Online chlamydia testing: an innovative approach that appeals to young people.

OBJECTIVE: To evaluate data from an online chlamydia testing program (OLC) developed to increase young people's access to testing for chlamydia, the most commonly notified disease in Australia and Western Australia, with a high proportion of notifications among young people (< 30 years). DESIGN AND SETTING: The OLC was launched in February 2010, and our study covers the period February 2010 to June 2011. Without needing to first visit a doctor, OLC participants receive risk self-assessment, education, testing, and, if necessary, referral for treatment, and can complete an online satisfaction survey. MAIN OUTCOME MEASURES: Number and proportion of downloaded pathology forms that resulted in a test; demographic characteristics of participants; prevalence of chlamydia; completeness and timeliness of follow-up of positive test results; and participant satisfaction. RESULTS: More than half (56%) of the 675 OLC pathology form downloads resulted in a test, and chlamydia was detected in 18% (66/377). Of those tested, over half were men (55%), and 71% were aged < 30 years. All participants with a positive test result received appropriate clinical management, with 50% being treated within 7 days of specimen collection. Of the 17% (55/332) who completed an online satisfaction survey, almost all said they would recommend the service to a friend. CONCLUSION: Internet-based screening for chlamydia is an effective means of increasing access to testing for young people at risk of sexually transmitted infections and is a valuable addition to opportunistic, clinic-based strategies.

Epidemiology of chlamydia and gonorrhoea among Indigenous and non-Indigenous Australians, 2000-2009.

OBJECTIVES: To assess notification trends for chlamydia and gonorrhoea infections in Indigenous Australians compared with non-Indigenous Australians in 2000-2009. DESIGN AND SETTING: We assessed trends in national notification rates using univariate Poisson regression and summary rate ratios. MAIN OUTCOME MEASURES: Crude notification rates and summary rate ratios, by Indigenous status, sex, age and area of residence. RESULTS: Over the 10-2012 period studied, chlamydia notification rates per 100,000 increased by 80% from 1383 in 2000 to 2494 in 2009 among Indigenous people, and by 335% from 51 in 2000 to 222 in 2009 among non-Indigenous people. The Indigenous versus non-Indigenous summary rate ratio was 23.92 (95% CI, 23.65-24.19; P<0.001). Gonorrhoea notification rates per 100,000 increased by 22% from 1347 in 2000 to 1643 in 2009 among Indigenous people, and by 70% from 10 in 2000 to 17 in 2009 among non-Indigenous people. The gonorrhoea summary notification rate ratio in Indigenous compared with non-Indigenous people was 173.78 (95% CI, 170.81-176.80; P<0.001). In Indigenous people, the highest chlamydia and gonorrhoea notification rates were in women, 15-19-2012-olds, and those living in remote areas. CONCLUSIONS: Chlamydia and gonorrhoea notification rates have increased in both populations but were higher among Indigenous people. Our findings highlight the need for targeted prevention programs for young people, especially Indigenous Australians residing in remote areas.

Sexual dysfunction and chronic pain: the role of psychological variables and impact on quality of life.

We report two studies examining the prevalence of sexual dysfunction, and the role of psychological variables, including quality of life, on sexual activity in patients at the commencement of an outpatient cognitive-behavioural pain management programme. In Study 1, 151 patients with non-cancer pain, predominantly of musculoskeletal origin, completed a range of standardised measures, including the Pain Disability Index, Beck Depression Inventory and Coping Strategies Questionnaire. Sexual dysfunction was common, and using stepwise multiple regression analysis was found to be more frequently reported by those with greater disability and depression, shorter pain duration, and infrequent use of coping self-statements. Study 2 was a pilot investigation of the impact of sexual dysfunction on quality of life (as measured by the WHOQOL-100) in a similar sample (n=41). Although sexual dysfunction was again commonly reported, subjects perceived it had less importance in quality of life than did other factors. The combined results support the previously proposed notion of adaptation to the impact of chronic illness on sexual function. In conclusion, sexual dysfunction is common in this population and is predicted by psychological factors and pain duration. However, other issues impact more significantly on quality of life. Therapeutic approaches to sexual dysfunction in these patients might best be focused on improving psychological factors, particularly depression and coping skills.

Improvement in antenatal testing for sexually transmissible infections and blood-borne viruses in Western Australian hospitals, 2007 to 2010.

OBJECTIVE: Antenatal testing for specified sexually transmissible infections (STIs) and blood-borne viruses (BBVs) is recommended by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). In 2007, the Department of Health, Western Australia (DoHWA) issued an operational directive (OD) recommending universal testing for chlamydia and additional testing for women in the STI endemic regions of Western Australia (WA). To assess adherence to these guidelines, seven WA public hospitals were audited. DESIGN AND SETTING: Demographic details and testing information of the last 200 women who gave birth immediately before 30 June 2007 (baseline audit) and 30 June 2010 (follow-up audit) were obtained from each hospital's antenatal records. RESULTS: Data from 2718 women who delivered at ≥36 weeks' gestation were analysed (baselinen=1353; follow-upn=1365). Testing at the first antenatal visit in accordance with the guidelines improved over time (RANZCOG: 68-74%; χ(2)-test = 13.96, d.f.=1, P<0.001; DoHWA OD: 12-40%; χ(2)-test = 279.71, d.f.=1, P<0.001). Retesting at 28-36 weeks' gestation in the STI endemic regions improved for chlamydia (3-10%; χ(2)-test = 17.40, d.f.=1, P<0.001) and gonorrhoea (3-7%; χ(2)-test=6.62, d.f.=1, P<0.05), but not for syphilis or HIV. Chlamydia prevalence was 3% and 8% among nonAboriginal and Aboriginal women, respectively. CONCLUSION: The proportion of women delivering in WA public hospitals who had antenatal STI and BBV tests improved after publication and promotion of the OD.

Syphilis epidemiology and public health interventions in Western Australia from 1991 to 2009.

OBJECTIVES: To describe the epidemiology of congenital and infectious syphilis during 1991-2009, examine the impact of public health interventions and discuss the feasibility of syphilis elimination among Aboriginal people in Western Australia (WA). METHODS: WA congenital and infectious syphilis notification data in 1991-2009 and national infectious syphilis notification data in 2005-2009 were analysed by Aboriginality, region of residence, and demographic and behavioural characteristics. Syphilis public health interventions in WA from 1991-2009 were also reviewed. RESULTS: During 1991-2009, there were six notifications of congenital syphilis (50% Aboriginal) and 1441 infectious syphilis notifications (61% Aboriginal). During 1991-2005, 88% of notifications were Aboriginal, with several outbreaks identified in remote WA. During 2006-2009, 62% of notifications were non-Aboriginal, with an outbreak in metropolitan men who have sex with men. The Aboriginal:non-Aboriginal rate ratio decreased from 173:1 (1991-2005) to 15:1 (2006-2009). CONCLUSIONS: These data demonstrate that although the epidemiology of syphilis in WA has changed over time, the infection has remained endemic among Aboriginal people in non-metropolitan areas. Given the continued public health interventions targeted at this population, the limited success in eliminating syphilis in the United States and the unique geographical and socioeconomic features of WA, the elimination of syphilis seems unlikely in this state.