Sexually transmitted infections diagnosed in individuals presenting for forensic and medical care following sexual assault.

BACKGROUND: People who report sexual assault express concerns regarding contracting sexually transmitted infection (STI); however, published literature regarding the risk of STI transmission in this context is sparse. METHOD: We audited STI and blood-borne virus (BBV) testing at a forensic and medical sexual assault care service in the Australian Capital Territory between 2004 and 2022. Eligibility for testing among 1928 presentations was defined based on risk (eg, reported penetration). Testing at presentation included chlamydia and gonorrhoea 1850, syphilis and BBV 1472, and after 2-6 weeks, 890 out of 1928 (46.2%) and after 3 months 881 out of 1928 (45.7%), respectively. RESULTS: At presentation, 100 out of 1928 (5.2%) individuals were diagnosed with chlamydia, of those, 95 out of 1799 (5.3%) were female, and 5 out of 121 (4.1%) were male. Gonorrhoea was diagnosed in 7 out of 1920 (0.4%), 5 out of 95 female and 2 out of 5 male. Hepatitis B, which was all pre-existing, was diagnosed in 5 out of 1799 (0.3%). Overall, chlamydia prophylaxis was given to 203 out of 1928 (10.5%) and HIV post-exposure prophylaxis to 141 out of 1928 (7.3%).At 2-6 weeks of follow-up, 10 out of 890 (1.1%) individuals were diagnosed with chlamydia, with no gonorrhoea diagnosed. There were no cases of syphilis, hepatitis B or HIV diagnosed at 3-month serology testing in 881 individuals. Chlamydia detection at follow-up was more common in the group aged 15-29 years. Of those provided with chlamydia prophylaxis, 203 out of 1928, only 16 out of 203 (7.9%) were diagnosed with chlamydia. CONCLUSIONS: The offer of STI testing is almost universally accepted by individuals presenting for post-sexual assault care. There were no identifiable factors to justify the routine use of chlamydia prophylaxis. STI testing provided an opportunity for screening and should remain part of the clinical care of people who report sexual assault.

Do we DARE? Improving digital ano-rectal examination in men who have sex with men living with HIV: a quality improvement initiative.

Men who have sex with men (MSM) living with HIV are at increased risk of anal cancer and annual screening via digital ano-rectal examination (DARE) is recommended. Baseline audit (Cycle 1) was undertaken of the medical records of MSM living with HIV aged ≥50years (n =85) from 1 January 2017 to 31 December 2018, in line with guidelines at the time. Data collection included whether DARE was discussed and offered, and whether DARE was accepted or declined. We provided staff training and altered clinic proformas aiming to increase DARE. Audit Cycle 2 (Cycle 2) was undertaken of eligible MSM (n =86) who attended between 1 January 2019 to 31 December 2020. DARE frequency increased from 4.7% in Cycle 1 to 41.8% in Cycle 2 (P <0.001) and discussion and offer of DARE increased from 8% to 64% in Cycle 2 (P <0.001).

On the Mechanism of Phenolate Photo-Oxidation in Aqueous Solution.

The photo-oxidation dynamics following ultraviolet (257 nm) excitation of the phenolate anion in aqueous solution is studied using broadband (550-950 nm) transient absorption spectroscopy. A clear signature from electron ejection is observed on a sub-picosecond timescale, followed by cooling dynamics and the decay of the signal to a constant offset that is assigned to the hydrated electron. The dynamics are compared to the charge-transfer-to-solvent dynamics from iodide at the same excitation wavelength and are shown to be very similar to these. This is in stark contrast to a previous study on the phenolate anion excited at 266 nm, in which electron emission was observed over longer timescales. We account for the differences using a simple Marcus picture for electron emission in which the electron tunneling rate depends sensitively on the initial excitation energy. After electron emission, a contact pair is formed which undergoes geminate recombination and dissociation to form the free hydrated electron at rates that are slightly faster than those for the iodide system. Our results show that, although the underlying chemical physics of electron emission differs between iodide and phenolate, the observed dynamics can appear very similar.

Time-resolved second harmonic generation with single-shot phase sensitivity.

A time-resolved, phase-sensitive second harmonic generation (SHG) method to probe the excited state dynamics of interfacial species is presented. It is based on an interference measurement between the SHG from a sample and a local oscillator generated at a reference surface in which an entire interference pattern is recorded in a single shot by using a spatially varying phase unit comprised of a pair of wedges that sandwich the reference sample. In combination with 30 kHz modulation of the experiment, shot-to-shot pump-probe measurements are presented. The technique is characterised by measuring the time-resolved change in the amplitude and phase of the interference pattern due to the excited state dynamics of the dye malachite green at the air/water interface. The key attributes of the technique are its excellent phase stability and sensitivity, and relatively short data acquisition times.

A pragmatic assessment of the relative efficiency of outreach chlamydia screening events conducted in non-clinical settings.

BACKGROUND: Opportunistic screening for chlamydia in non-clinical settings is becoming more common, but little is known about which settings (or events) offer the best return on investment. We measured the relative efficiency of each screening site and event during the conduct of a chlamydia education and screening outreach program which used a cash incentive to encourage participation (SOC2). METHODS: SOC2 staff identified sites and organised events in non-clinical sites where young people were likely to congregate. 16 to 30 years olds were offered chlamydia education and a cash reward of AUD10 if they chose to be screened for chlamydia. Data collected during these activities were used to calculated five measures of efficiency: i) screening yield' (proportion of people providing a sample), ii) proportion of positive tests, iii) 'event screening tempo' (number of screens performed for every hour that screening is offered), iv) 'staff hour screening tempo' (number of screens performed per hour of staff time) and v) 'chlamydia detection tempo' (number of positive tests detected per hour of screening). RESULTS: 3011 people (71% male) were screened during 18 events at 10 venues. Overall 'screening yield' was 43.8% (range: 20-77%) and 1.7% (95% CI: 1.1-3.0) of tests were positive (by event range 1-3%). Overall, the 'event screening tempo' was 23.7 screens per event hour (range 8.0-79.0), the 'staff hour screening tempo' was 6.5 screens per staff hour and the 'chlamydia detection tempo' was 0.4 positive tests per hour (range: 0-1.75). CONCLUSION: Assessing the efficiency of screening sites and programs should be integral to their conduct. We suggest the use of five measures to enable pragmatic assessment of any screening program. We introduce the terms 'event screening tempo', 'staff hour screening tempo' and 'chlamydia detection tempo' to describe three of these simple measures.

Maximising student preparation for clinical teaching placements.

BACKGROUND: With the increasing emphasis on ambulatory health care, clinical educators need to ensure that students are sufficiently prepared to maximise learning opportunities during placements in ambulatory settings. CONTEXT: This study focuses on third-year medical students entering urban or rural clinical placements at an Australian graduate entry medical school. INNOVATION: All rural and a subset of urban students received intensive training in taking Papanicolaou (Pap) smears prior to starting the clinical placement. Training involved gynaecological teaching associates, active practice and real-time feedback. Evaluation included workshop feedback, reflection on effectiveness during the placement, and comparison of trained and untrained students' recorded clinical experience of taking Pap smears. IMPLICATIONS: Students given pre-placement training praised their learning experience, and on average took more Pap smears during their placement than did their untrained peers. The difference, however, did not reach statistical significance. The pre-placement teaching workshop on a difficult skill was popular and worthy of further study regarding other challenging clinical skills.

Characteristics of sexual assaults in which adult victims report penetration by a foreign object.

This retrospective clinical audit reviews cases of adult sexual assault where the victim alleges that they were penetrated with a foreign object. These assaults were more likely to have positive genital and non-genital findings recorded by the clinician compared to assaults where no object was used. There is a suggestion that these assaults may be more violent with multiple assailants more common and an association with more use of threats and weapons. It is important to ask about the penetrative use of foreign objects in a sexual assault history and for clinicians to be aware of the greater possibility of injury in these cases.