Chlamydia retesting remains low among young women in Australia: an observational study using sentinel surveillance data, 2018-2022.

BACKGROUND: Chlamydia remains the most notified bacterial sexually transmissible infection in Australia with guidelines recommending testing for re-infection at 3months post treatment. This paper aimed to determine chlamydia retesting and repeat positivity rates within 2-4months among young women in Australia, and to evaluate what factors increase or decrease the likelihood of retesting. METHODS: Chlamydia retesting rates among 16-29-year-old women were analysed from Australian Collaboration for Coordinated Enhanced Sentinel Surveillance of sexually transmissible infection and bloodborne virus (ACCESS) sentinel surveillance data (n =62 sites). Among women with at least one positive test between 1 January 2018 and 31 August 2022, retesting counts and proportions within 2-4months were calculated. Logistic regression was performed to assess factors associated with retesting within 2-4months. RESULTS: Among 8758 women who were positive before 31 August 2022 to allow time for follow up, 1423 (16.2%) were retested within 2-4months, of whom 179 (12.6%) tested positive. The odds of retesting within 2-4months were 25% lower if tested in a coronavirus disease 2019 (COVID-9) pandemic year (2020-2022) (aOR=0.75; 95% CI 0.59-0.95). Among 9140 women with a positive test before 30 November 2022, 397 (4.3%) were retested too early (within 7days to 1month) and 81 (20.4%) of those were positive. CONCLUSIONS: Chlamydia retesting rates remain low with around a sixth of women retested within 2-4months in line with guidelines. Re-infection is common with around one in eight retesting positive. An increase in retesting is required to reduce the risk of reproductive complications and onward transmission.

How Much Do Young Australians Know About Syphilis Compared With Chlamydia and Gonorrhea? Findings From an Online Survey.

BACKGROUND: There is increased heterosexual transmission of syphilis in Australia, an infection with severe outcomes. Australian policy emphasizes increasing sexually transmissible infection knowledge/awareness. However, little is known about young Australians' perceptions and knowledge of syphilis. METHODS: Our online sexual health survey was open May 2 to June 21, 2022, to 16- to 29-year-olds in Australia. We asked participants if they were aware of syphilis, their personal risk perception, and perceived severity of infection and compared with results for chlamydia/gonorrhea. Multivariable and multinomial logistic regressions were used to assess characteristics associated with outcomes. We measured sexually transmissible infection knowledge using 10 true/false statements (5 syphilis, 5 chlamydia/gonorrhea). RESULTS: Among 2018 participants (69.1% women, 48.9% heterosexual), 91.3% had heard of syphilis (vs. 97.2% for chlamydia and 93.3% for gonorrhea). Older (25-29 years; adjusted odds ratio [aOR], 2.4; 95% confidence interval [CI], 1.4-4.4) and gay/lesbian (aOR, 2.8; 95% CI, 1.4-5.3) respondents were more likely to have heard of syphilis, as were those who were non-Aboriginal, sexually active, and with a school-based sex education. Syphilis knowledge was lower than chlamydia/gonorrhea knowledge ( P < 0.001). More than half (59.7%) perceived syphilis to have serious health impacts (vs. 36.4% for chlamydia and 42.3% for gonorrhea). Older respondents were more likely (25-29 years; aOR 2.1; 95% CI, 1.6-2.8), and gay/lesbian respondents less likely (aOR, 0.7; 95% CI, 0.6-1.0) to perceive syphilis to have serious health impacts. One-fifth of sexually active participants were unsure of their risk of syphilis. CONCLUSIONS: Most young Australians are aware of syphilis, but few have comprehensive knowledge about the infection relative to chlamydia/gonorrhea. Considering increasing heterosexual transmission, syphilis health promotion campaigns should expand their focus.

Informing the design of a digital intervention to support sexually transmissible infection care in general practice: a qualitative study exploring the views of clinicians.

BACKGROUND: Strengthening sexually transmissible infection (STI) management in general practice is prioritised in Australian STI strategy. Digital interventions incorporating clinical decision support offer a mechanism to assist general practitioners (GPs) in STI care. This study explored clinicians' views towards a proposed digital intervention for supporting STI care in Australian general practice as a first step in the tool's design. METHODS: Semi-structured one-to-one interviews were conducted during 2021 with sexual health physicians (n =2) and GPs (n =7) practicing in the state of Victoria, Australia. Interviews explored views on a proposed STI digital intervention for general practice. We applied the Theoretical Domains Framework (TDF), a behaviour change framework to our analysis. This involved: (1) directed content analysis of transcripts into TDF domains; and (2) thematic analysis to identify sub-themes within relevant TDF domains. Subthemes were subsequently categorised into enablers and barriers to the use and implementation of a STI computerised clinical decision support system (CDSS). RESULTS: All interviewees viewed a digital intervention for STI care favourably, expressing confidence in its potential to improve care and support management. Within the relevant TDF domains (e.g. environmental context and resources), subthemes emerged as barriers (e.g. lack of sensitivity to patient context) or enablers (e.g. clear communication and guidance) to the use and implementation of a STI CDSS in primary care. Multiple subthemes (e.g. time constraints) have the potential to be a barrier or an enabler, and is largely dependent on end-user needs being met and clinical context being appropriately addressed. CONCLUSIONS: A digital intervention incorporating clinical decision support was viewed favourably, indicating a possible role for such a tool in Australian general practice. Co-design with end-users and prototype evaluation with health consumers is recommended to ensure relevance and usefulness.

Patient delivered partner therapy for chlamydia infection is used by some general practitioners, but more support is needed to increase uptake: findings from a mixed-methods study.

OBJECTIVES: Patient-delivered partner therapy (PDPT) describes the giving of a prescription or antibiotics by an index case with chlamydia to their sexual partners. PDPT has been associated with higher numbers of partners receiving treatment. In Australia, general practitioners (GPs) previously expressed negative views about PDPT. Health authority guidance for PDPT has since been provided in some areas. We investigated recent use and perceptions of PDPT for chlamydia among GPs in Australia. METHODS: In 2019, we conducted an online survey comprising multiple-choice and open-ended questions to investigate GPs' chlamydia management practices, including PDPT. Logistic regression identified factors associated with ever offering PDPT. A directed content analysis of free-text data explored GPs' perceptions towards PDPT. RESULTS: The survey received responses from 323 GPs; 85.8% (n=277) answered PDPT-focused questions, providing 628 free-text comments. Over half (53.4%) reported never offering PDPT, while 36.5% sometimes and 10.1% often offered PDPT. GPs more likely to offer PDPT were aged ≥55 years (adjusted OR (AOR) 2.9, 95% CI 1.4 to 5.8), worked in non-metropolitan areas (AOR 2.5, 95% CI 1.5 to 4.4) and jurisdictions with health authority PDPT guidance (AOR 2.3, 95% CI 1.4 to 3.9). Qualitative data demonstrated that many GPs recognised PDPT's potential to treat harder to engage partners but expressed hesitancy to offer PDPT because they considered partners attending for care as best practice. GPs emphasised a case-by-case approach that considered patient and partner circumstances to determine PDPT suitability. To alleviate medicolegal concerns, many GPs indicated a need for professional and health authority guidance that PDPT is permissible. They also desired practical resources to support its use. CONCLUSION: GPs appear to accept the place of PDPT as targeted to those who may otherwise not access testing or treatment. Availability of health authority guidance appears to have supported some GPs to incorporate PDPT into their practice.

Telehealth for sexual and reproductive health issues: a qualitative study of experiences of accessing care during COVID-19.

BACKGROUND: Medicare, the health insurance system underpinning free healthcare in Australia, introduced free telehealth items in 2020 in response to the coronavirus disease 2019 (COVID-19) pandemic. Their uptake among healthcare providers was significant, including among general practitioners and sexual health services. Here, we report people's experiences of accessing sexual and reproductive health (SRH)-related care via telehealth collected as part of a survey exploring the impact of COVID on SRH health. METHODS: This study utilises qualitative data from two online surveys conducted in 2020. Surveys were advertised through social media and professional and personal networks. Anyone aged≥18years and living in Australia was eligible to participate. Respondents were asked whether they accessed care for their SRH via telehealth. A free-text question asking for further detail about their experience was analysed using content analysis. RESULTS: A total of 114/1070 respondents (10.7%) accessed healthcare services via telehealth for SRH-related reasons within the previous 4weeks. Three themes were identified from 78 free-text comments: (1) accessibility and convenience of telehealth; (2) appropriateness of telehealth for SRH issues; and (3) connecting and communicating with clinicians via telehealth. Respondents had a wide range of experiences. Telehealth improved access to services for some participants, and it was appropriate for some, but not all SRH issues. Difficulties connecting with clinicians on both an interpersonal and technical level was a key barrier to a satisfactory patient experience. CONCLUSIONS: Telehealth can offer a viable alternative to face-to-face care, providing patients can overcome key connection and communication barriers.

Sexual behaviour during COVID-19: a repeated cross-sectional survey in Victoria, Australia.

BACKGROUND: During 2020, the State of Victoria (Australia) experienced two COVID-19 waves. Both resulted in community lockdowns followed by eased restrictions. We examined variation of sexual behaviour in Victorians over time during COVID-19. METHODS: We conducted a repeated online survey at four timepoints corresponding with two lockdown (LD1, LD2) and two reduced restriction (RR1, RR2) periods in Victoria. A convenience sample of participants aged ≥18years was recruited via social media and asked about their recent (past 4weeks) sexual behaviour. Using multivariable logistic regression, we investigated variation in sexual behaviour between surveys. RESULTS: A total of 1828 surveys were completed; 72% identified as female, 69% were aged 18-29years, 90% were metropolitan residents. The proportion reporting recent partnered sex ranged from 54.9% (LD2) to 70.2% (RR1). Across all timepoints, the most common sexual partners were regular (81.5%, n =842) and 10.8% (n =111) reported casual partners (e.g. hook-ups). Compared with LD1, respondents were >2-fold more likely to report casual partner(s) during reduced restrictions (RR1: aOR 2.0; 95% CI 1.1-3.7; RR2: aOR 2.8; 95% CI 1.3-5.9). Across all timepoints, 26.6% (n =486) reported using dating apps. Compared with LD1, dating app use for face-to-face activities (e.g. dates, hook-ups) was >4-fold higher during reduced restrictions (RR1: aOR 4.3; 95% CI 2.3-8.0; RR2: aOR 4.1; 95% CI 1.9-8.8). App use for distanced activities (e.g. sexting, virtual dates) was highest during LD1 (48.8%) than other periods. CONCLUSIONS: In this convenience sample, self-reported sexual behaviours fluctuated between lockdowns and reduced restrictions. While dating apps may provide a mechanism for virtual connections, this may be temporary until physical connections are possible.

'It's literally giving them a solution in their hands': the views of young Australians towards patient-delivered partner therapy for treating chlamydia.

OBJECTIVES: Patient-delivered partner therapy (PDPT) is a method for providing antibiotic treatment for the sexual partners of an index patient with an STI by means of a prescription or medication that the index patient gives to their sexual partner(s). Qualitative research regarding barriers and enablers to PDPT has largely focused on the views of healthcare providers. In this study, we sought to investigate the views of young people (as potential health consumers) regarding PDPT for chlamydia. METHODS: Semi-structured telephone interviews were conducted with young Australian men and women. Participants were asked to provide their views regarding PDPT from the perspective of both an index patient and partner. Purposive and snowball sampling was used. Data were analysed thematically. RESULTS: We interviewed 22 people (13 women, 9 men) aged 18-30 years, 15 of whom had previously been tested for chlamydia. Despite none having previous knowledge of or experience using PDPT, all viewed it positively and thought it should be widely available. Participants reported that they would be willing to give PDPT to their sexual partners in situations where trust and comfort had been established, regardless of the relationship type. Protecting their partners' privacy was essential, with participants expressing reluctance to provide their partners' contact details to a doctor without consent. Beyond logistical benefits, PDPT was viewed as a facilitator to partner notification conversations by offering partners a potential solution. However, most interviewees indicated a preference to consult with a healthcare provider (GP or pharmacist) before taking PDPT medication. Participants indicated that legitimacy of information when navigating a chlamydia diagnosis was crucial and was preferably offered by healthcare providers. CONCLUSIONS: Though PDPT is unlikely to fully replace partners' interactions with healthcare providers, it may facilitate partner notification conversations and provide partners greater choice on how, when and where they are treated.

Epididymitis rates in Australian hospitals 2009-2018: ecological analysis.

OBJECTIVES: To investigate rates of acute epididymitis diagnosed in Australian hospital settings. METHODS: Yearly hospital admission and emergency department (ED) rates of epididymitis as primary diagnoses were calculated for 15-44-year-old men for three states (Victoria, New South Wales, Queensland) from 2009 to 2014 using population denominators. Zero inflated Poisson regression models were used to analyse variation in rates by year, age, and residential area. Additionally, we investigated national epididymitis admission trends from 2009 to 2018 using generalised linear models. RESULTS: Between 2009 and 2014, there was a total of 7375 admissions and 17 281 ED presentations for which epididymitis was the main reason for care. Most epididymitis diagnoses (94.0% in admissions, 99.7% in EDs) were without abscess, and 2.5% of admissions were for chlamydial epididymitis. Almost a quarter (23.3%) of epididymitis diagnosed in EDs resulted in hospital admission. In 2014, the epididymitis rate per 100 000 men was 38.7 in admissions and 91.9 in EDs. Comparing 2014 with 2009, the overall epididymitis diagnosis rate increased in admissions by 32% (adjusted incident rate ratio (aIRR) 1.32, 95% CI 1.20 to 1.44) and in ED attendances by 40% (aIRR 1.40, 95% CI 1.31 to 1.49). By age, the highest rates were among men 35-44 years in admissions and men 15-24 years in EDs. National admission rates of epididymitis during 2009-2018 showed a similar pattern. CONCLUSION: Rates of epididymitis diagnosis in hospital admission and ED presentations increased. Different age-related rates in these settings suggest a different aetiology or differential severity by age group.

Love during lockdown: findings from an online survey examining the impact of COVID-19 on the sexual health of people living in Australia.

INTRODUCTION: Australia recorded its first case of COVID-19 in late January 2020. On 22P March 2020, amid increasing daily case numbers, the Australian Government implemented lockdown restrictions to help 'flatten the curve'. Our study aimed to understand the impact of lockdown restrictions on sexual and reproductive health. Here we focus on sexual practices. METHODS: An online survey was open from the 23PP April 2020 to 11P May 2020. Participants were recruited online via social media and other networks and were asked to report on their sexual practices in 2019 and during lockdown. Logistic regression was used to calculate the difference (diff) (including 95% CIs) in the proportion of sex practices between time periods. RESULTS: Of the 1187 who commenced the survey, 965 (81.3%) completed it. Overall, 70% were female and 66.3% were aged 18-29 years. Most (53.5%) reported less sex during lockdown than in 2019. Compared with 2019, participants were more likely to report sex with a spouse (35.3% vs 41.7%; diff=6.4%; 95% CI 3.6 to 9.2) and less likely to report sex with a girl/boyfriend (45.1% vs 41.8%; diff=-3.3%; 95% CI -7.0 to -0.4) or with casual hook-up (31.4% vs 7.8%; 95% CI -26.9 to -19.8). Solo sex activities increased; 14.6% (123/840) reported using sex toys more often and 26.0% (218/838) reported masturbating more often. Dating app use decreased during lockdown compared with 2019 (42.1% vs 27.3%; diff= -14.8%; 95% CI -17.6 to -11.9). Using dating apps for chatting/texting (89.8% vs 94.5%; diff=4.7%; 95% CI 1.0 to 8.5) and for setting up virtual dates (2.6% vs 17.2%; diff=14.6%; 95% CI 10.1 to 19.2) increased during lockdown. CONCLUSION: Although significant declines in sexual activity during lockdown were reported, people did not completely stop engaging in sexual activities, highlighting the importance of ensuring availability of normal sexual and reproductive health services during global emergencies.

Diagnosis of pelvic inflammatory disease and barriers to conducting pelvic examinations in Australian general practice: findings from an online survey.

Background Pelvic inflammatory disease (PID) is under-diagnosed globally, particularly in primary care, and if untreated may cause reproductive complications. This paper investigates PID diagnosis by Australian general practitioners (GPs) and barriers to their conducting a pelvic examination. METHODS: An online survey investigating Australian GPs' chlamydia management, including PID diagnosis, was conducted in 2019. From 323 respondents, 85.8% (n = 277) answered multiple-choice questions about PID and 74.6% (n = 241) answered a free-text question about barriers to conducting pelvic examinations. Using multivariable logistic regression, we identified factors associated with conducting pelvic examinations. Barriers to performing pelvic examinations were explored using thematic analysis. RESULTS: Most GPs indicated that they routinely ask female patients with a sexually transmissible infection about PID symptoms, including pelvic pain (86.2%), abnormal vaginal discharge (95.3%), abnormal vaginal bleeding (89.5%), and dyspareunia (79.6%). Over half reported routinely conducting speculum (69.0%) and bimanual pelvic (55.3%) examinations for women reporting pelvic pain. Female GPs were more likely to perform speculum [adjusted odds ratio (AOR) 4.6; 95%CI: 2.6-8.2] and bimanual pelvic examinations (AOR 3.7; 95%CI: 2.1-6.5). GPs with additional sexual health training were more likely to routinely perform speculum (AOR 2.2; 95%CI: 1.1-4.2) and bimanual pelvic examinations (AOR 2.1; 95%CI: 1.2-3.7). Barriers to pelvic examinations were patient unwillingness and/or refusal, GP gender, patient health-related factors, time pressures, and GP reluctance. CONCLUSION: Although GPs typically ask about PID symptoms when managing patients with chlamydia, they are not consistently able or willing to perform pelvic examinations to support a diagnosis, potentially reducing capacity to diagnose PID.

The Views of Patients and Partners Toward Patient-Delivered Partner Therapy for Chlamydia: A Systematic Review.

BACKGROUND: The majority of research on patient-delivered partner therapy (PDPT) has focused on its impact on reinfections. This study aimed to systematically review the evidence regarding the acceptability of PDPT by patients and partners for chlamydia infection. METHODS: Three electronic databases were searched in March 2019 using terms related to PDPT. Studies were included if they reported on patient or partner acceptance of PDPT for chlamydia and were conducted in high-income countries. Actual and perceived acceptabilities of PDPT were assessed. RESULTS: Thirty-three studies were included: 24 quantitative, 3 qualitative, and 6 mixed methods. Most were clinic based. Quantitative data showed that participants' perceived willingness to give PDPT to their partner(s) ranged from 44.7% to 96.3% (median, 84%), and 24% to 71% (median, 65%) of people who offered PDPT for their partner(s) accepted it. Partners' perceived willingness to accept ranged from 42.7% to 67% (median, 62%), and actual acceptance ranged from 44.7% to 80% (median, 77%). Those in longer-term relationships were generally more likely to accept PDPT; however, beyond this, we identified few clear trends. Qualitative studies found that convenience of PDPT and assurance of partner treatment were benefits, whereas partners not seeing a health care professional was viewed as a downside. Packaging that appeared legitimate and coaching on delivering PDPT were facilitators. CONCLUSIONS: Because patients bear responsibility for the success of PDPT, this information is crucial in clinical settings. Acceptance, perceived and real, of PDPT was generally high. Patients are best placed to determine whether PDPT is appropriate for them, and it should be offered as an option.

Patient-delivered partner therapy for chlamydia in Australia: can it become part of routine care?

Background Patient-delivered partner therapy (PDPT) is a method for an index patient to give treatment for genital chlamydia to their sexual partner(s) directly. In Australia, PDPT is considered suitable for heterosexual partners of men and women, but is not uniformly endorsed. We explored the policy environment for PDPT in Australia and considered how PDPT might become a routine option. METHODS: Structured interviews were conducted with 10 key informants (KIs) representing six of eight Australian jurisdictions and documents relevant to PDPT were appraised. Interview transcripts and documents were analysed together, drawing on KIs' understanding of their jurisdiction to explore our research topics, namely the current context for PDPT, challenges, and actions needed for PDPT to become routine. RESULTS: PDPT was allowable in three jurisdictions (Victoria, New South Wales, Northern Territory) where State governments have formally supported PDPT. In three jurisdictions (Western Australia, Australian Capital Territory, Tasmania), KIs viewed PDPT as potentially allowable under relevant prescribing regulations; however, no guidance was available. Concern about antimicrobial stewardship precluded PDPT inclusion in the South Australian strategy. For Queensland, KIs viewed PDPT as not allowable under current prescribing regulations and, although a Medicine and Poisons Act was passed in 2019, it is unclear if PDPT will be possible under new regulations. Clarifying the doctor-partner treating relationship and clinical guidance within a care standard were viewed as crucial for PDPT uptake, irrespective of regulatory contexts. CONCLUSION: Endorsement and guidance are essential so doctors can confidently and routinely offer PDPT in respect to professional standards and regulatory requirements.

Clinical Features and Therapeutic Response in Women Meeting Criteria for Presumptive Treatment for Pelvic Inflammatory Disease Associated With Mycoplasma genitalium.

BACKGROUND: There are limited published data describing clinical features and therapeutic response in women meeting the criteria for presumptive treatment of pelvic inflammatory disease associated with Mycoplasma genitalium (MG-PID). The MG-PID has been reported to respond poorly to standard PID treatment regimens and while moxifloxacin is recommended in several treatment guidelines, published data to support its use are scant. METHODS: We conducted a retrospective study of women at Melbourne Sexual Health Centre between 2006 and 2017, who met the Centers for Disease Control and Prevention criteria for presumptive treatment of PID, and had MG detected as the sole pathogen. Clinical and laboratory characteristics of MG-PID were compared to cases of chlamydial PID (CT-PID) by multivariable analysis. Microbiological and clinical cure following moxifloxacin and standard PID treatment was determined for women with MG-PID who returned for test of cure between 14 and 120 days. RESULTS: Ninety-two patients with MG-PID were compared with 92 women with CT-PID. The MG-PID was associated with increased lower abdominal tenderness (adjusted odds ratio, 2.29; 95% confidence interval [CI], 1.14-4.60), but a lesser vaginal polymorphonuclear response compared to CT-PID by multivariable analysis. Of the 92 women with MG-PID, 54/92 (59%) received moxifloxacin (10-14 days) and 37/54 had a test of cure between 14 and 120 days; 27/37 (73%) cases had a median of 7 days of a standard regimen containing doxycycline and metronidazole +/- azithromycin before moxifloxacin. Microbial cure following moxifloxacin was 95% (95% CI, 82-99%) and did not differ from standard therapy (P = 0.948), however clinical cure was significantly higher following moxifloxacin (89%; 95% CI, 75-97%; P = 0.004)] although adverse effects were more common. CONCLUSIONS: Women meeting Centers for Disease Control and Prevention criteria for presumptive treatment of MG-PID did not significantly differ to those with CT-PID. Moxifloxacin was associated with higher rates of symptom resolution in women with PID, and although microbial cure was high, it did not differ between regimens.

Trends in diagnosis of pelvic inflammatory disease in an Australian sexual health clinic, 2002-16: before and after clinical audit feedback.

Background A 2006 Australian sexual health clinic audit of pelvic inflammatory disease (PID) diagnosis rates found variability between doctors. Doctors were given audit feedback towards increasing diagnosis and reducing variability. The clinic implemented other improvements to increase capacity. This study investigated PID diagnosis time trends before and after feedback. METHODS: Yearly PID diagnosis rates for women aged 16-49 years attending the clinic (2002-16) were calculated. Using multivariable generalised linear mixed models, adjusted for patient risk and lower genital infection (any of chlamydia, gonorrhoea, Mycoplasma genitalium, bacterial vaginosis) and stratified by before (2002-June 2007) and after (July 2007-2016) feedback, we assessed if PID rates changed over time, accounting for between-doctor variability. RESULTS: During 2002-16, 144 doctors undertook 84476 female consultations and diagnosed 1755 (2.1%, 95% confidence interval (CI) 2.0-2.2) with PID. Comparing 2002-03 to 2015-16, the yearly PID rate increased; 0.8% (37/4836) to 2.9% (209/7088). Comparing before and after feedback more women reported any symptoms at triage (35.1%-47.2%) or had a lower genital infection diagnosed (10.1%-14.9%). After feedback, PID rates increased by 8% yearly (incidence rate ratio (IRR) 1.08, 95% CI 1.06-1.11), but were unchanged (adjusted IRR (aIRR) 1.01, 95% CI 0.98-1.03) after adjustment for patient characteristics. Factors associated with PID were self-reported symptoms, younger age and a lower genital infection. Lower variability in doctor-specific rates was observed after feedback. CONCLUSIONS: Increasing PID diagnosis rates appeared to be driven by a greater female patient risk profile, influenced by increased capacity following service improvements.

Rates of pelvic inflammatory disease and ectopic pregnancy in Australia, 2009-2014: ecological analysis of hospital data.

OBJECTIVE: To analyse yearly rates of pelvic inflammatory disease (PID) and ectopic pregnancy (EP) diagnosed in hospital settings in Australia from 2009 to 2014. METHODS: We calculated yearly PID and EP diagnosis rates in three states (Victoria, New South Wales, Queensland) for women aged 15-44 years using hospital admissions and emergency department (ED) attendance data, with population and live birth denominators. We stratified PID diagnoses as chlamydial-related or gonorrhoeal-related (Chlamydia trachomatis (CT)-related or Neisseria gonorrhoeae (NG)-related), acute, unspecified and chronic, and analysed variations by year, age and residential area using Poisson regression models. RESULTS: For PID, the rate of all admissions in 2014 was 63.3 per 100 000 women (95% CI 60.8 to 65.9) and of all presentations in EDs was 97.0 per 100 000 women (95% CI 93.9 to 100.2). Comparing 2014 with 2009, the rate of all PID admissions did not change, but the rate of all presentations in EDs increased (adjusted incidence rate ratio (aIRR) 1.34, 95% CI 1.24 to 1.45), and for admissions by PID category was higher for CT-related or NG-related PID (aIRR 1.73, 95% CI 1.31 to 2.28) and unspecified PID (aIRR 1.09, 95% CI 1.00 to 1.19), and lower for chronic PID (aIRR 0.84, 95% CI 0.74 to 0.95). For EP, in 2014 the rate of all admissions was 17.4 (95% CI 16.9 to 17.9) per 1000 live births and of all ED presentations was 15.6 (95% CI 15.1 to 16.1). Comparing 2014 with 2009, the rates of all EP admissions (aIRR 1.06, 95% CI 1.04 to 1.08) and rates in EDs (aIRR 1.24, 95% CI 1.18 to 1.31) were higher. CONCLUSIONS: PID and EP remain important causes of hospital admissions for female STI-associated complications. Hospital EDs care for more PID cases than inpatient departments, particularly for young women. Updated primary care data are needed to better understand PID epidemiology and healthcare usage.

Characteristics of pelvic inflammatory disease where no sexually transmitted infection is identified: a cross-sectional analysis of routinely collected sexual health clinic data.

OBJECTIVES: Pelvic inflammatory disease (PID) occurs when pathogens, often sexually transmitted, ascend to the upper genital tract, yet a causative pathogen is not detected in a substantial proportion of diagnosed PID. We assessed the characteristics associated with PID in women in whom chlamydia, gonorrhoea, Mycoplasma genitalium (MG) and bacterial vaginosis (BV) were not detected ('pathogen-negative-PID'). METHODS: Cross-sectional analysis of routinely collected clinical data from new female patients attending a sexual health clinic between 2006 and 2013. Women were eligible if they had been diagnosed with PID and tested for genital chlamydia, gonorrhoea, MG and BV. Logistic regression was conducted to identify characteristics associated with pathogen-negative-PID. RESULTS: Among 330 women with clinically diagnosed PID, 204 (61.8%, 95% CI 56.3% to 67.1%) had pathogen-negative-PID. Compared with pathogen-positive-PID, pathogen-negative-PID cases were more likely to be aged ≥30 years (adjusted odds ratio (AOR) 1.7, 95% CI 1.0 to 3.0), had less evidence of vaginal inflammation (AOR 0.5, 95% CI 0.3 to 0.9) and reported less unprotected sex (AOR 0.6, 95% CI 0.4 to 1.0). CONCLUSIONS: These findings highlight uncertainties around PID diagnosis and aetiology. Pathogen-negative-PID could represent (i) a false positive diagnosis where the woman does not have a sexually transmitted infection (STI) or PID, (ii) PID of another microbiological aetiology or associated with a past STI or (iii) PID where the cervical infection has cleared. However, until diagnostic biomarkers are available, PID treatment should be based on clinical features and sexual risk.

Population attributable fraction of pelvic inflammatory disease associated with chlamydia and gonorrhoea: a cross-sectional analysis of Australian sexual health clinic data.

OBJECTIVES: Pelvic inflammatory disease (PID) is an important cause of female infertility and can occur when micro-organisms such as chlamydia or gonorrhoea ascend to the upper genital tract. PID has been used as an outcome measure in chlamydia screening trials; however, few data have quantified the PID burden that could be avoided by preventing chlamydia. We estimated the population attributable fraction (PAF) of PID associated with a current chlamydia or gonorrhoea infection among females 16-49 years attending an Australian sexual health clinic (SHC) (2006-2013). METHODS: Using multivariable logistic regression, PAF estimates were adjusted for age and behavioural factors. Two separate analyses were undertaken: one among 'chlamydia-tested' women and one among a subset of chlamydia-tested women who were also tested for gonorrhoea ('chlamydia+gonorrhoea-tested'). A sensitivity analysis using multiple imputation was conducted to assess the impact of missing data on results. RESULTS: Among 15 690 chlamydia-tested women, 1279 (8.2%, 95% CI 7.7% to 8.6%) were chlamydia positive, 436 (2.8%, 95% CI 2.5% to 3.0%) had PID diagnosed and the adjusted PAF for chlamydia was 14.1% (95% CI 9.9% to 18.0%). Among the chlamydia+gonorrhoea-tested subset (n=8839), 681 (7.7%, 95% CI 7.2% to 8.3%) tested positive for chlamydia only, 30 (0.3%, 95% CI 0.2% to 0.5%) for gonorrhoea only, 22 (0.2%, 95% CI 0.2% to 0.4%) for chlamydia and gonorrhoea and 419 (4.7%, 95% CI 4.3% to 5.2%) had PID diagnosed. The adjusted PAF was highest for chlamydia only (12.4%, 95% CI 8.4% to 16.2%) compared with gonorrhoea only (0.9%, 95% CI -0.1% to 1.8%) or concurrent infections (1.0%, 95% CI 0.0% to 1.9%). CONCLUSIONS: In this high chlamydia prevalence SHC population, eliminating a current chlamydia infection might at most reduce PID by about 14%.

Trends in chlamydia positivity among heterosexual patients from the Victorian Primary Care Network for Sentinel Surveillance, 2007-2011.

OBJECTIVE: To describe trends in chlamydia positivity from 2007 to 2011 among heterosexual people tested for chlamydia at selected clinics that provide services to people at high risk in Victoria, Australia. DESIGN: The Victorian Primary Care Network for Sentinel Surveillance is a prospective system that collates pathology results from laboratories and demographic and behavioural data from a questionnaire. SETTING: Two sexual health clinics and six other primary care clinics that target young people and women at high risk. PARTICIPANTS: All clients tested for chlamydia at sentinel clinics. Individuals aged less than 16 years, sex workers, or those reporting any same-sex sexual partners in the past 12 months were excluded from the analysis. MAIN OUTCOME MEASURES: Chlamydia positivity trends were assessed using three-level random-effects Poisson regression, with clinic and subject treated as nested random factors. Models were offset for total number of tests and adjusted for relevant covariates. RESULTS: Between 2007 and 2011, chlamydia positivity among 31 682 tests in women increased from 5.1% to 6.3%, and positivity among 23 771 tests in men increased from 7.4% to 8.2%. Adjusting for age, country of birth, number of sex partners, condom use, and presence of symptoms, chlamydia positivity increased between 2007 and 2011 significantly among women (incidence rate ratio [IRR], 1.29; 95% CI, 1.11-1.50) and non-significantly among men (IRR, 1.07; 95% CI, 0.92-1.23). Over time, a decrease in reported inconsistent condom use was also observed in both men and women; however, men became more likely to report more than one partner in the past year. CONCLUSION: We identified a concerning increase in chlamydia positivity over time, particularly among young women.

Young Australians' receptiveness to discussing sexual health with a general practitioner.

BACKGROUND: Most sexual health care in Australia is provided through general practice. However, many young Australians experience barriers to accessing sexual health care. This research examines young Australians' receptiveness to discussing sexual health with a general practitioner (GP). METHODS: We conducted an anonymous online sexual health survey (open 2 May to 21 June 2022). Anyone living in Australia aged 16-29years was eligible to participate. Participants were recruited via social media and asked whether they agreed with five statements exploring their receptivity to discussing sexual health with GPs. We explored characteristics associated with responses using multivariable logistic regression. RESULTS: Among 1915 participants, 69.3% were cisgender women, with a median age of 20years; 48.5% were heterosexual. Approximately one-fifth agreed they might not tell a GP the whole truth about their sexual history, would be worried about confidentiality when discussing their sexual history and would be too embarrassed to see their usual GP if they thought they had a sexually transmitted infection. Over half (55.8%) agreed they would be comfortable with a GP bringing up sexual health in an unrelated consultation, but 39.6% would be nervous to bring up sexual health in case they needed an intimate examination. Multivariate regression identified several characteristics associated with responses. Notably, having a school-based sex education and a usual GP were factors associated with increased receptivity to discussing sexual health. CONCLUSIONS: Young Australians were generally open to discussing sexual health with a GP. School-based sex education and GP-patient relationships are key to promoting sexual health among young people.