A psychological group intervention for high-risk pregnant women: a protocol of a feasibility and acceptability study of the STAR Mums program.

BACKGROUND: In pregnancy, the attachment relationship between a mother and her baby begins to develop and women are more motivated and willing to make changes to become more engaged and responsive mothers and have better relationships with their children. A transgenerational framework has proposed that dysfunctional relationship patterns are often repeated across generations and this has broadened the understanding of early difficulties in parenting. Despite this there has been little research specifically examining high-risk perinatal women and how their interactions with their infants are related to attachment or relational outcomes. METHODS: This pilot study aims to evaluate, and to explore the acceptability and feasibility, of participating in the Supporting Transitions, Attachment and Relationships (STAR Mums) program, a psychodynamic attachment-based group intervention, for pregnant women with risk factors for attachment difficulties. The STAR Mums program aims to intervene during pregnancy to assist women with risk factors in the transition to parenthood with the desired outcome to improve the quality of mother-infant emotional interactions, regulation and the attachment relationship. This is a mixed-methods design study incorporating both qualitative and quantitative assessments of five groups of five first-time mothers over a 12-month period. CONCLUSIONS: This paper outlines the STAR Mums intervention and protocol for assessing acceptability and feasibility. The STAR Mums program takes a preventative approach and supports early intervention for parents at risk of attachment difficulties with their infants. The results of this study will inform revisions to the current treatment manual and a larger-scale program evaluation to further examine the efficacy of this intervention.

Getting the terminology right in sexual health research: the importance of accurately classifying fuck buddies among men who have sex with men.

OBJECTIVE: The aim of this report was to raise the issue of the definition and classification of partner terminology in men who have sex with men (MSM) research, particularly in regards to 'fuck buddies'. If definitions in research differ from general consensus in the MSM population, it is possible that public health strategies will be ineffective as the target population may be inaccurate. METHODS: Thirty semistructured interviews with MSM attending the Melbourne Sexual Health Centre were conducted, focusing on the willingness to change sexual practices to reduce the risk of pharyngeal gonorrhoea. As part of these interviews, men were also asked their views on the terminology they used to describe their relationships and sexual partners. RESULTS: The degree of emotional attachment often defined the type or classification of relationships. There was a consensus among men that partners they engaged with for 'sex only' were classified as casual partners and partners with whom there was an emotional attachment or formalisation of the relationship were classified as 'regular partners'. However, the classification of 'fuck buddy' as a regular or casual partner was less clear. CONCLUSIONS: Further research is needed to ascertain the ways in which men conceptualise sexual relationships and define or classify partner types, particularly 'fuck buddy' relationships. A third category for sexual relationships should be considered to encapsulate fuck buddy relationships.

Patterns of sexual behaviour and sexual healthcare needs among transgender individuals in Melbourne, Australia, 2011-2014.

OBJECTIVE: Literature surrounding the healthcare needs of transgender individuals is limited in Australia. This study aimed to investigate the demographic characteristics, risk behaviours and HIV/STI positivity among male-to-female (MTF) and female-to-male (FTM) transgender individuals attending Melbourne Sexual Health Centre (MSHC), Australia, between 2011 and 2014. METHOD: A retrospective cohort analysis for 133 transgender individuals was conducted based on the first visit of individuals to MSHC during the study period. Demographic characteristics, sexual behaviours and HIV/STI positivity were examined. RESULTS: The majority of transgender individuals were single or never married (74%; n=99). Almost half of the individuals (47%; n=62) had ever engaged in sex work during their lifetime. The median number of male sexual partners (MSP) reported in the last 3 months was 1 (IQR: 1-2) and with female sexual partners (FSP) was 2 (IQR: 1-4). For those who reported having sexual partners in the previous 3 months, always using condoms with MSP was 31% (n=22), and that with FSP was 18% (n=2). HIV/STI positivity during the study period was 7% (n=8) for chlamydia, 5% (n=6) for gonorrhoea, 5% (n=5) for syphilis and 1% (n=1) for HIV. Hormone use for reassignment was reported by 63% (n=90) of individuals and reassignment surgery was reported by 27% (n=29+6=35). CONCLUSIONS: Transgender individuals in this study were found to be a diverse group, with a history of sex work being a common feature. These findings indicate that transgender individuals' sexual healthcare needs differ substantially from those in other countries, including the US and Canada. Attention to differences in MTF and FTM transgender persons must be considered in healthcare settings in Australia.

Clinical factors associated with syphilis concordance in men in sexual partnerships: a cross-sectional couples study.

BACKGROUND: Syphilis infections continue to increase among men who have sex with men (MSM) in many countries, with rates often higher among HIV-positive MSM. There is limited understanding of the risk and determinants of syphilis transmission between men. We aimed to examine the concordance of early syphilis infection between male sexual partners and clinical factors associated with transmission. METHODS: Men attending Melbourne Sexual Health Centre with their male partners, where at least one was diagnosed with early syphilis, were identified from linkage of partner records between March 2011 and April 2016. Early latent syphilis was defined as a new asymptomatic syphilis presentation of less than 2 years' duration. Associations between concordance and potential risk factors were examined using Fisher's exact test. RESULTS: Among 43 couples (86 men) identified, there were 13 couples (26 men) where both were diagnosed with early syphilis, representing a concordance rate of 30.2% (95% CI 17.2% to 46.1%). Among the 13 concordant couples, 5 men had primary syphilis (4 penile, 1 anal), 11 secondary syphilis (8 generalised rash, 3 penile, 2 anal, 1 oral lesion) and 10 early latent infections. Concordance was higher among couples where at least one partner had secondary syphilis compared with couples where neither partner had secondary syphilis (53% (9/17) vs 15% (4/26), P=0.016). Furthermore, concordance was higher among couples where one was HIV positive compared with couples where both were HIV negative (62% (5/8) vs 23% (8/35), P=0.042). CONCLUSIONS: There was an overall concordance rate of 30%. Higher concordance rates for early syphilis infection between male sexual partners were associated with HIV and secondary syphilis.

Concordance of gonorrhoea of the rectum, pharynx and urethra in same-sex male partnerships attending a sexual health service in Melbourne, Australia.

BACKGROUND: We aimed to describe anatomic site-specific concordance of gonococcal infections in partnerships of men who have sex with men (MSM). METHODS: We conducted a cross-sectional analysis of data from MSM partnerships attending Melbourne Sexual Health Centre between March 2011 and February 2015. Logistic regression models (random effect) were used to examine the association between gonococcal infections of the urethra, rectum and pharynx. Gonococci were detected by culture at all anatomic sites. RESULTS: The analysis included 495 partnerships. Of the men with urethral gonorrhoea, 33% (95% CI 18-52) had partners with pharyngeal gonorrhoea and 67% (95% CI 48-82) had partners with rectal gonorrhoea. The adjusted odds of having urethral gonorrhoea was 4.6 (95% CI 1.2-17.1) for a man whose partner had pharyngeal gonorrhoea, and 48.1 (95% CI 18.3-126.7) for a man whose partner had rectal gonorrhoea. Of the men with rectal gonorrhoea, 46% (95% CI 31-61) had a partner with urethral gonorrhoea and 23% (95% CI 12-37) had a partner with pharyngeal gonorrhoea. The adjusted odds of having rectal gonorrhoea was 63.9 (95% CI 24.7-165.6) for a man whose partner had urethral gonorrhoea. Of the men with pharyngeal gonorrhoea, 42% (95% CI 23-63) had a partner with rectal gonorrhoea and 23% (95% CI 9-44) had a partner with had a partner with pharyngeal gonorrhoea. The adjusted odds of having pharyngeal gonorrhoea was 8.9 (95% CI 3.2-24.6) for a man whose partner had rectal gonorrhoea. The crude odds of having pharyngeal gonorrhoea was 14.2 (95% CI 5.1-39.0) for a man whose partner had pharyngeal gonorrhoea. CONCLUSIONS: These data provide the first estimates of concordance of anatomic site-specific gonococcal infections in MSM partnerships, and confirm that urethral gonorrhoea is contracted from both rectal and pharyngeal sites, and suggest that gonococci transmit between the rectum and pharynx. However, due to use of culture rather than NAAT, our analysis was not adequately powered to assess pharynx-to-pharynx transmission of gonococci.

"It's just one of those things people don't seem to talk about..." women's experiences of social support following miscarriage: a qualitative study.

BACKGROUND: Miscarriage is a common event which is estimated to occur in approximately one in four confirmed pregnancies (Collins et al, Grief Matters Aust J Grief Bereave_ 17:44, 2014, St John et al, Aust J Adv Nurs_ 23:8, 2006). Social networks play an important role in supporting women following this event and positive support experiences can play a role in buffering women's experiences of grief, loss and psychological distress following miscarriage (Rowlands et al, J Reprod Infant Psychol_ 28:274-86, 2010, Stratton et al, Aust New Zeal J Obstet Gynaecol_ 48:5-11). METHODS: Women were recruited through existing networks known to the researcher, miscarriage support organisations and snowball sampling methods. Fifteen women living in Australia completed semi-structured interviews either in person or by telephone regarding their experiences of social support following miscarriage, and their recommendations for how this could be improved. RESULTS: Women reported both positive and negative social support experiences following miscarriage. Women's partners were identified as their central support figures for most women in this study, and women also identified other women who had previously experienced miscarriage as helpful and supportive. Conversely, women also expressed they felt there was a vast silence surrounding miscarriage, with others being commonly uncomfortable discussing the event leading to feelings of loneliness and isolation. Many women also felt the societal tradition of not disclosing pregnancy until after the first trimester contributed to the stigma surrounding miscarriage, and lead to poorer support experiences. CONCLUSIONS: Raising awareness of the psychological impact of miscarriage appears imperative to assist the community to support women experiencing this loss, as well as reducing the secret and hidden nature of the experience. The recommendations provided may assist well-meaning friends and family in providing appropriate support for their loved ones experiencing miscarriage. Yet as many people in the wider community are uncomfortable with others' grief, providing the recommended supports in the context of miscarriage would likely remain highly challenging.

Concordance of chlamydia infections of the rectum and urethra in same-sex male partnerships: a cross-sectional analysis.

BACKGROUND: Our study aimed to describe the concordance of chlamydia infections of the rectum and urethra in men who have sex with men (MSM) and their male partners. METHODS: This was a cross-sectional study of chlamydia in MSM and their male sexual partners both attending Melbourne Sexual Health Centre (MSHC), Australia, between February 2011 and March 2015. We excluded partnerships where testing for chlamydia at both the rectum and urethra were not undertaken. RESULTS: Our study included 473 partnerships (946 men). 30 men had urethral chlamydia, of whom 14 (47%, 95% CI 28 to 66) had a partner with rectal chlamydia. 46 men had rectal chlamydia, of whom 14 (30%, 95% CI 18 to 46) had a partner with urethral chlamydia. The proportion of men with rectal chlamydia when their partner had urethral chlamydia was significantly higher than the proportion of men with urethral chlamydia when their partner had rectal chlamydia (McNemar's p = 0.02). CONCLUSIONS: This is the first study of chlamydia concordance in male sexual partnerships and suggests that transmission of chlamydia between the urethra and rectum may be less efficient than has been reported for transmission between the urethra and cervix in heterosexual couples. It also suggests that transmission from the urethra to the rectum may be more efficient than in the opposite direction.

A recreational group intervention based on Relational Cultural Theory for women experiencing substance use disorders in Australia: A protocol.

Gender differences exist in the progression, initiation and maintenance of substance use disorders (SUDs). Women encounter unique barriers to accessing treatment for their SUDs and commonly report higher perceptions of stigma around their substance use. Currently, there is a paucity of women-specific treatment options that address their perception of stigma and shame regarding SUDs. The Women of the West (WOW) programme is a pilot study that explores the subjective acceptability and feasibility of participating in a recreational and relational skill development group for women with SUDs. The pilot study adopts qualitative research methods including focus groups and interviews with ten participants who self-identify as women experiencing SUDs and two programme facilitators. The programme's primary aim is to promote participants' relational skills with peers in an enjoyable, and therapeutic environment. It is anticipated as participants develop their relational skills with peers, their sense of stigma regarding their SUDs and social isolation will decrease. Ultimately this can promote their long-term recovery from SUDs and overall well-being. Findings from this study will provide direction for future programme development and treatment services seeking to promote better outcomes for women with SUDs.

"The loss was traumatic some healthcare providers added to that": Women's experiences of miscarriage.

BACKGROUND: Miscarriage is a common event in Australia and is estimated to occur in up to one in four confirmed pregnancies. Prior research has demonstrated that miscarriage is associated with significant distress, grief and loss, and in some cases clinically significant levels of depression, anxiety, and Post Traumatic Stress Disorder. Despite these consequences for women's emotional and mental health, studies have commonly found that women feel that healthcare providers often lack empathy, support, and acknowledgement of their loss. AIM: The aim of this study is to explore the psychological distress experienced by women as a result of miscarriage, as well as the perceived support provided by healthcare professionals. METHODS: Fifteen women were recruited in Australia and participated in semi-structured interviews either in person or over the telephone. FINDINGS: It was found that for most women, the levels of distress, grief, and loss associated with their miscarriages were significant. While women experienced both positive and negative interactions with healthcare providers throughout their miscarriage journeys, all women interviewed expressed their increased distress following negative experiences. CONCLUSION: A number of recommendations have been provided by women to improve the service of healthcare providers in the event of a miscarriage, including referral to a psychologist, and ongoing follow-up after their miscarriage, which women felt would assist them with managing their distress.

Online Health Seeking Behaviours: What Information Is Sought by Women Experiencing Miscarriage?

One in four pregnancies ends in miscarriage, a distressing event which can cause significant psychosocial impacts for many women, and yet often remains unseen and unspoken. Many would-be mothers turn to the internet for information and emotional support, and to share their experiences. In this paper, we present the results from 12 semi-structured interviews with women, investigating how and what online information they searched for at the time of miscarriage. We found that women are passive information seekers, searching for causes and preventive strategies to inform future pregnancies. Women want information presented in an easy to understand manner that is not overly clinical, and informed by credible sources. Women also seek psychological support and emotional relief through reading about others' experiences and sharing their stories online. The findings from this study provide a unique insight into the support and information needs of women, and will be used to guide the content, design and functionality of web-based technologies for women experiencing miscarriage.

Women view key sexual behaviours as the trigger for the onset and recurrence of bacterial vaginosis.

BACKGROUND: Bacterial vaginosis (BV) affects a third of women of reproductive age in the US and there is increasing evidence to suggest it may be sexually transmitted. This study aimed to extend and validate the findings of our earlier smaller qualitative study by exploring in detail women's views and experiences of the triggering factors associated with BV onset and recurrence. METHODS: Women aged 20-49, who had experienced one or more symptomatic episode of BV within 6 months, were opportunistically recruited to complete a 38-item questionnaire on their experience of BV. RESULTS: 103 women completed the questionnaire. Women were significantly more likely to report sexual than lifestyle factors triggered BV onset and recurrence (p<0.001). The top 3 factors women attributed to both BV onset and recurrence were identical-and all sexual. They included, in order: 1) unprotected sex; 2) sex with a new male partner; and 3) sex in general. The main lifestyle factors nominated included stress, diet, menstruation and the use of feminine hygiene products. While many women felt their BV had been transmitted through sexual contact (54%) and developed as a result of sexual activity (59%), few considered BV a sexually transmitted infection (STI) (10%). Despite this 57% felt partners should also be treated for BV. CONCLUSION: These data concur with our earlier qualitative findings that women believe BV is triggered by sexual activity. While many women felt BV was sexually transmitted and supported partner treatment, they did not consider BV an STI. This contradiction is likely due to information conveyed to women based on current guidelines. In the absence of highly effective BV treatments, this study highlights the need for guidelines to indicate there is scientific uncertainty around the pathogenesis of BV and to contain clear health messages regarding the evidence for practices shown to be associated with a reduced risk of BV (i.e. consistent condom use.

Chlamydia Infection Between Men and Women: A Cross-Sectional Study of Heterosexual Partnerships.

BACKGROUND: Studies of sexual partnerships can further our understanding of the sexual transmission of chlamydia, which is important for informing public health interventions and clinical management. The aim of this study was to ascertain among heterosexual dyads the proportion concordantly infected with chlamydia and factors associated with infection between partners. METHODS: This study was conducted at the Melbourne Sexual Health Centre between January 2006 and March 2015. Heterosexual partners attending the clinic on the same day were identified prospectively. Dyads where 1 or both individuals were diagnosed with chlamydia by a test performed on the day of joint attendance or within the prior 30 days were included. Testing was by strand displacement assay. Men and women with genital symptoms underwent clinical examination. RESULTS: Of 233 females with chlamydia, 76% (n = 178) of their male partners tested positive. Of the chlamydia-positive females with cervicitis, 91% of males were chlamydia positive. Male infection was less likely if their partner had taken azithromycin or doxycycline within 30 days (7% vs 25%; P = .039). Of 235 males with chlamydia, 77% (n = 178) of their female partners tested positive. No associations were found between male symptoms, signs, or recent antibiotic use and a positive chlamydia result in female partners. Sixty-one percent of the dyads were concordantly infected with chlamydia. CONCLUSIONS: These results underscore the high likelihood of heterosexual partners of men and women with chlamydia being infected and the importance that partners are tested and managed appropriately for chlamydia.

Pharyngeal Gonorrhoea: The Willingness of Australian Men Who Have Sex with Men to Change Current Sexual Practices to Reduce Their Risk of Transmission-A Qualitative Study.

BACKGROUND: The pharynx is a common site of gonorrhoea among men who have sex with men (MSM) and may serve as a reservoir for infection, with saliva implicated in transmission possibly through oral sex, kissing, and rimming. Reducing sexual activities involving saliva may reduce pharyngeal gonorrhoea. This study aimed to explore MSM's views and knowledge of pharyngeal gonorrhoea and their willingness to change saliva transmitting sexual practices. MSM were also asked their views on using alcohol-containing mouthwash to potentially reduce transmission. METHODS: Using a qualitative descriptive approach, 30 MSM who were part of a larger study (GONE) conducted at the Melbourne Sexual Health Centre agreed to take part in semi-structured interviews between 14th May and 8th September 2015. The 10 interviews conducted face to face and 20 by telephone, lasted between 20-45 minutes. Data were analysed using qualitative content analysis. RESULTS: Most men considered pharyngeal gonorrhoea to be a non-serious sexually transmitted infection and attributed transmission primarily to oral sex. Almost all men reported they would not stop kissing, oral sex, or consider using condoms for oral sex to reduce their risk of pharyngeal gonorrhoea. Kissing and oral sex were commonly practised and considered enjoyable low risk sexual activities. Men were more likely to consider stopping sexual activities they did not enjoy or practice often, in particular insertive rimming. If proven effective, the majority of men reported they would use alcohol-containing mouthwash to reduce or prevent their risk of pharyngeal gonorrhoea. CONCLUSION: Findings from this study suggest MSM are unlikely to stop saliva transmitting sexual practices they enjoy and consider low risk. Men would, however, consider using alcohol-containing mouthwash if found to be effective, highlighting the importance of exploring innovative strategies to reduce pharyngeal gonorrhoea.

Women's Views and Experiences of the Triggers for Onset of Bacterial Vaginosis and Exacerbating Factors Associated with Recurrence.

BACKGROUND: Bacterial vaginosis (BV) is the most common vaginal infection affecting women of childbearing age. While the aetiology and transmissibility of BV remain unclear, there is strong evidence to suggest an association between BV and sexual activity. This study explored women's views and experiences of the triggers for BV onset and factors associated with recurrence. METHODS: A descriptive, social constructionist approach was chosen as the framework for the study. Thirty five women of varying sexual orientation who had experienced recurrent BV in the past five years took part in semi-structured interviews. RESULTS: The majority of women predominantly reported sexual contact triggered the onset of BV and sexual and non-sexual factors precipitated recurrence. Recurrence was most commonly referred to in terms of a 'flare-up' of symptoms. The majority of women did not think BV was a sexually transmitted infection however many reported being informed this by their clinician. Single women who attributed BV onset to sex with casual partners were most likely to display self-blame tendencies and to consider changing their future sexual behaviour. Women who have sex with women (WSW) were more inclined to believe their partner was responsible for the transmission of or reinfection with BV and seek partner treatment or change their sexual practices. CONCLUSION: Findings from this study strongly suggest women believe that BV onset is associated with sexual activity, concurring with epidemiological data which increasingly suggest BV may be sexually transmitted. Exacerbating factors associated with recurrence were largely heterogeneous and may reflect the fact it is difficult to determine whether recurrence is due to persistent BV or a new infection in women. There was however evidence to suggest possible transmission and reinfection among WSW, reinforcing the need for new approaches to treatment and management strategies including male and female partner treatment trials.

Women's Management of Recurrent Bacterial Vaginosis and Experiences of Clinical Care: A Qualitative Study.

BACKGROUND: Few data are available on how women manage recurring bacterial vaginosis (BV) and their experiences of the clinical care of this condition. This study aimed to explore women's recurrent BV management approaches and clinical care experiences, with a view to informing and improving the clinical management of BV. METHODS: A descriptive, social constructionist approach was chosen as the framework for the study. Thirty-five women of varying sexual orientation who had experienced recurrent BV in the past 5 years took part in semi-structured interviews. RESULTS: The majority of women reported frustration and dissatisfaction with current treatment regimens and low levels of satisfaction with the clinical management of BV. Overall, women disliked taking antibiotics regularly, commonly experienced adverse side effects from treatment and felt frustrated at having symptoms recur quite quickly after treatment. Issues in clinical care included inconsistency in advice, misdiagnosis and inappropriate diagnostic approaches and insensitive or dismissive attitudes. Women were more inclined to report positive clinical experiences with sexual health physicians than primary care providers. Women's frustrations led most to try their own self-help remedies and lifestyle modifications in an attempt to treat symptoms and prevent recurrences, including well-known risk practices such as douching. CONCLUSION: In the face of considerable uncertainty about the cause of BV, high rates of recurrence, unacceptable treatment options and often insensitive and inconsistent clinical management, women are trying their own self-help remedies and lifestyle modifications to prevent recurrences, often with little effect. Clinical management of BV could be improved through the use of standardised diagnostic approaches, increased sensitivity and understanding of the impact of BV, and the provision of evidence based advice about known BV related risk factors.

The Impact of Sex Work on Women's Personal Romantic Relationships and the Mental Separation of Their Work and Personal Lives: A Mixed-Methods Study.

BACKGROUND: Very limited research has been undertaken on sex workers' personal romantic relationships and the impact the nature of their work has on their relationships. This exploratory study aimed to explore the impact sex work has on women's personal romantic relationships and the use of mental separation as a coping mechanism to balance the two aspects of their lives. METHODS: Fifty-five women working in the indoor sex industry in Melbourne, Australia, were recruited to complete a self-report questionnaire about various aspects of their work, including the impact of sex work on their personal relationships. Questionnaires were completed anonymously and included both closed and open-ended questions. A further six women were interviewed to 'member check' the accuracy of the questionnaire findings. RESULTS: Most women (78%) reported that, overall, sex work affected their personal romantic relationships in predominantly negative ways, mainly relating to issues stemming from lying, trust, guilt and jealousy. A small number of women reported positive impacts from sex work including improved sexual self-esteem and confidence. Just under half of women were in a relationship at the time of the study and, of these, 51% reported their partner was aware of the nature of their work. Seventy-seven percent of single women chose to remain single due to the nature of their work. Many women used mental separation as a coping mechanism to manage the tensions between sex work and their personal relationships. Member checking validated the accuracy of the questionnaire data. CONCLUSION: This exploratory study identified a number of ways in which sex work impacts negatively on women's personal romantic relationships. The findings of this study support the need for further studies to be undertaken to determine if the findings are reflected in a larger, more representative sample of Australian sex workers and should be considered in the context of any future intervention and support programs aimed at addressing the tensions sex workers experience between their work and personal relationships. Greater public awareness and education programs aimed at addressing the negative stigma associated with the sex industry may go some way towards easing the issues faced by women in their personal relationships.

Factors associated with participation and attrition in a longitudinal study of bacterial vaginosis in Australian women who have sex with women.

OBJECTIVE: A number of social and sexual risk factors for bacterial vaginosis (BV) have been described. It is important to understand whether these factors are associated with non-participation or attrition of participants from longitudinal studies in order to examine potential for recruitment or attrition bias. We describe factors associated with participation and attrition in a 24-month prospective cohort study, investigating incident BV among Australian women who have sex with women. STUDY DESIGN AND SETTING: Participants negative for prevalent BV were offered enrolment in a longitudinal cohort study. Participants self-collected vaginal samples and completed questionnaires 3-monthly to endpoint (BV-positive/BV-negative by 24 months). Factors associated with participation in the cohort study were examined by logistic regression and factors associated with attrition from the cohort were examined by Cox regression. RESULTS: The cross-sectional study recruited 457 women. 334 BV-negative women were eligible for the cohort and 298 (89%, 95%CI 85, 92) enrolled. Lower educational levels (aOR 2.72, 95%CI 1.09, 6.83), smoking (aOR 2.44, 95%CI 1.13, 5.27), past BV symptoms (aOR 3.42, 95%CI 1.16, 10.10) and prior genital warts (aOR 2.71, 95%CI 1.14, 6.46) were associated with non-participation; a partner co-enrolling increased participation (aOR 3.73, 95%CI 1.43, 9.70). 248 participants (83%, 95%CI 78, 87) were retained to study endpoint (BV-negative at 24 months or BV-positive at any stage). Attrition was associated being <30 yrs (aHR 2.15, 95%CI 1.13, 4.10) and a male partner at enrolment (aHR 6.12, 95%CI 1.99, 18.82). CONCLUSION: We achieved high participation and retention levels in a prospective cohort study and report factors influencing participation and retention of participants over a 24-month study period, which will assist in the design and implementation of future cohort studies in sexual health and disease.

The burden of bacterial vaginosis: women's experience of the physical, emotional, sexual and social impact of living with recurrent bacterial vaginosis.

BACKGROUND: Bacterial vaginosis is a common vaginal infection, causing an abnormal vaginal discharge and/or odour in up to 50% of sufferers. Recurrence is common following recommended treatment. There are limited data on women's experience of bacterial vaginosis, and the impact on their self-esteem, sexual relationships and quality of life. The aim of this study was to explore the experiences and impact of recurrent bacterial vaginosis on women. METHODS: A social constructionist approach was chosen as the framework for the study. Thirty five women with male and/or female partners participated in semi-structured interviews face-to-face or by telephone about their experience of recurrent bacterial vaginosis. RESULTS: Recurrent bacterial vaginosis impacted on women to varying degrees, with some women reporting it had little impact on their lives but most reporting it had a moderate to severe impact. The degree to which it impacted on women physically, emotionally, sexually and socially often depended on the frequency of episodes and severity of symptoms. Women commonly reported that symptoms of bacterial vaginosis made them feel embarrassed, ashamed, 'dirty' and very concerned others may detect their malodour and abnormal discharge. The biggest impact of recurrent bacterial vaginosis was on women's self-esteem and sex lives, with women regularly avoiding sexual activity, in particular oral sex, as they were too embarrassed and self-conscious of their symptoms to engage in these activities. Women often felt confused about why they were experiencing recurrent bacterial vaginosis and frustrated at their lack of control over recurrence. CONCLUSION: Women's experience of recurrent bacterial vaginosis varied broadly and significantly in this study. Some women reported little impact on their lives but most reported a moderate to severe impact, mainly on their self-esteem and sex life. Further support and acknowledgement of these impacts are required when managing women with recurrent bacterial vaginosis.