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Background: Chlamydia remains the most notified bacterial sexually transmissible infection in Australia with guidelines recommending testing for re-infection at 3 months post treatment. This paper aimed to determine chlamydia retesting and repeat positivity rates within 2–4 months among young women in Australia, and to evaluate what factors increase or decrease the likelihood of retesting. Methods: Chlamydia retesting rates among 16–29-year-old women were analysed from Australian Collaboration for Coordinated Enhanced Sentinel Surveillance of sexually transmissible infection and bloodborne virus (ACCESS) sentinel surveillance data (n = 62 sites). Among women with at least one positive test between 1 January 2018 and 31 August 2022, retesting counts and proportions within 2–4 months were calculated. Logistic regression was performed to assess factors associated with retesting within 2–4 months. Results: Among 8758 women who were positive before 31 August 2022 to allow time for follow up, 1423 (16.2%) were retested within 2–4 months, of whom 179 (12.6%) tested positive. The odds of retesting within 2–4 months were 25% lower if tested in a coronavirus disease 2019 (COVID-9) pandemic year (2020–2022) (aOR = 0.75; 95% CI 0.59–0.95). Among 9140 women with a positive test before 30 November 2022, 397 (4.3%) were retested too early (within 7 days to 1 month) and 81 (20.4%) of those were positive. Conclusions: Chlamydia retesting rates remain low with around a sixth of women retested within 2–4 months in line with guidelines. Re-infection is common with around one in eight retesting positive. An increase in retesting is required to reduce the risk of reproductive complications and onward transmission. Chlamydia remains as the most notified bacterial sexually transmissible infection in Australia and repeat infections can lead to significant reproductive complications, particularly for women. Guidelines recommended retesting at 3 months following a chlamydia diagnosis, but current retesting rates in line with guidelines are low, and re-infections are common. Increased efforts to improve timely retesting can aid in earlier identification, management and reduced risk of disease burden. [ABSTRACT FROM AUTHOR]

The 'Australian Sexually Transmitted Infection (STI) Management Guidelines For Use In Primary Care' (www.sti.guidelines.org.au) provide evidence-based, up-to-date guidance targeted at use in primary care settings. A major review of the guidelines was undertaken in 2020-22. All content was reviewed and updated by a multi-disciplinary group of clinical and non-clinical experts, and assessed for appropriateness of recommendations for key affected populations and organisational and jurisdictional suitability. The guidelines are divided into six main sections: (1) standard asymptomatic check-up; (2) sexual history; (3) contact tracing; (4) STIs and infections associated with sex; (5) STI syndromes; and (6) populations and situations. This paper highlights important aspects of the guidelines and provides the rationale for significant changes made during this major review process. [ABSTRACT FROM AUTHOR]

Background Prevalence of sexually transmissible infections (STIs) has been associated with availability of alcohol. This paper investigates potential associations between prevalent cases of chlamydia in young people in Australia and the availability of alcohol within their local area, defined as postcode of residence. Methods Alcohol availability was determined at the postcode level using liquor licensing data, classified as total number of licences, number of 'take-away' licences and number of licenses by population. Participant data were drawn from a survey targeting Australians aged 16-29years in rural and regional Australia, capturing demographic details including postcode of residence, indicators of sexual behaviour including condom use and chlamydia test results. Mixed-effects logistic regression was used to examine potential associations between first, alcohol availability and chlamydia, and second, between condom use and chlamydia. Results We found little evidence of associations between alcohol availability and chlamydia in either unadjusted or adjusted models. After adjusting for alcohol availability, we observed significant associations between inconsistent condom use and chlamydia prevalence, whether alcohol availability was measured as total number (adjusted odds ratio (AOR) 2.20; 95% confidence interval (CI) 1.20, 3.70), number of take-away licenses (AOR 2.19; 95% CI1.30, 3.69) or licenses per 1000 population (AOR 2.19; 95% CI 1.30, 3.68). Conclusion Little evidence of association between alcohol availability and chlamydia at the postcode level was found. Further research is required to determine appropriate measures of 'local area' and how characteristics thereof may impact on sexual health. [ABSTRACT FROM AUTHOR]

Background Pelvic inflammatory disease (PID) is under-diagnosed globally, particularly in primary care, and if untreated may cause reproductive complications. This paper investigates PID diagnosis by Australian general practitioners (GPs) and barriers to their conducting a pelvic examination.Methods: An online survey investigating Australian GPs' chlamydia management, including PID diagnosis, was conducted in 2019. From 323 respondents, 85.8% (n = 277) answered multiple-choice questions about PID and 74.6% (n = 241) answered a free-text question about barriers to conducting pelvic examinations. Using multivariable logistic regression, we identified factors associated with conducting pelvic examinations. Barriers to performing pelvic examinations were explored using thematic analysis.Results: Most GPs indicated that they routinely ask female patients with a sexually transmissible infection about PID symptoms, including pelvic pain (86.2%), abnormal vaginal discharge (95.3%), abnormal vaginal bleeding (89.5%), and dyspareunia (79.6%). Over half reported routinely conducting speculum (69.0%) and bimanual pelvic (55.3%) examinations for women reporting pelvic pain. Female GPs were more likely to perform speculum [adjusted odds ratio (AOR) 4.6; 95%CI: 2.6-8.2] and bimanual pelvic examinations (AOR 3.7; 95%CI: 2.1-6.5). GPs with additional sexual health training were more likely to routinely perform speculum (AOR 2.2; 95%CI: 1.1-4.2) and bimanual pelvic examinations (AOR 2.1; 95%CI: 1.2-3.7). Barriers to pelvic examinations were patient unwillingness and/or refusal, GP gender, patient health-related factors, time pressures, and GP reluctance.Conclusion: Although GPs typically ask about PID symptoms when managing patients with chlamydia, they are not consistently able or willing to perform pelvic examinations to support a diagnosis, potentially reducing capacity to diagnose PID. [ABSTRACT FROM AUTHOR]

Background In Australia, men who have sex with men (MSM) have high rates sexually transmissible infections (STIs) and sex-on-premises venue (SOPV) patrons are at risk. This paper assesses Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), syphilis and HIV prevalence in men tested at Australian SOPVs and describes testing services.Methods: EMBASE, Medline, PubMed and international conference proceedings were searched for articles reporting on-site SOPV testing between 1 January 2000 and 31 January 2017. Meta-analysis calculated pooled prevalence estimates of STIs by anatomical site.Results: Twelve cross-sectional studies were identified. Most (8/12) were local sexual health clinics (SHC) outreach services. Participants' mean age was 41.1 years (95% confidence interval (CI) 37.0-43.3; range 17 to 84 years). Testing included CT and NG (9/12), HIV (8/12) and syphilis (5/12). CT and NG prevalence overall summary estimates were 3.4% (95% CI 1.9-5.2%, I2 = 88.7%, P < 0.01) and 1.3% (95% CI 0.7-2.2%, I2 = 75.5%, P < 0.01) respectively. CT and NG prevalence was highest in the ano-rectum and oro-pharynx respectively. The HIV and syphilis pooled estimates were 2.3% (95% CI 1.6-2.9%, I2 = 93.1%, P < 0.01) and 3.2% (95% CI 1.8-4.6%, I2 = 72.8%, P < 0.01) respectively. Participation rate varied.Conclusion: This review examines HIV and STI testing in Australian SOPVs before HIV pre-exposure prophylaxis (PrEP). Findings indicate a high prevalence of STIs. PrEP use and resultant condomless sex may influence STI prevalence. Further research is required to determine the effect of PrEP on the STI prevalence among SOPV patrons. [ABSTRACT FROM AUTHOR]

Background: Sydney Sexual Health Centre (SSHC) partnered with a large sex-on-premises venue, South Eastern Sydney Local Health District HIV and Related Programs Unit and AIDS Council of NSW (ACON) to develop and implement a community-based sexually transmissible infection (STI) screening model co-located in a sex-on-premises venue. This paper describes the process, the outcomes and examines the cost of this model. Methods: A retrospective cross-sectional study of gay and bisexual men (GBM) attending a STI testing service co-located in a sex-on-premises venue in Sydney city between the 1 November 2012 and 31 May 2014. Results: A total of 402 patrons had 499 testing episodes in the study period. Testing patrons were a median of 39.5 years of age, 221 (55%) were born overseas, 85 (21%) spoke a language other than English at home and 54 (13%) had a STI at first testing. A total of 105 (26%) testing patrons had never tested for a STI before. Of the 297 (74%) who had been tested before, 83 (21%) had not been tested within the last 12 months. A total of 77 STIs were detected in 63 people over 499 testing episodes, giving a STI positivity rate of 15% in the testing episodes. The prevalence of rectal chlamydia was the highest at 8% followed by pharyngeal gonorrhoea at 3%. A total of 97% of testing patrons were successfully relayed their results via their preferred methods within a median of 7.5 days. Conclusion: This paper highlights that offering STI screening in a community-based setting was an effective and low-cost alternative to traditional testing services. [ABSTRACT FROM AUTHOR]

Background: Patient-delivered partner therapy (PDPT) involves providing a prescription or medication to a patient diagnosed with chlamydia to pass to their sexual partner/s. Barriers to PDPT include uncertainty about its integration into clinical practice and permissibility. In Victoria, Australia, the Department of Health provides clinical guidance for PDPT (updated in 2022). We explored health practitioner views on the usefulness of the updated guidance for providing PDPT. Methods: We conducted an online survey (12 December 2022 to 2 May 2023) of health practitioners who primarily work in Victoria and can prescribe to treat chlamydia. The survey displayed excerpts from the guidance, and asked closed and free-text questions about its ability to address barriers to PDPT. Quantitative data were descriptively analysed, complemented by conventional content analysis of qualitative data. Results: Of a total of 49 respondents (66.7% general practitioners), 74.5% were aware of PDPT, and 66.7% had previously offered PDPT. After viewing excerpts of the guidance, >80% agreed it could support them to identify patients eligible/ineligible for PDPT, and 66.7% indicated they would be comfortable to offer PDPT. The guidance was viewed as helpful to address some barriers, including complicated documentation (87.7%) and medico-legal concerns (66.7%). Qualitative data highlighted medico-legal concerns by a minority of respondents. Some raised concerns that the guidance recommended prescribing azithromycin, despite doxycycline being first-line chlamydia treatment. Conclusions: The guidance was largely viewed as supportive for PDPT decision-making. There is scope for further refinements and clarifications, and wider dissemination of the guidance. Patient-delivered partner therapy (PDPT) involves providing a prescription or medication to a patient with chlamydia to pass to their sexual partner/s, but clinicians have expressed uncertainty about its permissibility and integration into practice. We surveyed clinician perspectives on updated health authority guidance for PDPT; finding they largely viewed it as supportive for PDPT decision-making and addressed some practical barriers. Low awareness of the updated guidance, and medico-legal concerns, for some, highlight scope for further dissemination and clarification of PDPT permissibility. [ABSTRACT FROM AUTHOR]

Background Patient-delivered partner therapy (PDPT) for chlamydia is an effective and safe additional partner management strategy. Some Australian regulatory changes have been made to support PDPT, but implementation guidance is lacking. This paper describes a pilot implementation program of PDPT in New South Wales (NSW), the Australian Development and Operationalisation of Partner Therapy (ADOPT).Methods: ADOPT involved: (1) clarification of the NSW PDPT legal and policy framework; (2) development and implementation of PDPT service models, resources and data collection tools for select publicly funded sexual health services (PFSHS) and Family Planning (FP) NSW clinics; and (3) evaluation of PDPT uptake.Results: PDPT can be undertaken in NSW if accompanied by adequate provider, patient and partner information. Regulatory amendments enabled medication prescribing. The pilot implementation took place in four PFSHS and five FPNSW clinics from January to December 2016. In PFSHS, 30% of eligible patients were offered PDPT and 89% accepted the offer. In FPNSW clinics, 42% of eligible patients were offered PDPT and 63% accepted the offer. Most partners for whom PDPT was accepted were regular partners.Conclusions: A close collaboration of researchers, policy makers and clinicians allowed successful implementation of a PDPT model for chlamydia in heterosexual patients at select PFSHS and FPNSW clinics, providing guidance on its use as standard of care. However, for the full public health benefits of PDPT to be realised, it must be implemented in general practice, where most chlamydia is diagnosed. Further work is recommended to explore feasibility, develop guidelines and promote the integration of PDPT into general practice. [ABSTRACT FROM AUTHOR]

Background: Strengthening sexually transmissible infection (STI) management in general practice is prioritised in Australian STI strategy. Digital interventions incorporating clinical decision support offer a mechanism to assist general practitioners (GPs) in STI care. This study explored clinicians' views towards a proposed digital intervention for supporting STI care in Australian general practice as a first step in the tool's design. Methods: Semi-structured one-to-one interviews were conducted during 2021 with sexual health physicians (n = 2) and GPs (n = 7) practicing in the state of Victoria, Australia. Interviews explored views on a proposed STI digital intervention for general practice. We applied the Theoretical Domains Framework (TDF), a behaviour change framework to our analysis. This involved: (1) directed content analysis of transcripts into TDF domains; and (2) thematic analysis to identify sub-themes within relevant TDF domains. Subthemes were subsequently categorised into enablers and barriers to the use and implementation of a STI computerised clinical decision support system (CDSS). Results: All interviewees viewed a digital intervention for STI care favourably, expressing confidence in its potential to improve care and support management. Within the relevant TDF domains (e.g. environmental context and resources), subthemes emerged as barriers (e.g. lack of sensitivity to patient context) or enablers (e.g. clear communication and guidance) to the use and implementation of a STI CDSS in primary care. Multiple subthemes (e.g. time constraints) have the potential to be a barrier or an enabler, and is largely dependent on end-user needs being met and clinical context being appropriately addressed. Conclusions: A digital intervention incorporating clinical decision support was viewed favourably, indicating a possible role for such a tool in Australian general practice. Co-design with end-users and prototype evaluation with health consumers is recommended to ensure relevance and usefulness. Digital interventions may offer a mechanism to assist general practitioners (GPs) in optimising care for sexually transmissible infections (STIs). We interviewed GPs and sexual health physicians, who viewed the concept of digital intervention for STI care favourably and with potential to improve STI processes, contingent on its design being considerate of the time-pressured general practice environment, the clinician and patient context, and integration of key evidence-based resources. A prototype digital tool for STI care informed by these insights is in development. [ABSTRACT FROM AUTHOR]

Recent studies have provided evidence for the effectiveness of using doxycycline (Doxy-PEP) to prevent bacterial sexually transmissible infections (STI), namely chlamydia, gonorrhoea, and syphilis, among gay, bisexual, and other men who have sex with men who have experienced multiple STIs. However, there remain several unanswered questions around potential adverse outcomes from Doxy-PEP, including the possibility of inducing antimicrobial resistance in STIs and other organisms, and the possibility of disrupting the microbiome of people who choose to use Doxy-PEP. This interim position statement from the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine aims to outline the current evidence for Doxy-PEP, and to highlight potential adverse outcomes, to enable clinicians to conduct evidence-based conversations with patients in Australia and Aotearoa New Zealand who intend to use Doxy-PEP. This interim position statement from the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) outlines evidence for the effectiveness of doxycycline prophylaxis to prevent bacterial sexually transmitted infections (STI), namely syphilis, chlamydia and gonorrhoea, and outlines potential risks of this prevention strategy. This position statement aims to provide clinicians in Australia with the information needed to conduct evidence-based conversations with patients about this STI prevention strategy. [ABSTRACT FROM AUTHOR]

Background: Men who have sex with men (MSM) taking pre-exposure prophylaxis (PrEP) are recommended to have screening for asymptomatic chlamydia and gonorrhoea every 3 months with high rates of asymptomatic chlamydia and gonorrhoea detected. However, there is little evidence about the effectiveness of this screening interval and there is increasing concern about antibiotic consumption and its impact on antimicrobial resistance. There have been calls to reconsider this frequent screening for chlamydia and gonorrhoea. We conducted interviews with MSM to assess their attitudes to 3-monthly chlamydia and gonorrhoea screening. Methods: Individual semi-structured interviews were conducted with MSM living in Victoria, Australia. Participants were aged 20–62 years and had been taking PrEP for at least 6 months. Interviews were audio-recorded and transcribed, and these data were investigated through reflexive thematic analysis. Results: Thirteen interviews were conducted in August 2021. Participants were hesitant about reducing the screening frequency and reported that testing gave them a sense of security. While MSM recognised antimicrobial resistance was a concern, it did not impact their sexual behaviour, with many participants stating they would rather continue to take antibiotics to treat infections rather than adopt preventative measures such as condom use. Positive attitudes towards screening interval changes are more likely when PrEP patients are informed about the risks and benefits of sexual healthcare recommendations. Conclusion: While MSM on PrEP were initially hesitant to changes in screening frequency, changes may be acceptable if transparent communication, presenting the benefits and harms of screening and treatment, was delivered by a trusted healthcare professional. Current sexually transmitted infection (STI) guidelines recommend that men who have sex with men (MSM) taking pre-exposure prophylaxis (PrEP) should be tested every 3 months for chlamydia and gonorrhoea regardless of symptoms. However, these guidelines have not led to a noticeable reduction of gonorrhoea and chlamydia rates and there is increasing concern about antibiotic consumption among this group and its impact on antimicrobial resistance. We interviewed MSM to explore their attitudes to 3-monthly screening and how they would feel about screening less frequently. [ABSTRACT FROM AUTHOR]

This review assessed sexual health and sexually transmitted infection (STI) burden among American Indian/Alaska Native (AI/AN) peoples within the context of current clinical and public health services. We conducted a review of published literature about sexual health and bacterial STIs among AI/AN populations in the United States using Medline (OVID), CINAHL (EbscoHost) and Scopus. Peer-reviewed journals published during 1 January 2005-2 December 2021 were included and supplemented by other publicly available literature. A total of 138 articles from reference lists met inclusion criteria, including 85 peer-review articles and 53 additional references. Results indicate a disproportionate burden of STIs is carried by AI/AN populations compared to non-Hispanic Whites. Risk for STIs in AI/AN people has origins in historical trauma and structural and social determinants of health. STI services are available for AI/AN populations, but many barriers to care exist. Community-based sexual health programming has been successful, but has thus far focused primarily on adolescents and young adults. A myriad of factors contributes to high rates of STIs among AI/AN populations. Longstanding disparities show a clear need to increase the availability of integrated, low-barrier STI prevention and treatment services. Implementation of multi-level (individual, physician, clinic, healthcare organisation, and/or community level), culturally relevant sexual health and STI interventions should be community-based and person-centred, acknowledge social determinants of health, and grounded in deep respect and understanding of AI/AN histories and cultures. [ABSTRACT FROM AUTHOR]

Identifying groups most at risk of sexually transmissible infections (STIs) is important for prioritising screening, targeting prevention strategies and alleviating the burden of STIs. However, identifying those at risk of STIs is complicated by stigma associated with STIs, undisclosed risk behaviour, and the fact that STI epidemics are diversifying beyond traditional risk groups typically characterised by demographics and sexual behaviours alone. In this review, we describe the epidemiology of STIs among traditional and emerging risk groups, particularly in the context of uptake of HIV pre-exposure prophylaxis (PrEP), increasing STI transmission among heterosexual people, and the concentration of STI burden among specific subgroups not readily identifiable by health services. Risk diversification poses significant challenges, not only for risk-based testing, but also for the costs and resources required to reach a broader range of constituents with preventive and health promotion interventions. As drivers of STI risk are not purely behavioural, but relate to relative STI prevalence within sexual networks and access to sexual health care and testing, localised surveillance and research is important in ensuring risk is appropriately understood and addressed within local contexts. Here, we review the evidence on the benefits and harms of risk-guided versus population-based screening for STIs among key populations, discuss the importance of risk-guided interventions in the control of STIs, and explore contemporary approaches to risk determination. [ABSTRACT FROM AUTHOR]

Increased demand for sexual health services (including prevention and treatment) have spurred the development of digital STI/HIV services. Earlier advances in testing technologies opened the door for self-testing and self-sampling approaches, in line with broader self-care strategies. Advances in HIV management mean that many people are living well with HIV and no longer need intensive in-person monitoring, whereas those at-risk of HIV are recommended to have regular asymptomatic STI screening and pre-exposure prophylaxis. This narrative review examines the evidence and implications of digital STI/HIV services, focused on promoting testing, facilitating testing, clinical management and referrals, partner services, and prevention. We have used a prevention and care continuum to structure the review to increase utility to policy as well as practice. Digital STI/HIV services can be interwoven into existing clinical pathways to enhance face-to-face services or standalone digital STI/HIV services. A growing evidence base, including randomised controlled trials and observational studies, should help inform strategies for designing effective digital STI/HIV services. However, most studies to date have focused on high-income countries and people with smartphones, despite a substantial burden of STI/HIV in low- and middle-income countries. There are also important differences between digital STI and HIV services that require careful consideration. We discuss digital STI/HIV service evidence and implications to inform research and programs in this exciting field. [ABSTRACT FROM AUTHOR]

Background: Home-based sampling is a strategy to enhance uptake of sexually transmissible infection (STI) screening. This review aimed to compare the screening uptake levels of home-based self-sampling and clinic-based specimen collection for STIs (chlamydia (Chlamydia trachomatis), gonorrhoea (Neisseria gonorrhoeae) and trichomoniasis) in females aged 14-50 years. Acceptability and effect on specimen quality were determined. Methods: Sixteen electronic databases were searched from inception to September 2012. Randomised controlled trials (RCTs) comparing the uptake levels of home-based self-sampling and clinic-based sampling for chlamydia, gonorrhoea and trichomoniasis in females aged 14-50 years were eligible for inclusion. The risk of bias in the trials was assessed. Risk ratios (RRs) for dichotomous outcomes were meta-analysed. Results: Of 3065 papers, six studies with seven RCTs contributed to the final review. Compared with clinic-based methods, home-based screening increased uptake significantly (P = 0.001-0.05) in five trials and was substantiated in a meta-analysis (RR: 1.55; 95% confidence interval: 1.30-1.85; P = 0.00001) of two trials. In three trials, a significant preference for home-based testing (P = 0.001-0.05) was expressed. No significant difference was observed in specimen quality. Sampling was rated as easy by a significantly higher number of women (P = 0.01) in the clinic group in one trial. Conclusions: The review provides evidence that home-based testing results in greater uptake of STI screening in females (14-50 years) than clinic-based testing without compromising quality in the developed world. Home collection strategies should be added to clinic-based screening programs to enhance uptake. [ABSTRACT FROM AUTHOR]

Transmission of Chlamydia pecorum infection has generally been assumed to be via the urogenital route and in an attempt to confirm this we investigated an in vitro method of Chlamydia infection using naturally infected koala semen to inoculate a cell line and attempt to estimate C. pecorum infectious load. A total of 57% of 122 koala semen samples had low C. pecorum copy number or no burden, while 18% of semen samples contained >10 000 inclusion-forming units/mL, as determined by quantitative polymerase chain reaction. In vitro inoculation of a McCoy cell line resulted in successful infection from 4% of semen samples where C. pecorum burden was >105 inclusion-forming units/mL. Our preliminary study suggests that transmission of C. pecorum infectious dose may be restricted to peak bacterial shedding in semen associated with recent infection. Here, we report venereal transmission of C. pecorum in koala semen is possible; however, we speculate that antimicrobial factors and innate immune function receptors associated with semen may inhibit chlamydial growth. These mechanisms have yet to be reported in marsupial semen. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The Auckland chlamydia pilot project was one of three funded by the Ministry of Health to trial implementation of the 2008 Chlamydia Management Guidelines. Chlamydia is the most commonly notified sexually transmitted infection in New Zealand. AIM: To increase opportunistic testing in under-25-year-olds and to improve documentation of partner notification in primary care. METHODS: A four-month pilot was initiated in Total Healthcare Otara using a nurse-led approach. Laboratory testing data was analysed to assess whether the pilot had any impact on chlamydia testing volumes in the target age-group. Data entered in the practice management system was used to assess follow-up and management of chlamydia cases. RESULTS: During the pilot there was a 300% increase in the number of chlamydiatests in the target age-group from 812 to 2410 and the number of male tests increased by nearly 500%. Twenty-four percent of people tested were positive for chlamydia, with no significant difference in prevalence by ethnicity. The pilot resulted in better documentation of patient follow-up in the patient management system. DISCUSSION: There was a large increase in chlamydia testing during the pilot with a high prevalence found in the population tested. Chlamydia remains an important health problem in New Zealand. The cost benefit of increased chlamydia screening at a population level has yet to be established. [ABSTRACT FROM AUTHOR]

Background Hepatitis B vaccination is recommended for persons with current or past sexually transmitted infections (STI). Our aim is to systematically assess the association of hepatitis B virus (HBV) sero-markers for current or past infection with syphilis, chlamydia, gonorrhoea, or unspecified STIs.Methods: We conducted a systematic review and meta-analysis. PubMed, Embase, and Web of Science from 1982 to 2018 were searched using medical subject headings (MeSH) terms for HBV, STIs and epidemiology. We included studies conducted in Organisation for Economic Cooperation and Development countries or Latin America that permit the calculation of prevalence ratios (PRs) for HBV and STIs and extracted PRs and counts by HBV and STI status.Results: Of 3144 identified studies, 43 met inclusion requirements, yielding 72 PRs. We stratified outcomes by HBV sero-markers [surface antigen (HBsAg), hepatitis B core antibody (anti-HBc), combined], STI pathogen (syphilis, gonorrhoea/chlamydia, unspecified), and STI history (current, past) resulting in 18 potential outcome groups, for which results were available for 14. For the four outcome groups related to HBsAg, PR point estimates ranged from 1.65 to 6.76. For the five outcome groups related to anti-HBc, PRs ranged from 1.30 to 1.82; and for the five outcome groups related to combined HBV markers, PRs ranged from 1.15 to 1.89). The median HBsAg prevalence among people with a current or past STI was 4.17; not all studies reported HBsAg. Study settings and populations varied.Conclusion: This review found evidence of association between HBV infection and current or past STIs. [ABSTRACT FROM AUTHOR]

Online options to request sexually transmissible infections testing are increasingly popular and a free online chlamydia and gonorrhoea urine testing service is available for people living in Queensland, Australia. Data from 3 August 2017 to 31 August 2019 provide information for 1316 reminder calls to young people (aged 16-29 years) to encourage sample submission. The reminder calls generated few additional samples for testing, suggesting young people may have changed their mind about using the service, sought testing elsewhere or were reluctant to talk further about their original decision to request a test online. [ABSTRACT FROM AUTHOR]

Background Individuals diagnosed with a chlamydia infection are advised to notify their sexual partners from the previous 6 months so that they too can get tested and treated as appropriate. Partner notification is an essential component of chlamydia management, helping to prevent ongoing transmission and repeat infection in the index case. However, partner notification can be challenging, particularly in circumstances where a relationship has ended or transmission has occurred beyond the primary relationship.Methods: In this study we use data from 43 semistructured interviews with general practitioners (GPs) and people with a recent diagnosis of chlamydia. The interviews examined experiences of chlamydia case management in the general practice context. Here, we focus specifically on the effect of a chlamydia infection on intimate relationships in the context of the consultation and beyond.?Results: A chlamydia infection can have significant consequences for intimate relationships. Although GPs reported speaking to their patients about the importance of partner notification and participants with a recent chlamydia infection reported notifying their sexual partners, both would appreciate further support to engage in these conversations.Conclusions: Conversations with patients should go beyond simply informing them of the need to notify their sexual partners from the previous 6 months, and should provide information about why partner notification is important and discuss strategies for informing partners, particularly for those in ongoing relationships. Ensuring GPs have the training and support to engage in these conversations with confidence is vital. [ABSTRACT FROM AUTHOR]

Background The advent of fully automated nucleic acid amplification test (NAAT) technology brings new public health opportunities to provide Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) point-of-care testing (POCT) in non-traditional settings.Methods: This pilot study evaluated the integration of the CT/NG Xpert diagnostic assay into an urban peer-led community setting providing HIV and syphilis POCT. A comprehensive protocol of testing, result notification, referral and follow up, managed by peer test facilitators, was undertaken.Results: Over 67 weeks, there were 4523 occasions of CT/NG testing using urine, oropharyngeal and anorectal samples with 25.7% (803) of the 3123 unique participants returning for repeat testing. The prevalence of CT and NG was 9.5% and 5.4% respectively. Where CT and or NG infection was detected, 98.4% (604/614) of participants were successfully notified of detected infection and referred for treatment. Evaluation Survey responses (11.4%, 516/4523) indicated a substantial proportion of respondents (27.1%, 140/516) 'would not have tested anywhere else'. Of note, 17.8% (92/516) of participants reported no previous CT/NG test and an additional 17.8% (92/516) reported testing more than 12 months ago. A total of 95.9% (495/516) of participants 'Strongly agreed' or 'Agreed' to being satisfied with the service.Conclusion: The project successfully demonstrated an acceptable and feasible model for a peer-delivered community-led service to provide targeted molecular CT/NG POCT. This model offers capacity to move beyond the traditional pathology and STI testing services and establish community-led models that build trust and increase testing rates for key populations of epidemiological significance. [ABSTRACT FROM AUTHOR]

Introduction Despite a range of interventions, annual numbers of new diagnoses of HIV infection among men who have sex with men (MSM) in Australia have not declined in recent years. Peer-based sexual health clinics targeting MSM, such as the M Clinic in Perth (WA, Australia), have been put in place to provide safe sex counselling and to increase testing rates among MSM and who are at high risk of HIV infection. The aim of this study was to assess the incidence of HIV, chlamydia and gonorrhoea among men attending the M Clinic.Methods: This was a historical cohort study of repeated M Clinic clients from January 2011 to June 2015 inclusive. Testing and risk factor data from M Clinic client software were used to estimate the incidence of HIV, chlamydia and gonorrhoea and associated factors.Results: The incidence of HIV, chlamydia and gonorrhoea was 1.87, 13.58 and 6.48 per 100 person-years respectively. Older men had a higher incidence of HIV infection but a lower incidence of chlamydia and gonorrhoea than younger men.Conclusions: The HIV incidence was higher than found in similar studies in other Australian sexual health clinics, but the incidence of chlamydia and gonorrhoea was similar. The high HIV incidence among clients of the M Clinic points to the importance of making pre-exposure HIV prophylaxis available to clients of the M Clinic and similar services. [ABSTRACT FROM AUTHOR]

Background: This study aimed to examine trends in chlamydia and gonorrhoea testing and positivity in Aboriginal and non-Aboriginal women of reproductive age.Methods: A cohort of 318002 women, born between 1974 and 1995, residing in Western Australia (WA) was determined from birth registrations and the 2014 electoral roll. This cohort was then probabilistically linked to all records of chlamydia and gonorrhoea nucleic acid amplification tests conducted by two large WA pathology laboratories between 1 January 2001 and 31 December 2013. Trends in chlamydia and gonorrhoea testing and positivity were investigated over time and stratified by Aboriginality and age group.Results: The proportion of women tested annually for chlamydia increased significantly between 2001 and 2013 from 24.5% to 36.6% in Aboriginal and 4.0% to 8.5% in non-Aboriginal women (both P-values <0.001). Concurrent testing was high (>80%) and so patterns of gonorrhoea testing were similar. Chlamydia and gonorrhoea positivity were substantially higher in Aboriginal compared with non-Aboriginal women; age-, region- and year-adjusted incidence rate ratios were 1.52 (95% confidence interval (CI) 1.50-1.69, P<0.001) and 11.80 (95% CI 10.77-12.91, P<0.001) respectively. Chlamydia positivity increased significantly in non-Aboriginal women aged 15-19 peaking in 2011 at 13.3% (95% CI 12.5-14.2%); trends were less consistent among 15-19-year-old Aboriginal women but positivity also peaked in 2011 at 18.5% (95% CI 16.9-20.2%). Gonorrhoea positivity was 9.7% (95% CI 9.3-10.1%), 6.7% (95% CI 6.4-7.0%), 4.7% (4.4-5.0%), and 3.1% (2.8-3.4%) among Aboriginal women aged respectively 15-19, 20-24, 25-29 and ≥30 years, compared with <1% in all age groups in non-Aboriginal women. Over time, gonorrhoea positivity declined in all age groups among Aboriginal and non-Aboriginal women.Conclusion: Between 2001 and 2013 in WA chlamydia and gonorrhoea positivity remained highest in young Aboriginal women despite chlamydia positivity increasing among young non-Aboriginal women. More effective prevention strategies, particularly for young Aboriginal women, are needed to address these disparities. [ABSTRACT FROM AUTHOR]

Background Chlamydia (Chlamydia trachomatis) continues to be a public health challenge in Australia, with some contention as to the best screening approach. In the present study we examined chlamydia testing, positivity and sexual behaviour among women with the aim of informing targeted testing among women aged ≥30 years.Methods: A longitudinal analysis was conducted on retrospective surveillance data collected among women attending general practice, family planning and sexual health clinics participating in sentinel surveillance in Melbourne, Australia. Women were aged ≥16 years and underwent urogenital testing for C. trachomatis (chlamydia) at participating clinics between 2007 and 2014. Chlamydia incidence was calculated as positive chlamydia tests over person-years (PY) among women and reported by 5-year age groups. A Cox regression model examined correlates of a positive chlamydia test among women aged ≥30 years.Results: In all, 36770 women contributed 46432 PY and 52395 chlamydia tests, of which 2895 were positive. The overall chlamydia incidence rate was 6.2 per 100 PY (95% confidence interval (CI) 6.0-6.5). Chlamydia incidence declined with age, plateauing to <5 per 100 PY among women aged ≥30 years. Among women aged ≥30 years, being born in North-East Asia (adjusted hazard ratio (aHR) 2.9; 95% CI 1.9-4.5) and reporting multiple partners (aHR 2.5; 95% CI 1.8-3.5) in the past 12 months were associated with a positive chlamydia test.Conclusions: Chlamydia control remains challenging in Australia and optimising testing in primary care is a key priority. The results of the present study suggest that, at least among women aged ≥30 years, chlamydia testing should be risk-based and informed by appropriate sexual history taking. [ABSTRACT FROM AUTHOR]

Background: In high-incidence Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) settings, annual re-testing is an important public health strategy. Using baseline laboratory data (2009-10) from a cluster randomised trial in 67 remote Aboriginal communities, the extent of re-testing was determined, along with the associated patient, staffing and health centre factors.Methods: Annual testing was defined as re-testing in 9-15 months (guideline recommendation) and a broader time period of 5-15 months following an initial negative CT/NG test. Random effects logistic regression was used to determine factors associated with re-testing.Results: Of 10559 individuals aged ≥16 years with an initial negative CT/NG test (median age=25 years), 20.3% had a re-test in 9-15 months (23.6% females vs 15.4% males, P<0.001) and 35.2% in 5-15 months (40.9% females vs 26.5% males, P<0.001). Factors independently associated with re-testing in 9-15 months in both males and females were: younger age (16-19, 20-24 years); and attending a centre that sees predominantly (>90%) Aboriginal people. Additional factors independently associated with re-testing for females were: being aged 25-29 years, attending a centre that used electronic medical records, and for males, attending a health centre that employed Aboriginal health workers and more male staff.Conclusions: Approximately 20% of people were re-tested within 9-15 months. Re-testing was more common in younger individuals. Findings highlight the importance of recall systems, Aboriginal health workers and male staff to facilitate annual re-testing. Further initiatives may be needed to increase re-testing. [ABSTRACT FROM AUTHOR]

Annual chlamydia testing is recommended for all sexually active Australians aged 15-29 years; however, the testing rate is below recommended levels. Three surveys at a Melbourne music festival were conducted over 2012-14 to identify correlates of sexually transmissible infection (STI) testing among young people at risk of STIs. In total, 3588 participants were recruited; 72% reported having sex in the past year. Based on sexual behaviours, 38% of sexually active participants were classified as at risk of contracting STIs. In the past year, at-risk participants had significantly higher odds of reporting a STI test (37%) than participants classified as not at risk (24%) (OR = 1.9; CI = 1.6-2.3). Among at-risk participants, correlates of STI testing in the past year included being aged 20-24 years, visiting a GP, higher knowledge levels, earlier sexual debut and reporting more than five lifetime partners. Testing rates in our sample did not meet levels required to reduce chlamydia prevalence. However, the testing rate was higher in at-risk participants than participants who were not at risk. Future programs aiming to increase chlamydia testing should improve knowledge and promote the importance of testing after risk exposure, particularly among 16- to 19-year-olds. [ABSTRACT FROM AUTHOR]

Higher notification rates of sexually transmissible infections (STIs) are reported among Aboriginal and Torres Strait Islander (Aboriginal) compared with non-Aboriginal people in Australia. The aim of this study is to estimate the pooled prevalence of chlamydia, gonorrhoea, syphilis and trichomonas among Aboriginal people in Australia by sex, age-group, setting (clinic vs population/community-based) and population group [adults, pregnant females, young people (12-29 years) and prisoners]. The databases Medline, PubMed and Web of Science were searched in May 2015. A meta-analysis was conducted to estimate the pooled prevalence of the four STIs in Aboriginal people and if possible, by gender, age-group, setting and population group. A total of 46 studies were included. The pooled prevalence was 11.2% (95%CI: 9.4-13.0%) for chlamydia (36 studies), 12.5% (95%CI: 10.5-14.6%) for gonorrhoea (28 studies), 16.8% (95%CI: 11.0-22.6%) for syphilis (13 studies) and 22.6% (95%CI: 18.5-26.7%) for trichomonas (11 studies); however, there was significant heterogeneity between studies (I(2) <97.5%, P<0.01). In the subgroup analysis, a higher pooled prevalence occurred in females than males for chlamydia (12.7% vs 7.7%) and gonorrhoea (10.7% vs 8.1%). The prevalence of chlamydia was 12.4% in clinic-based compared with 4.3% in population-based studies. The highest pooled prevalence by population group was among pregnant females (16.8%) and young people (16.2%) for chlamydia, pregnant females (25.2%) for trichomonas; and young people for gonorrhoea (11.9%). This review highlights the need to decrease the prevalence of STIs among Aboriginal people through community-based programs that target asymptomatic young people. [ABSTRACT FROM AUTHOR]

Unlabelled: Background We aimed to determine the impact of a chlamydia (Chlamydia trachomatis) education program on the knowledge of and attitudes towards chlamydia testing of practice nurses (PNs).Methods: A cross-sectional survey was conducted at baseline and 6-12 months following recruitment with PNs in the Australian Chlamydia Control Effectiveness Pilot. Likert scales were analysed as continuous variables (scores), and t-tests were used to assess changes in mean scores between survey rounds and groups.Results: Of the 72 PNs who completed both surveys, 42 received education. Epidemiology knowledge scores increased significantly between surveys in the education group (P<0.01), with change in knowledge being greater in the education group compared with the non-education group (P<0.01). Knowledge of recommended testing scenarios (P=0.01) and retesting following treatment (P<0.01) increased in the education group. Attitudes to testing scores improved over time in the education group (P=0.03), with PNs more likely to want increased involvement in chlamydia testing (P<0.01). Change in overall attitude scores towards testing between surveys was higher in the education group (P=0.05). Barriers to chlamydia testing scores also increased in the education group (P=0.03), with change in barriers greater in the education vs the non-education group (P=0.03).Conclusion: The education program led to improved knowledge and attitudes to chlamydia, and could be made available to PNs working in general practice. Future analyses will determine if the education program plus other initiatives can increase testing rates. [ABSTRACT FROM AUTHOR]