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Sexual Health publishes contributions on sexual health from the widest perspectives including HIV/AIDS, STIs, issues of sexuality, and reproductive health. More

Editors: Christopher Fairley and Roy Chan

AIDS 2014: We would like to express our deepest sympathies to the families, friends and colleagues of delegates lost on MH17.
Out of respect for their work we are making our latest HIV Special Issue freely available online for 3 months.


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Published online 28 August 2014
Hepatitis E in Australian HIV-infected patients: an under-recognised pathogen? 
Michelle K. Yong, Emma K. Paige, David Anderson and Jennifer F. Hoy

This cross-sectional study revealed a seroprevalence of hepatitis E virus (HEV) of 8% in a random sample of HIV-infected patients with normal liver function and 4.4% in those with biochemical hepatitis. This is greater than the seroprevalence in the Australian general population, such that HEV may be an under-recognised cause of hepatitis in the population of individuals with HIV infection and should be considered in those with unexplained hepatitis.

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Published online 28 August 2014
A novel time-limited pop-up HIV testing service for gay men in Sydney, Australia, attracts high-risk men 
Vickie Knight, Vickie Knight, Marianne Gale, Marianne Gale, Rebecca Guy, Rebecca Guy, Nicolas Parkhill, Nicolas Parkhill, Jo Holden, Jo Holden, Craig Leeman, Craig Leeman, Anna McNulty, Anna McNulty, Phillip Keen, Phillip Keen, Handan Wand and Handan Wand

We compared uptake and outcomes of a novel time-limited pop-up community HIV testing service providing rapid HIV tests with those of an established fast-track screening service clinical model offering rapid and/or conventional HIV tests and tests for sexually transmissible infections (STI). This study showed that time-limited Pop-up community HIV testing is feasible and reached high-risk gay, bisexual and other men who have sex with men (GBM); however, compared with a clinic-based model, it only reached a smaller proportion of GBM who test infrequently or who have never been tested and are unaware of their HIV status. No STI testing was conducted through the Pop-up service, which allowed a higher throughput of HIV tests; however, a significant number of STIs may have been missed.

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Published online 28 August 2014
Early age at first sex: associations with sexual health and sociodemographic factors among a sample of young music festival attendees in Melbourne 
Alyce M. Vella, Paul A. Agius, Anna L. Bowring, Margaret E. Hellard and Megan S. C. Lim

Young age at first sex (AFS) is associated with adverse outcomes, including the acquisition of sexually transmissible infections. We explored factors and correlates of ‘early’ (<16 years) AFS among young festival attendees in Melbourne, Australia. Median AFS was 17 years; results indicated that being male, younger, having no post-high school education, multiple lifetime sex partners, reporting inconsistent condom use, living alone or with a partner and ever using drugs was associated with early AFS. Results highlight the importance of comprehensive sex education before sexual initiation

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Published online 21 August 2014
Epidemiology of gonorrhoea notifications in Australia, 2007–12 
April Roberts-Witteveen, Kate Pennington, Nasra Higgins, Carolyn Lang, Monica Lahra, Russell Waddell and John Kaldor

An increase in the notification rate of gonorrhoea was observed in the Australian surveillance system. Data analysis showed that although notification rates have increased, epidemiology remained constant, with highest rates in Indigenous people in remote areas. The greatest increase in rates was for men in urban settings. Prevention efforts should be strengthened and further analysis incorporating laboratory testing data should be undertaken.

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Published online 21 August 2014
Could point-of-care testing be effective for reducing the prevalence of trichomoniasis in remote Aboriginal communities? 
Ben B. Hui, James Ward, Louise Causer, Rebecca J. Guy, Matthew G. Law and David G. Regan

A high prevalence of trichomoniasis is reported for many remote Indigenous communities despite intensive screening and treatment. In this modelling study we investigate the potential impact for point-of-care (POC) testing and treatment to reduce trichomoniasis prevalence in this population. Our results suggest that POC testing, in place of conventional testing, may improve trichomoniasis control, but emphasis should be placed on testing older women.

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Published online 21 August 2014
Attitudes towards microbicide use for bacterial vaginosis in pregnancy 
Marina Catallozzi, Camille Y. Williams, Gregory D. Zimet, Katharine M. Hargreaves, Shari E. Gelber, Adam J. Ratner, Lawrence R. Stanberry and Susan L. Rosenthal

Microbicides could be an option for the prevention and treatment of bacterial vaginosis (BV) and other reproductive tract infections (RTIs) in pregnancy. Understanding pregnant women’s acceptability and use of these topical microbicide products will be crucial for future product development. In this qualitative study regarding hypothetical use of topical microbicides for BV, pregnant women were open to the use of a microbicide for the prevention, and particularly for the treatment, of BV for a variety of reasons, but especially if use would positively impact the baby’s health. Improved education regarding BV, its complications, overcoming practical problems in using microbicides and involving partners in decision making regarding microbicides may improve acceptability of microbicide use for BV.

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Published online 14 August 2014
Declining trends in the proportion of non-viral sexually transmissible infections reported by STD clinics in the US, 2000–10 
Kwame Owusu-Edusei, Bianca J. Sayegh, Alesia J. Harvey and Robert J. Nelson

Analyses of the proportion of non-viral sexually transmissible infections reported by STD clinics to the Centers for Disease Control from 2000 to 2010 showed significant declines for syphilis and gonorrhoea, and to a lesser extent for chlamydia.

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Published online 11 August 2014
High rates of sexually transmissible infections in HIV-positive patients in the Australian HIV Observational Database: a prospective cohort study 
Brian P. Mulhall, Stephen Wright, Debbie Allen, Katherine Brown, Bridget Dickson, Miriam Grotowski, Eva Jackson, Kathy Petoumenos, Phillip Read, Timothy Read, Darren Russell, David J. Smith, David J. Templeton, Christopher K. Fairley and Matthew G. Law

Sexually transmissible infections (STI) enhance transmission of HIV, probably even in the context of viral suppression by antiretroviral drugs. This study demonstrates high incidence rates for four STI (chlamydia, gonorrhoea, warts and syphilis) in a longitudinal treatment cohort of HIV-infected individuals between 2005 and 2011.

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Published online 11 August 2014
Sexual and reproductive health and philanthropic funding in Australia 
Liz Gill-Atkinson, Cathy Vaughan and Hennie Williams

Australia’s philanthropic sector is often not well understood, and little is known about philanthropic funding for sexual and reproductive health (SRH) initiatives. In-depth interviews with those working for Australian philanthropic trusts and foundations, and those working to improve SRH, identified a range of barriers and facilitators to both seeking and providing philanthropic funding for SRH-focused initiatives. Addressing the barriers identified and promoting the facilitators could enhance awareness of the possible role that Australia’s philanthropic sector could play in improving the SRH of Australians.

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Published online 07 August 2014
Time trends in adolescent sexual behaviour in Italy 
Claudia Marino, Alessio Vieno, Michela Lenzi and Massimo Santinello

This study describes trends in 15-year-old adolescent sexual behaviour in Italy from 2002 to 2010. The findings from this study expand the knowledge on adolescent sexual behaviour in Italy and indicate the importance of developing new strategies to improve sexual health among Italian adolescents.

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Published online 07 August 2014
Who are the sexual partners of transgender individuals? Differences in demographic characteristics and risk behaviours of San Francisco HIV testing clients with transgender sexual partners compared with overall testers 
Erin C. Wilson, Yea-Hung Chen, Nayla Raad, H. Fisher Raymond, Teri Dowling and Willi McFarland

Multiple drivers of HIV risk among transwomen have been investigated in the literature to date, but little work has been done to examine the sexual networks of transwomen. This study utilises San Francisco city-wide data from HIV counselling and testing sites to identify characteristics of individuals who report having a transgender sexual partner and examines their HIV-related risk behaviours. We found higher rates of risk behaviours among sexual partners of transgender people yet lower HIV positivity when comparing to the overall testing sample. These findings point to the need for a rigorous examination of the sexual networks of transgender people to better understand the disproportionately higher risk for HIV.

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Published online 04 August 2014
Assessment of psychosocial impact of genital warts among patients in Singapore 
Lucinda S. Tan, Martin T. W. Chio, Priya Sen, Yong Kuei Lim, Joseph Ng, Arunachalam Ilancheran, Jeffrey J. Low, Yen Shing Yeoh, Roy K. Chan and Nan Luo

Genital warts are associated with a negative impact on quality of life. Patients experience significant psychosocial burden, with gender differences in certain aspects of their quality of life.

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Published online 04 August 2014
Prevalence, correlates and attitudes towards sexting among young people in Melbourne, Australia 
Timothy H. Yeung, Danielle R. Horyniak, Alyce M. Vella, Margaret E. Hellard and Megan S. C. Lim

‘Sexting’ is the exchange of sexually explicit material via communication technologies. We conducted a cross-sectional questionnaire with 1372 young people and focus group discussions with 39 young people to better understand this practice. We found that sexting was common (40% had ever sexted) and participants considered consensual sexting to be an acceptable and normal part of relationships.

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Published online 24 July 2014
Reattendance and chlamydia retesting rates at 12 months among young people attending Australian general practice clinics 2007–10: a longitudinal study 
Emma R. Weaver, Anna L. Bowring, Rebecca Guy, Caroline van Gemert, Jane S. Hocking, Douglas I. Boyle, Tony Merritt, Clare Heal, Phyllis M. Lau, Basil Donovan, Margaret E. Hellard and

Clinical guidelines commonly recommend annual chlamydia testing in young people. The Australian Collaboration for Coordinated Enhanced Sentinel Surveillance of Sexually Transmitted Infections and Blood-Borne Viruses system (ACCESS) extracted consultation and pathology data on 16–29-year-olds attending 25 general practice (GP) clinics in 2007–10. We calculated the proportion of individuals with an initial negative test that reattended at 12 months (±3 months) and retested at 12 months (±3 months). Although over half of young people reattended their GP clinic approximately 1 year after a negative chlamydia baseline test, retesting at this visit was low. Strategies are needed to promote regular attendance and testing to both patients and clinicians.

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Volume 11 Number 3 2014

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Table of Contents 
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Australian sexually transmissible infection and HIV testing guidelines for asymptomatic men who have sex with men 2014: a review of the evidence 
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David J. Templeton , Phillip Read , Rajesh Varma and Christopher Bourne
pp. 217-229

A literature review was performed to inform the 2014 update of the Australian testing guidelines for asymptomatic men who have sex with men (MSM). Key changes include a recommendation for pharyngeal chlamydia testing, use of nucleic acid amplification tests alone for gonorrhoea testing, more frequent gonorrhoea and chlamydia testing in HIV-positive MSM, shorter time required since last void for chlamydia first-void urine collection, and the use of electronic reminders to increase STI and HIV retesting rates among MSM.


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Adherence-enhancing interventions for active antiretroviral therapy in sub-Saharan Africa: a systematic review and meta-analysis 
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Tim Mathes , Sunya-Lee Antoine and Dawid Pieper
pp. 230-239

In sub-Saharan Africa, an estimated 23% of HIV-infected patients are nonadherent. The aim of this systematic review was to evaluate the effectiveness of adherence-enhancing interventions for active antiretroviral therapy. Six randomised controlled trials were included in the review. The considered interventions increase adherence only slightly. The results indicate that adherence-enhancing interventions should focus on nonadherent patients.

    | Supplementary Material (196 KB)

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Female sexual dysfunction across the three pregnancy trimesters: an Egyptian study 
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Samy Hanafy , Neveen E. Srour and Taymour Mostafa
pp. 240-243

Pregnancy is a special period in the life of women that could affect their sexuality. This cross-sectional study evaluated female sexual dysfunction among pregnancy trimesters. It is concluded that female sexual function is affected significantly during pregnancy, in all domains, especially in the first and third trimesters.


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Psychosocial factors related to willingness to use pre-exposure prophylaxis for HIV prevention among Black men who have sex with men attending a community event 
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Lisa A. Eaton , Daniel D. Driffin , Harlan Smith , Christopher Conway-Washington , Denise White and Chauncey Cherry
pp. 244-251

In the US, Black men who have sex with men are disproportionately affected by HIV/AIDS. Using antiretroviral medications for HIV prevention is a promising option, yet many barriers to accessing this form of prevention exist. It is imperative that we prioritise research into understanding these barriers better; failure to do so will impede the potential of this prevention strategy


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Condom use motivations and selected behaviours with new versus established sex partners 
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Richard A. Crosby , Robin R. Milhausen , Cynthia A. Graham , William L. Yarber , Stephanie A. Sanders , Richard Charnigo and Lydia A. Shrier
pp. 252-257

Whether people use condoms differentially as a function of being in a new versus established relationship has never been investigated using event-level data. Applying an event-level analysis, this study found differences in motivation for condom use and actual use in a sample of males and females attending sexually transmissible infection clinics in the US. Clinic-based counselling to promote safer-sex behaviours should recognize differences between new versus established sex partners.


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'I demand to be treated as the person I am': experiences of accessing primary health care for Australian adults who identify as gay, lesbian, bisexual, transgender or queer 
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Chee S. Koh , Melissa Kang and Tim Usherwood
pp. 258-264

Individuals who identify as gay, lesbian, bisexual, transgender or queer suffer higher morbidity than the general population, but may experience significant barriers to accessing primary health care. An Internet survey of these experiences reinforced the importance of communicating acknowledgement and respect for the unique identity of each individual. Primary health care providers have a key role in ensuring equitable access


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Do family factors protect against sexual risk behaviour and teenage pregnancy among multiply disadvantaged young people? Findings from an English longitudinal study 
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Chris Bonell , Meg Wiggins , Adam Fletcher and Elizabeth Allen
pp. 265-273

It is common for policy makers to target ‘at risk’ youth and families for additional intervention, although we do not know if or how the family environment shapes sexual risk taking among disadvantaged youth. This study examined data from 1285 ‘at risk’ 13–15 year olds in England and found limited evidence of any family-related effects on sexual health or teenage pregnancy, although family structure and communication may influence young women’s sexual risk taking in deprived contexts. Targeted family-based interventions may not be appropriate for changing the sexual behaviour of disadvantaged young people, especially young men.


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Parents' views on human papillomavirus vaccination for sexually transmissible infection prevention: a qualitative study 
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Linda M. Niccolai , Caitlin E. Hansen , Marisol Credle , Sheryl A. Ryan and Eugene D. Shapiro
pp. 274-279

Human papillomavirus (HPV) vaccination coverage in the US remains suboptimal. The results of this qualitative study reveal that discussing sexually transmissible infection (STI) prevention in the context of HPV vaccination in addition to cancer prevention appears to be well accepted by urban low-income minority families. Communication of this comprehensive yet simple message may help raise awareness, acceptability and uptake of HPV vaccines.


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A case of gonococcal necrotising fasciitis 
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Kudzai Nzenza Kanhutu , Denis D. Spelman and Michael D. Weymouth
pp. 280-282

We describe an unusually severe case of disseminated gonococcal infection culminating in necrotizing fasciitis. Patient progress, treatment and outcomes are discussed with reference to currently recommended Australian guidelines. To our knowledge, this is the first such case described in the literature.


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Testing for ‘threads’ and leucocyte esterase in first-void urine to exclude the diagnosis of non-specific urethritis in asymptomatic men 
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Sanjeeva N. S. Pallawela , Christopher Sonnex , Julia Burdett , Dawn Cooper , Katrina Nethercott , Catherina M. Thomas , Peter Goon , Hayley Webb and Christopher Carne
pp. 283-284

The aim of this pilot study was to determine if testing for urinary threads, and/or leucocyte esterase (LE) or both in asymptomatic men is a good screening tool for nonspecific urethritis (NSU). Of the126 asymptomatic men, 8% met microscopic criteria for the diagnosis of NSU. The negative predictive value for threads and LE was 96% and 93% and combining both gave a negative predictive value of 96%. The absence of threads and negative LE makes urethritis highly unlikely, making urinary nucleic acid amplification testing sufficient.


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Social support and depressive symptoms among 'money' boys and general men who have sex with men in Shanghai, China 
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Huamei Yan , Frank Y. Wong , Tony Zheng , Zhen Ning , Yingying Ding , Eric J. Nehl , Lavinia Lin and Na He
pp. 285-287

Little was known about social support and depression among men who have sex with men (MSM) in China. The aim of this study was to fill this gap. The results indicate that social support is protective against depression among this population, whereas ‘Money boys’ experience more depression than general MSM. These findings underscore the need for tailored psychological programs targeting these two types of MSM.


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Cervical screening uptake and abnormalities among women attending sexual health clinics for HIV care 
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Donna M. Tilley , Catherine C. O'Connor , Sunil Adusumilli , Maggie Smith , Clara Marin-Zapata , Catriona Ooi and David J. Templeton
pp. 288-290

The aim of this study was to describe cervical screening uptake and assess correlates of screen-detected abnormalities in women attending sexual health services for HIV care. Of 156 women, 115 had documentation of a Pap test at least once in 3 years and 9.6% had an annual Pap test performed. Pap abnormalities were associated with younger age, being born in Sub-Saharan Africa, more recent arrival in Australia, lower CD4 count, detectable viral load, shorter time on antiretroviral therapy and more recent HIV diagnosis. Women accessing sexual health services for HIV care, especially those from culturally and linguistically diverse backgrounds, appear to be substantially under-screened and efforts to optimise screening are needed.


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These articles have been peer reviewed and accepted for publication. They are still in production and have not been edited, so may differ from the final published form.

    SH14093  Accepted 14 August 2014
    Tuberculosis-associated immune reconstitution inflammatory syndrome in HIV co-infected patients in Malaysia: prevalence, risk factors, and treatment outcomes
    Hong Yien Tan, Yean Kong Yong, Sin How Lim, Sasheela Ponnampalavanar, Sharifah Omar, Yong Kek Pang, Adeeba Kamarulzaman, Patricia Price, Suzanne Crowe, Martyn French

    SH14141  Accepted 12 August 2014
    The Association between known recent HIV infections and methamphetamine use (ASK HIM study) in Melbourne between 2011-2013 - a case control study
    Beng Eu, Norman Roth

    SH14015  Accepted 05 August 2014
    Vaccination against oncogenic human papillomavirus infection in HIV-infected populations – current status and future perspectives
    Lars Toft, Martin Tolstrup, Merete Storgaard, Lars Ostergaard, Ole Søgaard

    SH14041  Accepted 01 August 2014
    Comparing health survey data from web- and paper-based convenience samples of lesbian women in Germany
    Oliver Hirsch, Karina Löltgen, Annette Becker

The Most Read ranking is based on the number of downloads from the CSIRO PUBLISHING website of articles published in the previous 12 months. Usage statistics are updated daily.

Rank Paper Details
1. Published 1 August 2013
The impact of living with HIV: differences in experiences of stigma for heterosexual and homosexual people living with HIV in Australia

Loren Brener, Hannah Wilson, Sean Slavin and John de Wit

2. Published 14 October 2013
Are Australian sexual health clinics attracting priority populations?

Hammad Ali, Basil Donovan, Christopher K. Fairley, Nathan Ryder, Anna McNulty, Marcus Y. Chen, Lewis Marshall, Catherine C. O'Connor, Bridget Dickson, Andrew E. Grulich, Margaret E. Hellard, John M. Kaldor and Rebecca J. Guy

3. Published 14 July 2014
Predicting the population impact of increased HIV testing and treatment in Australia

James Jansson, Cliff C. Kerr and David P. Wilson

4. Published 26 March 2014
Management rates of sexually transmissible infections by Australian general practitioners, 2000–2012

Anthony J. Santella, Allan Pollack, Christopher Harrison, Shailendra N. Sawleshwarkar, Helena C. Britt and Richard J. Hillman

5. Published 14 July 2014
Transforming Australia’s HIV prevention and treatment efforts to achieve an AIDS-free generation: the United Nations Political Declaration on HIV/AIDS and the Melbourne Declaration ‘Action on HIV’

Bill Whittaker

6. Published 28 July 2014
Australian sexually transmissible infection and HIV testing guidelines for asymptomatic men who have sex with men 2014: a review of the evidence

David J. Templeton, Phillip Read, Rajesh Varma and Christopher Bourne

7. Published 1 August 2013
Men who have sex with men, infectious syphilis and HIV coinfection in inner Sydney: results of enhanced surveillance

Susan J. Botham, Kelly-Anne Ressler, Patrick Maywood, Kirsty G. Hope, Chris P. Bourne, Stephen J. Conaty, Mark J. Ferson and Darren J. Mayne

8. Published 14 July 2014
Recently diagnosed gay men talk about HIV treatment decisions

Ian Down, Garrett Prestage, Kathy Triffitt, Graham Brown, Jack Bradley and Jeanne Ellard

9. Published 1 August 2013
The potential impact of new generation molecular point-of-care tests on gonorrhoea and chlamydia in a setting of high endemic prevalence

Ben B. Hui, David P. Wilson, James S. Ward, Rebecca J. Guy, John M. Kaldor, Matthew G. Law, Jane S. Hocking and David G. Regan

10. Published 26 March 2014
Incident hepatitis B infection subsequent to the diagnosis of HIV infection in a Melbourne cohort: missed opportunities for prevention

Amy Body, Jennifer F. Hoy, Allen C. Cheng and Michelle L. Giles

11. Published 1 August 2013
Effective peer education in HIV: defining factors that maximise success

Steven M. Lambert, Joseph Debattista, Aleksandar Bodiroza, Jack Martin, Shaun Staunton and Rebecca Walker

12. Published 14 July 2014
HIV pre-exposure prophylaxis and treatment as prevention: a review of awareness and acceptability among men who have sex with men in the Asia-Pacific region and the Americas

Martin Holt

13. Published 26 March 2014
Rapid HIV testing increases the rate of HIV detection in men who have sex with men: using rapid HIV testing in a primary care clinic

Beng Eu, Norman Roth, Mark Stoové, Mark O'Reilly and Edward Clarke

14. Published 14 October 2013
Masculinity, condom use self-efficacy and abusive responses to condom negotiation: the case for HIV prevention for heterosexual African-American men

Jerris L. Raiford, Puja Seth, Nikia D. Braxton and Ralph J. DiClemente

15. Published 22 November 2013
Qualitative exploration of HIV-related sexual behaviours and multiple partnerships among Chinese men who have sex with men living in a rural area of Yunnan Province, China

Eric P. F. Chow, Liangmin Gao, Fung Kuen Koo, Liang Chen, Xiaoxing Fu, Jun Jing, David P. Wilson and Lei Zhang

16. Published 22 November 2013
Prevention and control of sexually transmissible infections among hotel-based female sex workers in Dhaka, Bangladesh

Duncan F. McCormick, Motiur Rahman, Sabrina Zadrozny, Anadil Alam, Lutfa Ashraf, Graham A. Neilsen, Robert Kelly, Prema Menezes, William C. Miller and Irving F. Hoffman

17. Published 1 August 2013
Preconception reflections, postconception intentions: the before and after of birth control in Australian adolescent females

Jennifer Lawson Smith, S. Rachel Skinner and Jennifer Fenwick

18. Published 14 October 2013
One confirmed and one suspected case of pharyngeal gonorrhoea treatment failure following 500mg ceftriaxone in Sydney, Australia

Phillip J. Read, E. Athena Limnios, Anna McNulty, David Whiley and Monica M. Lahra

19. Published 26 March 2014
High prevalence and incidence of HIV, sexually transmissible infections and penile foreskin cutting among sexual health clinic attendees in Papua New Guinea

Andrew Vallely, Claire E. Ryan, Joyce Allen, Joyce C. Sauk, Cassey S. Simbiken, Johanna Wapling, Petronia Kaima, Zure Kombati, Greg Law, Glenda Fehler, John M. Murray, Peter Siba and John M. Kaldor

20. Published 1 August 2013
Facilitating partner notification through an online messaging service: Let Them Know

Sarah Huffam, Christopher K. Fairley, Mark Chung, Jun Kit Sze, Jade Bilardi and Marcus Y. Chen

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