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Objectives: To describe the key elements of a comprehensive sexual health program implemented between 2002 and 2005 in remote Indigenous communities on the Tiwi Islands and to assess its effectiveness in reducing rates of bacterial sexually transmitted infections (STIs). Methods: A descriptive study using STI notification and laboratory testing data to analyse the occurrence of STI diagnoses over time compared to nearby similar regions. Results: Over the four years' of program implementation, the numbers of tests and individuals tested increased substantially and were sustained. The notification rate of chlamydia decreased from 1,581.3 to 80.0 per 100,000, that of gonorrhoea from 2,919.2 to 1,159.7 and that of syphilis from 1,743.4 to 200.0, representing a decrease of 94.9%, 60.2% and 88.5%, respectively. No similar trends in notification rates were observed in nearby regions. During the same time, the positivity rate (the number of positive tests divided by the total number of tests) of nucleic acid tests for gonorrhoea decreased from 5.9% (56/952) to 3.9% (39/1,004), and that for chlamydia decreased from 5.2% (38/1,003) to 0.3% (3/1,007), representing a decrease of 33.9% and 94.2%, respectively. Conclusion and implications: The Tiwi Sexual Health Program was accompanied by a significant reduction in STI rates between 2002 and 2005. This model of a comprehensive sexual health program with a dedicated co-ordinator located within a Primary Health Care service can be recommended as an effective approach to address high rates of STIs in remote Indigenous community settings. Key words: Indigenous, remote, sexually transmitted infection, sexual health program, laboratory testing data

To evaluate a leucocyte esterase test as a predictor of gonorrhoea or chlamydia in asymptomatic Aboriginal males at the Central Australian Aboriginal Congress Male Clinic (Ingkintja), first-void urine samples and clinical information were collected from consecutive asymptomatic males presenting to the Ingkintja in Alice Springs between March 2008 and December 2009. Urine was tested immediately with a leucocyte esterase test dipstick and then by polymerase chain reaction for gonorrhoea and chlamydia. Among the 292 specimens from asymptomatic males, 15.4% were positive for gonorrhoea or chlamydia. In this group, compared with polymerase chain reaction result for gonorrhoea or chlamydia, leucocyte esterase test alone and in combination with age ≤35 years showed sensitivities of 66.7% and 60%, specificities of 90.7% and 94.7%, positive predictive values of 56.6% and 67.5%, negative predictive values of 93.7% and 92.8% and the area under receiver operating characteristics curve values of 0.79 and 0.85, respectively. Leucocyte esterase tests can reasonably be used as a basis for immediate empirical treatment for gonorrhoea or chlamydia in asymptomatic central Australian Aboriginal men under 35 years of age. [ABSTRACT FROM PUBLISHER]

Objectives Systematic review of the performance and operational characteristics of point-of-care (POC) tests for the diagnosis of Neisseria gonorrhoeae. Methods We searched PubMed and Embase until August 2010 using variations of the terms: 'rapid test', 'Neisseria gonorrhoeae' and 'evaluation. Results We identified 100 papers, 14 studies were included; nine evaluated leucocyte esterase (LE) dipsticks and three immunochromatographic strips, and two clinical audits of microscopy were identified. Of the field evaluations the gold standard was nucleic acid amplification technology in six studies and bacterial culture in the other six. In four studies, 50% or more of the patients were symptomatic. The median sensitivity of - LE dipsticks was 71% (range 23 85%), median specificity was 70% (33-99%), median positive predictive value (PPV) was 19% (5-40%) and median negative predictive value (NPV) was 95% (56-99%). One LE study found a sensitivity of 23% overall, increasing to 75% in symptomatic women. LE dipsticks mostly involved three steps and took under 2 min. The median sensitivity of immunochromatographic tests (ICT) was 70% (60-94%), median specificity was 96% (89-97%), median PPV was 56% (55-97%) and median NPV was 93% (92-99%). Immunochromatic strips involved five to seven steps and took 15-30 min. Specificity of microscopy ranged from 38% to 89%. Conclusions ICT and LE tests had similar sensitivities, but sensitivity results may be overestimated as largely symptomatic patients were included in some studies. ICT had a higher specificity in women than LE tests. The findings highlight the need for improved POC tests for diagnosis of N gonorrhoeae and more standardised evaluations. [ABSTRACT FROM AUTHOR]