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ItemNo Preview AvailableUniversal lymphogranuloma venereum (LGV) testing of rectal chlamydia in men who have sex with men and detection of asymptomatic LGV(BMJ PUBLISHING GROUP, 2022-12)BACKGROUND: Lymphogranuloma venereum (LGV) is caused by Chlamydia trachomatis serovars L1-L3. This study determined the positivity for LGV testing before and after introduction of universal LGV testing of positive rectal Chlamydia trachomatis samples in men who have sex with men (MSM). METHODS: From March 2015 to February 2018, MSM with rectal C. trachomatis were not routinely tested for LGV at the Melbourne Sexual Health Centre unless they had HIV or symptoms of proctitis. From February 2018, universal testing for LGV of all positive rectal C. trachomatis specimens in men over the age of 25 years, regardless of symptoms was undertaken. LGV positivity was defined as the detection of LGV-associated C. trachomatis serovars. RESULTS: There were 3429 and 4020 MSM who tested positive for rectal chlamydia in the selective and universal LGV-testing periods, respectively. Of the total 3027 assessable specimens in both periods, 97 (3.2%; 95% CI 2.6% to 3.9%) specimens tested positive for LGV. LGV positivity in the selective testing period was higher than in the universal testing period (6.6% (33/502) vs 2.5% (64/2525), p<0.001). The proportion of LGV cases that were asymptomatic increased from 15.2% (5/33) in the selective testing period to 34.4% (22/64) in the universal testing period (p=0.045). Of the 70 symptomatic LGV cases symptoms included rectal discharge (71.4%, n=45) and rectal pain (60.0%, n=42). CONCLUSION: Universal LGV testing of all positive rectal chlamydia samples in MSM compared with selective testing led to the detection of asymptomatic rectal LGV, which constituted 34% of rectal LGV cases.
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ItemThe duration and body position during tongue-kissing among heterosexual men and women(FRONTIERS MEDIA SA, 2022-12-22)BACKGROUND: Emerging data suggest tongue-kissing may transmit gonorrhea. We aim to examine the duration or body position of heterosexual men and women during tongue-kissing (henceforth, known as kissing). METHODS: A cross-sectional survey among heterosexual men and women attending the Melbourne Sexual Health Centre in Australia between May 2019 and March 2020 collected data on the duration and body position (i.e., on top of or lying down underneath) of their most recent kissing partner in the past 3 months. Univariable and multivariable linear regressions were performed to examine the association between gender and kissing duration. RESULTS: Of 2,866 individuals, 93.6% (n = 2,683) had at least one kissing partner in the past 3 months, which included 1,342 (50.1%) men and 1,341 (49.9%) women, and 87.2% (n = 2,339) had sex with their opposite-gender kissing partner. The adjusted mean duration of kissing with the most recent opposite-gender kissing partner did not differ between men and women (12.2 vs. 11.5 min, p = 0.170). More men were on top of their most recent opposite-gender kissing partner compared to women (87.9 vs. 82.9%, p < 0.001). Men reported a longer kissing duration than women when they were on top of the opposite-gender kissing partner (8.3 vs. 7.4 min, p = 0.006). More women had same-gender kissing partners than men (9.6 vs. 2.8%, p < 0.001). CONCLUSION: Men spending longer than women on top of their opposite-gender kissing partner suggests a potential alternative explanation for oropharyngeal gonorrhea being seen more commonly in women. Further research should investigate whether body positioning and duration of kissing influence the risk of gonorrhea transmission.
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ItemAccessible health care is critical to the effective control of sexually transmitted infections(CSIRO PUBLISHING, 2022)Bacterial sexually transmitted infections (STIs) are rising relentlessly in virtually every country and among most risk groups. These infections have substantial individual and community consequences and costs. This review summarises the evidence for the effectiveness of different strategies to control STIs and assumes countries have sufficient financial resources to provide accessible health care. Reducing the probability of transmission essentially involves increasing condom use, which is problematic given that condom use is currently falling in most risk groups. Interventions to increase condom use are expensive and hard to sustain. Only a limited number of studies have shown it is possible to reduce the rate of partner change and sustained changes are difficult. In contrast, the provision of accessible health care has a powerful effect on the incidence rate of STIs, with dramatic falls in STIs in virtually all countries following the discovery of antibiotics. More recent studies support the powerful role of accessible health care as a strategy for putting substantial downward pressure on STI rates. Accessible health care has a powerful effect on the incidence of STIs. The professionals who are responsible for funding these services need to appreciate that they are ultimately responsible for the rates of STIs in their communities. In contrast, personal behaviour plays a less powerful role in determining the incidence of STIs and is hard to change and sustain at a population level. The public needs to appreciate that it is the governments they elect and not individuals who are responsible for the rates of STIs in their communities.
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ItemKissing, fellatio, and analingus as risk factors for oropharyngeal gonorrhoea in men who have sex with men: A cross-sectional study(ELSEVIER, 2022-09)BACKGROUND: Our aim was to determine whether exposure to the anatomical sites (oropharynx, penis, or anus) of male partners of men who have sex with men (MSM) were independent risk factors for oropharyngeal gonorrhoea after adjusting for exposures to these sites. METHODS: In this cross-sectional study, we invited MSM who attended the Melbourne Sexual Health Centre (MSHC) in Victoria, Australia between 26-November 2018 and 31-December 2020 to complete a survey of their sexual practices in the past three months. We collected data on the number of male partners with whom men engaged in sexual activities that exposed their oropharynx to their partners' oropharynx (kissing), penis (fellatio), and anus (rimming or analingus). Only men who were aged ≥16 years, tested for oropharyngeal gonorrhoea and did not have indeterminate or invalid results were included in the final analysis. We conducted univariable and multivariable logistic regression analyses to investigate associations between oropharyngeal gonorrhoea and the three exposures to the oropharynx. FINDINGS: The median age of the 2,322 men who completed the survey was 31 years (IQR: 26-40), and 5·2% (n = 120) were diagnosed with oropharyngeal gonorrhoea. Our univariate analysis showed that oropharyngeal gonorrhoea was significantly associated with increasing number of kissing (p trend<0·0001), rimming (p trend<0·0001) and fellatio (p trend<0·0001) partners. After adjusting for all three exposures, oropharyngeal gonorrhoea was associated with increasing number of kissing (p trend =0·014) and rimming partners (p trend = 0·037) but not fellatio (p trend = 0·61). INTERPRETATION: Our data suggest kissing and rimming are important practices in oropharyngeal gonorrhoea transmission in MSM Novel interventions which target the oropharynx are required for gonorrohoea prevention. FUNDING: Australian National Health and Medical Research Council.
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ItemComparison of gastrointestinal side effects from different doses of azithromycin for the treatment of gonorrhoea(OXFORD UNIV PRESS, 2022-06-29)OBJECTIVES: Azithromycin is commonly used to treat Neisseria gonorrhoeae. We compared its gastrointestinal side effects using 1 g single, 2 g single or 2 g split (i.e. 1 g plus 1 g 6-12 h later) dosing, representing our clinic's changing guidelines over the study period. METHODS: We recruited consecutive sexual health clinic patients who received azithromycin (and 500 mg ceftriaxone) for uncomplicated gonorrhoea. Each patient received a text message 48 h after their attendance to complete a questionnaire. RESULTS: Patients received 1 g single (n = 271), 2 g single (218) or 2 g split (105) doses. Vomiting was less common for 1 g versus 2 g single dose [1.1% versus 3.7%; risk difference (RD): -2.6%; 95% CI: -0.2 to -5.4] and 2 g split versus 2 g single dose (0.9% versus 3.7%; RD: -2.8%; 95% CI: -0.3 to -5.8). Nausea was less common for 1 g versus 2 g single dose (13.7% versus 43.1%; RD: -29.5%; 95% CI: -21.7 to -37.2) and 2 g split versus 2 g single dose (16.4% versus 43.1%; RD: -26.8; 95% CI: -17.2 to -36.3). Diarrhoea was less common for 1 g versus 2 g single dose (25.5% versus 50.9%; RD: -25.5%; 95% CI: -17.0 to -33.9) and 2 g split versus 2 g single dose (30.9% versus 50.9%; RD: -20.0; 95% CI: -9.1 to -30.9). Almost all were willing to retake the same dosing for gonorrhoea in the future: 97% for 1 g single; 94% for 2 g single; and 97% for 2 g split dose. CONCLUSIONS: Azithromycin 2 g split dose for gonorrhoea resulted in significantly less vomiting, nausea and diarrhoea than a 2 g single dose.
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ItemModelling the potential role of saliva use during masturbation in the transmission of Neisseria gonorrhoeae at multiple anatomical sites(CSIRO PUBLISHING, 2021)Background Neisseria gonorrhoeae can be cultured from saliva in men with pharyngeal gonorrhoea and could theoretically be transmitted from the pharynx to the urethra when saliva is used as a lubricant for masturbation. In this work, we proposed that saliva use during masturbation may be a potential transmission route of gonorrhoea. Methods We analysed the transmission of Neisseria gonorrhoeae at the oropharynx, urethra and anorectum with mathematical models among men who have sex with men using data from six different studies. Model 1 included transmission routes (oral sex, anal sex, rimming, kissing, and three sequential sex practices). In Model 2, we added saliva use during solo masturbation and mutual masturbation to model 1. Results Model 2 could replicate single site infection at the oropharynx, urethra and anorectum and multi-site infection across six different datasets. However, the calibration of Model 2 was not significantly different from Model 1 across four datasets. Model 2 generated an incidence of gonorrhoea from masturbation of between 5.2% (95% CI: 3.2-10.1) to 10.6% (95% CI: 5.8-17.3) across six data sets. Model 2 also estimated that about one in four cases of urethral gonorrhoea might arise from solo masturbation and mutual masturbation. Conclusions Our models raise the possibility that saliva use during masturbation may play a role in transmitting gonorrhoea. This is an important area to explore because it contributes to the knowledge base about gonorrhoea transmission.
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ItemTrends and differences in sexual practices and sexually transmitted infections in men who have sex with men only (MSMO) and men who have sex with men and women (MSMW): a repeated cross-sectional study in Melbourne, Australia(BMJ PUBLISHING GROUP, 2020)OBJECTIVES: In the 2010s, there has been an increase in sexually transmitted infections (STI) in men who have sex with men (MSM) in Australia, and since 2015 also in urban heterosexuals. Men who have sex with both men and women (MSMW) have characteristics that may differ from both men who have sex with men only (MSMO) and heterosexual men. We aimed to compare the sexual practices and the trends in HIV/STI positivity between MSMO and MSMW. DESIGN: Repeated cross-sectional study. SETTING: A sexual health centre in Melbourne, Australia. PARTICIPANTS: MSM aged 18 years and above who attended the Melbourne Sexual Health Centre for the first time between 2011 and 2018. This includes 12 795 MSMO and 1979 MSMW. PRIMARY OUTCOME MEASURES: Demographic characterics, sexual practices and HIV/STI positivity. RESULTS: Compared with MSMW, MSMO were more likely to practice anal sex and to have condomless receptive anal sex with casual male partners, and less likely to have a current regular relationship. Over the 8-year period, there was an increase in condomless receptive anal sex with casual male partners for both groups (MSMO: from 46.2% to 63.3%, ptrend <0.001; MSMW: from 41.3% to 57.9%, ptrend=0.011). Syphilis positivity increased in MSMO (from 5.5% to 7.9%, ptrend=0.012) and MSMW (from 0.9% to 6.4%, ptrend=0.004) and HIV remained stable. Gonorrhoea increased among MSMO from 2011 to 2014 (from 6.7% to 9.6%, ptrend=0.002), and remained stable from 2015 to 2018. MSMO had higher odds of testing positive for gonorrhoea (adjusted OR (aOR) 1.36, 95% CI 1.13 to 1.64), chlamydia (aOR 1.39, 95% CI 1.16 to 1.67), syphilis (aOR 1.74, 95% CI 1.37 to 2.22) and HIV (aOR 4.60, 95% CI 2.43 to 8.70) than MSMW. CONCLUSIONS: MSMW have overall lower condomless sex and lower HIV/STI positivity. In the last years, changes in sexual practices in MSM have affected both MSMW and MSMO leading to an increased STI risk.
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ItemSexually Transmitted Infection Diagnoses and Access to a Sexual Health Service Before and After the National Lockdown for COVID-19 in Melbourne, Australia(OXFORD UNIV PRESS INC, 2021-01)BACKGROUND: We aimed to examine the impact of lockdown on sexually transmitted infection (STI) diagnoses and access to a public sexual health service during the coronavirus disease 2019 (COVID-19) pandemic in Melbourne, Australia. METHODS: The operating hours of Melbourne Sexual Health Centre (MSHC) remained the same during the lockdown. We examined the number of consultations and STIs at MSHC between January and June 2020 and stratified the data into prelockdown (February 3 to March 22), lockdown (March 23 to May 10), and postlockdown (May 11 to June 28), with 7 weeks in each period. Incidence rate ratios (IRRs) and their 95% confidence intervals (CI) were estimated using Poisson regression models. RESULTS: The total number of consultations dropped from 7818 in prelockdown to 4652 during lockdown (IRR, 0.60; 95% CI, 0.57-0.62) but increased to 5347 in the postlockdown period (IRR, 1.15; 95% CI, 1.11-1.20). There was a 68% reduction in asymptomatic screening during lockdown (IRR, 0.32; 95% CI, 0.30-0.35), but it gradually increased during the postlockdown period (IRR, 1.59; 95% CI, 1.46-1.74). Conditions with milder symptoms showed a marked reduction, including nongonococcal urethritis (IRR, 0.60; 95% CI, 0.51-0.72) and candidiasis (IRR, 0.61; 95% CI, 0.49-0.76), during lockdown compared with prelockdown. STIs with more marked symptoms did not change significantly, including pelvic inflammatory disease (IRR, 0.95; 95% CI, 0.61-1.47) and infectious syphilis (IRR, 1.14; 95% CI, 0.73-1.77). There was no significant change in STI diagnoses during postlockdown compared with lockdown. CONCLUSIONS: The public appeared to be prioritizing their attendance for sexual health services based on the urgency of their clinical conditions. This suggests that the effectiveness of clinical services in detecting, treating, and preventing onward transmission of important symptomatic conditions is being mainly preserved despite large falls in absolute numbers of attendees.
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ItemNo Preview AvailableBrief Report: Changes in PrEP Use, Sexual Practice, and Use of Face Mask During Sex Among MSM During the Second Wave of COVID-19 in Melbourne, Australia(LIPPINCOTT WILLIAMS & WILKINS, 2021-02-01)BACKGROUND: A second wave of COVID-19 began in late June in Victoria, Australia. Stage 3 then Stage 4 restrictions were introduced in July-August. This study aimed to compare the use of pre-exposure prophylaxis (PrEP) and sexual practices among men who have sex with men taking PrEP between May-June (post-first lockdown) and July-August (second lockdown). METHODS: This was an online survey conducted among men who have sex with men who had their PrEP managed at the Melbourne Sexual Health Centre, Australia. A short message service with a link to the survey was sent to 503 PrEP clients who provided consent to receive a short message service from Melbourne Sexual Health Centre in August 2020. RESULTS: Of the 192 participants completed the survey, 153 (80%) did not change how they took PrEP. Of the 136 daily PrEP users, 111 (82%) continued to take daily PrEP, 3 (2%) switched to on-demand PrEP, and 22 (16%) stopped PrEP in July-August. Men generally reported that they had no partners or decreased sexual activities during second lockdown compared with post-first lockdown; the number of casual sex partners (43% decreased vs. 3% increased) and the number of kissing partners (36% decreased vs. 3% increased). Most men reported no chemsex (79%) or group sex (77%) in May-August. 10% (13/127) of men had ever worn face masks during sex in May-August. CONCLUSION: During the second wave of COVID-19 in Victoria, most men did not change the way they used PrEP but the majority had no risks or reduced sexual practices while one in 10 men wore a face mask during sex.
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ItemModelling the contribution that different sexual practices involving the oropharynx and saliva have on Neisseria gonorrhoeae infections at multiple anatomical sites in men who have sex with men(BMJ PUBLISHING GROUP, 2021-05)BACKGROUND: The spectrum of sexual practices that transmit Neisseria gonorrhoeae in men who have sex with men (MSM) is controversial. No studies have modelled potential Neisseria gonorrhoeae transmission when one sexual practice follows another in the same sexual encounter ('sequential sexual practices'). Our aim was to test what sequential practices were necessary to replicate the high proportion of MSM who have more than one anatomical site infected with gonorrhoea ('multisite infection'). METHODS: To test our aim, we developed eight compartmental models. We first used a baseline model (model 1) that included no sequential sexual practices. We then added three possible sequential transmission routes to model 1: (1) oral sex followed by anal sex (or vice versa) (model 2); (2) using saliva as a lubricant for penile-anal sex (model 3) and (3) oral sex followed by oral-anal sex (rimming) or vice versa (model 4). The next four models (models 5-8) used combinations of the three transmission routes. RESULTS: The baseline model could only replicate infection at the single anatomical site and underestimated multisite infection. When we added the three transmission routes to the baseline model, oral sex, followed by anal sex or vice versa, could replicate the prevalence of multisite infection. The other two transmission routes alone or together could not replicate multisite infection without the inclusion of oral sex followed by anal sex or vice versa. CONCLUSIONS: Our gonorrhoea model suggests sexual practices that involve oral followed by anal sex (or vice versa) may be important for explaining the high proportion of multisite infection.