Underdiagnosis of Chlamydia trachomatis and Chlamydia psittaci revealed by introduction of respiratory multiplex PCR assay with Chlamydiaceae family primers.

We describe unanticipated detection of respiratory infection with Chlamydia trachomatis and Chlamydia psittaci after introduction of respiratory multiplex polymerase chain reaction assay that includes Chlamydiaceae family primers. We detected cases of pediatric C. trachomatis and of adult C. psittaci infection in patients with previously unrecognized risk factors. Directed testing for C. trachomatis and C. psittaci based on clinical features and risk factors alone is likely to miss the majority of infected cases.

Partner Notification Outcomes for Men Who Have Sex With Men Diagnosed With Syphilis Referred to Partner Notification Officers, Melbourne, Australia.

BACKGROUND: We examined the extent of partner notification for men who have sex with men (MSM) who were diagnosed with syphilis, and offered referral to a partner notification officer (PNO), to assist them with informing recent sexual partners. METHODS: Between October 2013 and March 2015, MSM diagnosed with syphilis at the Melbourne Sexual Health Centre were routinely offered a referral to a PNO. The outcomes of this intervention were evaluated including the proportion of men who accepted PNO services and the number of sexual partners informed by the PNO. RESULTS: There were 380 MSM diagnosed with syphilis. Those with primary or secondary syphilis reported a total of 813 partners over 3 months and those with early latent syphilis reported a total of 1400 partners over 12 months. Sixty nine percent of index men (n = 262) had documented discussion of partner notification, 34% (n = 128) accepted PNO referral, and 28% (n = 105) were contacted by the PNO, 58 of whom reported they had already notified partners themselves. Only 14 index men (4%) provided the PNO with contact details for 28 partners, 25 of whom were notified by the PNO. Among those interviewed, the most common barrier to partner notification was the presence of anonymous partners and absence of contact details for partners. CONCLUSIONS: Despite offering an effective PNO service in our centre, ultimately only 4% of MSM with syphilis had at least 1 partner notified by the PNO with patients declining the PNO service and anonymous partners posing the major barriers. Alternative patient initiated methods for improving partner notification for syphilis among MSM using newer communication technologies are required.

Opt-Out Referral of Men Who Have Sex With Men Newly Diagnosed With HIV to Partner Notification Officers: Results and Yield of Sexual Partners Being Contacted.

BACKGROUND: Given its potential for reducing the proportion of people with human immunodeficiency virus (HIV) unaware of their diagnosis, partner notification for HIV has been underutilized. This study aimed to determine if the implementation of opt-out referral of men who have sex with men, newly diagnosed with HIV, to partner notification officers (PNO) increased the proportion of sexual partners notified. METHODS: In April 2013, all individuals newly diagnosed with HIV at the Melbourne Sexual Health Centre, Australia were referred to Department of Health PNO to facilitate partner notification. The number of sexual partners reported by men and the proportion contacted in the 12 months before (opt-in period) and after (opt-out period) this policy change were determined through review of the clinical PNO records. RESULTS: Overall, 111 men were diagnosed with HIV during the study period. Compared with men in the opt-in period (n = 51), men in the opt-out period (n = 60) were significantly more likely to accept assistance from the PNO (12 [24%] vs 51 [85%]; P < 0.001). A significantly higher proportion of reported partners were notified with opt-out referral (85/185, 45.9%; 95% confidence interval, 38.6-53.4) compared with opt-in referral (31/252, 12.3%; 95% confidence interval, 8.5-17.0) (P < 0.001). DISCUSSION: Opt-out referral to PNO was associated with a substantially higher proportion of partners at risk of HIV being contacted.

Characteristics of acute nongonococcal urethritis in men differ by sexual preference.

Nongonococcal urethritis (NGU) is a common clinical syndrome, but no etiological agent is identified in a significant proportion of cases. Whether the spectrum of pathogens differs between heterosexual men (MSW) and men who have sex with men (MSM) is largely unstudied but of considerable clinical relevance. A retrospective review was done using the electronic medical record database of Melbourne Sexual Health Centre, Australia. Cases were first presentations of symptomatic acute NGU with ≥ 5 polymorphonuclear leukocytes (PMNL)/high-powered field (HPF) on urethral Gram stain between January 2006 and December 2011. First-stream urine was tested for Chlamydia trachomatis and Mycoplasma genitalium by PCR. Demographic, laboratory, and behavioral characteristics of cases were examined by univariate and multivariable analyses. Of 1,295 first presentations of acute NGU, 401 (32%; 95% confidence interval [CI] of 29 to 34%) had C. trachomatis and 134 (11%; 95% CI of 9 to 13%) had M. genitalium detected. MSM with acute NGU were less likely to have C. trachomatis (adjusted odds ratio [AOR] = 0.4; 95% CI of 0.3 to 0.6) or M. genitalium (AOR = 0.5; 95% CI of 0.3 to 0.8) and more likely to have idiopathic NGU (AOR = 2.4; 95% CI of 1.8 to 3.3), to report 100% condom use for anal/vaginal sex (AOR = 3.6; 95% CI of 2.7 to 5.0), or to have engaged in sexual activities other than anal/vaginal sex (AOR = 8.0; 95% CI of 3.6 to 17.8). Even when C. trachomatis or M. genitalium was detected, MSM were more likely than MSW to report consistent condom use (OR = 4.7; 95% CI of 2.6 to 8.3). MSM with acute NGU are less likely to have the established bacterial sexually transmitted infections (STIs) and more likely to report protected anal sex or sexual activity other than anal sex prior to symptom onset than MSW. These data suggest that the etiologic spectrum of pathogens differs between MSM and MSW in acute NGU and that relatively low-risk practices are capable of inducing acute NGU.

Penile appearance, lumps and bumps.

BACKGROUND: Even after a thorough examination it can be difficult to distinguish a normal penile anatomical variant from pathology needing treatment. OBJECTIVE: This article aims to assist diagnosis by outlining a series of common penile anatomical variants and comparing them to common pathological conditions. DISCUSSION: The problems considered include pearly penile papules, penile sebaceous glands (Fordyce spots), Tyson glands, angiokeratomas of the scrotum, lymphocoele, penile warts, molluscum contagiosum, folliculitis and scabies.