The bacterial loads for gonococcal infections of the pharynx and rectum were determined among men with male sexual partners. The median bacterial load for rectal infections (18,960 copies/swab) was significantly higher than the load for pharyngeal infections (2,100 copies/swab; P ‫؍‬ 0.001). Bacterial loads among men with symptomatic proctitis were strikingly high (median, 278,000 copies/swab).Gonorrhea is one of the most common sexually transmitted diseases, and study results suggest that rectal gonorrhea enhances HIV transmission (1-3).There are limited data on the transmissibility of gonorrhea, particularly from the pharynx and rectum. To examine potential transmissibility from these sites, we measured gonococcal bacterial loads and examined associated clinical and laboratory factors.All men who have sex with men (MSM) attending the Melbourne Sexual Health Centre between January 2010 and April 2010 who underwent testing for sexually transmitted infections were included. Pharyngeal and rectal specimens were obtained using cotton-tipped swabs. Rectal specimens were obtained either by blind anal swabbing or, in men with symptomatic proctitis, via anoscopy. Swabs were plated onto modified Thayer-Martin medium, placed into phosphate-buffered saline, and then analyzed using real-time quantitative PCR (qPCR) targeting the opa gene of Neisseria gonorrhoeae (4). Positive PCR tests were confirmed using real-time PCR targeting the gonococcal porA pseudogene (7). Gonococcal loads were quantified by comparing the crossing threshold for each sample to the crossing threshold of a standard curve constructed by amplifying different, known copy numbers of N. gonorrhoeae in an opa assay. To determine the adequacy of sample collection, a qPCR targeting the 260-bp region of ␤-globin was performed.Inoculated culture plates were incubated at 36°C in 5% CO 2 for 48 h. Presumptive N. gonorrhoeae colonies were oxidase tested, and identification of specimens to the species level was confirmed by carbohydrate reaction tests. Specimens that were culture positive and/or PCR positive were regarded as representing true infections. The McNemar test was used to compare detection of gonorrhea by culture versus PCR. The Mann-Whitney test was used to compare bacterial loads. The Human Research Ethics Committee of the Alfred Hospital approved the study.Specimens were obtained from 1,076 MSM. The median age of the subjects was 32 (range, 18 to 69). For testing using both culture and PCR, 1,011 rectal and 1,076 pharyngeal specimens were obtained. There were 43 (3.9%) confirmed PCR-positive pharyngeal specimens, of which 17 were also culture positive (sensitivity, 39%). There were 47 (4.6%) confirmed PCR-positive rectal specimens, of which 25 were also culture positive (sensitivity, 53%).Twelve men had concurrent gonorrheal infections of the pharynx and rectum. A further 10 were concurrently infected at the urethra and rectum, while 2 were concurrently infected at the urethra, pharynx, and rectum. Five men were coinfected with rectal chlamydia and g...

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Hepatitis C virus (HCV) is more prevalent among people with experience of severe mental illness compared to the general population, due in part to higher levels of injecting drug use. Delivering HCV care through mental health services may reduce barriers to care and improve outcomes. A nurse-led HCV program was established in a co-located mental health and addiction service in Melbourne, Australia. People with a history of injecting drug use, including current use, were referred for HCV testing by nurses, with support provided on-site from a general practitioner and remotely from infectious disease and hepatology specialists. A nurse practitioner, general practitioner or specialists were able to prescribe HCV treatment. One-hundred and thirty people were referred to the nurse-led service, among whom 112 (86%) were engaged in care. Of those 112, 84 (75%) were found to have detectable HCV RNA, 70 (83%) commenced treatment; 28 (40%) prescriptions were nurse initiated, 19 (27%) were general practitioner initiated and 20 (29%) were prescribed from hospital clinics or elsewhere. All people with an SVR result (48/70) achieved HCV cure (intention to treat SVR 69%, per-protocol SVR 100%). Treatment commencement was highest among people prescribed opioid agonist therapy (28/29, 96%) compared to those who were not (18/26, 69%). In conclusion, a nurse-led, HCV service for people with severe mental illness including pathways to specialist support when needed can achieve high treatment uptake and cure. Further implementation work is required to improve treatment uptake, particularly among people not prescribed opioid agonist therapy, and to improve follow-up for SVR testing.

High HIV testing coverage of high-risk populations is required to reduce the number of HIV-infected individuals unaware of their status. The aim of this study was to determine HIV testing rates among men who have sex with men (MSM) attending a sexual health service, including the impact of the treating clinician on HIV testing rates. Factors associated with HIV testing of MSM attending the Melbourne Sexual Health Centre for the first time between 2003 and 2009 were determined, including testing rates for individual treating clinicians. Overall, 78% of 4425 men were tested for HIV. Clinician HIV testing rates were higher among nurses (median 89%; range 77-95%) than doctors (median 73%; range 45-88%) with significant differences between individual physicians (P < 0.001). Lower testing among doctors was independent of reported sexual risk and time since the last HIV test. Substantial differences in HIV testing rates between clinicians were evident with low testing by some. Increasing HIV testing rates among high-risk groups require engagement not only of individuals at risk but also awareness among health-care providers who perform HIV testing.

Background: Hepatitis C virus (HCV) treatment through primary care and communitybased services will be a critical component of HCV elimination. We evaluated a nursecoordinated programme providing care across eight sites and analysed progression through the HCV care cascade.Methods: People-accessing services from six primary care clinics, a homeless crisis accommodation provider and a mental health service were directly referred to nurses or engaged by nurses during regular clinic visits. Nurses supported HCV testing, treatment and follow-up. The prescription was provided by affiliated clinicians. Logistic regression was used to examine factors associated with treatment commencement and sustained virological response (SVR) testing. Results:Of 640 people referred to and/or engaged by the nurses from January 2017 to July 2019, 518 had an HCV RNA test of whom 381 (74%) were HCV RNA positive.Treatment was commenced by 281 (74%) people of whom 161 had an SVR test, 157 (97.5%) were cured. Opioid agonist therapy was associated with treatment commencement (aOR 2.68, 95% CI 1.48-4.88). People who were homeless/unstably housed

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