Medical handover.
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Attitude of Health Personnel↗
Biomedical subjects
Francis J Bowden
Publications and source records attributed to Francis J Bowden.
Prevalence of genital human papillomavirus DNA in a sample of senior school-aged women in the Australian Capital Territory.
BACKGROUND: A strong association between persistent infection with oncogenic types of human papillomavirus (HPV) and cervical cancer is well established. Small numbers of international studies examining adolescent HPV infection and the risk factors associated are published, but there is currently no evidence on the prevalence and risk factors for HPV in an Australian, sexually active female adolescent population. METHODS: To provide prevalence and risk factors for HPV in a female sexually active, senior high school population in the Australian Capital Territory (ACT), a convenience sample of 161, 16-19-year-old females attending a senior high school was evaluated. The sample formed part of a larger sample recruited for a study of sexually transmitted infections and blood-borne viruses in senior high school students. A clinical record was used to collect information about sexual and other risk behaviours, while self-collected vaginal swabs were tested for HPV DNA detection and genotyping using polymerase chain reaction. RESULTS: The prevalence of HPV DNA in this sample overall was 11.2%, with multiple genotypes in 38%. No statistically significant associations were found between HPV DNA and the number of male partners, age of coitarche, time since first sexually active, condom use, smoking or alcohol intake. CONCLUSIONS: This is the first Australian study that has examined the prevalence and risk factors for genital HPV in this demographic group. The prevalence of HPV infection is slightly lower than reported in similar age groups overseas and is lower than other Australian studies in older women and those attending sexual health centres. Of HPV-positive young women, high-risk genotypes were found in over half, with more than one-third of HPV existing as multiple genotypes. Large community-based prevalence studies are needed to guide the development of recommendations for the vaccination of young women against HPV and to support other health promotion initiatives.
Adolescent↗
Screening for chlamydia and gonorrhoea in men who have sex with men in clinical and non-clinical settings.
BACKGROUND: There are few published data on the rate of chlamydia and gonorrhoea infection in men who have sex with men (MSM). Our aim was to determine the rate of positive chlamydia and gonorrhoea tests in this population in the Australian Capital Territory (ACT). METHODS: Results of all chlamydia and gonorrhoea tests generated by Canberra Sexual Health Centre between June 2001 and September 2003, including those from outreach clinics, were reviewed (audit one). Between September 2003 and April 2004, Canberra Sexual Health Centre outreach program staff and a general practitioner with a high caseload of MSM offered screening of the throat, urethra and rectum to all MSM, irrespective of their reported participation in unprotected anal intercourse. Chlamydia and gonorrhoea test results generated during this period were reviewed (audit two). RESULTS: In the first audit, 1086 specimens from 314 individuals were tested and 30/314 (9.6%, 95% CI 6.6-13.4) men were positive for chlamydia in one or more anatomical site. A total of 306 specimens from 118 individuals were tested for gonorrhoea. Of these, eight (6.8%, 95% CI 3.0-12.9) individuals tested positive. In the second audit, 16 of 157 men (10.2%, 95% CI 9.5-16.0) tested positive for chlamydia and 4/155 (2.6%, 95% CI 0.7-6.5) tested positive for gonorrhoea. The rectum was the most commonly infected anatomical site for both infections. The overall proportions of positive chlamydia and gonorrhoea tests were 36/471 (7.6%, 95% CI 5.4-10.4) and 12/273 (4.4%, 95% CI 2.2-7.6) respectively. CONCLUSIONS: These data, collected in a range of settings, indicate high rates of chlamydia and gonorrhoea in MSM in the ACT and provide support for annual testing, particularly of the rectum, in this population.
Adolescent↗
Delayed diagnosis of HIV: missed opportunities and triggers for testing in the Australian Capital Territory.
BACKGROUND: To determine (i) the rate of delayed HIV diagnosis; (ii) the missed opportunities for HIV diagnosis; and (iii) to identify who initiates HIV testing and what triggers them to do so. METHODS: An analysis of the case records of all HIV-positive patients who attended Canberra Sexual Health Centre (CSHC) between 1985 and 2005 was conducted. RESULTS: During the study period, 319/355 CSHC patients diagnosed with HIV had sufficient data to allow analysis regarding the timeliness of their diagnosis. Of these, 52 (16.3%) received a delayed diagnosis. The rate of delayed diagnosis was 9.7% (95% CI 5.1-15.3) in the 1980s and 25.6% (95% CI 13-42.1) between 2000 and 2004. There were no statistically significant differences in sociodemographic or behavioural characteristics between patients with delayed and timely HIV diagnoses. To determine who initiated testing, and if there were missed opportunities for testing, the records of CSHC patients diagnosed with HIV between 1995 and 2005 were examined. Of the 115 people diagnosed in this period, only 71 had documentation concerning missed opportunities for testing. Forty-one of these (58%) had been in contact with a health professional while infected, but before their diagnosis of HIV and 39/41 (95%) had a significant risk factor in their history that could have initiated an HIV test. Clinicians initiated testing for 43.5% of the patients, 11.3% were identified through contact tracing and only 28.7% were self referred for testing. CONCLUSIONS: Late diagnosis of HIV is common in the Australian Capital Territory and may have increased over time. Clinicians need to be aware of the sometimes-subtle manifestations of early and late HIV infection and have a lower threshold for HIV antibody testing.
Adolescent↗
Mini-clinEx versus mini-CEX.
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Education, Medical↗
An epidemic of infection, not just testing: chlamydia prevalence estimates in the Australian Capital Territory 1998-2004.
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Adolescent↗
Screening for chlamydia with the Pap test.
The implementation of the recent National Health and Medical Research Council Guidelines for the management of asymptomatic women with screen detected abnormalities is welcome and should address the current practice of unnecessary repeated investigation of young women infected with human papilloma virus (HPV). It is timely to consider the overall benefit of the Pap test in this group for whom rates of cervical cancer are extremely low.
Adolescent↗
Controlling HIV in Indigenous Australians.
We know what to do, but doing it is the challenge.
Australia↗
Sexually transmitted infections, blood-borne viruses and risk behaviour in an Australian senior high school population--the SHLiRP study.
OBJECTIVES: To determine the feasibility and acceptability of screening for sexually transmitted infections and blood-borne viruses and to study the profile of sexual activity and other risk behaviours in a senior high school population. METHODS: In this descriptive study we provided sexual health education and screening to students from two senior high schools in the Australian Capital Territory. We collected behavioural data using a self-administered questionnaire. Urines and swabs were tested for Chlamydia trachomatis (Ct), Neisseria gonorrhoea (Ng), Trichomonas vaginalis (Tv) and human papilloma virus (HPV). Blood specimens were tested for hepatitis B and C, HIV, herpes simplex viruses (HSV-1 and HSV-2) and syphilis. RESULTS: A total of 795 students participated (31% of the enrolled population; female to male ratio 60:40) and 67.0% were sexually active. Of 795 students, 644 (81.0%) were screened. Rates of infection were Ct 1.1% (95% CI: 0.4-2.6), HPV 11.7% (95% CI: 7.4-17.3), HSV-1 32.5% (95% CI: 28.9-36.3), HSV-2 2.4% (95% CI: 1.3-3.9), hepatitis B surface antigen 0.3% (95% CI: 0.04-1.1) and hepatitis C antibodies 0.7% (95% CI: 0.07-1.6). Only 22.3% (95% CI: 19.3-25.7) of students had immunity to hepatitis B. There were no cases of HIV, gonorrhoea, trichomoniasis or syphilis. Of the sexually active students, 49.2% (95% CI: 38.9-59.2%) reported never or only sometimes using condoms, 41.5% (95% CI: 32.2-52.3%) reported unsafe drinking, 33.3% (95% CI: 23.9-43.1%) were smokers and 1.9% (95% CI: 0.2-7.0%) reported injecting drug use. CONCLUSIONS: Rates of STI and blood-borne viruses and immunity to hepatitis B were low in this population, but unsafe sex and other risk behaviours were common. We have demonstrated that STI screening, including serological testing, was well accepted in a senior high school population.
Adolescent↗
Reconsidering HIV testing--consent is still the key.
The high quality and easy accessibility of HIV testing in Australia has been one of the reasons for Australia's effective response to the epidemic. However there have been a number of changes in the epidemiology of HIV and new technologies and treatments have emerged since the last Australian HIV policy was released in 1998. Antenatal testing to prevent vertical transmission, the licensing of rapid, point-of-care test kits in the United States and the problem of late diagnosis of infection in some populations are important issues to consider in the context of the drafting of a new HIV testing policy. The terms 'pre- and post-test counselling' are seen, by some, as barriers to HIV testing in the broader community. Reframing the process with a focus on the desired result (i.e. informed consent for voluntary testing) rather than on the process (i.e. pre-test counselling) could be one way to increase the rate of appropriate testing.
Attitude to Health↗
The prevalence of genital Chlamydia trachomatis in Australia 1997-2004: a systematic review.
OBJECTIVES: To determine by systematic review the prevalence of genital chlamydial infection in Australia between 1997 and 2004. METHODS: Electronic literature databases, reference lists, and conference proceedings were searched and health agencies and jurisdictions were contacted for published and unpublished reports. Studies were eligible if they offered a diagnostic nucleic acid amplification test to consecutive individuals presenting during the study period. As a summary measure of the available data, mean prevalence rates, weighted by sample size and irrespective of participant age, were calculated for the population sub-groups. RESULTS: 40 studies of 50 populations and 40,587 individuals met the inclusion criteria, but only one of these was population-based. The use of non-systematic methodologies prevented an assessment of time trends and a statistical comparison of population sub-groups. The mean overall prevalence of genital chlamydial infection was 4.6% (95% CI 4.4-4.8%), reflecting over-sampling of high-risk groups. The mean community-based rates were 7.5% (95% CI 6.4-8.6%) and 8.7% (95% CI 7.9-9.7%) for Indigenous men and women, and 1.5% (95% CI 1.1-1.9%) and 1.4% (95% CI 0.9-2.0%) for non-Indigenous men and women. The overall mean estimates for other groups were 3.3% (95% CI 3.0-3.7%) for female attendees of sexual health and related clinics, 5.6% (95% CI 4.9-6.4%) for adolescents and young adults, 3.3% (95% CI 2.8-3.9%) for sex workers, and 1.6% (95% CI 1.2-2.0%) for urethral infection in men who have sex with men. Clinic-based estimates were generally, although not consistently, higher than community-based estimates. There is no serial population-based data for sexually active young men and women, but the available age-specific rates suggest under-ascertainment by the routine surveillance systems. CONCLUSIONS: The prevalence of genital chlamydial infection in Indigenous Australians and young adults is unacceptably high and quality epidemiological studies are urgently required to supplement the routinely collected national notification data.
Adolescent↗
An audit of contact tracing for cases of chlamydia in the Australian Capital Territory.
BACKGROUND: Contact tracing is one of the central pillars of the management of sexually transmitted infections. The aims of this audit were to determine the yield of chlamydia infection from contact tracing the sexual partners of individuals diagnosed with chlamydia and to evaluate and compare the effectiveness of contact tracing undertaken at the Communicable Diseases Control Section (CDCS) of Australian Capital Territory (ACT) Health and the Canberra Sexual Health Centre (the clinic). METHODS: A retrospective review of the notification records and contact-tracing documentation was undertaken at CDCS and the clinic from 1 September 2002 to 30 September 2003 (13 months). RESULTS: The background rate of chlamydia in those tested in the ACT community is 3-5%. During the study period, 512 cases of chlamydia were notified to CDCS. Of these, 351 were referred for contact tracing, 293 by CDCS and 98 by the clinic. Of the 437 nominated sexual contacts (average of 1.12 per index case), 272 (62.2%) were contacted, 125 (28.6%) were tested and 51 (11.7%; 95% CI 8.8-15.1) tested positive for chlamydia (15.5%; 95% CI 11.5-20.6% in sexual contacts of CDCS index cases and 7.8%; 95% CI 4.8-12.5% in those of the clinic patients). Contact tracing through the CDCS reached significantly more nominated sexual contacts (78.4% v. 41.7%; P = 0.001) and significantly more of the nominated sexual contacts of index cases reported to CDCS were described as tested (34.7% v. 20.8%; P = 0.01). The average time taken to identify each chlamydia-positive sexual contact was 6.8 hours. CONCLUSIONS: Contact tracing more than doubled the case finding effectiveness of chlamydia screening, but was time consuming. These results suggest that provider-initiated contact tracing has clinical and public health value, but that the cost-effectiveness of this approach to chlamydia control should be further evaluated.
Chlamydia Infections↗
Pooling of clinical specimens prior to testing for Chlamydia trachomatis by PCR is accurate and cost saving.
The accuracy and cost savings of pooling specimens prior to testing for Chlamydia trachomatis by PCR were evaluated with genital and urine specimens (n = 2,600). There was a 60% reduction in tests without significant loss of accuracy. The efficiency of pooling vaginal swabs is demonstrated for the first time.
Cervix Uteri↗
Staphylococcus aureus and stethoscopes.
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2-Propanol↗
Doctors should be warned of the risks of necrotising fasciitis.
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Fasciitis, Necrotizing↗
Infectious diseases. 6: Sexually transmitted infections: new diagnostic approaches and treatments.
1. Commercially available nucleic acid amplification assays (eg, polymerase or ligase chain reaction) are now the "gold standard" tests for genital chlamydial infection and also have a role in screening for gonococcal infection. 2. Single-dose oral antibiotics are available for treatment of Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis infections. 3. Strains of N. gonorrhoeae in urban Australia are often penicillin resistant, while strains from South East Asia and those in homosexually active men may show high-level resistance to quinolones. 4. Imiquimod, a novel immune-response modifier, is now available for effective, safe, self-administered treatment of genital warts. 5. The Pap smear remains the cornerstone of screening for precursor lesions of cervical cancer, but human papillomavirus genotyping may have a role in clinical decision-making for women with equivocal or early precancerous lesions. 6. Treatment of primary genital herpes changes the clinical course, and long-term suppressive therapy is effective for those with multiple recurrences. New technologies have made diagnosis and screening easier for patients and clinicians
Adolescent↗