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.

Asymptomatic Mycoplasma genitalium infection amongst marginalised young people accessing a youth health service in Melbourne.

We conducted a study to establish the prevalence of Mycoplasma genitalium amongst asymptomatic young people experiencing homelessness in the context of comprehensive health care delivery. All asymptomatic young people at risk of sexually transmitted infections were offered urinary polymerase chain reaction testing for M. genitalium whilst being tested for Chlamydia trachomatis and Neisseria gonorrhoeae over a four-month period in 2012. Those who tested positive were notified of the infection and offered treatment. Sixty asymptomatic young people (36 female and 24 male) were tested for M. genitalium, identifying eight cases (13%) (six female and two male). Ten young people (17%) tested positive for C. trachomatis, three (5%) of whom were positive for both M. genitalium and C. trachomatis. There were no cases of N. gonorrhoeae. Of the eight cases of M. genitalium, seven were contactable and five were treated at our clinic with azithromycin 1 g stat. Two of the five returned after a month for a test of cure, identifying one resistant infection. Further data on the epidemiology of M. genitalium are required before testing recommendations can be made; however, consideration should be given to testing for M. genitalium in settings where other sexually transmitted infections are prevalent.

Women's experiences of pelvic inflammatory disease: implications for health-care professionals.

This study explored the health-care experiences of women diagnosed with pelvic inflammatory disease. Semi-structured interviews were conducted with 23 women diagnosed with pelvic inflammatory disease. Many women felt empowered about their health post-diagnosis; however, a smaller number reported becoming hyper-vigilant towards symptoms. Infertility was the greatest concern for women. Inadequate information and treatment resulted in negative health experiences, whereas clinician honesty and concern were viewed positively. The findings highlight the need for community education encouraging early presentation for the treatment of pelvic pain and emphasise the need for health practitioners to be responsive to the psychosocial aspects of pelvic inflammatory disease.

Chlamydia screening in young people as an outcome of a HEADSS; Home, Education, Activities, Drug and alcohol use, Sexuality and Suicide youth psychosocial assessment tool.

AIMS AND OBJECTIVES: To identify the percentage of young people presenting to a primary healthcare service targeting homeless youth, in Melbourne, Australia, who, based on youth-specific Home, Education, Activities, Drug and alcohol use, Sexuality and Suicide (HEADSS) psychosocial assessment tool, were screened for the sexually transmitted infection Chlamydia and tested positive. BACKGROUND: Homeless young people are at high risk of poor health outcomes including sexual health. Chlamydia prevalence is highest in 16-24 years. Youth psychosocial assessment tools such as the HEADSS can engage young people and provide comprehensive health assessment that identifies health risks. DESIGN: A retrospective audit. METHODS: One hundred consecutive client files of youth who presented to a primary healthcare service for the first time were selected. Client data were collected at the health services' inner city drop-in clinic and clinical refuge outreach (CRO). HEADSS assessments were made on new presentations to identify those at risk of Chlamydia. These young people were then offered screening for Chlamydia using a first-pass urine sample. RESULTS: One hundred HEADSS assessments were audited, of which 15 were incomplete. Of the 85 completed HEADSS assessments, 43 were tested and 11 had Chlamydia-positive results. CONCLUSION: Comprehensive youth assessment tools, such as the HEADSS, can provide a valuable resource in identifying sexual health risks such as Chlamydia. In turn, skilled nursing staff can provide opportunistic screening. Early identification and treatment for Chlamydia can reduce the spread and sequela of this highly infectious STI. RELEVANCE TO CLINICAL PRACTICE: Youth health nurses can enhance their nursing practice in working with young people at risk of homelessness and improve their health outcomes by employing youth-specific assessments.

Key informant perceptions of youth-focussed sexual health promotion programs in Australia.

BACKGROUND: This paper explores key informant (KI) perceptions of the barriers to effective sexual health promotion programs in Australia and suggests strategies to overcome these barriers. Three types of sexual health promotion programs were explored in this study: those targeting all young people (under 30), Aboriginal young people, and young people from culturally and linguistically diverse (CALD) backgrounds. METHODS: The study utilised a qualitative approach and involved 33 semistructured interviews with sexual health professionals involved in funding or delivering Australian sexual health promotion programs or working clinically with individuals diagnosed with sexually transmissible infections. RESULTS: Fourteen barriers to effective sexual health promotion programs were identified. Barriers included: difficulties associated with program evaluation, lack of involvement of the target community, the short-term nature of programs, problems with program resources and concerns about the content of programs. Additional barriers to programs targeting Aboriginal and CALD young people were also identified and included: a lack of cultural sensitivity; a failure to acknowledge differences in literacy, knowledge, and language skills; stigma and shame associated with sexual health; and the continued use of programs that lack inclusivity. KIs suggested strategies to overcome these barriers. CONCLUSION: Sexual health promotion in Australia suffers from several barriers that are likely to impede the effectiveness of programs. In particular, poor or nonexistent program evaluation and lack of community involvement are among the key areas of concern. It is hoped that the findings of this study will be useful in informing and shaping future Australian sexual health promotions.

Screening for chlamydia trachomatis: barriers for homeless young people.

OBJECTIVE: The study explored homeless young people's knowledge and attitudes of Chlamydia trachomatis (Chlamydia) and its screening. DESIGN: Semi-structured interviews using focus groups. SETTING: An inner city clinic for homeless young people. SUBJECTS: Homeless young people aged 16 -26 years. OUTCOMES: Perceptions of Chlamydia and its screening. RESULTS: 19 males and 6 females aged 16-26 years participated. Content analysis confirmed a lack of knowledge, prior education and misinformation about Chlamydia and barriers to being screened. Ideas for informing young people about Chlamydia included advertising on billboards, in free newspapers, and improved school sex education programs. CONCLUSIONS: Homeless young people have poor knowledge of Chlamydia and its screening and barriers to the screening process. Culturally-specific education and health promotion programs and services are needed.