Clinical management of patients presenting following a sexual assault.

BACKGROUND: Sexual assault is a common and distressing occurrence. The medical needs of individuals presenting in the immediate aftermath of an assault may be obvious: addressing injuries and distress and providing the option of a forensic medical exam. However, the initial assessment and response to a disclosure of sexual assault is an important opportunity to address medical, safety and psychosocial concerns. OBJECTIVE: The aim of this article is to discuss the practitioner's response to disclosures of recent sexual assault and the consequent legal, forensic and medical options. In particular, emergency contraception, sexually transmissible infections and management of injuries may be the patient's predominant concerns. Legal concerns, particularly relating to privacy and documentation, are also important in these cases. DISCUSSION: Following a disclosure of recent sexual assault, a general practitioner may be juggling many concerns, both medical and legal. This article addresses some of these concerns and considers a medical response to a distressing situation in a way that minimises further trauma to the patient and the practitioner.

Prevalence of Chlamydia trachomatis infection among 'high risk' young people in New South Wales.

International research on homeless adolescents has found that incidence and prevalence of sexually transmissible infections is relatively high. This study reports on a chlamydia prevalence survey conducted among high-risk young people (14-25 years) in New South Wales. The participants were recruited from youth health centres, which target homeless and high-risk youth. Of 333 clients (42.6% male), 84.1% were sexually active and mean number of sexual partners over the preceding 3 months was 1.4. Among sexually active participants, 24.6% claimed to use condoms always and 25% never. Sixteen of 274 available urine samples tested positive for Chlamydia trachomatis infection. Further research is warranted to better define high-risk groups and clarify the nature of associations between various factors impacting on sexual health. Most importantly, research is now called for into effective strategies for engaging and attracting young people to screening, treatment and contact tracing.

Symptomatic HIV viraemia during a drug holiday: an argument against treatment interruption?

An HIV-positive African woman developed severe constitutional symptoms associated with rebound viraemia during a planned antiretroviral treatment interruption, requiring reinitiation of highly active antiretroviral therapy.

Epidemiology of herpes and HIV co-infection.

Most HIV infections are transmitted sexually, particularly in sub-Saharan Africa and Asia. In this article we review various strands of epidemiological evidence linking herpes simplex virus type 2 (HSV-2) and HIV. This includes a consideration of the similarity of the sexual risk factors and behaviours associated with acquisition of these two infections (younger age at coitarche, higher number of sexual partners, women at greater risk than men, homosexual males at greater risk than heterosexual males, previous sexually transmitted infections (STIs), a greater number of years of sexual activity and contact with female sex workers), studies looking at the prevalence and incidence of these infections in the general population and also in populations at increased risk for HIV acquisition, studies showing that HSV-2 is acquired before HIV and finally that individuals with pre-existing HSV-2 are more likely to acquire HIV and that the prevalence of HSV-2 infection in the general population has a major impact on the sexual transmission of HIV. Cohort and nested case-control studies provided information about pre-existing HSV-2 and HIV acquisition and the relative risk (RR) ratio was 2.1 (95% confidence interval, 1.4-3.2). By using this estimate, it has been calculated that in HSV-2-positive individuals, 52% of sexually transmitted risk can be attributed to HSV-2. In addition, the calculated population-attributable risk percentage (also know as the aetiological fraction) varied with the HSV-2 seroprevalence in the population. In populations where HSV-2 prevalence is 80% or more, almost half of the sexually acquired HIV can be attributed to HSV-2.

Epidemiological, clinical and laboratory aids for the diagnosis of neonatal herpes -- an Australian perspective.

Neonatal herpes is rare in Australia, possibly because of the older average age at pregnancy compared with other developed countries, low herpes simplex virus (HSV)-2 seroprevalence in the general community, low risk of HSV-2 acquisition during pregnancy and relatively high HSV-1 seroprevalence in adults. Guidelines on herpes management in pregnancy have been produced by the Australian Society for Infectious Diseases and endorsed by the Australian College of Obstetricians and Gynaecologists. However, diagnosing and managing neonatal infection remains difficult. Until an effective strategy to prevent neonatal herpes is developed, our efforts should focus on improving early diagnosis of HSV disease in the neonate and developing more effective strategies to reduce early reactivation and long-term morbidity.