IntroductionAustralia recorded its first case of COVID-19 in late January 2020. On 22P March 2020, amid increasing daily case numbers, the Australian Government implemented lockdown restrictions to help ‘flatten the curve’. Our study aimed to understand the impact of lockdown restrictions on sexual and reproductive health. Here we focus on sexual practices.MethodsAn online survey was open from the 23PP April 2020 to 11P May 2020. Participants were recruited online via social media and other networks and were asked to report on their sexual practices in 2019 and during lockdown. Logistic regression was used to calculate the difference (diff) (including 95% CIs) in the proportion of sex practices between time periods.ResultsOf the 1187 who commenced the survey, 965 (81.3%) completed it. Overall, 70% were female and 66.3% were aged 18–29 years. Most (53.5%) reported less sex during lockdown than in 2019. Compared with 2019, participants were more likely to report sex with a spouse (35.3% vs 41.7%; diff=6.4%; 95% CI 3.6 to 9.2) and less likely to report sex with a girl/boyfriend (45.1% vs 41.8%; diff=−3.3%; 95% CI −7.0 to -0.4) or with casual hook-up (31.4% vs 7.8%; 95% CI −26.9 to -19.8). Solo sex activities increased; 14.6% (123/840) reported using sex toys more often and 26.0% (218/838) reported masturbating more often. Dating app use decreased during lockdown compared with 2019 (42.1% vs 27.3%; diff= −14.8%; 95% CI −17.6 to -11.9). Using dating apps for chatting/texting (89.8% vs 94.5%; diff=4.7%; 95% CI 1.0 to 8.5) and for setting up virtual dates (2.6% vs 17.2%; diff=14.6%; 95% CI 10.1 to 19.2) increased during lockdown.ConclusionAlthough significant declines in sexual activity during lockdown were reported, people did not completely stop engaging in sexual activities, highlighting the importance of ensuring availability of normal sexual and reproductive health services during global emergencies.

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Introduction: Australia recorded its first case of COVID-19 in late January 2020. On 22 March 2020, amid increasing daily case numbers, the Australian Government implemented lockdown restrictions to help flatten the curve. Our study aimed to understand the impact of lockdown restrictions on sexual and reproductive health. Here we focus on sexual practices. Methods: An online survey was open from the 23 April 2020 to the 11 May 2020. Participants were recruited online via social media and other networks and were asked to report on their sexual practices in 2019 and during lockdown. Logistic regression was used to calculate the difference (including 95% confidence intervals) in the proportion of sex practices between time periods. Results: Of the 1187 who commenced the survey, 965 (81.3%) completed it. Overall 70% were female and 66.3% were aged 18 to 29 years. Most (53.5%) reported less sex during lockdown than in 2019. Compared with 2019, participants were more likely to report sex with a spouse (35.3% vs 41.7%; difference=6.4%; 95%CI: 3.6, 9.2) and less likely to report sex with a girl/boyfriend (45.1% vs 41.8%; diff=-3.3%; 95%CI: -7.0, -0.4) or with casual hook-up (31.4% vs 7.8%; 95%CI:-26.9, -19.8). Solo sex activities increased, 14.6% (123/840) reported using sex toys more often and 26.0% (218/838) reported masturbating more often. Dating app use decreased during lockdown compared with 2019 (42.1% vs 27.3%; difference= -14.8%; 95%CI: -17.6, -11.9). Using dating apps for chatting/texting (89.8% vs 94.5%; diff=4.7%; 95%CI:1.0, 8.5) and for setting up virtual dates (2.6% vs 17.2%; diff=14.6%; 95%CI:10.1, 19.2) increased during lockdown. Conclusion: Although significant declines in sexual activity during lockdown were reported, people did not completely stop engaging in sexual activities during the pandemic, highlighting the importance of ensuring availability of normal sexual and reproductive health services during global emergencies.

Background Pelvic inflammatory disease (PID) is under-diagnosed globally, particularly in primary care, and if untreated may cause reproductive complications. This paper investigates PID diagnosis by Australian general practitioners (GPs) and barriers to their conducting a pelvic examination. Methods: An online survey investigating Australian GPs’ chlamydia management, including PID diagnosis, was conducted in 2019. From 323 respondents, 85.8% (n = 277) answered multiple-choice questions about PID and 74.6% (n = 241) answered a free-text question about barriers to conducting pelvic examinations. Using multivariable logistic regression, we identified factors associated with conducting pelvic examinations. Barriers to performing pelvic examinations were explored using thematic analysis. Results: Most GPs indicated that they routinely ask female patients with a sexually transmissible infection about PID symptoms, including pelvic pain (86.2%), abnormal vaginal discharge (95.3%), abnormal vaginal bleeding (89.5%), and dyspareunia (79.6%). Over half reported routinely conducting speculum (69.0%) and bimanual pelvic (55.3%) examinations for women reporting pelvic pain. Female GPs were more likely to perform speculum [adjusted odds ratio (AOR) 4.6; 95%CI: 2.6–8.2] and bimanual pelvic examinations (AOR 3.7; 95%CI: 2.1–6.5). GPs with additional sexual health training were more likely to routinely perform speculum (AOR 2.2; 95%CI: 1.1–4.2) and bimanual pelvic examinations (AOR 2.1; 95%CI: 1.2–3.7). Barriers to pelvic examinations were patient unwillingness and/or refusal, GP gender, patient health-related factors, time pressures, and GP reluctance. Conclusion: Although GPs typically ask about PID symptoms when managing patients with chlamydia, they are not consistently able or willing to perform pelvic examinations to support a diagnosis, potentially reducing capacity to diagnose PID.

Background. Medicare, the health insurance system underpinning free healthcare in Australia, introduced free telehealth items in 2020 in response to the coronavirus disease 2019 (COVID-19) pandemic. Their uptake among healthcare providers was significant, including among general practitioners and sexual health services. Here, we report people's experiences of accessing sexual and reproductive health (SRH)-related care via telehealth collected as part of a survey exploring the impact of COVID on SRH health. Methods. This study utilises qualitative data from two online surveys conducted in 2020. Surveys were advertised through social media and professional and personal networks. Anyone aged ≥18 years and living in Australia was eligible to participate. Respondents were asked whether they accessed care for their SRH via telehealth. A free-text question asking for further detail about their experience was analysed using content analysis. Results. A total of 114/1070 respondents (10.7%) accessed healthcare services via telehealth for SRH-related reasons within the previous 4 weeks. Three themes were identified from 78 free-text comments: (1) accessibility and convenience of telehealth; (2) appropriateness of telehealth for SRH issues; and (3) connecting and communicating with clinicians via telehealth. Respondents had a wide range of experiences. Telehealth improved access to services for some participants, and it was appropriate for some, but not all SRH issues. Difficulties connecting with clinicians on both an interpersonal and technical level was a key barrier to a satisfactory patient experience. Conclusions. Telehealth can offer a viable alternative to face-to-face care, providing patients can overcome key connection and communication barriers.

Australians were subject to a series of COVID-19 lockdown restrictions throughout 2020. Although accessing medical care was allowable, concerns were raised that people were avoiding healthcare services. We explored young Australians' reasons for delaying seeking sexual and reproductive health (SRH) care during the pandemic, using data from two cross-sectional surveys. The surveys included a question asking whether respondents had delayed accessing care during the pandemic. Free-text responses from young Australians (aged 18-29 years) were analysed using conventional content analysis. In all, 1058 under-30s completed a survey, with 262 (24.8%) reporting they had delayed seeking SRH care. Of these, 228 (87.0%) respondents provided a free-text comment. Participants who commented were predominantly female (86.4%) and had a median age of 23 years (interquartile range 20-26 years). Most commonly, respondents delayed testing for sexually transmissible infections, cervical cancer screening, and contraceptive care. Some delayed accessing care despite experiencing symptoms. Participants avoided seeking care due to concerns about contracting COVID-19, uncertainty about accessing care during restrictions and anxiety relating to accessing SRH care. Although some reported a reduced need for SRH care, others required but did not access care. Young people should be reassured that SRH issues are a valid reason to access services, especially when experiencing symptoms.

ObjectivesPatient-delivered partner therapy (PDPT) describes the giving of a prescription or antibiotics by an index case with chlamydia to their sexual partners. PDPT has been associated with higher numbers of partners receiving treatment. In Australia, general practitioners (GPs) previously expressed negative views about PDPT. Health authority guidance for PDPT has since been provided in some areas. We investigated recent use and perceptions of PDPT for chlamydia among GPs in Australia.MethodsIn 2019, we conducted an online survey comprising multiple-choice and open-ended questions to investigate GPs’ chlamydia management practices, including PDPT. Logistic regression identified factors associated with ever offering PDPT. A directed content analysis of free-text data explored GPs’ perceptions towards PDPT.ResultsThe survey received responses from 323 GPs; 85.8% (n=277) answered PDPT-focused questions, providing 628 free-text comments. Over half (53.4%) reported never offering PDPT, while 36.5% sometimes and 10.1% often offered PDPT. GPs more likely to offer PDPT were aged ≥55 years (adjusted OR (AOR) 2.9, 95% CI 1.4 to 5.8), worked in non-metropolitan areas (AOR 2.5, 95% CI 1.5 to 4.4) and jurisdictions with health authority PDPT guidance (AOR 2.3, 95% CI 1.4 to 3.9). Qualitative data demonstrated that many GPs recognised PDPT’s potential to treat harder to engage partners but expressed hesitancy to offer PDPT because they considered partners attending for care as best practice. GPs emphasised a case-by-case approach that considered patient and partner circumstances to determine PDPT suitability. To alleviate medicolegal concerns, many GPs indicated a need for professional and health authority guidance that PDPT is permissible. They also desired practical resources to support its use.ConclusionGPs appear to accept the place of PDPT as targeted to those who may otherwise not access testing or treatment. Availability of health authority guidance appears to have supported some GPs to incorporate PDPT into their practice.

BackgroundChlamydia is the most commonly diagnosed bacterial sexually transmissible infection (STI) in Australia. Partner management is key to reducing transmission and a cornerstone of best practice chlamydia management. While most patients will opt for telling their partner(s) themselves, patient-delivered partner therapy (PDPT) offers an alternative way to inform and treat partners where usual management is inappropriate or unlikely to be undertaken.