BACKGROUND:Modern assays for the detection of Chlamydia trachomatis (CT) rely on nucleic acid amplification testing (NAAT) of DNA or ribosomal RNA. However, it is also known that both viable ("living") and non-viable ("dead") CT can be detected by NAAT. Multiple laboratory techniques to measure CT viability have emerged. METHODS:We searched PubMed, EMBASE, Scopus, and Dimensions as well as conference abstracts for entries between January 2000 and May 2023. We included any studies that measured CT viability among NAAT-positive samples. Viability assays include enhanced cell culture, direct fluorescent antibody (DFA), messenger RNA (mRNA) detection via digital droplet polymerase chain reaction (PCR, ddPCR), viability PCR (V-PCR), and real-time PCR measuring RNA-to-DNA ratio (RDR) (eg, InSignia®). A meta-analysis was performed on the proportions of non-viable CT by anatomical site. RESULTS:We screened 31 342 records and included 16 studies in the analysis. The pooled proportions of non-viable CT by site were: 33% (95% confidence interval [CI]: 19%-47%) in rectal swabs (8 studies), 17% (95% CI: 7%-27%) in cervical swabs (6 studies), 15% (95% CI: 6%-25%) in vaginal swabs (6 studies), and 11% (95% CI: 9%-17%) in urine/urethral swabs (2 studies). CONCLUSIONS:All included studies found that a proportion of NAAT-detected CT is non-viable. The findings have far-reaching implications for screening programs and studies evaluating new STI tests and antimicrobial regimens.

OBJECTIVES:The global rise in Neisseria gonorrhoeae (NG) infections, particularly oropharyngeal cases, drives treatment failures from antibiotic resistance. However, infection dynamics within oropharyngeal sites remain unclear. We developed an in vitro model using three human oropharyngeal epithelial cells to investigate infection dynamics and evaluate treatment strategies. METHODS:Tonsillar, floor of mouth (FOM) and gingival cell lines were infected with NG strains: antimicrobial-susceptible FA1090 and antimicrobial-resistant WHO-R. Oral commensal Neisseria oralis served as a bacterial negative control. Infected cells were treated with antibiotics known to cure NG strains (ie, ciprofloxacin/azithromycin/ceftriaxone/cefixime) and an antimicrobial negative control that does not cure NG strains (ie, tetracycline) at 1×, 2× and 3× the minimum inhibitory concentration for 30, 60 and 120 min. Post-treatment, cells were treated with gentamicin to eliminate extracellular bacteria, lysed and internalised NG quantified. RESULTS:NG invasion for both strains was highest in tonsillar cells and lowest in FOM cells. Gingival cells only demonstrated high invasion by FA1090. Validation experiments confirmed FA1090 clearance was highest with azithromycin, ceftriaxone and ciprofloxacin, while cefixime and tetracycline showed variable efficacy. No tested antibiotics cleared WHO-R from all cell lines. Gentamicin consistently failed to clear infections. There was minimal invasion of N. oralis across all cell lines. CONCLUSIONS:NG demonstrates site-specific and strain-specific invasion of oral cells, targeting tonsils and gingiva. The model's validity is supported by drug efficacy results aligning with clinical data and limited invasion by N. oralis. This model provides a basis for developing a three-dimensional system to better understand oropharyngeal NG infections and identify and evaluate novel treatments.

OBJECTIVES:Many countries recommend 3-monthly chlamydia/gonorrhoea screening for gay, bisexual and other men who have sex with men (GBMSM). Evidence about the limited impact of frequent, asymptomatic gonorrhoea/chlamydia screening on population prevalence, coupled with concerns about overburdened health services and antimicrobial resistance (from frequent treatment), calls into question current approaches to asymptomatic screening. We explored sexual health professionals/experts' arguments in favour/against reducing asymptomatic screening using Polis (www.Pol.is), an online, crowdsourcing tool for understanding what large groups think. METHODS:Recruited via global peak bodies/networks, 99 individuals in the field of sexually transmitted infections (STIs) (43.4 % clinicians, 35.4% researchers) primarily from Australasia (41.4%), UK/Europe (29.3%) and North America (22.2%) participated. Ninety-one statements were submitted in favour/against reduced screening for GBMSM (eg, 'Bisexual men who don't test regularly risk putting women at risk'). Participants voted on submitted statements (agree/disagree/pass). Statements with ≥80% agreement were considered as 'strong' support, 70%-79% 'moderate' and ≤69% 'mixed'. Statements were grouped using content analysis to assess support for clusters of related statements. RESULTS:There was 'mixed support' for statements on: (1) the impact of screening in reducing prevalence; (2) whether asymptomatic infections pose clinical harm/necessitate treatment; and (3) risk of antimicrobial resistance. Statements advocating for 6-monthly screening received 'moderate support', with arguments centring on resource use. Participants 'strongly supported' the need for community engagement and maintaining frequent HIV/syphilis screening. CONCLUSIONS:While there were mixed opinions about relative utility, risks and harms of reducing chlamydia/gonorrhoea screening for GBMSM, arguments relating to resource constraints may provide common ground for policy changes.

BACKGROUND:Despite not being a priority group in sexual health (SH) promotion, there is increasing interest, concerns, and knowledge gaps regarding older adults SH information needs. METHODS:In 2021, the 'SHAPE2' online survey of Australians aged 60+ years old on SH information-seeking was conducted. Data was obtained from two questions: (1) the SH topics that participants wanted more information about; and (2) the most recent SH topic that participants sought information on since turning 60 years old. Quantitative data were collected as Topics and organised into Categories. Free-text comments were classified into Categories using Content Analysis. Data were analysed using descriptive statistics and chi2 test. RESULTS:There were 1470 respondents (median age, 69 years old; gender balance between men and women).  The Categories of most interest were 'sexual anatomy and physiology' (1043/1248, 83.6%; 95% CI: 81.4-85.6), 'sex and ageing' (942/1175, 80.2%; 95% CI: 77.8-82.4), and 'sexual difficulties' (937/1236, 75.8%; 95% CI: 73.3-78.2). The Topics of most interest were 'ageing and libido (sex drive)' (771/1175, 65.6%; 95% CI: 62.8-68.3), 'ageing and sexual pleasure' (766/1175, 65.2%; 95% CI: 62.4-67.9), and 'ageing and sexual performance' (765/1175, 65.1%; 95% CI: 62.3-67.8). Men were more likely to seek information (51.5% vs 30.6%, P < 0.001) and indicated higher levels of interest. Women were interested in and/or had sought information on a wider range of issues. Differences were observed between SH issues of interest and those that participants had sought information. CONCLUSION:Older adults are interested in a variety of SH topics. To improve their sexual wellbeing, the priorities of older adults needs consideration when designing SH promotion strategies.

BACKGROUND:Chlamydia infection is a frequently reported notifiable condition in Queensland, with the highest prevalence observed among young people. Infection can occur in several sites including the anus, eye, pharynx, cervix/vagina, and urethra. Currently, historical trends in chlamydia by site of infection in Queensland are unknown. METHODS:A descriptive analysis of all chlamydia notifications in Queensland, 2000-2019, was performed. Queensland Health statewide notification data were classified as either anorectal, eye, genitourinary, upper respiratory tract, or other/unspecified. The number of chlamydia tests and proportion of tests positive for chlamydia were calculated using Medicare online testing data. Population denominator values were obtained from the Australian Bureau of Statistic's catalogues. RESULTS:Over the 20-year period, chlamydia notifications increased, particularly among individuals aged 20-24 years. However, there was a noticeable decline in genitourinary notifications among those aged 15-19 years since 2010. Despite increased testing, the ratio of positive specimens to testing decreased among females aged 15-24 years. CONCLUSIONS:Across the period of our study, there was a substantial and sustained decline in chlamydia notifications in those aged 15-19 years. Further research is required to understand factors that have contributed to this decrease and to guide programs for controlling chlamydia.

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.

Objectives:Sexual expression is important to many older adults, but this population may be overlooked by sexual health campaigns and services. This study sought to understand the sexual health information-seeking behaviors and preferences of older adults, including whether and where they seek this information, the characteristics associated with seeking it, as well as satisfaction, preferences, and reasons for not seeking it. Methods:The data were gathered in 2021 via a cross-sectional online survey of Australians aged 60 and over. There were seven quantitative outcomes and one set of free-text comments. Quantitative outcomes were analyzed using descriptive statistics, chi2 test, and logistic regression. The free-text comments were analyzed using qualitative content analysis. Results:The survey sample was comprised of 1,470 respondents with an equal balance of men (49.9%) and women (49.7%) and a median age of 69 years (range of 60-92 years). Findings showed that 41.2% (602/1,461; 95%CI 38.7-43.7) had sought information, and 63.6% were satisfied with the information found. Being male, STI testing, online dating, age 70-79, and urban-living were associated with information-seeking. Healthcare providers were the most utilized and trusted information source, and many respondents were willing to look online. One in five did not seek information when they needed it, outlining various barriers preventing them from doing so. Conclusions:Many older adults seek sexual health information, and with some experiencing access barriers and one-third unsatisfied, there is room for improvement. Relevant, accessible information should be provided by healthcare professionals and credible websites.

BACKGROUND AND OBJECTIVES:In July 2022, a policy change was enacted in the National Cervical Screening Program (NCSP) to allow all women and people with a cervix (hereafter people) the choice of a self-collected sample. This study aimed to understand healthcare practitioners' decisions, and factors related to, the provision (or not) of this change. METHOD:Semi-structured interviews (n=28) were conducted between February and July 2023 with general practitioners, nurses and practice managers. The COM-B model of behaviour change framework informed the analysis. RESULTS:Although most (n=22) interviewees reported that they, or healthcare practitioners at their practice, were providing a choice of self-collection to all, a minority (n=6) reported that either they (n=4) or their practice (n=2) were not. Factors that informed the selective provision of self-collection are reported. DISCUSSION:For self-collection to facilitate improved equity in the NCSP, strategies are needed to reassure healthcare practitioners that self-collection is an appropriate screening modality, and ensure people are aware of their screening choices.

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.

Infection with Neisseria gonorrhoeae, the causative agent of gonorrhea, causes significant morbidity worldwide and can have long-term impacts on reproductive health. The greatest global burden of gonorrhea occurs in low- and middle-income settings. Global public health significance is increasing due to rising antimicrobial resistance, which threatens future gonorrhea management. The oropharynx is an important asymptomatic reservoir for gonorrhea transmission and a high-risk site for development of antimicrobial resistance and treatment failure. Controlled human infection model (CHIM) studies using N gonorrhoeae may provide a means to accelerate the development of urgently needed therapeutics, vaccines, and other biomedical prevention strategies. A gonorrhea urethritis CHIM has been used since the 1980s with no reported serious adverse events. Here, we describe the rationale for an oropharyngeal gonorrhea CHIM, including analysis of potential ethical issues that should inform the development of this novel study design.

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.

Background Web-based, testing for sexually transmitted infections (STI) is becoming increasingly available. However, treatment pathways from web-based services are often not well-coordinated, contributing to treatment delays and access gaps. This study investigated clinician perspectives on building service linkages with a new, web-based, STI testing service in Victoria, Australia. Methods We interviewed 16 clinicians from regional/outer metropolitan areas who are part of government-funded, primary care programs to strengthen sexual health services in Victoria. Interviews enquired about: clinician attitudes, considerations for managing referrals, compatibility with clinic systems, and broader policy/healthcare system factors. Results Clinicians were enthusiastic, perceived web-based services as complementary (not competition), and believed local treatment pathways were important for patient choice/access. They felt that administrative aspects of handling referrals from an online service could be managed without problems. To inform treatment, clinicians recommended that referral letters from the web-based service list all tests ordered, dates, and complete results. Tensions were raised regarding the utility and appropriateness of including treatment guidelines and pre-prepared prescriptions in referral letters. Respondents reported that most clinics did not stock injectable antibiotics, raising concerns by clinicians about potential treatment delays and privacy challenges related to patient-led procurement at pharmacies. Conclusions Our study suggests that clinicians are receptive to local treatment pathways being designed as part of web-based STI testing services, and strengthened service linkages could improve client access, particularly outside urban areas. Capacity-building and additional resourcing of local partner clinics may be needed to support decentralised, patient-centred treatment pathways.

BackgroundThe rates of sexually transmitted infections (STIs) continue to rise across Australia among 16- to 29-year-olds. Timely testing is needed to reduce transmission, but sexual health clinics are at capacity. This demand, coupled with barriers to getting tested faced by young people, has led to web-based services as a pragmatic solution. However, for young people to use these services, they must be acceptable, attractive, and usable. Social marketing principles combined with end user engagement can be used to guide the development of a web-based service and create a marketing strategy to attract them to the service. ObjectiveWorking closely with end users and guided by social marketing, this project explored messaging, design elements (imagery), and promotional strategies that will support high usage of a web-based STI/blood-borne virus (BBV) testing service for young people in Victoria, Australia. MethodsYoung people were recruited to participate in half-day workshops via youth organizations and targeted Meta (Facebook/Instagram) advertisements. An initial web-based survey was deployed to inform workshop content. Workshops were held in metropolitan, outer metropolitan, and regional Victoria. Young people were presented with a range of “image territories” developed by a social marketing firm and social marketing messages that were informed by the literature on communicating health messages. Participants discussed the feelings and reactions evoked by the content. Data collected through mixed methods (transcribed notes, audio recording, and physical outputs) were thematically analyzed to understand features of messaging and imagery that would attract young people to use the service. ResultsA total of 45 people completed the initial survey with 17 participating in focus group workshops (metropolitan: n=8, outer metropolitan: n=6, and regional: n=3). Young people preferred messages that highlight the functional benefits (confidential, affordable, and accessible) of a web-based service and include professional imagery and logos that elicit trust. Young people indicated that the service should be promoted through digital communications (eg, dating apps and social media), with endorsement from government or other recognized institutions, and via word-of-mouth communications. ConclusionsThis study has highlighted the value of applying social marketing theory with end user engagement in developing a web-based STI/BBV testing service. Through the voices of young people, we have established the foundations to inform the design and marketing for Victoria’s first publicly funded web-based STI/BBV testing clinic. Future research will measure the reach and efficacy of social marketing, and how this service complements existing services in increasing STI/BBV testing uptake among young Victorians.

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.

Introduction: Sexually transmissible infection (STI) rates continue to rise across Australian rural and regional areas. Reported STI rates are often misleadingly low due to barriers in accessing testing, lack of service accessibility and affordability. Utilising innovative solutions such as vending machines can improve access by providing an alternative testing option that increases privacy and convenience.Methods: Community reference groups were assembled to support an STI test vending machine pilot (STI-X) for 12 months across six planned and two temporary regional locations in northern Victoria, Australia. The vending machines were generally situated in publicly accessible areas where consumers could obtain a test kit for chlamydia, gonorrhoea and HIV, complete the specimen collection in a private setting and then post the kit to a laboratory.Results: STI-X was deemed an acceptable solution for increasing access to specialist sexual health testing. Professionals were supportive of the additional option for individuals who may not use standard healthcare pathways. They identified that the vending machines were easy to use; however, better communication was needed to enhance uptake. Therefore, utilising community-driven promotional approaches, such as word of mouth, are necessary to ensure that information on novel health initiatives reaches the intended audiences. Conclusion: STI testing vending machines have proved feasible and acceptable to professionals and users in rural and regional Australian communities. This technology would benefit from future research specifically in rural communities to determine whether priority populations will increase their STI testing. Policymakers should encourage innovative solutions in rural communities to combat growing workforce concerns.

OBJECTIVE:This study investigated local public health authorities' perspectives on implementing a new online STI testing service for young people in regional/rural Victoria, Australia. SETTING:Study was conducted to support the design of Test it, a free, online STI testing service being developed for Victoria. After completing an online registration and sexual health questionnaire, users receive an electronic test request form to take directly to a pathology centre without seeing a general practitioner (GP). PARTICIPANTS:Ten individuals responsible for the coordination of community sexual health services within 7 Victorian Local Public Health Units (LPHUs) and the Department of Health, and a state-wide health promotion organisation. DESIGN:Semi-structured interview topics covered: attitudes towards online STI testing, advantages and challenges of online STI testing for regional and rural communities, and strategies to support effective implementation. RESULTS:Participants were enthusiastic about the potential of an online STI testing service, perceiving it to offer options in settings with limited sexual health providers, provide users with greater anonymity (bypassing GPs), improve efficiency, and support LPHUs to deliver their priorities. However, needing to attend a pathology service in-person may reduce appeal and create barriers given limited transport/opening hours and stigmatisation concerns by young people. Navigating treatment, if needed, may also be challenging. CONCLUSION:Despite offering advantages, regional/rural young people are likely to encounter barriers to online STI testing that are different from and more significant than those faced by young people in urban areas. Strategies are needed to support implementation in regional/rural areas to realise the full potential of online testing to improve equitable access for underserved communities.