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  • 1
    In: Medical Journal of Australia, Wiley, Vol. 217, No. 3 ( 2022-08), p. 149-154
    Materialart: Online-Ressource
    ISSN: 0025-729X , 1326-5377
    URL: Issue
    Sprache: Englisch
    Verlag: Wiley
    Publikationsdatum: 2022
    ZDB Id: 2035730-8
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 2
    Online-Ressource
    Online-Ressource
    CSIRO Publishing ; 2020
    In:  Sexual Health Vol. 17, No. 2 ( 2020), p. 155-
    In: Sexual Health, CSIRO Publishing, Vol. 17, No. 2 ( 2020), p. 155-
    Kurzfassung: Background In the current era of antimicrobial stewardship, the availability of highly sensitive assays and faster turnaround times, the practice of empiric treatment of asymptomatic contacts of gonorrhoea needs review. The views of clinicians in a range of settings across Australia and clinic costs associated with a change of practice was examined. Methods: An online anonymous survey for nurses and doctors working in public sexual health clinics and general practices in urban, regional and rural Australia was developed. Information on the relative importance of a range of factors influencing delivery of empiric treatment was collected. Participants were asked whether current guidelines should change. Results: Surveys were distributed to 468 healthcare providers and 188 (40.2%) fully completed the survey. Most of the participants worked in public practice (84.9%) and 86 (43.2%) were doctors. Factors influencing provision of empiric treatment were: if the patient was unable to return (95.9%) or may not return (95.3%); risk of transmission to others (93.3%); likelihood of infection (88.6%); and patient request (82.9%). Respondents were evenly split as to whether current guidelines should change, with providers in private practice being less likely to support guideline change (P = 0.03). The model of empiric treatment of all asymptomatic sexual contacts was 34% more expensive than a model of testing and treatment of those with a positive result. Conclusion: Currently, the majority of clinicians provide empiric treatment for asymptomatic contacts in Australia. There was significant support for a change in guidelines with specific scenarios requiring individualised responses.
    Materialart: Online-Ressource
    ISSN: 1448-5028
    Sprache: Englisch
    Verlag: CSIRO Publishing
    Publikationsdatum: 2020
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 3
    Online-Ressource
    Online-Ressource
    BMJ ; 2021
    In:  Sexually Transmitted Infections Vol. 97, No. 6 ( 2021-09), p. 420-422
    In: Sexually Transmitted Infections, BMJ, Vol. 97, No. 6 ( 2021-09), p. 420-422
    Kurzfassung: Between 2013 and 2014, a third of Australian adults reported using the internet to investigate medical symptoms before consulting a medical practitioner. However, there is limited evidence regarding internet health information seeking behaviour (HISB) in sexual health. This study aims to determine the frequency, predictors and accuracy of internet HISB for sexual health self-diagnosis. Methods A cross-sectional paper-based survey, available in English, Chinese and Thai, was conducted during April to August 2019 at the Sydney Sexual Health Centre (SSHC). Symptomatic patients were recruited to answer an 18-item survey on their HISB, self-assessed diagnosis, anxiety and health literacy. Survey responses were correlated with SSHC electronic medical record data including participant demographics and clinician diagnosis. Data analyses were performed using Stata V.14. Results The majority of participants searched the internet (355; 79.1%) before attending clinic, and of these only 16.9% made a correct self-diagnosis. Multivariate analyses demonstrated that relative to Australian-born participants, people born in Asia were twice as likely to undertake internet HISB (adjusted OR (AOR) 2.41, 95% CI 1.25 to 4.64, p 〈 0.01), and those born in Latin America were more likely to self-diagnose correctly (AOR 3.35, 95% CI 1.20 to 9.37, p 〈 0.01). On average, participants who searched the internet scored higher relative to those who did not search, on measures of feeling generally tense (2.26, 95% CI 2.16 to 2.7 and 1.86, 95% CI 1.67 to 2.05, p 〈 0.001), upset (1.96, 95% CI 1.85 to 2.08 and 1.53, 95% CI 1.35 to 1.72, p 〈 0.001) and worried (2.55, 95% CI 2.44 to 2.65, and 2.16, 95% CI 1.95 to 2.38, p=0.001). Conclusions This study has filled important gaps in the literature and highlighted the high prevalence of adults engaging in HISB for sexual health information. Of concern are the increased levels of anxiety and low accuracy of self-diagnoses associated with HISB. Strategies to direct patients to reputable and user-friendly health websites that mitigate anxiety and misinterpretation of online health information should be explored.
    Materialart: Online-Ressource
    ISSN: 1368-4973 , 1472-3263
    Sprache: Englisch
    Verlag: BMJ
    Publikationsdatum: 2021
    ZDB Id: 2027968-1
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 4
    In: Sexual Health, CSIRO Publishing, Vol. 17, No. 2 ( 2020), p. 187-
    Kurzfassung: Background Previous guidelines at the Sydney Sexual Health Centre (SSHC) recommended empirical antibiotic treatment for asymptomatic contacts of Neisseria gonorrhoeae at the time of testing. With increasing concerns around gonorrhoea antibiotic resistance, it has been suggested that asymptomatic contacts should only be treated based on test results. Methods: This retrospective study of data from the SSHC electronic medical record included a total of 295 gonorrhoea contacts from 1 January 2018 to 30 June 2018. The primary outcome was the proportion of asymptomatic gonorrhoea contacts with a positive gonorrhoea result from any anatomical site. Statistically significant differences in gonorrhoea positivity according to gender, sexual preference, use of PrEP, sex worker status, country of birth, preferred language and number of partners, were calculated using Fisher’s exact test. Results: The overall proportion of asymptomatic gonorrhoea contacts with a positive gonorrhoea result was 27.1% (95% CI: 22.1–32.6%). The proportion of gonorrhoea positivity was significantly higher in females compared to males (52.0% vs 25.7%, P & lt; 0.01), gay and bisexual men compared to heterosexual men (28.7% vs 0%, P & lt; 0.01) and non-users of PrEP compared to PrEP users (31.2% vs 12.5%, P & lt; 0.05). No statistically significant differences in gonorrhoea positivity were found in subgroups divided by sex worker status, country of birth, preferred language and number of partners. Conclusion: The relatively low gonorrhoea positivity rate (27.1%) in asymptomatic gonorrhoea contacts at the SSHC between January and June 2018 supports guideline changes to no longer provide empirical antibiotic treatment to asymptomatic contacts.
    Materialart: Online-Ressource
    ISSN: 1448-5028
    Sprache: Englisch
    Verlag: CSIRO Publishing
    Publikationsdatum: 2020
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 5
    Online-Ressource
    Online-Ressource
    CSIRO Publishing ; 2020
    In:  Sexual Health Vol. 17, No. 5 ( 2020), p. 462-
    In: Sexual Health, CSIRO Publishing, Vol. 17, No. 5 ( 2020), p. 462-
    Kurzfassung: Background The prevalence of Neisseria gonorrhoeae (gonorrhoea) in sexual contacts of gonorrhoea has not been established, but limited data suggest that the majority of contacts are not infected. Contacts of gonorrhoea who receive empirical treatment at the point of testing may receive unnecessary antimicrobial treatment for an infection that is known to have multidrug resistance. This study evaluated patient acceptability of non-empirical treatment.? Methods: We conducted an anonymous cross-sectional survey of patients attending sexual health centres in New South Wales, Australia, on the acceptability of empirical and non-empirical treatment models and patients’ concerns about antimicrobial resistance. Results: Most of the 823 survey participants were willing to wait for treatment until their results were reported; 77% and 53% would agree to wait for treatment if results were available in 2 and 7 days respectively. Participants were less likely to agree to non-empirical treatment if they lived in regional and remote areas compared with those in a major city (odds ratio (OR) 0.5; 95% confidence interval (CI) 0.35–0.73). Most participants (70%) were worried about infections becoming resistant to antibiotics, with heterosexual men and women being less likely than gay and bisexual men to be worried (heterosexual men: OR 0.64, 95% CI 0.44–0.94; women: OR 0.64 95%, CI 0.44–0.92). Conclusions: Non-empirical treatment was acceptable to most participants, but patient preference, ability to return for treatment and timeliness of results are factors that should inform individual treatment decisions.
    Materialart: Online-Ressource
    ISSN: 1448-5028
    Sprache: Englisch
    Verlag: CSIRO Publishing
    Publikationsdatum: 2020
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 6
    In: Sexually Transmitted Infections, BMJ, Vol. 99, No. 1 ( 2023-02), p. 30-34
    Kurzfassung: In 2019, informed by favourable patient and provider acceptability surveys and concerns about antimicrobial resistance, Sydney Sexual Health Centre stopped routinely providing empirical antibiotic treatment to asymptomatic contacts of Chlamydia trachomatis (chlamydia) and Neisseria gonorrhoea (gonorrhoea). We aimed to assess if this policy change had any negative impact on patient outcomes. Methods A retrospective file review of people who presented as asymptomatic contacts of chlamydia and gonorrhoea cases before and after the policy change was conducted. Data on infection type, test results and treatment were extracted. For contacts who tested positive and were treated non-empirically, additional data were reviewed including sexual activity and symptom or complication development between testing and treatment, time from testing to notification and treatment and loss to follow-up. Results Of 1194 asymptomatic sexual contacts of chlamydia or gonorrhoea, most tested negative to both infections (814, 68%). All contacts with a positive result who were not treated empirically were notified of their result and 173 (99%) were treated within a mean time of 5 days. More contacts were overtreated in 2018 (n=355, 58%) under the empirical treatment model compared with 2019 (n=58, 11%, p≤0.001). There was no significant difference in the proportion of contacts who tested positive and were treated (p=0.111) or developed symptoms (p=0.413) before and after the policy change and no contacts who were treated non-empirically developed complications of pelvic inflammatory disease, epididymitis or proctitis between testing and treatment. Conclusion In this population, a switch from empirically treating all asymptomatic contacts to treating only those who tested positive significantly reduced antibiotic overuse with minimal adverse outcomes. Our findings support results-directed treatment for asymptomatic sexual contacts of chlamydia and gonorrhoea.
    Materialart: Online-Ressource
    ISSN: 1368-4973 , 1472-3263
    Sprache: Englisch
    Verlag: BMJ
    Publikationsdatum: 2023
    ZDB Id: 2027968-1
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 7
    Online-Ressource
    Online-Ressource
    CSIRO Publishing ; 2018
    In:  Sexual Health Vol. 15, No. 1 ( 2018), p. 86-
    In: Sexual Health, CSIRO Publishing, Vol. 15, No. 1 ( 2018), p. 86-
    Kurzfassung: This study aimed to assess the level of condomless sex advertised online by private sex workers (PSW) in Sydney. In 2015, 750 online profiles of PSW, including 339 female, 53 male and 39 transgender PSWs, were reviewed. It was found that PSWs advertise protected anal and vaginal sex. However, 50% of female PSW advertised condomless oral sex. Age less than 25 years was associated with advertised condomless oral sex (odds ratio 1.56; 95% confidence interval 1.03–2.37; P = 0.037). Online platforms are widely used for advertising, especially by female PSWs. Levels of condom use advertised reflect that of other studies of sex workers in Sydney.
    Materialart: Online-Ressource
    ISSN: 1448-5028
    Sprache: Englisch
    Verlag: CSIRO Publishing
    Publikationsdatum: 2018
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 8
    In: Sexual Health, CSIRO Publishing, Vol. 10, No. 6 ( 2013), p. 530-
    Kurzfassung: BackgroundThe NSW Sexual Health Infoline (SHIL) is a free and confidential sexual health information and referral line. The ability of Australian sexual health helplines to facilitate successful referrals has not been studied. In the present study, we sought to determine whether callers were successful in accessing the publicly funded sexual health services (PFSHS) or general practitioners (GP) they were referred to. Methods: Callers to SHIL who were directly referred to a PFSHS or GP for HIV and/or sexually transmissible infection testing from 3 January to 31 March 2012 were offered a follow-up phone call 1 week later. Results: Of 474 eligible callers, 190 (40%) agreed to disclose a first name and contact details and to be contacted by a study nurse on an agreed-upon date. One hundred and twenty (63%) callers were successfully contacted 1 week later; of these, 85% had attended or had a future appointment booked for testing. Conclusions: We conclude that among the study sample that was successfully followed up, most callers to the SHIL had attended or booked appointments to the services they were referred to.
    Materialart: Online-Ressource
    ISSN: 1448-5028
    Sprache: Englisch
    Verlag: CSIRO Publishing
    Publikationsdatum: 2013
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 9
    Online-Ressource
    Online-Ressource
    CSIRO Publishing ; 2015
    In:  Sexual Health Vol. 12, No. 5 ( 2015), p. 458-
    In: Sexual Health, CSIRO Publishing, Vol. 12, No. 5 ( 2015), p. 458-
    Kurzfassung: Hepatitis B virus (HBV) is a vaccine-preventable disease. Sexual health clinics in New South Wales see a high caseload of populations at risk of HBV, and thus screening and vaccination are part of routine care. Uptake of screening and vaccination at Sydney Sexual Health Centre was assessed and it was found that among 1577 new patients with an elevated risk of HBV infection, 864 (55%) were potentially susceptible. Of those susceptible, the majority were screened (76%) and approximately one-third (35%) were found to be eligible for vaccination. The majority (83%) initiated vaccination. Of concern, however, is that incremental gaps between initiation and completion of the vaccine course resulted in an overall HBV vaccine coverage of 26% among those HBV susceptible.
    Materialart: Online-Ressource
    ISSN: 1448-5028
    Sprache: Englisch
    Verlag: CSIRO Publishing
    Publikationsdatum: 2015
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 10
    In: Sexual Health, CSIRO Publishing, Vol. 15, No. 6 ( 2018), p. 595-
    Kurzfassung: There is little evidence and no standardised model for nurse-led HIV pre-exposure prophylaxis (PrEP). In 2016, public sexual health clinics in the state of New South Wales (NSW), Australia, participating in the population-scale PrEP access trial Expanded PrEP Implementation In Communities in New South Wales (EPIC-NSW) were authorised to adopt a nurse-led model of PrEP provision in order to facilitate the rapid expansion of PrEP access to more than 8000 participants in under 2 years without additional resources. The model has been implemented successfully in public clinics in 10 of 14 local health districts, with widespread support and no serious safety events reported. With the increasing importance of PrEP as an HIV prevention tool, non-traditional models of care, including nurse-led PrEP, are needed.
    Materialart: Online-Ressource
    ISSN: 1448-5028
    Sprache: Englisch
    Verlag: CSIRO Publishing
    Publikationsdatum: 2018
    Standort Signatur Einschränkungen Verfügbarkeit
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