RESUMEN
Abstract: In 2023, an increased number of urogenital and anorectal infections with Neisseria meningitis serogroup Y (MenY) were reported in New South Wales (NSW). Whole genome sequencing (WGS) found a common sequence type (ST-1466), with limited sequence diversity. Confirmed outbreak cases were NSW residents with a N. meningitidis isolate matching the cluster sequence type; probable cases were NSW residents with MenY isolated from a urogenital or anorectal site from 1 July 2023 without WGS testing. Of the 41 cases, most were men (n = 27), of whom six reported recent contact with a female sex worker. Five cases were men who have sex with men and two were female sex workers. Laboratory alerts regarding the outbreak were sent to all Australian jurisdictions through the laboratories in the National Neisseria Network. Two additional states identified urogenital MenY ST-1466 infections detected in late 2023. Genomic analysis showed all MenY ST-1466 sequences were interspersed, suggestive of an Australia-wide outbreak. The incidence of these infections remains unknown, due to varied testing and reporting practices both within and across jurisdictions. Isolates causing invasive meningococcal disease (IMD) in Australia are typed, and there has been no MenY ST-1466 IMD recorded in Australia to end of March 2024. Concerns remain regarding the risk of IMD, given the similarity of these sequences with a MenY ST-1466 IMD strain causing a concurrent outbreak in the United States of America.
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Infecciones Meningocócicas , Neisseria meningitidis , Trabajadores Sexuales , Minorías Sexuales y de Género , Masculino , Humanos , Femenino , Serogrupo , Homosexualidad Masculina , Australia/epidemiología , Infecciones Meningocócicas/epidemiología , Brotes de EnfermedadesRESUMEN
This study examined the impact of a pathway between a sexual assault service and a public sexual health service developed to improve rates of post-sexual assault medical follow-up. Follow-up attendances improved in the first 12months of the pathway (2014) compared with attendances in 2013 (17.8%vs 9.6%, P =0.01). Factors independently associated with attendance at follow-up were being prescribed HIV post-exposure prophylaxis and knowing the assailant. Those with physical injuries were less likely to attend. The prevalence of sexually transmissible infections in this cohort, 8% at the acute presentation and 5% at follow-up, suggests a need for alternatives to clinic-based follow-up.
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Delitos Sexuales , Humanos , Estudios Transversales , Estudios Retrospectivos , Estudios de Seguimiento , Conducta SexualRESUMEN
Heterosexuals living with HIV report feeling additional HIV stigma compared to homosexual men, which may affect clinical outcomes. Yet, beyond routinely collected surveillance data, little is known about the characteristics of individuals who acquire HIV heterosexually and clinical outcomes by mode of sexual acquisition have not been directly compared. Using data from the Australian HIV Observational Database, we compared clinical characteristics of those with heterosexually-acquired (Het-HIV) to homosexually-acquired HIV (Hom-HIV) to investigate any differences and their implications for clinical management. 513 Het-HIV and 1467 Hom-HIV patients were included and contributed 3,127 and 9,457 person-years of follow-up, respectively. Compared with Hom-HIV, Het-HIV were more often born outside Australia (62.5% vs 39.9%, p<0.001), less likely to have Hepatitis C (4.8% vs 7.8%, p=0.029) and had lower median CD4 counts at diagnosis (292 vs 450 cells/µL, p<0.001) and cART initiation (270 vs 340 cells/µL, p<0.001). Despite these lower CD4 counts, there were no significant differences between groups for time to the major clinical endpoints of cART initiation, viral suppression, virological failure or all-cause mortality. Het-HIV had a lower risk of loss-to-follow-up than Hom-HIV (aHR 0.78; 95% CI 0.64-0.95). Further studies examining factors associated with, and interventions to inform retention in care are required.
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Infecciones por VIH , Australia/epidemiología , Recuento de Linfocito CD4 , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Heterosexualidad , Homosexualidad , Humanos , MasculinoRESUMEN
OBJECTIVES: To investigate factors associated with larger burden of intra-anal high-grade squamous intraepithelial lesions (HSIL) in a natural history study of HSIL. METHODS: 617 gay and bisexual men (GBM) attended a baseline visit. High-resolution anoscopy-directed biopsy was performed of suspected HSIL. GBM with biopsy-confirmed HSIL (bHSIL) affecting a single-octant were compared with those who had bHSIL affecting a larger area. RESULTS: Of 196 men with bHSIL at baseline, 73 (37.2 %) had larger bHSIL burden. Larger burden was independently associated with anal HPV16 detection (aOR 2.06, 95 % CI 1.09-3.89, p = 0.026) and infection with a greater number of high-risk HPV types (aOR per type increase 1.25, 95 % CI 1.05-1.49, p-trend = 0.010). CONCLUSION: The observation that men with a larger burden of HSIL also had more risk factors for anal cancer suggests this group may warrant closer observation to ensure earlier detection, and thus improved prognosis, of individuals whose HSIL may progress to anal cancer.
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Neoplasias del Ano/epidemiología , Homosexualidad Masculina/estadística & datos numéricos , Minorías Sexuales y de Género/estadística & datos numéricos , Lesiones Intraepiteliales Escamosas/epidemiología , Adulto , Neoplasias del Ano/patología , Neoplasias del Ano/prevención & control , Neoplasias del Ano/virología , Australia/epidemiología , Estudios de Cohortes , Femenino , Papillomavirus Humano 16/aislamiento & purificación , Humanos , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Infecciones por Papillomavirus/epidemiología , Infecciones por Papillomavirus/patología , Infecciones por Papillomavirus/virología , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Lesiones Intraepiteliales Escamosas/patología , Lesiones Intraepiteliales Escamosas/virología , Carga TumoralRESUMEN
OBJECTIVES: As HIV-positive people age, diagnosis and management of comorbidities associated with ageing are of increasing concern. In this study, we aimed to compare the self-reported prevalences of heart disease, stroke, thrombosis and diabetes in older Australian HIV-positive and HIV-negative gay and bisexual men (GBM). METHODS: We analysed data from the Australian Positive & Peers Longevity Evaluation Study (APPLES), a study of a prospectively recruited cross-sectional sample of 228 (51.1%) HIV-positive and 218 (48.9%) HIV-negative GBM, aged ≥ 55 years. Regression methods were used to assess the association of HIV status with self-reported comorbidities. RESULTS: Of 446 patients, 389 [200 (51.4%) HIV-positive] reported their disease history. The reported prevalence of comorbidities was higher in the HIV-positive group than in the HIV-negative group: heart disease, 19.5 versus 12.2%; stroke, 7.5 versus 4.2%; thrombosis, 10.5 versus 4.2%; and diabetes, 15.0 versus 9.0%, respectively. In adjusted analyses, HIV-positive GBM had significantly increased odds of reporting heart disease [adjusted odds ratio (aOR) 1.99; P = 0.03] and thrombosis (aOR 2.87; P = 0.01). In our analysis, HIV status was not significantly associated with either age at diagnosis of heart disease (median 53 years for HIV-positive GBM versus 55 years for HIV-negative GBM; P = 0.64) or 5-year cardiovascular disease (CVD) risk estimated using the Framingham risk score. CONCLUSIONS: HIV-positive GBM more commonly reported heart disease and thrombosis compared with their HIV-negative peers. These results further highlight the need to understand the impact of HIV on age-related comorbidities in GBM, to guide optimal screening and treatment strategies to reduce the risk of these comorbidities among the HIV-positive population.
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Enfermedades Cardiovasculares/epidemiología , Diabetes Mellitus/epidemiología , Infecciones por VIH/epidemiología , Homosexualidad Masculina/estadística & datos numéricos , Minorías Sexuales y de Género/estadística & datos numéricos , Anciano , Australia/epidemiología , Comorbilidad , Estudios Transversales , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios ProspectivosRESUMEN
BACKGROUND: The association between anal high-grade squamous intraepithelial lesion (HSIL) and anal symptoms has not been systematically investigated. METHODS: The Study of Prevention of Anal Cancer is a prospective cohort study of men who have sex with men (MSM) ≥ 35 years old in Sydney, Australia. Self-reported symptoms were collected. Anal cytology and high-resolution anoscopy were undertaken. Using baseline visit data, men negative for squamous intra-epithelial lesion (SIL) were compared with men diagnosed with composite-HSIL (cytology and/or histology). Logistic regression analyses were performed to assess the association of symptoms with HSIL. RESULTS: Among 414 MSM included (composite-HSIL (n = 231); negative for SIL (n = 183)), 306 (73.9%) reported symptom(s) within the last 6 months. There was no association between any symptom and composite-HSIL. A significant association between anal lump and a larger burden of HSIL (at least 2 intra-anal octants) (anal lump within last month: p = 0.014; anal lump within last 6 months: p = 0.010) became non-significant after adjusting for HIV-status and recent anal warts (anal lump within last month: p = 0.057; anal lump within last 6 months: p = 0.182). CONCLUSIONS: Among MSM age 35 years and older, most anal symptoms are not a useful marker of anal HSIL.
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Canal Anal/patología , Homosexualidad Masculina , Infecciones por Papillomavirus/complicaciones , Lesiones Intraepiteliales Escamosas/etiología , Adulto , Neoplasias del Ano/diagnóstico , Neoplasias del Ano/etiología , Neoplasias del Ano/prevención & control , Australia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Lesiones Intraepiteliales Escamosas/complicaciones , Lesiones Intraepiteliales Escamosas/diagnósticoRESUMEN
OBJECTIVE: Human papillomavirus-related anal cancer rates are increasing and are particularly high in gay, bisexual and other men who have sex with men (GBM/MSM), especially HIV-positive individuals. Although screening programs for high-risk populations have been advocated, concerns about possible adverse psychological consequences exist. This study aimed to investigate GBM/MSM's experience, understanding and emotional response to screening techniques for anal cancer to determine how best to minimise psychological distress in future programs. METHODS: In-depth qualitative face-to-face interviews were conducted with 21 GBM/MSM participating in the "Study of the Prevention of Anal Cancer" in Sydney, Australia, between June 2013 and June 2014. Nonrandom, purposive sampling was used to ensure heterogeneity with respect to HIV status and screening test results. Framework analysis method was used to organise the data and identify emerging themes. RESULTS: Knowledge about anal cancer, human papillomavirus and the link between them was limited. Abnormal screening results affected participants' sense of well-being and were associated with anxiety and concern about developing anal cancer. HIV-negative men receiving abnormal results showed higher levels of distress compared to their HIV-positive counterparts. Consultations with general practitioners about abnormal results had an important role in increasing participants' understanding and in moderating their anxiety. CONCLUSION: Anal cancer screening should be accompanied by health education around anal cancer, its aetiology and the meaning of associated test results. Simple and effective communication strategies should be encouraged. Collaboration with general practitioners could assist the process of education and reporting test results.
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Neoplasias del Ano/diagnóstico , Bisexualidad/psicología , Detección Precoz del Cáncer , Seronegatividad para VIH , Seropositividad para VIH/complicaciones , Conocimientos, Actitudes y Práctica en Salud , Homosexualidad Masculina/psicología , Adulto , Ansiedad/psicología , Australia , Seropositividad para VIH/psicología , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Factores de Riesgo , Conducta SexualAsunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Tiempo de Tratamiento/tendencias , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Terapia Antirretroviral Altamente Activa , Australia/epidemiología , Recuento de Linfocito CD4 , Femenino , Infecciones por VIH/inmunología , Infecciones por VIH/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Adulto JovenRESUMEN
BACKGROUND: Australia has increased coverage of antiretroviral treatment (ART) over the past decade, reaching 73% uptake in 2014. While ART reduces AIDS-related deaths, accumulating evidence suggests that it could also bolster prevention efforts by reducing the risk of HIV transmission ('treatment as prevention'). While promising, evidence of community-level impact of treatment as prevention on reducing HIV incidence among gay and bisexual men is limited. We describe a study protocol that aims to determine if scale up of testing and treatment for HIV leads to a reduction in community viraemia and, in turn, if this reduction is temporally associated with a reduction in HIV incidence among gay and bisexual men in Australia's two most populous states. METHODS: Over the period 2009 to 2017, we will establish two cohorts making use of clinical and laboratory data electronically extracted retrospectively and prospectively from 73 health services and laboratories in the states of New South Wales and Victoria. The 'positive cohort' will consist of approximately 13,000 gay and bisexual men (>90% of all people living with HIV). The 'negative cohort' will consist of at least 40,000 HIV-negative gay and bisexual men (approximately half of the total population). Within the negative cohort we will use standard repeat-testing methods to calculate annual HIV incidence. Community prevalence of viraemia will be defined as the proportion of men with a viral load ≥200RNA copies/mm3, which will combine viral load data from the positive cohort and viraemia estimates among those with an undiagnosed HIV infection. Using regression analyses and adjusting for behavioural and demographic factors associated with infection, we will assess the temporal association between the community prevalence of viraemia and the incidence of HIV infection. Further analyses will make use of these cohorts to assess incidence and predictors of treatment initiation, repeat HIV testing, and viral suppression. DISCUSSION: This study will provide important information on whether 'treatment as prevention' is associated with a reduction in HIV incidence at a community level among gay and bisexual men.
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Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Adulto , Australia/epidemiología , Bisexualidad , Estudios de Cohortes , VIH/genética , VIH/aislamiento & purificación , Infecciones por VIH/epidemiología , Infecciones por VIH/virología , Homosexualidad Masculina , Humanos , Estudios Longitudinales , Masculino , Prevalencia , ARN Viral/sangre , Estudios Retrospectivos , Carga ViralRESUMEN
INTRODUCTION: Despite a number of HIV prevention strategies, the number of new HIV infections remains high. In Australia, over three-quarters of new HIV diagnoses are in gay and bisexual men (GBM). Pre-exposure prophylaxis (PrEP) has been shown to be effective at preventing new HIV infections in several randomised trials. The PRELUDE study aims to evaluate the implementation of PrEP in healthcare settings in New South Wales (NSW), Australia, among a sample of high-risk adults. METHODS AND ANALYSIS: PRELUDE is an ongoing open-label, single-arm demonstration project, conducted in public and private clinics across NSW, Australia. Enrolment began in November 2014. The study is designed for 300 high-risk participants-mainly GBM and heterosexual women. Participants receive daily oral PrEP, composed of emtricitabine (FTC) and tenofovir disoproxil fumarate (TDF), for up to 2.5â years. Quarterly study visits include testing for HIV and sexually transmitted infections (STIs), assessment of ongoing eligibility and side effects, and self-reported adherence. Following each study visit, online behavioural surveys are administered to collect information on medication adherence, risk behaviours and attitudes. Blood samples will be collected in a subset of patients 1, 6 and 12â months after PrEP initiation to measure FTC/TDF concentrations. Analyses using longitudinal regression models will focus on feasibility, adherence, safety, tolerability and effects of PrEP on behaviour. This study will inform PrEP policy and guide the implementation of PrEP in Australia in people at high risk of HIV. ETHICS AND DISSEMINATION: The study will be conducted in accordance with the Declaration of Helsinki. All patients will provide written informed consent prior to participation in the study. Publications relating to each of the primary end points will be gradually released after 12â months of follow-up is complete. TRIAL REGISTRATION NUMBER: NCT02206555; Pre-results.
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Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/prevención & control , Cumplimiento de la Medicación , Profilaxis Pre-Exposición/métodos , Adolescente , Adulto , Anciano , Emtricitabina/uso terapéutico , Femenino , Hospitales Privados , Humanos , Masculino , Persona de Mediana Edad , Nueva Gales del Sur , Práctica de Salud Pública , Proyectos de Investigación , Asunción de Riesgos , Autoinforme , Tenofovir/uso terapéutico , Factores de Tiempo , Adulto JovenRESUMEN
OBJECTIVES: We established a subcohort of HIV-positive individuals from 10 sexual health clinics within the Australian HIV Observational Database (AHOD). The aim of this study was to assess demographic and other factors that might be associated with an incident sexually transmitted infection (STI). METHODS: The cohort follow-up was from March 2010 to March 2013, and included patients screened at least once for an STI. We used survival methods to determine time to first new and confirmed incident STI infection (chlamydia, gonorrhoea, syphilis or genital warts). Factors evaluated included sex, age, mode of HIV exposure, year of AHOD enrolment, hepatitis B or C coinfection, time-updated CD4 cell count, time-updated HIV RNA viral load, and prior STI diagnosis. RESULTS: There were 110 first incident STI diagnoses observed over 1015 person-years of follow-up, a crude rate of 10.8 [95% confidence interval (CI) 9.0-13.0] per 100 person-years. Factors independently associated with increased risk of incident STI included younger age [≥ 50 vs. 30-39 years old, adjusted hazards ratio (aHR) 0.4; 95% CI 0.2-0.8; P < 0.0001]; prior STI infection (aHR 2.5; 95% CI 1.6-3.8; P < 0.001), and heterosexual vs. men who have sex with men (MSM) as the likely route of exposure (aHR 0.2; 95% CI 0.1-0.6; P < 0.001). CONCLUSIONS: In this cohort of individualsbeing treated with antiretroviral drugs, those who were MSM, who were 30-39 years old, and who had a prior history of STI, were at highest risk of a further STI diagnosis.
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Condiloma Acuminado/epidemiología , Infecciones por VIH/complicaciones , Enfermedades Bacterianas de Transmisión Sexual/epidemiología , Adulto , Fármacos Anti-VIH/uso terapéutico , Estudios de Seguimiento , Infecciones por VIH/tratamiento farmacológico , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Factores de RiesgoRESUMEN
OBJECTIVES: Australian HIV postexposure prophylaxis (PEP) guidelines recommend Chlamydia trachomatis (CT) and Neisseria gonorrheae (NG) testing at both baseline and 2-week postexposure visits. We aimed to determine the diagnostic yield of testing at one or more visits, and predictors of infection. METHODS: Data were collected from patients prescribed PEP at RPA Sexual Health over a 4-year period from January 2008 to December 2011. Predictors of CT/NG were assessed by logistic regression. RESULTS: 282 individuals presented for PEP on 319 occasions during the study period. The majority (94.3%) were male and over 90% of presentations followed unprotected anal sexual exposures. Most (279, 87.5%) had CT/NG testing at least once. Almost half (153, 48.0%) of baseline presentations, two-thirds (214, 67.1%) of 2-week presentations and over a quarter (88, 27.6%) of both presentations included CT/NG testing. CT/NG was diagnosed at baseline in eight (5.2%, 95% CI 2.3% to 10.0%) presentations. A new CT/NG diagnosis occurred at the 2-week visit in 18 (8.4%, 95% CI 5.1% to 13.0%) presentations, of whom 7 tested negative and 11 were not tested at baseline. Over one-quarter (28.1%) of PEP recipients reported sexual contact between baseline and 2-week visits. Independent predictors of CT/NG at baseline were recent sex work (OR 48.0, 95% CI 3.77 to 611.94); and at 2 weeks a known HIV-positive PEP exposure source (OR 3.54, 95% CI 1.04 to 12.06) and sex between baseline and 2-week visits (OR 3.63, 95% CI 1.10 to 11.96). CONCLUSIONS: Our findings suggest that screening PEP recipients for CT/NG at both baseline and 2 weeks may be warranted.
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Infecciones por Chlamydia/diagnóstico , Servicios de Diagnóstico/estadística & datos numéricos , Gonorrea/diagnóstico , Adulto , Australia/epidemiología , Infecciones por Chlamydia/epidemiología , Estudios Transversales , Femenino , Gonorrea/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo , Adulto JovenRESUMEN
OBJECTIVES: The objective of the study was to conduct a within-cohort assessment of risk factors for incident AIDS-defining cancers (ADCs) and non-ADCs (NADCs) within the Australian HIV Observational Database (AHOD). METHODS: A total of 2181 AHOD registrants were linked to the National AIDS Registry/National HIV Database (NAR/NHD) and the Australian Cancer Registry to identify those with a notified cancer diagnosis. Included in the current analyses were cancers diagnosed after HIV infection. Risk factors for cancers were also assessed using logistic regression methods. RESULTS: One hundred and thirty-nine cancer cases were diagnosed after HIV infection among 129 patients. More than half the diagnoses (n = 68; 60%) were ADCs, of which 69% were Kaposi's sarcoma and 31% non-Hodgkin's lymphoma. Among the NADCs, the most common cancers were melanoma (n = 10), lung cancer (n = 6), Hodgkin's lymphoma (n = 5) and anal cancer (n = 5). Over a total of 21021 person-years (PY) of follow-up since HIV diagnosis, the overall crude cancer incidence rate for any cancer was 5.09/1000 PY. The overall rate of cancers decreased from 15.9/1000 PY [95% confidence interval (CI) 9.25-25.40/1000 PY] for CD4 counts < 100 cells/µL to 2.4/1000 PY (95% CI 1.62-3.39/1000 PY) for CD4 counts > 350 cells/µL. Lower CD4 cell count and prior AIDS diagnoses were significant predictors for both ADCs and NADCs. CONCLUSIONS: ADCs remain the predominant cancers in this population, although NADC rates have increased in the more recent time period. Immune deficiency is a risk factor for both ADCs and NADCs.
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Síndrome de Inmunodeficiencia Adquirida/epidemiología , Fármacos Anti-VIH/uso terapéutico , Neoplasias del Ano/epidemiología , Enfermedad de Hodgkin/epidemiología , Neoplasias Pulmonares/epidemiología , Linfoma Relacionado con SIDA/epidemiología , Melanoma/epidemiología , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/inmunología , Adulto , Envejecimiento , Terapia Antirretroviral Altamente Activa , Neoplasias del Ano/inmunología , Australia/epidemiología , Recuento de Linfocito CD4 , Bases de Datos Factuales , Femenino , Estudios de Seguimiento , Enfermedad de Hodgkin/inmunología , Humanos , Modelos Logísticos , Neoplasias Pulmonares/inmunología , Linfoma Relacionado con SIDA/tratamiento farmacológico , Linfoma Relacionado con SIDA/inmunología , Masculino , Melanoma/inmunología , Persona de Mediana Edad , Estudios Prospectivos , Factores de RiesgoRESUMEN
Women in a residential drug-rehabilitation program had lower rates of cervical screening attendance and higher rates ofdetected abnormalities than women attending a local Well Women's Clinic. As a result ofthis study we plan to include a more comprehensive sexual health history into routine women's health consultations.
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Trastornos Relacionados con Sustancias/rehabilitación , Neoplasias del Cuello Uterino/prevención & control , Frotis Vaginal , Adulto , Detección Precoz del Cáncer , Femenino , Humanos , Nueva Gales del Sur/epidemiología , Tratamiento Domiciliario , Factores de Riesgo , Neoplasias del Cuello Uterino/epidemiologíaRESUMEN
OBJECTIVES: There are few data on the distribution of specific Chlamydia trachomatis serovars among men who have sex with men (MSM) outside clinical settings. To investigate these patterns, serovar determination was performed on chlamydia-positive samples from two community-based cohort studies of HIV-positive and HIV-negative MSM in Sydney, Australia. METHODS: From January 2005 to June 2007 all positive C trachomatis pharyngeal, urine and anal samples were evaluated. The serovar of each C trachomatis infection was determined by omp1 gene sequencing with confirmatory quantitative PCR screening. Symptom data were routinely reported by study participants at the time of testing. RESULTS: Serovar determination was possible for 54 samples among 52 participants. Seven samples were not able to be typed. Site-specific symptoms were reported by fewer than 10% of participants diagnosed with pharyngeal and anogenital chlamydia. The most commonly identified serovars were serovar D (n=32, 59.3%, 95% CI 45.0 to 72.4), followed by serovar G (n=11, 20.4%, 95% CI 10.6 to 33.5) and serovar J (n=5, 9.3%, 95% CI 3.1 to 20.3). Only one lymphogranuloma venereum serovar was identified (L2b). CONCLUSIONS: This community-based study found a similar distribution of chlamydia serovars to that observed among Australian community-based MSM several years ago, and serovar distribution recently observed among predominantly symptomatic MSM at a Sydney clinic. These findings suggest little change in C trachomatis serovar distribution in Australian MSM over the past decade and a lack of correlation of specific chlamydia serovars with anogenital symptoms among MSM.
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Infecciones por Chlamydia/clasificación , Chlamydia trachomatis/clasificación , Seronegatividad para VIH , Seropositividad para VIH/microbiología , Homosexualidad Masculina , Porinas/genética , Adulto , Enfermedades del Ano/epidemiología , Enfermedades del Ano/microbiología , Infecciones por Chlamydia/epidemiología , Infecciones por Chlamydia/genética , Estudios de Cohortes , Humanos , Masculino , Persona de Mediana Edad , Nueva Gales del Sur/epidemiología , Enfermedades Faríngeas/epidemiología , Enfermedades Faríngeas/microbiología , Serotipificación/métodos , Enfermedades Uretrales/epidemiología , Enfermedades Uretrales/microbiologíaRESUMEN
OBJECTIVES: To determine the prevalence, incidence and risk factors for pharyngeal Chlamydia trachomatis in the community based Health in Men (HIM) cohort of HIV negative homosexual men in Sydney, Australia. METHODS: From January 2003, all HIM participants were offered annual screening for pharyngeal chlamydia using BD ProbeTec nucleic acid amplification testing (NAAT). Detailed sexual behavioural data were collected every 6 months, and risk factors for infection and hazard ratios were calculated using Cox regression. RESULTS: Among 1427 participants enrolled, the prevalence of pharyngeal chlamydia on initial testing was 1.06% and the incidence rate was 0.58 per 100 person-years. More than 50% of all infections were identified on baseline testing and 68% of men with pharyngeal infection had no evidence of concurrent anogenital chlamydia. There was no association of pharyngeal chlamydia with sore throat. Infection was significantly associated with increasing frequency of receptive penile-oral sex with ejaculation with casual partners (p = 0.009), although approximately half of infections occurred in participants not reporting this risk behaviour. Neither kissing nor oro-anal practices were associated with infection. CONCLUSION: The incidence of pharyngeal chlamydia infection in the HIM study was relatively low; however, the relatively high prevalence on baseline testing compared to incidence suggests a long duration of infection. Occasional screening for pharyngeal chlamydia in homosexual men who frequently practise receptive oral sex with ejaculation may be warranted.
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Infecciones por Chlamydia/epidemiología , Chlamydia trachomatis , Homosexualidad Masculina , Enfermedades Faríngeas/epidemiología , Sexo Inseguro/estadística & datos numéricos , Adolescente , Adulto , Anciano , Infecciones por Chlamydia/etiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Nueva Gales del Sur/epidemiología , Prevalencia , Factores de RiesgoRESUMEN
OBJECTIVE: Misreporting of circumcision status may affect observed relationships between circumcision status and HIV or other sexually transmissible infections. As no data exist on the validity of self-reported circumcision status among homosexual men, we investigated the agreement between self-report and examination findings in a subgroup of participants in the Health in Men (HIM) study in Sydney, Australia. METHODS: A subgroup of 240 participants in the community based HIM cohort study attending annual interview agreed to a brief genital examination by a trained study nurse who was unaware of their previous self-reported circumcision status. RESULTS: Five participants reported being uncircumcised at baseline but were classified as circumcised on examination. All participants who self-reported being circumcised were found on examination to be circumcised. Three cases in which the examining study nurse was unsure of participants' circumcision status were excluded. Of the remaining 237 participants, 155 (65.4%) were classified as circumcised on examination, including five men who self identified as uncircumcised. Compared with examination, self-reported circumcision status resulted in a sensitivity of 96.8%, specificity of 100%, positive predictive value of 100% and negative predictive value of 94.3%. The overall agreement between circumcision status on examination and self-report was 97.9% (kappa score, 0.95; p<0.001) CONCLUSION: Self-report was a valid measure of circumcision status in this group of predominantly Anglo gay-community-attached men. We believe our findings can be generalised to similarly aged gay-community-attached men in other developed countries.
Asunto(s)
Circuncisión Masculina/psicología , Homosexualidad Masculina/psicología , Autorrevelación , Adulto , Anciano , Circuncisión Masculina/estadística & datos numéricos , Estudios de Cohortes , Homosexualidad Masculina/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Nueva Gales del SurRESUMEN
BACKGROUND: Early detection and treatment of bacterial sexually transmitted infections has been advocated as an HIV prevention strategy. AIM: To inform screening guidelines, the incidence and risk factors for urethral and anal gonorrhoea and chlamydia were studied in a prospective cohort of community-based HIV negative homosexual men in Sydney, New South Wales, Australia. METHODS: All participants were offered annual screening for gonorrhoea and chlamydia (study-visit diagnoses) on urine and anal swabs using nucleic acid amplification. Participants also reported diagnoses of gonorrhoea and chlamydia made elsewhere between interviews (interval diagnoses). All diagnoses were summed to create a combined incidence rate, and detailed data on specific sexual practices with casual and regular partners were collected. RESULTS: Among 1427 men enrolled, the combined incidence rates were 3.49 and 2.96 per 100 person-years for urethral and anal gonorrhoea, respectively; and 7.43 and 4.98 per 100 person-years for urethral and anal chlamydia, respectively. Urethral infections were associated with unprotected anal intercourse (UAI) with HIV-positive partners (hazard ratio (HR) = 2.58, 95% CI 1.10 to 6.05 for urethral gonorrhoea) and with frequent insertive oral sex (p for trend 0.007 for urethral chlamydia). Anal infections were associated with receptive UAI (p for trend 0.001 for both anal gonorrhoea and chlamydia) and other receptive anal sexual practices. Stratified analyses showed the independence of the associations of insertive oral sex with urethral infections and of non-intercourse receptive anal practices with anal infections. CONCLUSION: Incident gonorrhoea and chlamydia were common. Risk behaviours for both urethral and anal infections were not restricted to UAI. Screening that includes tests for anal and urethral infections should be considered for all sexually active homosexual men, not just for those who report UAI.