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Background: Chlamydia is one of the most common sexually transmissible infections globally and can lead to reproductive complications, including pelvic inflammatory disease and infertility. Interventions to reduce disease burden, including retesting for reinfection, partner management, and early detection of complications, are the focus of the Management of Chlamydia Cases in Australia (MoCCA) study, an implementation and feasibility trial aiming to strengthen chlamydia management in Australian general practice. This study aimed to identify factors influencing participation in and adoption of a multifaceted chlamydia management intervention within the general practice setting. Methods: We conducted semi-structured interviews with general practice staff (n = 13) from clinics (n = 9) participating in the MoCCA study. Data were analysed using inductive content analysis to identify facilitators and barriers to study participation and intervention adoption. Results: Participants felt that practice champions, motivated staff and interventions that improved workflow efficiency, integrated with existing processes and improved patient interactions, facilitated participation in, and adoption of, study interventions. A perceived lack of staff engagement related to time constraints, competing priorities, staff retention issues and interventions that were less convenient to use or had reduced patient uptake were identified as barriers to participation. Conclusions: Identifying perceived facilitators and barriers to successful implementation of a multifaceted chlamydia intervention enables public health practitioners to better support general practice in the ongoing uptake and use of evidence-based chlamydia management strategies, ultimately aiming to reduce the burden of chlamydia and its complications in Australia. Chlamydia is a common sexually transmissible infection in Australia, and can lead to permanent reproductive complications. Management of Chlamydia Cases in Australia (MoCCA) involves a multifaceted intervention aiming to strengthen the management of chlamydia in general practice. Our findings show that practice champions, motivated staff and useful resources facilitated adoption of interventions, whereas competing priorities, difficulties retaining staff, and a lack of staff and patient engagement hindered adoption. Findings can support general practitioners and reduce burden of disease. [ABSTRACT FROM AUTHOR]

Objective: To examine the impact of COVID-19 lockdown on drug consumption and sexual behaviors, among people living in Australia. Methods: Retrospective data analysis via logistic regression of 806 responses from an online, cross-sectional survey conducted during August 2020 was performed. State was a proxy for lockdown (Victoria = lockdown, other states = no lockdown). Results: Some participants increased drug usage from 2019–2020: 25.0% for alcohol, followed by marijuana (11.0%), other drugs (8.9%), and tobacco (7.0%). Risk factors for increasing use included women who have sex with women (WSW) and unsecure employment; protective factors included being in a relationship. TAFE/Diploma/Certificate level education was a risk factor for tobacco use, but a protective factor for alcohol use. There was a strong association between drug use and high-risk sexual behaviors. Multivariable analysis found no significant difference in patterns of drug use in Victoria (lockdown), relative to other states (without lockdown). Conclusion: Several risk factors for drug use were identified, and high-risk sexual behaviors were associated with drug use. However, given the lack of difference between Victoria and other states, it is unclear if these changes are attributable to lockdown. Further research could explore the nature/causes of these changes, to inform future pandemic preparedness. [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: Sexual health research rarely includes older age groups and the sexual health needs of older Australians are not well understood. Older adults are online in increasing numbers; however, internet surveys involving samples of older adults and sensitive topics remain uncommon. In 2021, we developed an online survey to explore the sexual health needs of Australians aged 60+ years. We describe here survey recruitment and sample obtained, comparing it with national population data (Australian Bureau of Statistics) and the sample of the similar 'Sex, Age and Me' study from 2015. Methods: We recruited 1470 people with a staggered three-phase strategy: (1) emails to organisations and community groups; (2) paid Facebook advertising; and (3) passive recruitment. Half (50.6%) found out about the study via an organisation or group and just over a third (35.7%) from Facebook. Results: The sample was equally balanced between men (49.9%) and women (49.7%) (0.4% other gender identities). Participants were aged 60–92 years (median 69 years) with all Australian States/Territories represented. Facebook recruits were younger, more likely to be working rather than retired, and more likely to live outside a major city, than those recruited by other means. Conclusions: Using the recruitment methods described, we successfully obtained a diverse and fairly representative sample of older Australians within the constraints of a convenience sample and on a modest budget. This research sheds light on ways to engage an under-served demographic in sexual health research. Our experience shows that many older adults are amenable to recruitment for online sexual health surveys using the approaches outlined. Older adults' sexual health is not well understood and older Australians may have unmet sexual health needs. To better address the sexual wellbeing of older adults, we need to be able to effectively recruit them for sensitive health research. This paper outlines the recruitment and sample of the SHAPE2 sexual health study of Australians aged 60 years and over. It demonstrates that sexual health matters to many older adults and that they are willing to engage in online sexual health surveys. [ABSTRACT FROM AUTHOR]

Background: Most sexual health care in Australia is provided through general practice. However, many young Australians experience barriers to accessing sexual health care. This research examines young Australians' receptiveness to discussing sexual health with a general practitioner (GP). Methods: We conducted an anonymous online sexual health survey (open 2 May to 21 June 2022). Anyone living in Australia aged 16–29 years was eligible to participate. Participants were recruited via social media and asked whether they agreed with five statements exploring their receptivity to discussing sexual health with GPs. We explored characteristics associated with responses using multivariable logistic regression. Results: Among 1915 participants, 69.3% were cisgender women, with a median age of 20 years; 48.5% were heterosexual. Approximately one-fifth agreed they might not tell a GP the whole truth about their sexual history, would be worried about confidentiality when discussing their sexual history and would be too embarrassed to see their usual GP if they thought they had a sexually transmitted infection. Over half (55.8%) agreed they would be comfortable with a GP bringing up sexual health in an unrelated consultation, but 39.6% would be nervous to bring up sexual health in case they needed an intimate examination. Multivariate regression identified several characteristics associated with responses. Notably, having a school-based sex education and a usual GP were factors associated with increased receptivity to discussing sexual health. Conclusions: Young Australians were generally open to discussing sexual health with a GP. School-based sex education and GP–patient relationships are key to promoting sexual health among young people. Young Australians are a priority population for sexually transmitted infection control, but experience barriers to discussing their sexual health with GPs. Our large, cross-sectional survey found that young Australians (aged 16–29 years) were generally receptive to discussing their sexual health. Our findings further highlight the important role that a school-based sex education and ongoing relationship with a GP can play in providing sexual health to young people. [ABSTRACT FROM AUTHOR]

Pubic hair grooming (hair removal) has been linked to body image and sexual behaviour and, given the impacts of COVID-19 restrictions on access to sexual partners and beauty salons, we explored these associations. Data derive from a cross-sectional online survey. Participants were aged 18 years or over and in Australia. All genders were included. We explored factors associated with changes to hair removal using logistic regression and analysed free-text responses using content analysis. Of 256 participants, 89 (34.8%) had changed their grooming practices. Multivariable analysis found that female participants had 4.5 times increased odds of changed grooming (95%CI 1.8, 11.0; p = 0.001) compared with males. Individuals who reported 'more' or 'less' oral sex compared with the previous year were more likely to report increased odds of changed grooming (AOR 3.2; 95%CI: 1.4, 7.7; p = 0.009 and AOR: 3.3; 95%CI:1.6, 6.7; p = 0.001, respectively). Most who changed their grooming practices said it had reduced, attributing this to lack of partners, inability to access beauticians, and the mental health effects of the pandemic. For most, this change had no impact on sexual behaviour or body image; however, some spoke of reduced sexual desire and willingness to receive oral sex. Partner expectations influenced whether reduced grooming had negative consequences, and women were more affected than men, highlighting a gendered impact. [ABSTRACT FROM AUTHOR]

Objectives: Patient-delivered partner therapy (PDPT) describes the giving of a prescription or antibiotics by an index case with chlamydia to their sexual partners. PDPT has been associated with higher numbers of partners receiving treatment. In Australia, general practitioners (GPs) previously expressed negative views about PDPT. Health authority guidance for PDPT has since been provided in some areas. We investigated recent use and perceptions of PDPT for chlamydia among GPs in Australia.Methods: In 2019, we conducted an online survey comprising multiple-choice and open-ended questions to investigate GPs' chlamydia management practices, including PDPT. Logistic regression identified factors associated with ever offering PDPT. A directed content analysis of free-text data explored GPs' perceptions towards PDPT.Results: The survey received responses from 323 GPs; 85.8% (n=277) answered PDPT-focused questions, providing 628 free-text comments. Over half (53.4%) reported never offering PDPT, while 36.5% sometimes and 10.1% often offered PDPT. GPs more likely to offer PDPT were aged ≥55 years (adjusted OR (AOR) 2.9, 95% CI 1.4 to 5.8), worked in non-metropolitan areas (AOR 2.5, 95% CI 1.5 to 4.4) and jurisdictions with health authority PDPT guidance (AOR 2.3, 95% CI 1.4 to 3.9). Qualitative data demonstrated that many GPs recognised PDPT's potential to treat harder to engage partners but expressed hesitancy to offer PDPT because they considered partners attending for care as best practice. GPs emphasised a case-by-case approach that considered patient and partner circumstances to determine PDPT suitability. To alleviate medicolegal concerns, many GPs indicated a need for professional and health authority guidance that PDPT is permissible. They also desired practical resources to support its use.Conclusion: GPs appear to accept the place of PDPT as targeted to those who may otherwise not access testing or treatment. Availability of health authority guidance appears to have supported some GPs to incorporate PDPT into their practice. [ABSTRACT FROM AUTHOR]

Introduction: Australia recorded its first case of COVID-19 in late January 2020. On 22P March 2020, amid increasing daily case numbers, the Australian Government implemented lockdown restrictions to help 'flatten the curve'. Our study aimed to understand the impact of lockdown restrictions on sexual and reproductive health. Here we focus on sexual practices.Methods: An online survey was open from the 23PP April 2020 to 11P May 2020. Participants were recruited online via social media and other networks and were asked to report on their sexual practices in 2019 and during lockdown. Logistic regression was used to calculate the difference (diff) (including 95% CIs) in the proportion of sex practices between time periods.Results: Of the 1187 who commenced the survey, 965 (81.3%) completed it. Overall, 70% were female and 66.3% were aged 18-29 years. Most (53.5%) reported less sex during lockdown than in 2019. Compared with 2019, participants were more likely to report sex with a spouse (35.3% vs 41.7%; diff=6.4%; 95% CI 3.6 to 9.2) and less likely to report sex with a girl/boyfriend (45.1% vs 41.8%; diff=-3.3%; 95% CI -7.0 to -0.4) or with casual hook-up (31.4% vs 7.8%; 95% CI -26.9 to -19.8). Solo sex activities increased; 14.6% (123/840) reported using sex toys more often and 26.0% (218/838) reported masturbating more often. Dating app use decreased during lockdown compared with 2019 (42.1% vs 27.3%; diff= -14.8%; 95% CI -17.6 to -11.9). Using dating apps for chatting/texting (89.8% vs 94.5%; diff=4.7%; 95% CI 1.0 to 8.5) and for setting up virtual dates (2.6% vs 17.2%; diff=14.6%; 95% CI 10.1 to 19.2) increased during lockdown.Conclusion: Although significant declines in sexual activity during lockdown were reported, people did not completely stop engaging in sexual activities, highlighting the importance of ensuring availability of normal sexual and reproductive health services during global emergencies. [ABSTRACT FROM AUTHOR]

Background: Sexually transmissible infections (STIs) are common in Australia among young people. Guidelines recommend diagnosing healthcare providers encourage patients to notify sexual partners of an infection when safe to do so. However, there is little research exploring who else young people decide to disclose an STI diagnosis to, and the support they receive after disclosing a diagnosis. Methods: We conducted an anonymous online survey (open 2nd May -- 21st June 2022) of over 2000 young people (aged 16-29 years) living in Australia. We asked participants about their history of an STI diagnosis. Those who had been diagnosed were asked who they had told about their diagnosis, and were also asked in a free-text question about the reaction they received from the person/people they disclosed their diagnosis. Free-text comments were imported into NVivo 12 and analysed using content analysis. Results: A total of 205 (13.2%; 95%CI 11.6-15.0%) people had been diagnosed with an STI. They had a median age of 25 years (IQR: 22-27). Most were cisgender women (66.3%) and a third (33.7%) were heterosexual. Most commonly, participants had been diagnosed with chlamydia (n=109) followed by herpes (n=48), HPV (n=57), and gonorrhoea (n=40). Almost all (94.6%) had disclosed their diagnosis to at least one person, including partners (73.2%), friends (71.7%), and family (30.7%). Free-text comments largely fell into three themes, outlined in Table 1. Most people received non-judgemental, supportive responses to their diagnosis. However, some described negative responses, usually from upset or angry sexual partners. Several respondents described the impact of disclosing a diagnosis. Some discussed the emotional impact on themselves, while others talked about actions taken by themselves or others after the disclosure of a diagnosis. Conclusions: Partner notification is recognised as an important aspect of STI management. However, there is little research that explores where else young people may go for support after being diagnosed with an STI. We found that many young people disclose a diagnosis to partners and friends, and that for the most part, they receive nonjudgemental and supportive reactions. However, it is clear that many still experience stigma and shame when disclosing a diagnosis. [ABSTRACT FROM AUTHOR]

Background: Young people are disproportionately burdened by sexually transmissible infections (STIs), but experience barriers to discussing their sexual health. Most sexual health care, including testing for STIs, is provided by general practitioners (GPs) in Australia. This research examines young Australians' receptiveness to discussing sexual health with a GP. Methods: We conducted an anonymous online survey (open 2nd May -- 21st June 2022) exploring young peoples' sexual health perspectives and experiences of accessing sexual health care. People aged 16-29 years and living in Australia were eligible to participate. The survey asked about several key characteristics, including past sex education and whether participants had a usual GP. We asked whether participants agreed with five statements about discussing their sexual health with a GP ('GP statements', see Figure 1). Multivariate logistic regression explored factors associated with responses to statements. Results: Among 1915 participants, 69.3% were cisgender women, with a median age of 20 years (IQR: 17-24), about half were heterosexual (48.5%), 86.4% had sex education and 66.9% had a usual GP. Responses to GP statements varied by age (p< 0.001) with the youngest the most hesitant about discussing sexual health.(Figure 1) After adjusting for age, participants with a school-based sex education were less hesitant about discussing sexual health; they were less likely to be embarrassed (AOR 0.63, 95%CI 0.43-0.91), lie about sexual history (AOR 0.60, 95%CI 0.43-0.85), worry about confidentiality (AOR 0.52, 95%CI 0.37-0.72), and fear examination (AOR 0.68, 95%CI 0.51-0.91) and more likely to be open to discussing sexual health in a non-sexual health consultation (AOR 1.48, 95%CI 1.11-1.96). People with a usual GP were less likely to worry about confidentiality (AOR 0.66, 95%CI 0.51-0.85) and fear an exam (AOR 0.80, 95%CI 0.64-0.99) and more likely to be open to discussing sexual health issues in a non-sexual health consultation (AOR 1.77, 95%CI 1.44-2.17). Conclusions: Young Australians are mostly open to discussing their sexual health and history with a GP. Having received a school-based sex education and having an existing relationship with a GP were factors associated with increased receptiveness to discussing sexual health, highlighting the importance of GPs for sexual health care. [ABSTRACT FROM AUTHOR]

Background: There has been a recent resurgence of syphilis in Australia, with evidence of increasing heterosexual transmission. Syphilis can have severe health outcomes, particularly for pregnant women. Little is known about young Australians' perceptions and knowledge of syphilis. Methods: Our anonymous online survey (open 2nd May -- 21st June 2022) explored young peoples' sexual health perspectives and experiences of accessing sexual health care. People aged 16-29 years and living in Australia were eligible to participate. We calculated the proportions who were aware, perceived themselves at risk of syphilis, and knew the severity of infection and compared this with the results for chlamydia/gonorrhoea. Multivariable logistic regression assessed characteristics associated with these outcomes. We measured STI knowledge using ten true/false statements (five syphilis, five chlamydia/gonorrhoea) (Figure 1). Results: Among 2018 survey respondents (69.1% cisgender women, 48.9% heterosexual), 91.3% had heard of syphilis compared with 97.2% for chlamydia (p< 0.001) and 93.3% for gonorrhoea (p=0.021). Older (AOR= 2.4, 95%CI 1.4-4.4) and gay/lesbian (AOR= 2.8, 95%CI 1.4-5.3) respondents were more likely to have heard of syphilis, as were those who were non-Aboriginal, sexually active, and with a school-based sex education. Whilst syphilis knowledge was lower than chlamydia/gonorrhoea knowledge (score of 2.1 vs 2.9, p< 0.001) respondents were more likely to perceive syphilis as having serious health impacts (59.7%) compared with chlamydia (36.4%, p< 0.001) and gonorrhoea (42.3%, p< 0.001). Older respondents were more likely (AOR 2.1, 95%CI 1.6-2.8), and gay/lesbian respondents less likely (AOR 0.7, 95%CI 0.6-1.0) to perceive syphilis to have serious health impacts. 5.1% of sexually active respondents considered themselves at high risk of syphilis (5.1%) compared with 12.6% for chlamydia (p< 0.001) and 7.6% for gonorrhoea (p< 0.001). Men (AOR 2.1, 95%CI 1.2- 3.7), gay/lesbian respondents (AOR 2.5, 95%CI 1.3- 4.6), and respondents with multiple sexual partners (AOR 5.3, 95%CI 2.8-9.9) were more likely to consider themselves at high risk of syphilis. Conclusions: Most young Australians are aware of syphilis, but their knowledge is lower than for chlamydia and gonorrhoea. Few have comprehensive knowledge about the infection. In light of rising heterosexual transmission, syphilis health promotion campaigns should expand their focus. [ABSTRACT FROM AUTHOR]