Abstract There are several barriers to uptake of intrauterine devices (IUDs), with the fear of pain during insertion an emerging concern. Using data from an online survey, we sought to understand the experience of women who had undergone IUD insertion, with a particular focus on their expectation compared with their reported experience of pain. We found that, while most participants expected a moderate level of pain at insertion, many reported a high level of pain. Pain relief offered was variable, and, aside from that administered by an anaesthetist, no single method appeared to significantly reduce reported pain.

Recruiting participants is a vital component of social research. Finding the right people (and the right number of them) at the right time to participate in your study can make or break its success; it can also challenge research budgets and requires considerable flexibility. Online recruitment strategies are becoming increasingly popular ways to recruit to both qualitative and quantitative studies. In this paper, we detail our experiences of using social media, primarily Meta platforms Facebook and Instagram, to recruit participants for our sexual and reproductive health research. Here, we provide a practical guide to using social media to recruit participants, and include examples throughout from our own research. We outline our triumphs and pitfalls in using this recruitment strategy, the challenges we have faced and the lessons we have learnt. In doing so, we hope to provide useful guidance for others wishing to use social media to recruit to their research studies.

Background Chlamydia is one of the most common sexually transmissible infections globally and can lead to reproductive complications, including pelvic inflammatory disease and infertility. Interventions to reduce disease burden, including retesting for reinfection, partner management, and early detection of complications, are the focus of the Management of Chlamydia Cases in Australia (MoCCA) study, an implementation and feasibility trial aiming to strengthen chlamydia management in Australian general practice. This study aimed to identify factors influencing participation in and adoption of a multifaceted chlamydia management intervention within the general practice setting. Methods We conducted semi-structured interviews with general practice staff (n = 13) from clinics (n = 9) participating in the MoCCA study. Data were analysed using inductive content analysis to identify facilitators and barriers to study participation and intervention adoption. Results Participants felt that practice champions, motivated staff and interventions that improved workflow efficiency, integrated with existing processes and improved patient interactions, facilitated participation in, and adoption of, study interventions. A perceived lack of staff engagement related to time constraints, competing priorities, staff retention issues and interventions that were less convenient to use or had reduced patient uptake were identified as barriers to participation. Conclusions Identifying perceived facilitators and barriers to successful implementation of a multifaceted chlamydia intervention enables public health practitioners to better support general practice in the ongoing uptake and use of evidence-based chlamydia management strategies, ultimately aiming to reduce the burden of chlamydia and its complications in Australia.

Background Gonorrhoea notification rates in Australia have more than doubled between 2014 and 2019. We explored gonorrhoea testing patterns and management of gonorrhoea infection in general practice. Methods We analysed de-identified electronic medical record data for individuals who attended 73 Australian general practices (72 in the state of Victoria) between January 2018 and December 2020. The 'care cascade' model was utilised to explore gonorrhoea detection and management. Descriptive analysis and logistic regression were used to investigate factors associated with gonorrhoea testing, treatment and retesting. Results During the study period, there were a total of 1,027,337 clinical episodes. Of these, 5.6% (n =57,847, 95% confidence interval [CI] 4.5-6.7) involved a gonorrhoea test and 1.1% (n =637, 95% CI 0.8-1.4) tested positive. Of the 637 gonorrhoea cases, 48.4% (n =308, 95% CI 29.8-67.0) had an Australian guideline-recommended dual antibiotic prescription (ceftriaxone and azithromycin) recorded. Of 329 cases without a dual antibiotic prescription, 84.2% (n =277, 95% CI 77.5-90.9) had reattended the clinic. Among the 206 gonorrhoea cases with dual antibiotic prescription recorded in 2018 and 2019, 32.0% (n =66, 95% CI 25.3-38.8) were retested from 6weeks to 6months post-treatment. Of the 140 gonorrhoea cases that were not retested, 54.3% (n =76, 95% CI 46.8-61.8) reattended the clinic within 6months of treatment. Conclusion The low proportion of gonorrhoea cases prescribed recommended antibiotics and retested within recommended timeframes suggests opportunities for integrating Australian STI guidelines into primary care. Further exploration of care pathways is warranted to determine if care was provided but not recorded, provided elsewhere or not provided.

Background Partner notification is an important step in the control of sexually transmissible infections (STIs). STIs remain at high rates among young people and can have serious reproductive consequences if left untreated. This study aimed to determine the preferences and motivations for partner notification among young people in Australia. Methods Quantitative and free-text qualitative data were collected through the 2024 Sex, Drugs and Rock 'n' Roll survey, an annual cross-sectional survey conducted among people aged 15-29years old in Victoria, Australia. Respondents were recruited using convenience sampling through social media advertisements. Counts and proportions were calculated for the preferences and motivations for partner notification by regular and casual sexual partners as well as methods of communication. Inductive content analysis was used to analyse free-text responses. Results The partner notification module of the survey was completed by 1163 people (60.3% identified as women, 40.2% as heterosexual) who provided a total of 1720 free-text responses. The majority, 1056 (90.8%) stated that they would notify their sexual partners and 1142 (98.2%) would want to be notified by a sexual partner of an STI risk. Qualitative analysis highlighted that respondents felt that partner notification is the responsible thing to do to look after their own and their partner's health and protect others by reducing transmission. Few stated that embarrassment and fear of repercussions may make them less likely to notify their partners or that it would depend on the type of relationship. Most preferred to notify regular partners face-to-face (941, 80.9%) and casual partners via text message (785, 67.5%). Conclusion Almost all young people want to notify and be notified by partners of an STI risk regardless of age, gender or sexual identity. Tailoring resources by communication method and partner type is one way in which practitioners and public health authorities can support young people in undertaking this important step in STI control.

Objective: To evaluate the implementation and impact of the Management of Chlamydia Cases in Australia (MoCCA) intervention for strengthening chlamydia management in Australian general practice. Design: Non randomised implementation and feasibility trial Setting: General practices in the Australian states of New South Wales, Queensland and Victoria. Participants: 14 general practices participated and implemented the MoCCA intervention. General practitioners (GPs) and nurses from participating clinics were interviewed about implementation and use of MoCCA. Deidentified patient attendance and clinical data for patients aged 16 to 44 years were collected for each clinic. Intervention: Multifaceted intervention (website (www.mocca.org.au/), patient factsheets, shortcuts for documenting a chlamydia consultation, mailed specimen kits for chlamydia re-testing, guidance articles, continuing professional development activities) to facilitate chlamydia management in general practice. Clinicians (GPs and nurses) were asked to use the MoCCA intervention to guide their chlamydia and pelvic inflammatory disease (PID) diagnosis and management over a 12-month intervention period. Main outcome measures: The primary outcomes focussed on intervention implementation (acceptability, adoption, appropriateness, feasibility, fidelity, penetration, sustainability). Secondary outcomes focused on chlamydia retesting and reinfection among patients who had a chlamydia infection and PID rates among female patients, comparing the intervention period with a 12-month preintervention period. Results: Clinicians (doctors=26, nurses=7) largely viewed MoCCA as compatible (appropriateness) with the general practice setting and an acceptable approach to streamlining chlamydia management. Some MoCCA components (e.g. website, shortcuts, factsheets, patient delivered partner therapy [PDPT] resources) were preferred for their ease of use and support for decision making over other components (e.g. postal retesting kits). Intention to use MoCCA (adoption) and its uptake (penetration) varied between clinicians and MoCCA components. Some clinicians intended to use MoCCA but did not due to lack of opportunity, forgetting, or other preferred practices. MoCCA was not used uniformly (fidelity), but its flexible design let clinicians use MoCCA components to suit their needs. Clinicians liked that MoCCA facilitated best practice chlamydia management (feasibility) as outlined in Australian STI management guidelines. Reported improvements in care included better quality, continuity and time-efficiency (e.g. website simplified chlamydia management) and patient communication (e.g. shortcuts/factsheets remind to discuss retesting). Many wanted access to MoCCA resources post-study (sustainability). Chlamydia tests were conducted in 17.2% patients preintervention (n=7670/44607, with 4.6% positive) and 18.0% (n=9703/54008, with 5.0% positive) during the intervention. Proportions retested were 18.1% (95% confidence interval (CI) 13.4, 23.7) preintervention and 23.1% (95%CI 18.7, 28.1) in the intervention period (difference=5.0%, 95%CI -2.1, 12.1). Adjusting for gender and clinic location (metropolitan vs non-metropolitan), retesting for 16 to 25 year olds increased between the preintervention and intervention period (adjusted relative risk (aRR) 2.12, 95%CI 1.43, 3.15) and for individuals aged 26 to 44 years results were inconclusive (aRR 1.01, 95%CI 0.66, 1.55). PID diagnosis per 1000 consultations among females were 16.9 preintervention and 19.1 intervention period (absolute difference = 2.18%, 95% CI 0.13, 4.23). Conclusions: MoCCA aligned with the general practice setting and supported improved chlamydia management. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Protocols ### Funding Statement This study was supported by a National Health and Medical Research Council (NHMRC) Partnership Grant (APP1150014). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The University of Melbourne Human Research Ethics Committee (ID: 22665) gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The data that support the findings are not publicly available due to ethical approval for the patient attendance and clinical data pertaining to its collection specifically for the purposes of this study. All relevant data for the present work are contained in the manuscript.

BACKGROUND:Australian general practitioners encounter a vast array of health issues in their clinical practice. High-quality clinical record keeping is crucial to support continuity of care for patients and decision making for clinicians. Many clinical software programs used in general practice contain shortcut features that allow insertion of pre-stored, editable text into progress notes. These can be used to support documentation of specific health issues. OBJECTIVE:Drawing on our experience within a research project seeking to strengthen chlamydia management in general practice, this article describes the co-design, implementation and use of documentation shortcuts for chlamydia management. DISCUSSION:Shortcuts are useful as a memory prompt and timesaver for general practice clinicians. It is important that they do not replace clinical acumen and judgement. General practices using our chlamydia management shortcuts found them easy to set up, that they acted as a prompt for best practice chlamydia management and that they integrated well with the general practice workflow.

Background Chlamydia remains the most notified bacterial sexually transmissible infection in Australia with guidelines recommending testing for re-infection at 3 months post treatment. This paper aimed to determine chlamydia retesting and repeat positivity rates within 2–4 months among young women in Australia, and to evaluate what factors increase or decrease the likelihood of retesting. Methods Chlamydia retesting rates among 16–29-year-old women were analysed from Australian Collaboration for Coordinated Enhanced Sentinel Surveillance of sexually transmissible infection and bloodborne virus (ACCESS) sentinel surveillance data (n = 62 sites). Among women with at least one positive test between 1 January 2018 and 31 August 2022, retesting counts and proportions within 2–4 months were calculated. Logistic regression was performed to assess factors associated with retesting within 2–4 months. Results Among 8758 women who were positive before 31 August 2022 to allow time for follow up, 1423 (16.2%) were retested within 2–4 months, of whom 179 (12.6%) tested positive. The odds of retesting within 2–4 months were 25% lower if tested in a coronavirus disease 2019 (COVID-9) pandemic year (2020–2022) (aOR = 0.75; 95% CI 0.59–0.95). Among 9140 women with a positive test before 30 November 2022, 397 (4.3%) were retested too early (within 7 days to 1 month) and 81 (20.4%) of those were positive. Conclusions Chlamydia retesting rates remain low with around a sixth of women retested within 2–4 months in line with guidelines. Re-infection is common with around one in eight retesting positive. An increase in retesting is required to reduce the risk of reproductive complications and onward transmission.

Background In Australia, syphilis notifications increased 2.5-fold during 2013–2022 and 83 congenital syphilis cases were reported. Timely diagnosis and management are crucial. We developed a tool to promote syphilis testing into our existing ‘Future Health Today’ (FHT) software and explored its acceptability in general practice. Methods Our tool (FHT-syphilis) scans electronic medical record data to identify and prompt testing for pregnant women, and, people recently tested for sexually transmissible infection (STI) or HIV, but not syphilis. It links to relevant guidelines and patient resources. We implemented FHT-syphilis in 52 general practices using FHT for other conditions and interviewed practice clinicians (n = 9) to explore it’s acceptability. Data were analysed deductively guided by the Theoretical Framework of Acceptability. Results Interviewees considered syphilis an important infection to focus on and broadly viewed FHT-syphilis as acceptable for identifying patients and giving clinicians authority to discuss syphilis testing. Time constraints and unrelated reasons for a patient’s visit were barriers to initiating syphilis testing discussions. Australian STI guidelines were considered appropriate to link to. Some interviewees considered prompts should be based on sexual behaviour, however this is not well captured in the electonic medical record. Two interviewees were alerted to updated Australian STI guidelines via their interaction with FHT-syphilis and expanded their syphilis testing practices. Expertise to initiate discussions about syphilis and risk was deemed important. Conclusions A digital tool for prompting syphilis testing was acceptable to clinicians already using FHT. Linkage to STI guidelines alerted some end-users to updated guidelines, informing STI testing practices.

Background Patient-delivered partner therapy (PDPT) involves providing a prescription or medication to a patient diagnosed with chlamydia to pass to their sexual partner/s. Barriers to PDPT include uncertainty about its integration into clinical practice and permissibility. In Victoria, Australia, the Department of Health provides clinical guidance for PDPT (updated in 2022). We explored health practitioner views on the usefulness of the updated guidance for providing PDPT. Methods We conducted an online survey (12 December 2022 to 2 May 2023) of health practitioners who primarily work in Victoria and can prescribe to treat chlamydia. The survey displayed excerpts from the guidance, and asked closed and free-text questions about its ability to address barriers to PDPT. Quantitative data were descriptively analysed, complemented by conventional content analysis of qualitative data. Results Of a total of 49 respondents (66.7% general practitioners), 74.5% were aware of PDPT, and 66.7% had previously offered PDPT. After viewing excerpts of the guidance, >80% agreed it could support them to identify patients eligible/ineligible for PDPT, and 66.7% indicated they would be comfortable to offer PDPT. The guidance was viewed as helpful to address some barriers, including complicated documentation (87.7%) and medico-legal concerns (66.7%). Qualitative data highlighted medico-legal concerns by a minority of respondents. Some raised concerns that the guidance recommended prescribing azithromycin, despite doxycycline being first-line chlamydia treatment. Conclusions The guidance was largely viewed as supportive for PDPT decision-making. There is scope for further refinements and clarifications, and wider dissemination of the guidance.

Objective: Young people are a priority group for sexual and reproductive health (SRH) care. We considered which SRH topics young Australians want to discuss with a general practitioner (GP) and explored barriers they encounter to discussing these issues. Methods: We conducted an online survey (2nd May - 21st June 2022) of Australians aged 16-29 years. Participants were asked to identify from a list of SRH topics which they wanted to discuss, but never had, with a GP. Those who selected any topic/s (with 'undiscussed SRH issues') were asked a free-text follow-up question about what prevented them from discussing issues. We explored characteristics associated with having undiscussed issues using multivariate logistic regression. Free-text comments were analysed using content analysis. Results: A total of 1887 people completed relevant survey questions. Most (67.1 %) were women and 48.5 % were heterosexual. Two-thirds (67.0 %) had a usual GP. Nearly half (45.6 %) had undiscussed issues. Most commonly, women wanted to discuss cervical screening and sexual problems, and men wanted to discuss sexual problems and STIs. Participants who were male, older, heterosexual, and with a usual GP were least likely to have undiscussed issues. Barriers to accessing care for SRH were identified from free-text comments, including discomfort, lack of opportunity, fear of negative outcomes, low priority of SRH issues, and perceptions about the role and expertise of GPs. Conclusions: Many young people would welcome more preventative SRH care. Young people may be reassured that all issues, including sexual difficulties and dysfunction, are appropriate to discuss with a GP.

Early detection and treatment of sexually transmitted infections, HIV, and hepatitis B and C are vital to minimise the harm they cause. This Evidence Check aimed to identify effective initiatives that engage and support GPs and the GP clinic workforce in NSW to increase testing for these conditions. It also aimed to identify effective modifications to practice management software to increase GP engagement in screening and care for these conditions. Sixty-two articles were found in total. The most effective initiatives used multiple interventions, particularly provider education and quality improvement. They involved both GPs and other health workers, and offered clinic-level initiatives to help identify patients at higher risk (e.g. software-generated alerts) and engage them in testing (e.g. through self-collected specimens). Models of care that used nurse-led testing or links to specialist services offered a way to increase capacity to carry out testing. The quality of evidence was mixed—there were few randomised controlled trials, and little evidence about the sustainability of the initiatives over time, highlighting the need for further high-quality research.

Background Most sexual health care in Australia is provided through general practice. However, many young Australians experience barriers to accessing sexual health care. This research examines young Australians' receptiveness to discussing sexual health with a general practitioner (GP).Methods We conducted an anonymous online sexual health survey (open 2 May to 21 June 2022). Anyone living in Australia aged 16-29 years was eligible to participate. Participants were recruited via social media and asked whether they agreed with five statements exploring their receptivity to discussing sexual health with GPs. We explored characteristics associated with responses using multivariable logistic regression.Results Among 1915 participants, 69.3% were cisgender women, with a median age of 20 years; 48.5% were heterosexual. Approximately one-fifth agreed they might not tell a GP the whole truth about their sexual history, would be worried about confidentiality when discussing their sexual history and would be too embarrassed to see their usual GP if they thought they had a sexually transmitted infection. Over half (55.8%) agreed they would be comfortable with a GP bringing up sexual health in an unrelated consultation, but 39.6% would be nervous to bring up sexual health in case they needed an intimate examination. Multivariate regression identified several characteristics associated with responses. Notably, having a school-based sex education and a usual GP were factors associated with increased receptivity to discussing sexual health.Conclusions Young Australians were generally open to discussing sexual health with a GP. School-based sex education and GP-patient relationships are key to promoting sexual health among young people.

ObjectivesGay, bisexual and other men who have sex with men (GBMSM) and trans and gender diverse (TGD) people are disproportionately affected by poorer sexual health outcomes compared to heterosexual populations. We aimed to explore the preferences of GBMSM and TGD for using eHealth for sexual health (eSexualHealth).MethodsWe distributed an anonymous online survey from April to August 2021among the lesbian, gay, bisexual, transgender, intersex, queer and other people of diverse sexuality or gender (LGBTIQA+) community in Australia. The survey collected data on sociodemographic characteristics and sexual behaviors, their preferences for app/website functions and preferred HIV and sexually transmitted infection (STI) testing reminders. We used descriptive statistics to summarize the characteristics of the study population. Free-text responses were thematically analyzed.ResultsOf 466 participants included, most identified as cisgender males (92.7%). The median age was 48 [interquartile range (IQR): 37–56]. For accessing sexual health-related information, 160 (34.6%) would use either a website or an app, 165 (32.7%) would prefer a website, 119 (25.8%) would prefer an app, and 33 (7.1%) would not use either platform. There was no significant difference between GBMSM and TGD people. Participants were most interested in information about STI clinics, HIV/STI hotspots, and sexual health education. Participants stressed the need for privacy and anonymity when using eHealth. Regarding reminders to test for HIV/STIs, receiving regular SMS was most popular (112/293, 38.2%), followed by regular emails (55/293 18.8%) and a reminder function on their phone (48/293, 16.4%).ConclusionOur study suggests a promising future for eHealth among GBMSM and TGD people. Sexual health is still a stigmatized area, and eHealth may circumvent barriers this population faces.

BACKGROUND:There is increased heterosexual transmission of syphilis in Australia, an infection with severe outcomes. Australian policy emphasizes increasing sexually transmissible infection knowledge/awareness. However, little is known about young Australians' perceptions and knowledge of syphilis.METHODS:Our online sexual health survey was open May 2 to June 21, 2022, to 16- to 29-year-olds in Australia. We asked participants if they were aware of syphilis, their personal risk perception, and perceived severity of infection and compared with results for chlamydia/gonorrhea. Multivariable and multinomial logistic regressions were used to assess characteristics associated with outcomes. We measured sexually transmissible infection knowledge using 10 true/false statements (5 syphilis, 5 chlamydia/gonorrhea).RESULTS:Among 2018 participants (69.1% women, 48.9% heterosexual), 91.3% had heard of syphilis (vs. 97.2% for chlamydia and 93.3% for gonorrhea). Older (25-29 years; adjusted odds ratio [aOR], 2.4; 95% confidence interval [CI], 1.4-4.4) and gay/lesbian (aOR, 2.8; 95% CI, 1.4-5.3) respondents were more likely to have heard of syphilis, as were those who were non-Aboriginal, sexually active, and with a school-based sex education. Syphilis knowledge was lower than chlamydia/gonorrhea knowledge ( P < 0.001). More than half (59.7%) perceived syphilis to have serious health impacts (vs. 36.4% for chlamydia and 42.3% for gonorrhea). Older respondents were more likely (25-29 years; aOR 2.1; 95% CI, 1.6-2.8), and gay/lesbian respondents less likely (aOR, 0.7; 95% CI, 0.6-1.0) to perceive syphilis to have serious health impacts. One-fifth of sexually active participants were unsure of their risk of syphilis.CONCLUSIONS:Most young Australians are aware of syphilis, but few have comprehensive knowledge about the infection relative to chlamydia/gonorrhea. Considering increasing heterosexual transmission, syphilis health promotion campaigns should expand their focus.