Purpose: To introduce the concept of screening for the control of sexually transmissible infections (STIs) in a review article and specifically, to describe: the use of screening tests (including their sensitivity, specificity, positive predictive value and negative predictive value); the World Health Organization guidelines on screening; and the factors that determine the effectiveness of screening for STIs, particularly in Australian Indigenous communities. Methods: Recent articles published up to February 2001 were included using a MEDLINE search on 'Sexually transmitted diseases' and 'Mass screening'. Results: Screening for STIs involves the application of diagnostic testing to people who are not known to have infection. It may take place in contexts ranging from clinical settings to community- based programs. The effectiveness of screening for STIs at a population level is determined by several factors, including the ability of the program to reach people at higher risk of STI, the proportion of those with infection who do not have symptoms sufficient to cause them to seek treatment, the mean duration of an infection in the community without screening, the frequency of screening, the methods for selecting individuals in the community to be screened, the sensitivity of the laboratory test, the effectiveness of the proposed treatment, and the extent of any adverse health or social consequences of screening. The relative contribution of each of these factors varies across communities. Conclusions: Screening can greatly reduce the prevalence of STIs in populations. Prior to implementation, careful consideration should be given to factors that influence the effectiveness of screening programs, to increase the likelihood that they will achieve their goals. (author abstract)
Aims: To provide a review and analysis of the non-Australian literature on screening and mass treatment for bacterial sexually transmissible infections (STIs) for health services to consider in developing local programs. Methods: Systematic search of the English- language literature since 1985 via MEDLINE, with a more limited search back to 1970 and, in addition, hand searching of references cited in articles reviewed. Results: Various studies showed the feasibility of a broad range of strategies. Cost benefit studies demonstrated the utility of antenatal syphilis screening at very low prevalences of disease and of chlamydia screening in women at prevalences of 2 to 14 per cent. Chlamydia screening programs in America and Sweden involving millions of people over several years were followed by large falls in rates of infection. A randomised controlled trial of screening for chlamydia was followed by a substantially lower incidence of pelvic inflammatory disease. Mass treatment programs were associated with reduced rates of infection in treated groups and their sexual partners who were not treated. Conclusions: Taken individually, the lack of control groups and the influence of simultaneous education and condom promotion in most studies make it impossible to directly ascribe the reduction in infection to screening. However, the body of evidence strongly suggests that, if appropriately conducted, screening programs can have a positive effect, particularly for chlamydia. The literature provides many examples to assist the development of locally appropriate strategies. (author abstract)
The National Public Health Partnership decided in June 2001 to abandon a wide ranging national sexual health framework and instead to give priority to the development of a national approach to the control of sexually transmitted infections. (non-author abstract)
Mathematical modelling has become an acceptable methodology to overcome some limitations of experimental studies in medicine. This paper demonstrates how modelling techniques can facilitate our understanding of the impact of clinical and epidemiological factors on sexual health outcomes. Heterogeneous influences such as the impact of client behaviour on clinical response, and clinician variability in investigation and treatment can be quantified through modelling. Practical dilemmas of resource utilisation, such as cost effective choice of laboratory test or pharmaceuticals, can be addressed for any given situation. Models can be customised to address local conditions and issues and to estimate clinical efficacy as well as cost effectiveness, therefore assisting with clinical practice guideline development, and providing economic justification for government funding and health policy.This paper takes as an example a model of the cost effectiveness of general practitioner management of genital chlamydia in New Zealand. This extended mathematical model applied appropriate clinical, behavioural and epidemiological data, and reflected locally appropriate costs and conditions, to determine the factors which influence efficacy and cost effectiveness of chlamydia management in New Zealand. The resulting analysis, a union of mathematical modelling, clinical epidemiology and sexual health, was capable of evaluating new tests and changes in disease management. With this single model, information was evaluated for development of clinical guidelines and public health policy. This modelling approach is well suited to answer the difficult questions facing decision makers in sexual health and other disciplines into the coming millennium.
Vaginal trichomoniasis, or infection with the parasite Trichomonas vaginalis, is a very common sexually transmitted infection (STI) which infects disadvantaged populations. It is of major public health concern worldwide. It has a strong association with adverse pregnancy outcomes and HIV transmission and yet is readily treatable with effective single dose, low cost treatment. Trichomoniasis should be considered in the diagnosis of vaginitis and should be part of any STI screen. Mass screening and treatment strategies for Trichomonas infection have the potential globally to be the single most cost effective achievable strategy for the reduction of HIV incidence. A greater understanding of the pathogenesis (including virulence factors) of this parasite is required if we are to combat this parasite effectively.
Objectives: To determine the history of childhood sexual abuse in male and female prisoners and to examine the association between sexual abuse and mental health outcome measures and behavioural risk factors. Method: Cross sectional random sample of 789 prisoners (657 men and 132 women) from 27 correctional centres across New South Wales, stratified by sex, age and Aboriginality data were collected in face to face interviews. Participants were asked about sexual activity before the age of 16 involving an adult or older person. Measures of mental health included the Beck Depression Inventory and the Alcohol Use Disorders Identification Test. Results: Approximately half of the female prisoners and 16 per cent of the men reported being sexually abused before the age of 16. Sexual abuse was associated with a history of psychiatric treatment and suicide attempts. Male victims were more likely to report self harm, depression and involvement in violent relationships. In both sexes, those with a history of childhood sexual abuse were more likely to have had a sexually transmissible disease. Women victims were more likely to report subsequent abusive adult relationships involving physical assault, sexual assault and verbal abuse. Both intrafamilial abuse and abuse before age 10 were associated with a history of suicide attempts. Conclusions: A history of childhood sexual abuse is much more common in NSW prisoners than in the general community and is associated with long term mental health and behavioural risks. Prisons could encourage disclosure of childhood sexual abuse and provide counselling and support to victims. (author abstract)
