The usefulness of type-specific testing for herpes simplex virus type 2 (HSV-2) is much debated with proponents arguing for likely change in the sexual behaviour of asymptomatic carriers and opponents suggesting that testing may have significant adverse psychological impact while not promoting behaviour change. In the present study we examine the impact of HSV-2 serological testing on psychological well-being, self-esteem, anxiety, sexual self-perceptions and sexual practices among a sample of 180 clients of a sexual health clinic. Of the participants, 21 (11.7%) were HSV-2 positive at entry to the study. No adverse psychological consequences of a positive test were observed among those participants followed for 3 months (n=124) or for 6 months (n=97). There was little significant change observed in sexual behaviour although a general but not significant pattern of decreased sexual behaviour with casual partners was observed among participants who tested HSV-2 negative. While supportive of the value of HSV-2 testing, these findings require replication in larger samples and different populations.

BackgroundRisk of pelvic inflammatory disease associated with Chlamydia trachomatis and Mycoplasma genitalium is increased after termination of pregnancy (TOP) and may be increased after insertion of intrauterine devices (IUDs). Screening prior to these procedures is recommended only for C. trachomatis. We examined C. trachomatis and M. genitalium prevalence and associated factors among women presenting to a pregnancy termination and contraception service over 10 years.MethodsRetrospective analysis of clinical data collected from 17 573 women aged 15–45 years in 2009–2019 and for 266 M. genitalium positive women tested for macrolide resistance-associated mutations in 2016–2019.ResultsC. trachomatis and M. genitalium prevalence was 3.7% and 3.4%, respectively. In multivariable analyses, shared risk factors were younger age (p<0.001, for both C. trachomatis and M. genitalium), socioeconomic disadvantage (p=0.045 and p=0.008, respectively) and coinfection (p<0.001, for both sexually transmitted infections), with 10.1% of C. trachomatis positive women also positive for M. genitalium. Additional risk factors were earlier year of visit (p=0.001) for C. trachomatis and for M. genitalium residing outside a major city (p=0.013). The proportion of M. genitalium infections tested between 2016 and 2019 with macrolide resistance-associated mutations was 32.7%.ConclusionsGiven the high level of antimicrobial resistance and the prevalence of coinfection, testing C. trachomatis positive women for M. genitalium could be considered in this setting to prevent further spread of resistant infections. Further research is required into the causal link between M. genitalium and pelvic inflammatory disease in women undergoing TOP and IUD insertion.

Immunoglobulin G (IgG) and T-cell-derived antigen binding molecules (TABM) specific to whole Candida extract and to Candida-derived mannans prepared by both the cetryltrimethylammonium bromide (CTAB) and alkaline degradation (PEAT) methods were measured in the sera of women with vulvovaginal candidiasis and controls. In the patients there were significantly higher levels of IgG to both CTAB and PEAT mannans and of TABM to CTAB mannan. TABM specific to CTAB mannan was purified from the serum of a patient with a high titer of this TABM. The purified TABM bound specifically to CTAB mannan and to other yeast and mold extracts. This TABM preparation was associated with transforming growth factor ␤2 (TGF-␤2), and on specific binding to mannan there was a marked increase in the level of detectable TGF-␤2. This increase in TGF-␤2 level was critically dependent on the relative concentrations of the purified TABM and mannan, being smallest when either was in excess. The TABM specific to CTAB mannan was also shown to inhibit Candida-stimulated gamma interferon production. The results suggest that CTAB mannan-specific TABM may increase susceptibility to vulvovaginal candidiasis in association with a shift in the immune response to the Th2 type.

Introduction Recurrent vulvovaginal candidiasis (RVVC) results in significant physical, financial and psychological sequelae for women, and many women report that VVC affects their intimate relationships. The aetiology of RVVC remains uncertain, and some studies suggest sexual intercourse may be responsible for transmission of Candida species. No publications have documented the affect of sexual intercourse on vaginal candida colonisation. Methods Fifty nine participants who were culture positive for Candida spp. at screening took part in a randomised controlled trial investigating the effect of oral garlic and placebo on vaginal candidal colonisation. Participants self-collected daily vaginal swabs during the two weeks before menstruation. They kept a daily diary and recorded incidence of sexual intercourse and abnormal vaginal symptoms. Swabs were analysed for quantitative colony counts of candida before and after sexual intercourse. Results There were 149 episodes of sexual intercourse in participants reporting sexual activity (n = 38) over the two week study period. Colonisation levels rose the day following sexual intercourse in 51 episodes, and fell in 56 episodes. In 42 episodes of sexual intercourse, the levels remained the same or women were culture negative on the day following and two days following sexual intercourse. On fifty occasions women had symptoms (itch, abnormal vaginal discharge) on the day of sexual intercourse, and 41 women reported abnormal symptoms two days after sexual intercourse. In 75 episodes, there were no abnormal symptoms the day of, or the day following sexual intercourse. Conclusion In this study, sexual intercourse, colonisation levels and abnormal vaginal symptoms appeared to be unrelated. Further investigation is recommended into dyspareunia and abnormal vaginal symptoms following sexual intercourse experienced by women with RVVC. Disclosure of interest statement No pharmaceutical grants were received in the development of this study.

Background Chlamydia trachomatis (C. trachomatis) prevalence has been reported to be increasing. Whether this is a true increase over time or confounded by increases in testing and/or use of more sensitive assays is to be determined. Materials and Methods One laboratory service has been detecting C. trachomatis for the past 30 years within the Royal Women's Hospital Melbourne. We conducted a retrospective audit of records over the period 1986–2016 from a clinic population routinely offered chlamydia screening. These were women presenting for family planning advice (termination of pregnancy, intrauterine device insertion or considered at high risk), who underwent chlamydia testing in the context of various diagnostic assays used over this time period. Assays utilised included culture, enzyme immunoassay (EIA), DNA probe, and nucleic acid amplification testing (NAAT). Non‐parametric test for trend was used to determine significant differences between prevalence estimates across ordered groups. Least squares regression was conducted to describe a linear trend matching known data points. Results Overall, there was no significant change for chlamydia prevalence which was 2.2%, in the 30‐year study period (P = 0.7). Over time diagnostic assays changed from culture, to EIA, DNA probe, to the more sensitive NAAT. The bulk of the positives were in women under 25 years of age (57%). Conclusion Chlamydia prevalence has been stable over 30 years, remaining a problem in young women. Screening for those at risk needs underscoring in a national sexual health program.

participant demographic or behavioural characteristics between arms. Adherence to study medication did not differ between arms: 382 (91%) took all or most oral metronidazole and 330 (80%) all or most vaginal therapy. Retention rates were high, with 77 (17%) lost to follow-up over 6 months, and did not differ between arms. Participants contributed 153.7 person years of follow-up to analyses. On exit survey 88% of participants did not know or correctly guess the vaginal therapy they had received. Six month cumulative BV recurrence rates did not differ between study arms by per protocol analysis: MetPlac (32%, 95% CI 24% to 41%) MetProb (33%, 25% to 42%) and MetClin (34%, 26% to 42%), p>0.05 (Abstract O3-S5.06 figure 1 Abstract O3-S5.06 Figure 1 Conclusions The addition of vaginal clindamycin or a vaginal probiotic to oral metronidazole does not improve 6 month BV recurrence rates. This is the first RCT to evaluate the efficacy of combination clindamycin/metronidazole for BV treatment, and has important implications for clinical practice. Combination therapy is often used in patients with recurrent BV, but evidence to support this practice has not been available.

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