Miscarriage, affecting one in four confirmed pregnancies in Australia, has well-established psychological impacts, yet support remains limited and largely centred on cisgender heterosexual experiences. As LGBTIQA+ families continue to grow in numbers and considering the disproportionately high rates of mental health diagnoses within LGBTIQA+ populations, it is critical to understand how miscarriage affects members of this community. This qualitative study explored LGBTIQA+ experiences of miscarriage through semi-structured interviews with 16 participants recruited via purposive and snowball sampling. Thematic analysis identified three key themes: 1) navigating discrimination and marginalisation; 2) compounded burden of LGBTIQA+ conception and loss; and 3) LGBTIQA+ identity facilitating connection and meaning. Participants described how pervasive discrimination and a lack of visibly inclusive services shaped their experiences and often deterred them from seeking care. The emotional impact of miscarriage was intensified by lengthy, complex, and inequitable pathways to conception, leaving grief under-recognised and further marginalised. Despite these challenges, participants drew on community resilience and shared identity to find validation and rebuild connection. Findings highlight the need for miscarriage care that is visibly affirming, knowledgeable, and inclusive of diverse LGBTIQA+ families, and point to the importance of further research across broader identities and healthcare contexts.

Background Syphilis is caused by the bacteria Treponema pallidum. Primary syphilis might present with multiple, painful lesions that are clinically indistinguishable from herpes. In this prospective cohort study, we aimed to evaluate whether the implementation of routine multiplex PCR testing for T pallidum and herpes simplex virus (HSV) in general practice improves the detection of primary syphilis. Methods From Sept 1, 2022, the PlexPCR VHS (SpeeDx, Eveleigh, NSW, Australia) test, which simultaneously detects T pallidum and HSV-1 and HSV-2 was implemented by Melbourne Pathology (Victoria, Australia). Multiplex testing was done on all samples from patients aged 18 years or older if: (1) the clinician ordered HSV PCR testing only from an anogenital site, or an oral or unspecified site that was also accompanied by a test for another sexually transmitted infection (eg, Chlamydia trachomatis, Neisseria gonorrhoeae, or Mycoplasma genitalium); or (2) the clinician specifically requested T pallidum PCR. All positive T pallidum PCR results were reported to prompt treatment. The number and proportion of T pallidum PCR tests done and T pallidum PCR-positive cases detected were compared between requested T pallidum PCR and T pallidum PCR added to HSV PCR-only requests due to multiplex testing. Syphilis serology was examined among T pallidum PCR-positive cases in which T pallidum PCR had not been requested, to establish the proportion that might have been missed without multiplex testing. Findings Between Sept 1, 2022, and March 27, 2024, 8873 multiplex tests were done in 5847 (65·9%) female patients and 3026 (34·1%) male patients. In 6667 (75·1%) of 8873 T pallidum PCR tests, and 27 (25·2%) of 107 cases detected, T pallidum PCR was added to HSV-only requests through multiplex testing. Compared with cases in which T pallidum PCR was requested, a higher proportion of the 27 cases identified through added T pallidum PCR testing were from female patients (seven [25·9%] of 27 vs eight [10·0%] of 80; p=0·039), syphilis reinfections (eight [29·6%] of 27 vs nine [11·3%] of 80; p=0·024), clinically atypical presentations (12 [44·4%] of 27 vs 16 [20·0%] of 80; p=0·013), or those co-infected with HSV (three [11·1%] of 27 vs one [1·3%] of 80; p=0·049). In 17 (63·0%) of 27 added cases, serology for syphilis was not done or did not indicate reinfection. Interpretation Multiplex PCR testing for syphilis and herpes among patients for whom HSV PCR alone was ordered improved detection of primary syphilis in primary care. More widespread implementation would reduce misdiagnosis of primary syphilis in primary care, potentially reducing transmission and complications. Funding Australian National Health and Medical Research Council.

Background:Earlier syphilis detection is needed to reduce infectiousness and transmission and to improve control. Polymerase chain reaction (PCR) for Treponema pallidum is highly sensitive for detecting primary syphilis but is not often widely available or used. The aim of this systematic review and meta-analysis was to investigate the proportion of PCR-positive, seronegative primary syphilis infections when serology was performed at clinical presentation. Methods:We undertook a systematic review and meta-analysis to identify studies of patients presenting with primary syphilis where T pallidum PCR was performed on the primary syphilis lesion and serology for syphilis was performed on the same occasion. The review was conducted according to the Cochrane protocol. Medline, Embase, and PubMed were searched from 1 January 2000 to 27 November 2022 (date of search). Only studies published in English were included. A pooled estimate of the proportion of PCR-positive, seronegative primary infections was calculated via a random effects model. Results:Of 2571 studies identified, 8 met inclusion criteria and were included. This contributed to 758 individuals with T pallidum PCR-positive primary lesions who had serology performed at the same initial visit. Among these, a pooled estimate of 10% (95% CI, 6%-13%; 73/758; I 2 = 65%, P < .01) was negative on all serologic markers, ranging between 4% (95% CI, 0%-7%; 4/108) and 20% (95% CI, 10%-29%; 14/71). Conclusions:T pallidum was detected by PCR in 10% cases, which would have been missed if serology alone was used. T pallidum PCR is important for optimizing early detection of primary syphilis.

This editorial examines recruitment challenges during a qualitative study on LGBTIQA+ experiences of miscarriage. Despite targeted outreach, engagement was low, prompting reflection on broader barriers. We suggest four key factors: systemic discrimination in medicine and law; the small number of LGBTIQA+ people who have pursued conception and experienced miscarriage; increasing hostility toward LGBTIQA+ communities; and the psychosocial sensitivity of the topic. These challenges reflect wider patterns of exclusion from reproductive health and research. We argue for academic advocacy to address these inequities and to protect the rights and visibility of LGBTIQA+ people in health research and beyond.

Growing rates of bacterial sexually transmitted infections (STIs) demand new approaches to STI prevention. Sexual practices involving saliva or direct contact with the mouth increase the risk of STI transmission, but community awareness remains largely unexplored in the literature. The Community Awareness and Surveillance of STI Transmission study sought to explore sexual health clinic attendees' awareness of oral STIs; experiences when seeking testing and treatment; and acceptable educational and clinical interventions. Twenty-one semi-structured interviews were conducted with a diverse group of Melbourne Sexual Health Center attendees'. Reflective thematic analysis was undertaken, revealing key themes across people of different genders, sexual identities, ages, and nationalities. All participants emphasized the importance of understanding how their sexual practices might put them at risk of an oral STI. They also sought care from specialist sexual health services with the expectation that health-care providers (HCPs) in these settings had more understanding of diverse sexual practices. Participants' decisions to protect themselves against oral STIs were primarily driven by the effect the decision had on pleasure and intimacy. Comfort during the health-care encounter and trust in HCPs facilitated better understanding of individual STI risk. Differences in awareness and risk reduction strategies were noted based on past experience with oral testing and STIs. These findings highlight the importance of HCPs and public health interventions providing solutions that recognize the central role of pleasure and intimacy in our sexual lives.

Miscarriage, defined as the unintended loss of pregnancy before 20 weeks affects 1 in 4 pregnancies in Australia. Despite its prevalence, the emotional impact is often overlooked, and can lead to many women experiencing psychological distress including depression, anxiety, and post-traumatic stress disorder (PTSD). Healthcare professionals play a vital role in providing support, however, many women experiencing miscarriage report dissatisfaction with their care, primarily due to the lack of emotional support. This study explores the perspectives of both women and General Practitioners-in-Training (GPiTs) to improve communication and provide actionable solutions for better miscarriage care during consultations. A qualitative study was undertaken. Recruitment occurred with consumers from pregnancy loss support networks, and GPiTs from the national General Practice training organisation in Australia. Online focus groups were conducted to discuss personal experiences, challenges and needs related to the miscarriage consultation. The data was transcribed, analysed using NVivo and coded using an inductive thematic approach. The research team identified key themes and reached a consensus on the findings. Three key themes were developed: Emotional care: Both women and GPiTs highlighted the need for improved emotional support, including acknowledgment of the loss, addressing guilt, and offering follow-up care. Women valued inclusivity and informed choices, while GPiTs reported challenges due to limited training. Provision of clear information: Women preferred simple, clear explanations and written materials regarding miscarriage management. GPiTs recognised the importance of empathetic communication when conveying sensitive information. Training and skills: GPiTs highlighted the need for early, formal training in miscarriage counselling whilst women emphasised the importance of education for all healthcare providers involved in miscarriage care. This study highlights the need to integrate emotional care into all miscarriage consultations. Additionally, early training to support and deliver a consistent approach in a sensitive manner, covering both the physical and emotional aspects of miscarriage is needed. This is essential to improve the quality of care provided, and ensure better support for women during this emotionally challenging time.

OBJECTIVE:To understand the father's lived experience of childbirth as a significant life situation within the well-being concept framework. To understand the father's lived experience of childbirth within the framework of the concept of well-being as a significant life situation. METHOD:Secondary data analysis from a qualitative study about the experience of twelve Chilean fathers who were prepared to actively participate at childbirth from a mixed public-private health system institution between 2016-2017, was carried out. Qualitative data were extracted from transcripts of open interviews with eight of the twelve fathers after childbirth. Data were analyzed using an interpretive-phenomenological approach. RESULTS:Four central themes emerged from data, which were framed and understand within the psychological well-being concept: I. Feeling as a part of the healthcare team; II. Perceiving himself capable of containing and supporting his partner and being a guardian of the process; III. Being committed to being a father from the first moment of contact with the child; IV. Being wrapped in a whirlwind of emotions. CONCLUSION:Father's lived experience at childbirth can be understood considering the psychological well-being concept. Prepared fathers could live the childbirth experience within a state of well-being, focusing on their achievements, commitments, and being satisfied with their roles as father and partner.

The Supporting Transitions and Relationships (STAR Mums) program was developed in response to the clinical need for psychological intervention in pregnancy where mothers have risk factors for difficulties in the transition to parenthood. The program focuses on the developing relationship between the mother and the unborn child and aims to facilitate the normal psychological processes that are known to occur in pregnancy to prepare for the relationship with the infant and to reduce risk factors that may negatively impact this relationship. This article reports on interview data from the final follow-up of 12 high-risk participants at 12 to 14 weeks postpartum regarding their transition to parenthood and aspects of parental reflective function. These women presented with issues in developing their maternal identity and representation in the context of difficulties processing their own difficult childhood experiences. They also demonstrated some issues with limited reflective capacity in their understanding of their infant’s emotional world and experiences. Though there are ongoing issues for these women, they provided feedback that the STAR Mums program included valued discussion around the changes in both self and relationships involved in parenting that helped them to prepare for their experiences of early parenthood by supporting their wondering about the baby and the changes that this new relationship may bring for them as a parent.

Background Delayed diagnosis and treatment of sexually transmitted infections (STIs) contributes to poorer health outcomes and onward transmission to sexual partners. Access to best-practice sexual health care may be limited by barriers such as cost, distance to care providers, sexual stigma, and trust in health care providers. Online assessments of risk offer a novel means of supporting access to evidence-based sexual health information, testing, and treatment by providing more individualized sexual health information based on user inputs. Objective This developmental evaluation aims to find potential users’ views and experiences in relation to an online assessment of risk, called iSpySTI (Melbourne Sexual Health Center), including the likely impacts of use. Methods Individuals presenting with urogenital symptoms to a specialist sexual health clinic were given the opportunity to trial a web-based, Bayesian-powered tool that provides a list of 2 to 4 potential causes of their symptoms based on inputs of known STI risk factors and symptoms. Those who tried the tool were invited to participate in a once-off, semistructured research interview. Descriptive, action, and emotion coding informed the comparative analysis of individual cases. Results Findings from interviews with 14 people who had used the iSpySTI tool support the superiority of the online assessment of STI risk compared to existing sources of sexual health information (eg, internet search engines) in providing trusted and probabilistic information to users. Additionally, potential users reported benefits to their emotional well-being in the intervening period between noticing symptoms and being able to access care. Differences in current and imagined urgency of health care seeking and emotional impacts were found based on clinical diagnosis (eg, non-STI, curable and incurable but treatable STIs) and whether participants were born in Australia or elsewhere. Conclusions Online assessments of risk provide users experiencing urogenital symptoms with more individualized and evidence-based health information that can improve their health care–seeking and provide reassurance in the period before they can access care.

BackgroundThe risk factors for oropharyngeal gonorrhea have not been examined in sex workers despite the increasing prevalence of gonorrhea infection. ObjectiveThis study aims to determine the risk factors for oropharyngeal gonorrhea in female and gender-diverse sex workers (including cisgender and transgender women, nonbinary and gender fluid sex workers, and those with a different identity) and examine kissing, oral sex, and mouthwash practices with clients. MethodsThis mixed methods case-control study was conducted from 2018 to 2020 at 2 sexual health clinics in Melbourne, Victoria, and Sydney, New South Wales, Australia. We recruited 83 sex workers diagnosed with oropharyngeal gonorrhea (cases) and 581 sex workers without (controls). Semistructured interviews with 19 sex workers from Melbourne were conducted. ResultsIn the case-control study, the median age of 664 sex workers was 30 (IQR 25-36) years. Almost 30% of sex workers (192/664, 28.9%) reported performing condomless fellatio on clients. Performing condomless fellatio with clients was the only behavior associated with oropharyngeal gonorrhea (adjusted odds ratio 3.6, 95% CI 1.7-7.6; P=.001). Most participants (521/664, 78.5%) used mouthwash frequently. In the qualitative study, almost all sex workers reported kissing clients due to demand and generally reported following clients’ lead with regard to kissing style and duration. However, they used condoms for fellatio because they considered it a risky practice for contracting sexually transmitted infections, unlike cunnilingus without a dental dam. ConclusionsOur study shows that condomless fellatio is a risk factor for oropharyngeal gonorrhea among sex workers despite most sex workers using condoms with their clients for fellatio. Novel interventions, particularly targeting the oropharynx, will be required for oropharyngeal gonorrhea prevention.

Background:The rising prevalence of bacterial sexually transmitted infections (STIs) is cause for concern in the context of antimicrobial resistance and the potential health outcomes of untreated infections.Objective:The Community Awareness and Surveillance of Transmission (CAST) study sought sexual health service users' views on reducing the prevalence of STIs.Methods:Semi-structured interviews were conducted with sexual health clinic attendees who had received a diagnosis of chlamydia, gonorrhea or syphilis in the previous six months. Participant comments relating to antibiotic post-exposure prophylaxis (APEP) and vaccination were inductively coded, then compared using comparative qualitative data analysis methods described by Miles and Huberman.Findings:Twenty-one participants with differing genders, ages, nationalities and sexual orientations, were interviewed. Participants across informant groups expressed concerns about APEP for STI prevention because of potential antimicrobial resistance and personal health impacts. Vaccination against bacterial STIs was more acceptable. Common factors mentioned in relation to both interventions included perception of individual STI risk over time, safety, effectiveness and accessibility.Conclusions:The views of sexual health service users support efforts to find alternatives to more frequent use of antibiotics, such as vaccinations against bacterial STIs, to reduce STI incidence and support antimicrobial stewardship.

Miscarriage and recurrent miscarriage affect a significant proportion of every population with research consistently showing it results in profound and often prolonged psychological impacts. Despite the serious psychological impacts, support for miscarriage remains grossly inadequate. There are many ways to ameliorate the impact of these losses, which are not difficult, expensive, or time consuming. At a basic level, people want and need acknowledgment and validation of their grief and loss and greater information provision at the time of loss. A clear discrepancy also exists between the bereavement care offered by health care providers and the care wanted and needed by those affected, that must be addressed as a matter of urgency. At a health care system level, the collection of national miscarriage data must begin, to allow for a true understanding of the socioeconomic cost of miscarriage and the burden of early pregnancy loss on individuals, families, and our social systems. Furthermore, to direct research funding appropriately, establishing national research funding priorities for miscarriage support, as they have in the United Kingdom, is vital in assisting researchers and other key stakeholders to effectively target research in areas that are likely to have the greatest public health benefit. Consumers, health practitioners, and policymakers could achieve a lot for many with just a little commitment to change.