CSIRO Publishing blank image blank image blank image blank imageBooksblank image blank image blank image blank imageJournalsblank image blank image blank image blank imageAbout Usblank image blank image blank image blank imageShopping Cartblank image blank image blank image You are here: Journals > Sexual Health   
Sexual Health
Journal Banner
  Publishing on sexual health from the widest perspective
blank image Search
blank image blank image
blank image
  Advanced Search

Journal Home
About the Journal
Editorial Structure
For Advertisers
Online Early
Current Issue
Just Accepted
All Issues
Special Issues
Sample Issue
For Authors
General Information
Submit Article
Author Instructions
Open Access
For Referees
Referee Guidelines
Review an Article
Annual Referee Index
For Subscribers
Subscription Prices
Customer Service
Library Recommendation

blue arrow e-Alerts
blank image
Subscribe to our Email Alert or RSS feeds for the latest journal papers.

red arrow Submit Article
blank image
Use the online submission system to send us your paper.

red arrow Connect with us
blank image
facebook twitter logo LinkedIn

red arrow Interview with Kit Fairley
blank image
Hear Kit Fairley speak about what is sexual health.


Article << Previous     |     Next >>   Contents Vol 11(1)

High prevalence and incidence of HIV, sexually transmissible infections and penile foreskin cutting among sexual health clinic attendees in Papua New Guinea

Andrew Vallely A B I, Claire E. Ryan B C, Joyce Allen B D, Joyce C. Sauk E, Cassey S. Simbiken B, Johanna Wapling B C, Petronia Kaima D, Zure Kombati D, Greg Law F, Glenda Fehler G, John M. Murray H, Peter Siba B and John M. Kaldor on behalf of the Male Circumcision Acceptability and Impact Study (MCAIS) team A

A The Kirby Institute, University of New South Wales, Darlinghurst, NSW 2010, Australia.
B Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
C The Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia.
D Mount Hagen General Hospital, Mount Hagen, Papua New Guinea.
E National Capital District Department of Health, Port Moresby, Papua New Guinea.
F National Department of Health, Port Moresby, Papua New Guinea.
G Melbourne Sexual Health Centre, 580 Swanston Street, Carlton, Vic. 3053, Australia.
H School of Mathematics and Statistics, University of New South Wales, Sydney, NSW 2052, Australia.
I Corresponding author. Email: avallely@kirby.unsw.edu.au

Sexual Health 11(1) 58-66 http://dx.doi.org/10.1071/SH13197
Submitted: 18 December 2013  Accepted: 2 February 2014   Published: 12 March 2014

 Full Text
 PDF (188 KB)
 Export Citation

Background: Papua New Guinea (PNG) has one of the highest prevalences of HIV and sexually transmissible infections (STIs) in the Asia-Pacific region, and one of the highest burdens of maternal syphilis and cervical cancer globally. Despite this disease burden, only limited clinical research in sexual and reproductive health has been conducted in PNG. Methods: A longitudinal clinical cohort study was conducted at two sexual health clinics. Participants completed a behavioural interview, clinical assessment and genital examination at baseline, and at 12, 24 and 50 weeks, including specimen collection for STI diagnostics. Results: In total, 154 people attended a screening visit. Reattendance at 12, 24 and 50-weeks was 87%, 78% and 80% respectively. At baseline, HIV prevalence was 3.3%; chlamydia (Chlamydia trachomatis), 29.2%; gonorrhoea (Neisseria gonorrhoeae), 22.1%; Trichomonas vaginalis 15.6%; herpes simplex type-2 (HSV-2), 46.1%; active syphilis, 11.7%. Multiple infections were common particularly among women. The incidence of chlamydia was 27 per 100 person-years (PY); gonorrhoea, 15 out of 100 PY; T. vaginalis, 29 out of 100 PY; HSV-2, 12 out of 100 PY; syphilis, 8 out of 100 PY. No incident HIV cases were recorded. At baseline, 39% of men in Mt Hagen and 65% in Port Moresby had a penile foreskin cut, with a dorsal slit being the most common. Two men underwent penile cutting during the follow-up period. Conclusions: The prevalence and incidence of STIs, HIV and penile cutting were high among sexual health clinic attendees. High retention figures suggest that this population may be suitable for future interventions research and clinical trials.


[1]  Vallely A, Mola G, Kaldor JM. Human papillomavirus and cervical cancer in Papua New Guinea. P N G Med J 2013; : .

[2]  World Health Organization (WHO). Investment case for eliminating mother-to-child transmission of syphilis: promoting better maternal and child health and stronger health systems. Geneva: WHO; 2012.

[3]  Vallely A, Ryan C, Mola GDL, Kaldor JM. Human papillomavirus and cervical cancer in Papua New Guinea. Invited oral presentation No. 1150. International Union against Sexually Transmitted Infections World Congress, 15–17 October, 2012;Melbourne, Australia.

[4]  Tabone T, Garland SM, Mola G, O’Connor M, Danielewski J, Tabrizi SN. Prevalence of human papillomavirus genotypes in women with cervical cancer in Papua New Guinea. Int J Gynaecol Obstet 2012; 117: 30–2.
CrossRef | PubMed |

[5]  National AIDS Council (NAC). Papua New Guinea HIV prevalence: 2010 estimates. Port Moresby: NAC; 2011.

[6]  Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organization (WHO). Oceania: AIDS epidemic update. Regional summary. Geneva: UNAIDS/WHO;. 2008.

[7]  National AIDS Council (NAC). The 2007 estimation report on the HIV epidemic in Papua New Guinea. Port Moresby: NAC; 2008.

[8]  Garland SM, Brotherton JM, Skinner SR, Pitts M, Saville M, Mola G, et al Human papillomavirus and cervical cancer in Australasia and Oceania: risk-factors, epidemiology and prevention. Vaccine 2008; 26: M80–8.
CrossRef | PubMed |

[9]  National AIDS Council (NAC). 2013 HIV/AIDS estimations and projections. Port Moresby: NAC; 2013.

[10]  Kelly A, Kupul M, Man WYN, et al. Askim na save (ask and understand): People who sell and/or exchange sex in Port Moresby. Key quantitative findings. Sydney: Papua New Guinea Institute of Medical Research and University of New South Wales; 2011.

[11]  Vallely A, Page A, Dias S, Siba P, Lupiwa T, Law G, et al The prevalence of sexually transmitted infections in Papua New Guinea: a systematic review and meta-analysis. PLoS ONE 2010; 5: e15586.
CrossRef | CAS | PubMed |

[12]  Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin 2011; 61: 69–90.
CrossRef | PubMed |

[13]  Hill PS, Tynan A, Law G, Millan J, Browne K, Sauk J, et al A typology of penile cutting in Papua New Guinea: results of a modified Delphi study among sexual health specialists. AIDS Care 2012; 24: 77–86.
CrossRef | PubMed |

[14]  Kelly A, Kupul M, Aeno H, Shih P, Naketrumb R, Neo J, et al Why women object to male circumcision to prevent HIV in a moderate-prevalence setting. Qual Health Res 2013; 23: 180–93.
CrossRef | PubMed |

[15]  Kelly A, Kupul M, Fitzgerald L, Aeno H, Neo J, Naketrumb R, et al “Now we are in a different time; various bad diseases have come.” Understanding men’s acceptability of male circumcision for HIV prevention in a moderate prevalence setting. BMC Public Health 2012; 12: 67.
CrossRef | PubMed |

[16]  Kelly A, Kupul M, Nake Trumb R, Aeno H, Neo J, Fitzgerald L, et al More than just a cut: a qualitative study of penile practices and their relationship to masculinity, sexuality and contagion and their implications for HIV prevention in Papua New Guinea. BMC Int Health Hum Rights 2012; 12: 10.
CrossRef | PubMed |

[17]  Tynan A, Vallely A, Kelly A, Kupul M, Neo J, Naketrumb R, et al Socio-cultural and individual determinants for motivation of sexual health workers in Papua New Guinea and their implications for male circumcision as an HIV prevention strategy. Hum Resour Health 2013; 11: 7.
CrossRef | PubMed |

[18]  Tynan A, Vallely A, Kelly A, Law G, Millan J, Siba P, et al Vasectomy as a proxy: extrapolating health system lessons to male circumcision as an HIV prevention strategy in Papua New Guinea. BMC Health Serv Res 2012; 12: 299.
CrossRef | PubMed |

[19]  Vallely A, Fitzgerald L, Fiya V, Aeno H, Kelly A, Sauk J, et al Intravaginal practices and microbicide acceptability in Papua New Guinea: implications for HIV prevention in a moderate-prevalence setting. BMC Res Notes 2012; 5: 613.
CrossRef | PubMed |

[20]  Vallely A, MacLaren D, Kaleva W, et al Male circumcision for HIV prevention in Papua New Guinea: summary of research evidence and recommendations for public health policy following a national policy forum. P N G Med J 2013; : .

[21]  Gray RT, Murray JM, Wilson DP, Vallely A, Kaldor J. The PNG HIV model – summary and results: explaining the past, describing the present, and forecasting the future of the HIV epidemic in PNG. Sydney: The Kirby Institute, The University of New South Wales; 2011.

[22]  Wisniewski CA, White JA, Michel C-EC, Mahilum-Tapay L, Magbanua JPV, Nadala ECB, et al Optimal method of collection of first-void urine for diagnosis of Chlamydia trachomatis infection in men. J Clin Microbiol 2008; 46: 1466–9.
CrossRef | PubMed |

[23]  Saiki RK, Gelfand DH, Stoffel S, Scharf SJ, Higuchi R, Horn GT, et al Primer-directed enzymatic amplification of DNA with a thermostable DNA polymerase. Science 1988; 239: 487–91.
CrossRef | CAS | PubMed |

[24]  Riley DE, Roberts MC, Takayama T, Krieger JN. Development of a polymerase chain reaction-based diagnosis of Trichomonas vaginalis. J Clin Microbiol 1992; 30: 465–72.
| CAS | PubMed |

[25]  Jalal H, Stephen H, Curran MD, Burton J, Bradley M, Carne C. Development and validation of a rotor-gene real-time PCR assay for detection, identification, and quantification of Chlamydia trachomatis in a single reaction. J Clin Microbiol 2006; 44: 206–13.
CrossRef | CAS | PubMed |

[26]  Tabrizi SN, Chen S, Tapsall J, Garland SM. Evaluation of opa-based real-time PCR for detection of Neisseria gonorrhoeae. Sex Transm Dis 2005; 32: 199–202.
CrossRef | CAS | PubMed |

[27]  Nugent RP, Krohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol 1991; 29: 297–301.
| CAS | PubMed |

[28]  Wu H, Wu PY, Li SY, et al Maximising the potential of voluntary counselling and testing for HIV: sexually transmitted infections and HIV epidemiology in a population testing for HIV and its implications for practice. Sex Transm Infect 2012; 88: 612–6.
CrossRef | PubMed |

[29]  Morbidity and Mortality Weekly Report. HIV and syphilis infection among men who have sex with men – Bangkok, Thailand, 2005–2011. MMWR Morb Mortal Wkly Rep 2013; 62: 518–20.
| PubMed |

[30]  Das A, Pathni AK, Narayanan P, George B, Morineau G, Saidel T, et al High rates of reinfection and incidence of bacterial sexually transmitted infections in a cohort of female sex workers from two Indian cities: need for different STI control strategies? Sex Transm Infect 2013; 89: 5–10.
CrossRef | PubMed |

[31]  MacLaren D, Tommbe R, Mafile OT, Manineng C, Fregonese R, Redman-MacLaren M, et al Foreskin cutting beliefs and practices and the acceptability of male circumcision for HIV prevention in Papua New Guinea. BMC Public Health 2013; 13: 818.
CrossRef | PubMed |

[32]  Mugo N, Dadabhai SS, Bunnell R, Williamson J, Bennett E, Baya I, et al Prevalence of herpes simplex virus type 2 infection, human immunodeficiency virus/herpes simplex virus type 2 coinfection, and associated risk factors in a national, population-based survey in Kenya. Sex Transm Dis 2011; 38: 1059–66.
CrossRef | PubMed |

[33]  Tobian AA, Charvat B, Ssempijja V, Kigozi G, Serwadda D, Makumbi F, et al Factors associated with the prevalence and incidence of herpes simplex virus type 2 infection among men in Rakai, Uganda. J Infect Dis 2009; 199: 945–9.
CrossRef | PubMed |

[34]  Tobian AA, Kigozi G, Gravitt PE, Xiao C, Serwadda D, Eaton K, et al Human papillomavirus incidence and clearance among HIV-positive and HIV-negative men in sub-Saharan Africa. AIDS 2012; 26: 1555–65.
CrossRef | PubMed |

[35]  Weiss HA. Male circumcision as a preventive measure against HIV and other sexually transmitted diseases. Curr Opin Infect Dis 2007; 20: 66–72.
CrossRef | PubMed |

[36]  Van Howe RS. Sexually transmitted infections and male circumcision: a systematic review and meta-analysis. ISRN Urol 2013; 2013: 109846.
| PubMed |

[37]  Fox L. Three dead after violent PNG riot. Sydney: ABC News; 2011. Available online at: http://www.abc.net.au/news/2011-08-21/three-dead-in-png-riot/2849024 [verified February 2014].

Legal & Privacy | Contact Us | Help


© CSIRO 1996-2016