Psychiatrists' knowledge and practices in screening and assessment of Hepatitis C for inpatients with severe mental illness.

OBJECTIVE: The aim of this study was to assess psychiatrists' Hepatitis C virus (HCV)-related knowledge and behaviour practices. METHOD: A self-report survey was completed by doctors working at an urban psychiatric hospital in Australia. RESULTS: Doctors working in psychiatry underestimated the prevalence of HCV infection for their patients and less than one-third felt well informed about HCV. Overall, there was good knowledge regarding HCV acquisition epidemiology but knowledge of management was poor. CONCLUSION: Improving knowledge about HCV, especially current management, may facilitate better health care for patients with severe mental illness.

Immunodominant epitopes in herpes simplex virus type 2 glycoprotein D are recognized by CD4 lymphocytes from both HSV-1 and HSV-2 seropositive subjects.

In human recurrent cutaneous herpes simplex, there is a sequential infiltrate of CD4 and then CD8 lymphocytes into lesions. CD4 lymphocytes are the major producers of the key cytokine IFN-gamma in lesions. They recognize mainly structural proteins and especially glycoproteins D and B (gD and gB) when restimulated in vitro. Recent human vaccine trials using recombinant gD showed partial protection of HSV seronegative women against genital herpes disease and also, in placebo recipients, showed protection by prior HSV1 infection. In this study, we have defined immunodominant peptide epitopes recognized by 8 HSV1(+) and/or 16 HSV2(+) patients using (51)Cr-release cytotoxicity and IFN-gamma ELISPOT assays. Using a set of 39 overlapping 20-mer peptides, more than six immunodominant epitopes were defined in gD2 (two to six peptide epitopes were recognized for each subject). Further fine mapping of these responses for 4 of the 20-mers, using a panel of 9 internal 12-mers for each 20-mers, combined with MHC II typing and also direct in vitro binding assay of these peptides to individual DR molecules, showed more than one epitope per 20-mers and promiscuous binding of individual 20-mers and 12-mers to multiple DR types. All four 20-mer peptides were cross-recognized by both HSV1(+)/HSV2(-) and HSV1(-)/HSV2(+) subjects, but the sites of recognition differed within the 20-mers where their sequences were divergent. This work provides a basis for CD4 lymphocyte cross-recognition of gD2 and possibly cross-protection observed in previous clinical studies and in vaccine trials.

Severe mental illness is a new risk marker for blood-borne viruses and sexually transmitted infections.

OBJECTIVE: To determine whether severe mental illness (SMI) constitutes a risk for the acquisition of sexually transmissible infections (STIs) and blood-borne viruses (BBVs), including human immunodeficiency virus (HIV), both locally and globally. METHOD: Database searches revealed 51 eligible studies for the review. Studies with samples of patients with SMI were analysed and compared with population data. RESULTS: Most studies were conducted in the United States and the majority examined levels of risk behaviours. The review revealed that many countries, including Australia, had not had any prevalence studies for STIs or any BBVs among patients with SMI. STIs, HIV and other BBVs, as well as risk behaviours, were more prevalent in patients with SMI, compared with population rates. Overall, a weighted mean of 4% of patients with SMI had HIV infection and 10-20% had hepatitis C virus (HCV). CONCLUSIONS: Severe mental illness appears to be a risk marker for the presence of STIs, HIV and other BBVs. HIV and HCV prevalences were elevated for those with risk behaviour histories, but rates also seem elevated for patients with SMI lacking such histories when compared with the general population. IMPLICATIONS: Programs are needed, particularly in the United States, for screening all patients with SMI for STIs and BBVs to kerb this epidemic. Such strategies could also be applicable in Australia, but there is less conclusive evidence.

Sex in the suburbs.

BACKGROUND: Many suburban sexual health clinics exist in Australasia. However, sexual health research has hitherto been restricted to populations from major metropolitan centres. OBJECTIVE: To describe the demographic, sexual characteristics and presenting diagnoses of 6521 new patients attending a sexual health clinic in the western suburbs of Sydney (New South Wales). DISCUSSION: Patients originated from over 50 different countries. Postcode analysis suggested the clinic sample was representative of the socioeconomic distribution of the area, but there were notable ethnic disparities. The classic bacterial sexually transmitted infections constituted only a small proportion of presentations, with asymptomatic infections and those requiring complex therapies more commonly encountered. This has resource implications for general practitioners and specialist clinics alike. Improved liaison between specialist sexual health clinics and GPs, together with a raised awareness of sexual health services in general, has the potential to significantly improve overall public health.

A retrospective case note review of sex worker attendees at sexual health clinics in the western suburbs of Sydney.

BACKGROUND: Sex workers (SWs) are globally recognised to be at high risk for the acquisition and transmission of sexually transmissible infections (STIs). There is a paucity of published data concerning SWs from the western suburbs of Sydney, with the last published study conducted in 1988. Therefore, we conducted a study to determine the demographics, sexual practices and health care needs of SWs attending Sexual Health Clinics (SHCs) in the region. METHODS: Self-identified SWs presenting to SHCs in western Sydney between April 2007 and March 2008 were identified using clinic databases. A case note review was then undertaken. RESULTS: One hundred and eighty-five female SWs were included in the analysis. Ninety-eight (54.5%) were born overseas (predominantly China) and 82 (45.6%) were born in Australia. One hundred and seventeen (68%) were English speaking backgrounds (ESB), while 55 (32%) were from non-English speaking backgrounds (NESB). Seventy-two (38.9%) were symptomatic on attendance, with vaginal discharge the most common symptom. Chlamydia was the most commonly reported STI in the previous 12 months with 28 cases (15.1%). SWs from NESB were significantly more likely to be older, symptomatic, have a hepatitis B diagnosis in the previous year and work more shifts per week, compared with SWs from ESB. SWs born overseas were more likely to be symptomatic than Australian born SWs who, in turn, were more likely to have a hepatitis C diagnosis in the previous year. CONCLUSION: SWs from NESB would potentially benefit from evidenced-based, culturally and linguistically appropriate interventions and targeted health promotion.

Regional differences in men attending a sexual health clinic in Sydney for premature ejaculation.

INTRODUCTION: Previous investigation from UK sexual health clinics has suggested that men from Central Asian and Middle Eastern backgrounds are more likely to present with premature ejaculation (PE) than men from Western backgrounds. This interesting finding requires replication, especially in populations from other countries. AIM: The current study aimed to determine whether men who had sought treatment for PE from a community sexual health clinic were more likely to come from Central Asian and Middle Eastern backgrounds than from Western backgrounds. MAIN OUTCOME MEASURES: Demographic and clinical data were collected retrospectively from patient files over a 3-year period. Patient-defined ethnicity for outpatients seeking psychological interventions for PE was compared to the ethnicity of those attending for other sexual dysfunctions and also to local population census data. METHOD: Clinical files for 215 men seeking psychological interventions for sexual dysfunctions at an urban sexual health clinic in Sydney were examined. Men were included in the study if they reported being born in one of two regional groups: Western countries or Middle Eastern/Central Asian countries. The rates of men seeking help for PE vs. other sexual dysfunctions were compared between these two regional groups and were compared with the representation of each region in the broader sexual health service as well as the local population. RESULTS: Relative to men born in Western regions, men from Central Asian/Middle Eastern countries were more likely to present with PE than with other sexual dysfunctions. The proportion of men from Central Asian/Middle Eastern countries presenting with PE was considerably higher than expected for the population attending the sexual health clinic or the broader local community. CONCLUSION: Consistent with previous research, Asian and Middle Eastern men living in a Western society appear to be more likely than Western men to report difficulties with PE.