Bacterial vaginosis after menopause: factors associated and women's experiences: a cross-sectional study of Australian postmenopausal women.

Background Bacterial vaginosis (BV) is the most common cause of vaginal discharge in reproductive age women; however, little is known about it after menopause. We aimed to learn more about BV in Australian postmenopausal women. Methods We conducted an online survey (July-September 2021). Participants were recruited via social media and professional networks and asked about demographic characteristics, sexual history and BV experiences. Outcomes of interest were the proportion who had heard of BV, had BV ever, or had BV after menopause. Factors associated with these outcomes were assessed using logistic regression. Results Of 906 participants, 83% were included in the analysis. Overall, 37.9% had heard of BV, 11.0% reported having a BV diagnosis ever, 6.3% reported having a BV diagnosis after menopause and 4.4% reported having a BV diagnosis only after menopause. Multivariable analysis found that among all women the odds of having a BV diagnosis after menopause were increased for those who had BV before menopause, had douched in the past 12months, or had a previous STI diagnosis. Among those in a sexual relationship, a BV diagnosis after menopause was associated with a BV diagnosis before menopause, or being in a sexual relationship of 5years or less in duration. About half who reported BV after menopause described recurrences, distress, and a detrimental effect on sexual relationships. Conclusions BV in postmenopausal women is associated with sexual activity, and impacts negatively on their lives. Research into BV should not be limited to reproductive age women.

Emerging sexual and reproductive health in Australia and New Zealand: gaps, challenges and solutions.

This Virtual Special Issue explores emerging topics in reproductive health in the Australian and New Zealand context. The included manuscripts cover pregnancy and termination of pregnancy, priority populations for sexual and reproductive health, digital technology and its impact on reproductive health, and perspectives from clinicians.

Googling long-acting reversible contraception: A scoping review examining the information available online about intrauterine devices and contraceptive implants.

ISSUE ADDRESSED: The internet is an important source of health information, however, the quality of information about long-acting reversible contraception (LARC, including intrauterine devices (IUDs) and contraceptive implants) found online is largely unknown. METHODS: A scoping review of webpages returned in a Google search was conducted. The first three pages of results were included if they were written in English and contained information about LARC. Results were critically reviewed and assessed using the DISCERN quality of health information tool. RESULTS: Of 778 results, 306 pages met the eligibility criteria. While most webpages provided key information about LARC, including location in the body, benefits, side effects and risks, the information provided varied considerably. Only half mentioned efficacy and many webpages did not provide information about the cost of insertion and removal, how and where to access the devices or how they work. Despite side effects being mentioned in more than three-quarters of webpages, the depth and specificity of these varied considerably and were often contradictory across different webpages. CONCLUSIONS: Most webpages provided medically accurate information to consumers; however, many did not include key information such as cost or how they work. Descriptions of side effects varied between webpages, and this may inhibit informed decision-making. SO WHAT?: Most people make decisions about what contraceptive method they might like to use before visiting a health care provider, and most will get this information from the internet. Providing comprehensive, medically accurate and consistent information about both IUDs and contraceptive implants is vital to support informed decision-making.

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.

Are COVID-19 lockdowns associated with a change in sexual desire? Results from an online survey of Australian women.

In early 2020, the Australian government implemented lockdown restrictions to prevent the spread of COVID-19. Our study aims to investigate the impact of lockdowns on sexual desire and enjoyment of sex among Australian women. We conducted an online survey in August 2020 when Victoria was in strict lockdown, but all other states/territories had minimal restrictions. Here, we report on responses from female participants aged ≥18 years. Respondents were asked whether COVID-19 had impacted their desire and/or enjoyment of sex (yes/no). Those who responded "yes" were asked to elaborate in a free-text question. Factors associated with desire were investigated using the chi-square test. Conventional content analysis was used to explore free-text responses. Of the 622 participants, 44.1% reported COVID-19 related impacts on their sexual desire. Women living in Victoria, who were not heterosexual, and whose employment was negatively affected by lockdown were all more likely to report an impact on their sexual desire. Free-text comments revealed that mental health, living arrangements, and a reduced ability to meet with sexual partners were key reasons behind these impacts. The COVID-19 pandemic and lockdown measures clearly impacted the desire and enjoyment of sex for many women, important factors of people's relationships, health, and wellbeing.

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.

Would men who have sex with men support less frequent screening for asymptomatic chlamydia and gonorrhoea to improve antibiotic stewardship? A qualitative study.

BACKGROUND: Men who have sex with men (MSM) taking pre-exposure prophylaxis (PrEP) are recommended to have screening for asymptomatic chlamydia and gonorrhoea every 3months with high rates of asymptomatic chlamydia and gonorrhoea detected. However, there is little evidence about the effectiveness of this screening interval and there is increasing concern about antibiotic consumption and its impact on antimicrobial resistance. There have been calls to reconsider this frequent screening for chlamydia and gonorrhoea. We conducted interviews with MSM to assess their attitudes to 3-monthly chlamydia and gonorrhoea screening. METHODS: Individual semi-structured interviews were conducted with MSM living in Victoria, Australia. Participants were aged 20-62years and had been taking PrEP for at least 6months. Interviews were audio-recorded and transcribed, and these data were investigated through reflexive thematic analysis. RESULTS: Thirteen interviews were conducted in August 2021. Participants were hesitant about reducing the screening frequency and reported that testing gave them a sense of security. While MSM recognised antimicrobial resistance was a concern, it did not impact their sexual behaviour, with many participants stating they would rather continue to take antibiotics to treat infections rather than adopt preventative measures such as condom use. Positive attitudes towards screening interval changes are more likely when PrEP patients are informed about the risks and benefits of sexual healthcare recommendations. CONCLUSION: While MSM on PrEP were initially hesitant to changes in screening frequency, changes may be acceptable if transparent communication, presenting the benefits and harms of screening and treatment, was delivered by a trusted healthcare professional.

Who does what? Reproductive responsibilities between heterosexual partners.

Managing fertility and sexual and reproductive health across the life course is associated with numerous responsibilities disproportionately experienced by women. This extends beyond dealing with the physical side effects of contraception and can include the emotional burden of planning conception and the financial cost of accessing health services. This scoping review aimed to map how reproductive responsibilities were defined and negotiated (if at all) between heterosexual casual and long-term partners during any reproductive life event. Original research in high-income countries published from 2015 onwards was sourced from Medline (Ovid), CINAHL and Scopus. In studies that focused on pregnancy prevention and abortion decision making, men felt conflict in their desire to be actively engaged while not wanting to impede their partner's agency and bodily autonomy. Studies identified multiple barriers to engaging in reproductive work including the lack of acceptable male-controlled contraception, poor sexual health knowledge, financial constraints, and the feminisation of family planning services. Traditional gender roles further shaped men's involvement in both pregnancy prevention and conception work. Despite this, studies reveal nuanced ways of sharing responsibilities - such as companionship during birth and abortion, ensuring contraception is used correctly during intercourse, and sharing the costs of reproductive health care.

Changes to pubic hair removal practices during COVID-19 restrictions and impact on sexual intimacy.

Pubic hair grooming (hair removal) has been linked to body image and sexual behaviour and, given the impacts of COVID-19 restrictions on access to sexual partners and beauty salons, we explored these associations. Data derive from a cross-sectional online survey. Participants were aged 18 years or over and in Australia. All genders were included. We explored factors associated with changes to hair removal using logistic regression and analysed free-text responses using content analysis. Of 256 participants, 89 (34.8%) had changed their grooming practices. Multivariable analysis found that female participants had 4.5 times increased odds of changed grooming (95%CI 1.8, 11.0; p = 0.001) compared with males. Individuals who reported 'more' or 'less' oral sex compared with the previous year were more likely to report increased odds of changed grooming (AOR 3.2; 95%CI: 1.4, 7.7; p = 0.009 and AOR: 3.3; 95%CI:1.6, 6.7; p = 0.001, respectively). Most who changed their grooming practices said it had reduced, attributing this to lack of partners, inability to access beauticians, and the mental health effects of the pandemic. For most, this change had no impact on sexual behaviour or body image; however, some spoke of reduced sexual desire and willingness to receive oral sex. Partner expectations influenced whether reduced grooming had negative consequences, and women were more affected than men, highlighting a gendered impact.

Is there a place for a molecular diagnostic test for pelvic inflammatory disease in primary care? An exploratory qualitative study.

INTRODUCTION: There is currently no test for pelvic inflammatory disease (PID) that is non-invasive and sufficiently sensitive and specific. Clinicians must therefore diagnose PID clinically, ruling out medical emergencies and conducting pelvic examinations where possible. While guidelines state that clinicians should be prepared to over-diagnose PID, it remains an under-diagnosed condition, with severe reproductive health impacts when left untreated. This research is the first to consider the perspectives of end-users on the development of a diagnostic test for PID. METHODS: Semi-structured live video feed online (Zoom) interviews were conducted with 11 clinicians and nine women (aged 18-30 years) in Australia to understand how a diagnostic test might be used, and what characteristics a test would need for it to be acceptable to clinicians and young women. Participants were recruited via researcher and university student networks. Reflexive thematic analysis was used to identify key themes relating to the acceptability and characteristics of a diagnostic test for PID. RESULTS: Seven general practitioners, four clinicians working in sexual health clinics, and nine young women (aged 21-27 years) were interviewed. Clinicians were aged between 31-58 years and were predominantly female. Clinicians recognised that the development of an accurate test to diagnose PID would be valuable to themselves and other clinicians, particularly those who lack experience diagnosing PID, and those working in certain settings, including emergency departments. They discussed how they might use a test to enhance their clinical assessment but highlighted that it would not replace clinical judgement. Clinicians also considered how a test would impact the patient experience and time to treatment, emphasising that it should be minimally invasive and have a quick turnaround time. Young women said a test would be acceptable if endorsed by a trustworthy clinician. CONCLUSIONS: PID remains a challenging diagnosis. Development of a minimally invasive and sufficiently accurate diagnostic test would be acceptable to young women and benefit some clinicians, although no test would completely replace an experienced clinician's judgement in making a PID diagnosis.

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.

Patient-delivered partner therapy: One option for management of sexual partner(s) of a patient diagnosed with a chlamydia infection.

BACKGROUND: Chlamydia is the most commonly diagnosed bacterial sexually transmissible infection (STI) in Australia. Partner management is key to reducing transmission and a cornerstone of best practice chlamydia management. While most patients will opt for telling their partner(s) themselves, patient-delivered partner therapy (PDPT) offers an alternative way to inform and treat partners where usual management is inappropriate or unlikely to be undertaken. Guidelines for PDPT vary across Australia. Recent research found that general practitioners (GP)s want practical guidance for using PDPT in appropriate situations. OBJECTIVE: The aim of this article is to provide an overview of the process of offering PDPT and note the challenges GPs may face in its provision. DISCUSSION: PDPT is one option for partner management when sexual partner(s) are unlikely or unable to seek timely care themselves. However, there are challenges to the use of PDPT in general practice. The provision of clear guidelines is an essential step to promote its appropriate use.

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.

Access to period products during the first nation-wide lockdown in Australia: Results from an online survey.

In early 2020, Australia experienced a nation-wide lockdown to help stop the spread of COVID-19. While many aspects of normal life were put on hold, others, like menstruation, did not stop. We examined the impact of the lockdown on the ability of people to access their usual period products. We conducted an online survey open for 2.5 weeks during the lockdown. Here, we report on responses from participants who identified as female, who were of reproductive age, and who answered questions regarding their ability to access their usual products. We fitted univariable and multivariable logistic regression models to explore factors associated with difficulty accessing period products and utilized a conventional content analysis for the free-text qualitative data. Of the 410 participants, nearly one-third reported difficulties accessing their usual period products during lockdown. Women under 25 years were more likely to experience difficulty accessing products. Free-text comments revealed the ways in which women handled this, often purchasing whatever was available regardless of whether it was a product that met their needs or not. Periods do not stop in a pandemic, and it is vital that people are able to access the products they require to manage their periods hygienically and comfortably.

‘I didn’t want to visit a doctor unless it was extremely necessary’: perspectives on delaying access to sexual and reproductive health care during the COVID-19 pandemic in Australia from an online survey.

Australians were subject to a series of COVID-19 lockdown restrictions throughout 2020. Although accessing medical care was allowable, concerns were raised that people were avoiding healthcare services. We explored young Australians' reasons for delaying seeking sexual and reproductive health (SRH) care during the pandemic, using data from two cross-sectional surveys. The surveys included a question asking whether respondents had delayed accessing care during the pandemic. Free-text responses from young Australians (aged 18-29 years) were analysed using conventional content analysis. In all, 1058 under-30s completed a survey, with 262 (24.8%) reporting they had delayed seeking SRH care. Of these, 228 (87.0%) respondents provided a free-text comment. Participants who commented were predominantly female (86.4%) and had a median age of 23 years (interquartile range 20-26 years). Most commonly, respondents delayed testing for sexually transmissible infections, cervical cancer screening, and contraceptive care. Some delayed accessing care despite experiencing symptoms. Participants avoided seeking care due to concerns about contracting COVID-19, uncertainty about accessing care during restrictions and anxiety relating to accessing SRH care. Although some reported a reduced need for SRH care, others required but did not access care. Young people should be reassured that SRH issues are a valid reason to access services, especially when experiencing symptoms.

Prevalence of bacterial vaginosis in postmenopausal women: a systematic review and meta-analysis.

Bacterial vaginosis (BV), the most common cause of vaginal discharge in women of reproductive age, is associated with considerable reproductive and gynaecological sequelae and increases the risk of acquiring sexually transmissible infections including HIV. Although we understand the burden of BV in women of reproductive age, much less is known about the burden of BV in postmenopausal women. We undertook this systematic review and meta-analysis to estimate the prevalence of BV in postmenopausal women. The electronic databases PubMed, EMBASE, Web of Science, and The Cochrane Library were searched for English-language papers reporting on the prevalence of BV in postmenopausal women and published up until the end of July 2020. Search terms included: (prevalence OR survey OR proportion) AND 'bacterial vaginosis'. Meta-analysis was used to calculate pooled estimates of prevalence. We identified 2461 unique references and assessed 328 full-text articles for eligibility, with 13 studies included in the meta-analysis. The prevalence of BV ranged from 2.0 to 57.1%, with a summary estimate of 16.93% (95% CI: 8.5-27.4; I 2 =97.9). There was considerable heterogeneity between studies and quality varied considerably. Further research is needed to provide a better understanding of the condition in postmenopausal women and understand its effect on their lives.

Management of Chlamydia Cases in Australia (MoCCA): protocol for a non-randomised implementation and feasibility trial.

INTRODUCTION: The sexually transmitted infection chlamydia can cause significant complications, particularly among people with female reproductive organs. Optimal management includes timely and appropriate treatment, notifying and treating sexual partners, timely retesting for reinfection and detecting complications including pelvic inflammatory disease (PID). In Australia, mainstream primary care (general practice) is where most chlamydia infections are diagnosed, making it a key setting for optimising chlamydia management. High reinfection and low retesting rates suggest partner notification and retesting are not uniformly provided. The Management of Chlamydia Cases in Australia (MoCCA) study seeks to address gaps in chlamydia management in Australian general practice through implementing interventions shown to improve chlamydia management in specialist services. MoCCA will focus on improving retesting, partner management (including patient-delivered partner therapy) and PID diagnosis. METHODS AND ANALYSIS: MoCCA is a non-randomised implementation and feasibility trial aiming to determine how best to implement interventions to support general practice in delivering best practice chlamydia management. Our method is guided by the Consolidated Framework for Implementation Research and the Normalisation Process Theory. MoCCA interventions include a website, flow charts, fact sheets, mailed specimen kits and autofills to streamline chlamydia consultation documentation. We aim to recruit 20 general practices across three Australian states (Victoria, New South Wales, Queensland) through which we will implement the interventions over 12-18 months. Mixed methods involving qualitative and quantitative data collection and analyses (observation, interviews, surveys) from staff and patients will be undertaken to explore our intervention implementation, acceptability and uptake. Deidentified general practice and laboratory data will be used to measure pre-post chlamydia testing, retesting, reinfection and PID rates, and to estimate MoCCA intervention costs. Our findings will guide scale-up plans for Australian general practice. ETHICS AND DISSEMINATION: Ethics approval was obtained from The University of Melbourne Human Research Ethics Committee (Ethics ID: 22665). Findings will be disseminated via conference presentations, peer-reviewed publications and study reports.

"I never went to see that doctor again": A qualitative study examining Australian women's experiences requesting removal of LARC within 12 months of insertion.

OBJECTIVES: Removal or discontinuation of long-acting reversible contraception (LARC) requires cooperation of healthcare providers. The objective of this study was to explore young women's experiences when they request removal of LARC within 12 months of insertion. STUDY DESIGN: We conducted a qualitative study using individual semi-structured telephone interviews with women living in Victoria, Australia. We recruited participants using physical and online advertising flyers. We audio-recorded and transcribed interviews and thematically analyzed the data. RESULTS: Fifteen women participated in an interview. The experience of unacceptable side effects prompted "early" LARC removal in all cases. The non-autonomous nature of LARC removal was not considered by women pre-insertion and participants reported confidence in their ability to access LARC removal when requested. Although satisfaction was reported when LARC was removed on request, participants reported negative feelings towards their healthcare provider when there was perceived pressure to continue with LARC for longer than desired. This had implications for the patient-clinician relationship. Women experienced resistance to removal as a challenge to their bodily autonomy and this resulted in a loss of trust in health services. CONCLUSION: Resistance to removal of LARC can damage the patient-clinician relationship and be experienced as a challenge to women's autonomy and reproductive rights. IMPLICATIONS: Patients have confidence in their ability to get their LARC removed on request and autonomy is not largely considered prior to LARC initiation. Supportive removal services should be emphasized for women who request removal of LARC at any point after insertion in order to maintain trust in healthcare providers and health services.

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.

How young Australian women explain their use of condoms, withdrawal and fertility awareness: a qualitative analysis of free-text comments from the CUPID study.

Rates of oral contraceptive pill use have declined over the past decade in Australia. While some women use highly effective methods, others rely on less effective methods such as condoms, withdrawal and fertility awareness. We aimed to understand motivations for relying on these methods among young women in Australia. Women aged 18-23 years who reported using less effective methods and participated in the Contraceptive Use, Pregnancy Intention and Decisions (CUPID) study formed the sample for this analysis. Using thematic analysis, we analysed 140 free-text comments. Findings suggest that less effective methods were used when they were assessed as being best suited to current reproductive needs. These methods were perceived as offering benefits that hormonal and more invasive methods did not, and participants were largely satisfied with them. By contrast, some less effective method use was driven by a lack of choice or alternative options, previous bad experiences with hormonal methods, a lack of appropriate information about alternatives and difficulty accessing other methods. It is therefore essential to move beyond 'LARC-first' contraceptive counselling approaches to ensure young women are provided with accurate information regarding all contraceptive options available (including how to negotiate their use) and how to use them to their greatest efficacy.