphilis, when serology is performed at clinical presentation for primary syphilis. Methods: We undertook a systematic review to identify studies of patients presenting with primary syphilis where PCR for T. pallidum was performed on the primary syphilis lesion and serology for syphilis on the same occasion. The review was conducted according to the PRISMA checklist. Three databases (Medline, Embase, PubMed) were searched from 1 January 2000 to 27 November 2022. Only studies published in English were included. The search terms used were: 'primary syphilis', 'Treponema pallidum', 'polymerase chain reaction', 'PCR', 'nucleic acid amplification test', 'NAAT'. Medical subject headings (MeSH) were used where possible. Results: Of 2,569 studies identified, 10 studies were included: 2 prospective, 7 retrospective and 1 mixed prospective and retrospective. All studies were conducted in clinical/sexual health settings (Canada, Australia, UK, France, Czechia, Cuba). Across the 10 studies, there were a total of 1084 individuals who had T. pallidum positive primary lesions. This included 867 men: gender was not specified in 2 studies. A total of 1043 individuals with T. pallidum positive primary lesions had serology performed. Among these, 14% (147/1043) (95% CI: 12-16%) were negative by serology, ranging between 4% (4/108) (95% CI 1-9%) and 50% (51/102) (95% CI: 40- 60%). Among studies where the anatomical site of the primary lesion was provided there were a total of 503 anogenital and 8 oral primary lesions that were T. pallidum PCR-positive. Conclusion: Among patients with primary syphilis, a proportion will have PCR-confirmed primary infection when serology is negative. This proportion may vary depending on a number of factors. More widespread availability and appropriate testing with PCR for T. pallidum may improve detection of primary syphilis, resulting in earlier diagnosis. [ABSTRACT FROM AUTHOR]

Background: Syphilis epidemics are worsening in many countries and earlier diagnosis is needed to reduce infectiousness and transmission. Better detection of primary syphilis is needed in primary care settings as this is where many syphilis cases present. The aim of this study was to evaluate whether the use of multiplex PCR testing of anogenital lesions for Treponema pallidum and herpes simplex virus (HSV) in general practice improves the detection of primary syphilis. Methods: Between September and December 2022, multiplex PlexPCR VHS (SpeeDx) testing for T. pallidum and HSV type-1 and -2 was performed on all clinical specimens received from general practitioners across Victoria using the Melbourne Pathology laboratory network if HSV PCR testing of anogenital lesions was requested in a patient aged ≥18, even if T. pallidum PCR was not requested. Multiplex PCR was also performed if testing for other STIs or T. pallidum PCR was requested. Clinics were made aware of this testing via a letter that included a link to an educational video on PCR testing for syphilis. Results: During the period,1,291 multiplex tests were performed, 882 in women and 398 in men, 18 of which were positive for T. pallidum. Of the positive T. pallidum samples, 6/18 (33%) (95%CI: 13-59%) were from patients where the practitioner had requested PCR for HSV but not T. pallidum: 2 female and 4 male. All 6 cases were negative for HSV on PCR. Among the 2 females, both swabs were from genital sites. Among the 4 males, 3 swabs were genital and one anal. Four individuals (2 women, 2 men) resided in more socioeconomically disadvantaged areas known to have higher rates of syphilis in women of reproductive age. Conclusion: Multiplex PCR testing for syphilis and herpes in primary care resulted in the detection of primary syphilis in male and female patients which may have otherwise not been identified. This is likely to have led to earlier diagnosis and treatment, potentially reducing infectiousness and progression of infection. [ABSTRACT FROM AUTHOR]

Project: Implementation of routine syphilis screening in later pregnancy at antenatal services across Victoria, Australia. Issue: Syphilis is increasing among women globally, leading to an increase in congenital syphilis in many countries. Screening for syphilis in later pregnancy could help prevent congenital syphilis but is generally only advised for women identified as being at high risk for infection. However, there are barriers to the identification of risk. This project adopted an implementation science approach to embed syphilis screening into the routine 28-week antenatal clinic visit undertaken by pregnant women across several antenatal services in Victoria with differing health service systems. Results: Data analysis from seven metropolitan and rural antenatal services informed the development of a low-cost implementation package to support practice change, with routine syphilis screening at the 28-week visit. The package comprises four core elements: (1) clinical guidelines recommending routine inclusion of syphilis serology with other blood tests taken for the 28-week visit; (2) automation of pathology ordering that includes syphilis testing with other tests; (3) clinician reminders within clinical records; and (4) training and resources for midwives and obstetricians including an educational video on screening and management for syphilis (Table 1). Use of a hybrid implementation framework identified contextual and behavioural barriers and facilitators that guided the development and integration of these elements to fit within existing clinical workflows and systems, including different systems for pathology ordering and electronic records. The Consolidated Framework for Implementation Research facilitated a deep contextual analysis of the intervention settings, informing tailored implementation strategies. The COM-B model for behaviour change assessed motivation, capability, and opportunity for change, which informed the development of training and resources. Lessons learned: Applying a change in process across varied health service settings required a deep contextual analysis of existing systems, local practices and resources within each setting. Meaningful engagement with clinical staff underpinned by implementation frameworks enabled identification of key elements for implementation that can be tailored according to local conditions. The resulting implementation package could be useful across a variety of healthcare settings to address the preventable epidemic of congenital syphilis. [ABSTRACT FROM AUTHOR]

Background: Miscarriage can result in significant psychological morbidity. Research suggests health professionals play a role in shaping women's experience of miscarriage. Aims: This study explored the views and practices of Australian health professionals in caring for women experiencing miscarriage. Materials and Methods: Twelve health professionals from disciplines including medicine, midwifery and sonography were purposively sampled. Semi‐structured interviews were recorded, transcribed and subjected to thematic analysis. Results: Participants acknowledged miscarriage is often a distressing event associated with feelings of grief and failure. They believed women who conceived through in vitro fertilisation, had experienced multiple miscarriages, or had a pre‐existing mental illness were likely to experience more distress than others. Despite limited training, participants generally felt competent in their abilities to provide emotional support. They viewed their role largely as guilt‐mitigation, which they achieved by stressing the frequency of miscarriage and emphasising that women were not at fault. Follow‐up practices varied, and where they did occur, focused on physical recovery. Generally, participants relied on women to express the need for further support. Participants reported that time and resource issues, compassion fatigue and a need for self‐protection restricted their abilities to provide better support care. Conclusions: There are discrepancies between the emotional support health professionals think women want and are able to provide, and the support women would like. This exploratory study suggests the need for further investigation into provision of improved health professional support for women. [ABSTRACT FROM AUTHOR]

Objective: The aim of this report was to raise the issue of the definition and classification of partner terminology in men who have sex with men (MSM) research, particularly in regards to 'fuck buddies'. If definitions in research differ from general consensus in the MSM population, it is possible that public health strategies will be ineffective as the target population may be inaccurate.Methods: Thirty semistructured interviews with MSM attending the Melbourne Sexual Health Centre were conducted, focusing on the willingness to change sexual practices to reduce the risk of pharyngeal gonorrhoea. As part of these interviews, men were also asked their views on the terminology they used to describe their relationships and sexual partners.Results: The degree of emotional attachment often defined the type or classification of relationships. There was a consensus among men that partners they engaged with for 'sex only' were classified as casual partners and partners with whom there was an emotional attachment or formalisation of the relationship were classified as 'regular partners'. However, the classification of 'fuck buddy' as a regular or casual partner was less clear.Conclusions: Further research is needed to ascertain the ways in which men conceptualise sexual relationships and define or classify partner types, particularly 'fuck buddy' relationships. A third category for sexual relationships should be considered to encapsulate fuck buddy relationships. [ABSTRACT FROM AUTHOR]

Background: Bacterial vaginosis (BV) is estimated to affect 1 in 3 women globally and is associated with obstetric and gynaecological sequelae. Current recommended therapies have good short-term efficacy but 1 in 2 women experience BV recurrence within 6 months of treatment. Evidence of male carriage of BV-organisms suggests that male partners may be reinfecting women with BV-associated bacteria (henceforth referred to as BV-organisms) and impacting on the efficacy of treatment approaches solely directed to women. This trial aims to determine the effect of concurrent male partner treatment for preventing BV recurrence compared to current standard of care.Methods: StepUp is an open-label, multicentre, parallel group randomised controlled trial for women diagnosed with BV and their male partner. Women with clinical-BV defined using current gold standard diagnosis methods (≥3 Amsel criteria and Nugent score (NS) = 4-10) and with a regular male partner will be assessed for eligibility, and couples will then be consented. All women will be prescribed oral metronidazole 400 mg twice daily (BID) for 7 days, or if contraindicated, a 7-day regimen of topical vaginal 2% clindamycin. Couples will be randomised 1:1 to either current standard of care (female treatment only), or female treatment and concurrent male partner treatment (7 days of combined antibiotics - oral metronidazole tablets 400 mg BID and 2% clindamycin cream applied topically to the glans penis and upper shaft [under the foreskin if uncircumcised] BID). Couples will be followed for up to 12 weeks to assess BV status in women, and assess the adherence, tolerability and acceptability of male partner treatment. The primary outcome is BV recurrence defined as ≥3 Amsel criteria and NS = 4-10 within 12 weeks of enrolment. The estimated sample size is 342 couples, to detect a 40% reduction in BV recurrence rates from 40% in the control group to 24% in the intervention group within 12 weeks.Discussion: Current treatments directed solely to women result in unacceptably high rates of BV recurrence. If proven to be effective the findings from this trial will directly inform the development of new treatment strategies to impact on BV recurrence.Trial Registration: The trial was prospectively registered on 12 February 2019 on the Australian and New Zealand Clinical Trial Registry (ACTRN12619000196145, Universal Trial Number: U1111-1228-0106, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376883&isReview=true ). [ABSTRACT FROM AUTHOR]

Background: The risk factors for oropharyngeal gonorrhea have not been examined in sex workers despite the increasing prevalence of gonorrhea infection., Objective: This study aims to determine the risk factors for oropharyngeal gonorrhea in female and gender-diverse sex workers (including cisgender and transgender women, nonbinary and gender fluid sex workers, and those with a different identity) and examine kissing, oral sex, and mouthwash practices with clients., Methods: This mixed methods case-control study was conducted from 2018 to 2020 at 2 sexual health clinics in Melbourne, Victoria, and Sydney, New South Wales, Australia. We recruited 83 sex workers diagnosed with oropharyngeal gonorrhea (cases) and 581 sex workers without (controls). Semistructured interviews with 19 sex workers from Melbourne were conducted., Results: In the case-control study, the median age of 664 sex workers was 30 (IQR 25-36) years. Almost 30% of sex workers (192/664, 28.9%) reported performing condomless fellatio on clients. Performing condomless fellatio with clients was the only behavior associated with oropharyngeal gonorrhea (adjusted odds ratio 3.6, 95% CI 1.7-7.6; P=.001). Most participants (521/664, 78.5%) used mouthwash frequently. In the qualitative study, almost all sex workers reported kissing clients due to demand and generally reported following clients' lead with regard to kissing style and duration. However, they used condoms for fellatio because they considered it a risky practice for contracting sexually transmitted infections, unlike cunnilingus without a dental dam., Conclusions: Our study shows that condomless fellatio is a risk factor for oropharyngeal gonorrhea among sex workers despite most sex workers using condoms with their clients for fellatio. Novel interventions, particularly targeting the oropharynx, will be required for oropharyngeal gonorrhea prevention., (©Tiffany R Phillips, Christopher K Fairley, Kate Maddaford, Anna McNulty, Basil Donovan, Rebecca Guy, Ruthy McIver, Rebecca Wigan, Rick Varma, Jason J Ong, Denton Callander, Gabrielle Skelsey, Mish Pony, Dylan O'Hara, Jade E Bilardi, Eric PF Chow. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 20.05.2024.)