How is cervical cancer screening discussed with clients at a sexual health clinic in Melbourne, Australia?

We conducted a survey among 40 clinicians working at the Melbourne Sexual Health Centre in November 2021. We asked clinicians how they discussed cervical screening with their clients. All clinicians used the term 'Cervical Screening Test (CST)' when discussing cervical cancer screening with clients. However, 19 clinicians (48%) also used the term 'Pap smear', particularly among older women as they were more familiar with Pap smear than CST. Twenty-five (63%) clinicians believed that clients did not understand the difference between Pap smears and CST. Further education is required to improve the understanding between the terminologies.

Clinical Characteristics of Herpes Simplex Virus Urethritis Compared With Chlamydial Urethritis Among Men.

BACKGROUND: The aim of this study was to ascertain the clinical characteristics associated with herpes simplex virus (HSV) urethritis in men and to compare those with chlamydial urethritis. METHODS: We compared clinical and laboratory data from men diagnosed with polymerase chain reaction confirmed HSV urethritis with those of men with chlamydial urethritis presenting to Melbourne Sexual Health Centre between 2000 and 2015. RESULTS: Eighty HSV urethritis cases were identified: 55 (68%, 95% confidence interval, 58-78) were by HSV-1 and 25 (32%, 95% confidence interval, 22-42) by HSV-2. Compared with chlamydial urethritis, men with HSV urethritis were significantly more likely to report severe dysuria (20% vs 0%, P < 0.01) or constitutional symptoms (15% vs 0%, P < 0.01). Men with HSV urethritis were significantly more likely to have meatitis (62% vs 23%, P < 0.01), genital ulceration (37% vs 0%, P < 0.01), or inguinal lymphadenopathy (30% vs 0%, P < 0.01) but less likely to have urethral discharge (32% vs 69%, P < 0.01). There was no significant difference in the proportion of men who had raised (≥5) polymorphonuclear leukocytes per high-powered field between the two groups (P = 0.46). CONCLUSIONS: The clinical presentation of HSV urethritis in men may differ from those of chlamydial urethritis and guide testing for HSV in men presenting with non-gonococcal urethritis.

Recurrence of bacterial vaginosis is significantly associated with posttreatment sexual activities and hormonal contraceptive use.

BACKGROUND: Bacterial vaginosis (BV) recurrence posttreatment is common. Our aim was to determine if behaviors were associated with BV recurrence in women in a randomized controlled trial (RCT). METHODS: Symptomatic 18- to 50-year-old females with BV (≥3 Amsel criteria and Nugent score [NS] = 4-10) were enrolled in a 3-arm randomized double-blind RCT Melbourne Sexual Health Centre, Australia, in 2009-2010. All 450 participants received oral metronidazole (7 days) and were equally randomized to vaginal clindamycin, lactobacillus-vaginal probiotic or vaginal placebo. At 1, 2, 3, and 6 months, participants self-collected vaginal smears and completed questionnaires. Primary endpoint was NS = 7-10. Cox regression was used to estimate hazard ratios (HRs) for risk of BV recurrence associated with baseline and longitudinal characteristics. RESULTS: Four hundred four (90%) women with postrandomization data contributed to analyses. Cumulative 6-month BV recurrence was 28% (95% confidence interval [CI], 24%-33%) and not associated with treatment. After stratifying for treatment and adjusting for age and sex frequency, recurrence was associated with having the same pre-/posttreatment sexual partner (adjusted HR [AHR] = 1.9; 95% CI, 1.2-3.0), inconsistent condom use (AHR = 1.9; 95% CI, 1.0-3.3), and being non-Australian (AHR = 1.5; 95% CI, 1.0-2.1), and halved with use of an estrogen-containing contraceptive (AHR = 0.5; 95% CI, .3-.8). CONCLUSIONS: Risk of BV recurrence was increased with the same pre-/posttreatment sexual partner and inconsistent condom use, and halved with use of estrogen-containing contraceptives. Behavioral and contraceptive practices may modify the effectiveness of BV treatment. CLINICAL TRIALS REGISTRATION: ACTRN12607000350426.

Efficacy of oral metronidazole with vaginal clindamycin or vaginal probiotic for bacterial vaginosis: randomised placebo-controlled double-blind trial.

BACKGROUND: To determine if oral metronidazole (MTZ-400 mg bid) with 2% vaginal clindamycin-cream (Clind) or a Lactobacillus acidophilus vaginal-probiotic containing oestriol (Prob) reduces 6-month bacterial vaginosis (BV) recurrence. METHODS: Double-blind placebo-controlled parallel-group single-site study with balanced randomization (1:1:1) conducted at Melbourne Sexual Health Centre, Australia. Participants with symptomatic BV [Nugent Score (NS) = 7-10 or ≥3 Amsel's criteria and NS = 4-10], were randomly allocated to MTZ-Clind, MTZ-Prob or MTZ-Placebo and assessed at 1,2,3 and 6 months. MTZ and Clind were administered for 7 days and Prob and Placebo for 12 days. Primary outcome was BV recurrence (NS of 7-10) on self-collected vaginal-swabs over 6-months. Cumulative BV recurrence rates were compared between groups by Chi-squared statistics. Kaplan-Meier, log rank and Cox regression analyses were used to compare time until and risk of BV recurrence between groups. RESULTS: 450 18-50 year old females were randomized and 408 (91%), equally distributed between groups, provided ≥1 NS post-randomization and were included in analyses; 42 (9%) participants with no post-randomization data were excluded. Six-month retention rates were 78% (n = 351). One-month BV recurrence (NS 7-10) rates were 3.6% (5/140), 6.8% (9/133) and 9.6% (13/135) in the MTZ-Clind, MTZ-Prob and MTZ-Placebo groups respectively, p = 0.13. Hazard ratios (HR) for BV recurrence at one-month, adjusted for adherence to vaginal therapy, were 0.43 (95%CI 0.15-1.22) and 0.75 (95% CI 0.32-1.76) in the MTZ-Clind and MTZ-Prob groups compared to MTZ-Plac respectively. Cumulative 6-month BV recurrence was 28.2%; (95%CI 24.0-32.7%) with no difference between groups, p = 0.82; HRs for 6-month BV recurrence for MTZ-Clind and MTZ-Prob compared to MTZ-Plac, adjusted for adherence to vaginal therapy were 1.09(95% CI = 0.70-1.70) and 1.03(95% CI = 0.65-1.63), respectively. No serious adverse events occurred. CONCLUSION: Combining the recommended first line therapies of oral metronidazole and vaginal clindamycin, or oral metronidazole with an extended-course of a commercially available vaginal-L.acidophilus probiotic, does not reduce BV recurrence. TRIAL REGISTRATION: ANZCTR.org.au ACTRN12607000350426.

Bacterial vaginosis (BV) candidate bacteria: associations with BV and behavioural practices in sexually-experienced and inexperienced women.

BACKGROUND: In recent years several new fastidious bacteria have been identified that display a high specificity for BV; however no previous studies have comprehensively assessed the behavioural risk associations of these bacterial vaginosis-candidate organisms (BV-COs). METHODS: We examined the associations between 8 key previously described BV-COs and BV status established by Nugent's score (NS). We also examined the sexual practices associated with each BV-CO. We incorporated 2 study populations: 193 from a sexually-inexperienced university population and 146 from a highly sexually-active clinic population. Detailed behavioural data was collected by questionnaire and vaginal smears were scored by the Nugent method. Stored samples were tested by quantitative PCR assays for the 8 BV-COs: Atopobium vaginae, Gardnerella vaginalis, Leptotrichia spp., Megasphaera type I, Sneathia spp., and the Clostridia-like bacteria BVAB1, BVAB2 and BVAB3. Associations between BV-COs and BV and behaviours were examined by univariate and multivariable analyses. RESULTS: On univariate analysis, all BV-COs were more common in BV compared to normal flora. However, only Megasphaera type I, BVAB2, A. vaginae and G. vaginalis were significantly independently associated with BV by multivariable analysis. Six of the eight BV-COs (Megasphaera type I, BVAB2, BVAB3, Sneathia, Leptotrichia and G. vaginalis) were rare or absent in sexually-unexposed women, and demonstrated increasing odds of detection with increasing levels of sexual activity and/or numbers of lifetime sexual partners. Only G. vaginalis and A. vaginae were commonly detected in sexually-unexposed women. Megasphaera type I was independently associated with women-who-have-sex-with women (WSW) and lifetime sexual partner numbers, while unprotected penile-vaginal-sex was associated with BVAB2 detection by multivariate analysis. CONCLUSIONS: Four of eight key BV-COs were significantly associated with BV after adjusting for the presence of other BV-COs. The majority of BV-COs were absent or rare in sexually-unexposed women, and associated with increasing sexual exposure, suggesting potential sexual transmission of BV-COs.

Low incidence of bacterial vaginosis in cohort of young Australian women.

Cohort study of incident bacterial vaginosis (BV) in Australian students. BV only occurred in vaginally sexually active women (BV incidence = 2.2 [95% confidence interval, 0.8-4.9]/100 woman-years), and no incident BV occurred in women who did not engage in vaginal sex during the cohort period (0 [95% confidence interval, 0-3.2]/100 woman-years), P = 0.10. In university students, incident BV was uncommon and absent in sexually abstinent women.

Estimating the number of unlicensed brothels operating in Melbourne.

OBJECTIVE: To estimate the number of unlicensed brothels operating in Melbourne, Australia, and the sexual health of the women working in them. METHODS: Advertisements from Melbourne newspapers published in July 2006 were systematically analysed based on the language used to identify premises likely to be unlicensed brothels. A visit was made to each of the businesses where an address was available. Participating sex workers were tested for Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium and Trichomonas vaginalis using self-collected tampons and polymerase chain reaction. RESULTS: There were 438 advertisements collated, representing 174 separate establishments. Of these, 78 were not considered likely to be brothels. Of the remaining 96, addresses were available for 42 and all of these premises were visited. Thirteen were confirmed as unlicensed brothels. We estimate there were between 13 and 70 unlicensed brothels in Melbourne. Twenty-three women were recruited from four brothels. Only 56% (95% confidence interval (CI) 35-77%) reported having regular sexual health checks and only 13% (95%CI 3-36%) reported prior testing for HIV. Among the 22 women tested, one had chlamydia while another had gonorrhoea, a prevalence of 4.5% (95%CI: 2.3-20.4%) for each infection. CONCLUSIONS: The number of unlicensed brothels in Melbourne is much smaller than is generally believed. Women in the sector are infrequently tested for STIs. IMPLICATIONS: As long as a licensing system persists, promotion of sexual health among women in this sector is likely to face hurdles. Further research is needed into the best model for regulating or not regulating sex industries.

Early sexual experiences and risk factors for bacterial vaginosis.

BACKGROUND: We have undertaken a cross-sectional study that investigates the association between bacterial vaginosis (BV) and sexual practices in sexually experienced and inexperienced women. METHODS: Participants were 17-21-year-old females who attend Melbourne University, Australia. Study kits that contained an information and consent form, questionnaire, swab, and slide were distributed. Information regarding demographic characteristics and a broad range of sexual practices were collected. Gram-stained, self-collected vaginal smears were scored with the Nugent method. Associations between BV and behaviors were examined by univariate and multivariate analysis. RESULTS: BV was diagnosed in 25 (4.7%) of 528 women (95% confidence interval [CI], 3.1%-6.9%). Importantly, BV was not detected in women (n = 83) without a history of coital or noncoital sexual contact (0%; 95% CI, 0%-4.3%). BV was detected in 3 (3.8%) of 78 women (95% CI, 0.8%-10.8%) with noncoital sexual experience only and in 22 (6.0%) of 367 women (95% CI, 3.8%-8.9%) who reported penile-vaginal sex. BV was associated with a history of any genital contact with a sexual partner (P=.02). BV was strongly associated with >3 penile-vaginal sex partners in the prior year (adjusted odds ratio, 7.1; 95% CI, 2.7-18.4) by multivariable analysis. CONCLUSIONS: This study shows a strong association between BV and penile-vaginal sex with multiple partners but found no BV in sexually inexperienced women, once a history of noncoital sexual practices was elicited. Our findings indicate that BV is not present in truly sexually inexperienced women.

Changes in the diagnosis and management of bacterial vaginosis following clinical research.

BACKGROUND: It has become common practice to offer patients attending public sexual health clinics participation in research studies. We investigated the premise that clinician involvement in research leads to improvements in clinical practice within a sexual health service in Melbourne, Australia. METHODS: Retrospective case note reviews were conducted of 100 cases of bacterial vaginosis (BV) during three time periods; 2000, 2002 and 2004. The first and second reviews were conducted 2 years before and immediately prior to a cross-sectional study of BV at Melbourne Sexual Health Centre. The third review was conducted immediately after study completion. Diagnostic criteria and treatment for BV were recorded. Clinicians were divided into high and low recruiters, according to the percentage of eligible patients that they recruited into the cross-sectional study. No audited cases were enrolled in the study. RESULTS: Significant improvements in the use of Amsel's criteria occurred between the second and third audit periods (51 to 65%, P = 0.04) but not between the first and second audits (51% for both, P = 1.0). The improvement was seen in high-recruiting clinicians (P = 0.02) but not low-recruiting clinicians (P = 0.75). Although treatment with 7 days of metronidazole or vaginal clindamycin increased for all clinicians between the first and second audit periods (8 to 18%, P = 0.04), it was greater between the second and third audit periods (18 to 72%, P < 0.01). No difference was observed between high- and low-recruiting clinicians. CONCLUSION: Introduction of research was temporally associated with improved clinical practice in high-recruiting clinicians only.

Anorectal lymphogranuloma venereum in a Melbourne man.

We report the first case of anorectal lymphogranuloma venereum (LGV) in a man who has sex with men (MSM) in Australia in the setting of the recent emergence of LGV among MSM in Europe and the USA. A 33-year-old man presented with a 2 month history of mild external anal discomfort. He gave a history of unprotected receptive and insertive anal intercourse with one partner in Europe during the preceding 6 months. No symptoms suggested proctitis and examination revealed two small anal fissures. An anal swab was positive for Chlamydia trachomatis; investigation for other STIs including HIV were negative. On review 6 days later, he was investigated and treated presumptively for LGV. The LGV diagnosis was confirmed by identifying the L2 serovar of C. trachomatis using a genotype test on the original anal specimen. This case is in keeping with the more recent reports of LGV from Europe, and has demonstrated the need for a high index of suspicion for asymptomatic or minimally symptomatic anorectal LGV.

High recurrence rates of bacterial vaginosis over the course of 12 months after oral metronidazole therapy and factors associated with recurrence.

BACKGROUND: We wished to determine recurrences of bacterial vaginosis (BV) after treatment over the course of 12 months and to establish factors associated with recurrence. METHODS: Women with symptomatic BV (a Nugent score [NS] of 7-10 or of 4-6 with >or=3 Amsel criteria) were enrolled. BV was treated with 400 mg of oral metronidazole twice a day for 7 days. Participants completed a questionnaire and vaginal swabs were collected at 1, 3, 6, and 12 months; the study end point was an NS of 7-10. RESULTS: A total of 121 (87%) women with an NS of 7-10 and 18 (13%) with an NS of 4-6 and >or=3 Amsel criteria were enrolled; 130 (94%) returned >or=1 vaginal samples. Sixty-eight women (58% [95% confidence interval {CI}, 49%-66%]) had a recurrence of BV (NS 7-10), and 84 (69% [95% CI, 61%-77%]) had a recurrence of abnormal vaginal flora (NS 4-10) by 12 months. A past history of BV, a regular sex partner throughout the study, and female sex partners were significantly associated with recurrence of BV and abnormal vaginal flora by multivariate analysis; the use of hormonal contraception had a negative association with recurrence. CONCLUSION: Current recommended treatment is not preventing the recurrence of BV or abnormal vaginal flora in the majority of women; factors associated with recurrence support a possible role for sexual transmission in the pathogenesis of recurrent BV.

Higher-risk behavioral practices associated with bacterial vaginosis compared with vaginal candidiasis.

OBJECTIVE: Bacterial vaginosis has been associated with hormonal factors and sexual practices; however, the cause is unclear, and the notion that bacterial vaginosis is a sexually transmitted infection is still debated. To investigate whether bacterial vaginosis is associated with specific sexual practices or instead has features in common with a sexually transmitted infection, we compared behavioral associations in women with bacterial vaginosis to women with vaginal candidiasis. METHODS: Women with symptoms of abnormal vaginal discharge or odor who attended Melbourne Sexual Health Centre between July 2003 and August 2004 were eligible for enrollment in the study. Information on demographics and behavioral and contraceptive practices were collected by self-completed questionnaire. Participants were tested for bacterial vaginosis, Candida spp (microscopy and culture), and sexually transmitted infections. Statistical comparisons were made between women with and without bacterial vaginosis and women with and without candidiasis, using univariate and multivariate analysis. RESULTS: A total of 342 women were enrolled in the study; 157 were diagnosed with bacterial vaginosis, 51 had candidiasis by microscopy, and 95 had candidiasis by culture. Bacterial vaginosis was associated with indicators of high-risk sexual behavior such as a new sexual partner and greater number of male partners in the last year, increased number of lifetime sexual partners, less than 13 years of education, a past history of pregnancy, and smoking (P < .05). Candidiasis was not associated with these risk behaviors and was instead related to practices such as receptive anal and oral sex and douching. CONCLUSION: The association between bacterial vaginosis and practices that are associated with sexually transmitted infections, in contrast to those observed with candidiasis, suggests a possible sexually transmitted cause. LEVEL OF EVIDENCE: II-2.