BackgroundChlamydia is a sexually transmitted infection that can cause serious upper genital tract infections, however, in Australia there are limited population data for chlamydia. Understanding the incidence of chlamydia will be important in the design of a chlamydia screening program in Australia.MethodWomen aged 16–25 years were recruited from sexual health clinics (SHC) and general practice clinics (GP) in South-Eastern Australia and consented to participate in longitudinal study over a 12-month period. Participants were requested to send back questionnaires and self-collected vaginal swabs through the post which were tested for chlamydia.ResultsOverall, 1116 women were recruited from 29 clinics; with a 79% retention rate.C trachomatisprevalence at baseline was 4.9% (95% CI: 2.9% to 7.0%) and incidence rate for the 12-month study period was 4.4 per 100 women-years (95% CI: 3.3% to 5.9%). PrevalentC trachomatiswas associated with having hadC trachomatispreviously [AOR: 2.0 (95% CI: 1.1% to 3.9%)], increased numbers of sexual partners [AOR: 6.4 (95% CI: 3.6% to 11.3%)] and unprotected sex [AOR: 3.1 (95% CI: 1.0% to 9.5%)]. Antibiotic use and older age were protective against having a prevalent infection ([AOR: 0.4 (95% CI: 0.2% to 1.0%)] and [AOR: 0.9 (95% CI: 0.8% to 1.0%)] respectively) and an incident infection ([AHR: 0.1 (95% CI: 0.0% to 0.6%)] and [AHR: 0.4 (95% CI: 0.2% to 0.8%)] respectively). IncidentC trachomatiswas also associated with more partners [AHR: 4.0 (95% CI: 1.9% to 8.6%)]. More than 20% of women withC trachomatishad a re-infection during the study [20.3% (95% CI: 11.6% to 31.7%)] with an infection rate of 20.0 (95% CI: 11.9% to 33.8%) per 100 women years. The median chlamydia organism load was 1.4×105/5цl and the most common serovar identified was serovar E (51.9%).ConclusionChlamydia is a common STI in young Australian women, and an incidence of 4.9 per 100 women years for chlamydia suggests annual testing is appropriate for a chlamydia screening program. The high re-infection rate indicates the importance of partner notification and re-testing 3 months after treatment.

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.

The proportion of clinically important diagnoses in a low-risk, asymptomatic population who use a computer-assisted self-interview (CASI) to assess risk was needed to determine optimal health service delivery. Medical records were retrospectively analysed between July 2008 and June 2009 for risk characteristics and diagnoses. A total of 7733 new patients completed a CASI, of whom 1060 were asymptomatic heterosexuals. From this low-risk group, 26 diagnoses were made on the day of presentation, including 22 cases of genital warts (2.08% [95% confidence interval (CI) 1.22-2.93]), three cases of genital herpes (0.28% [95% CI 0.055-0.82]) and one case of unintended pregnancy (0.094% [95% CI 0.0061-0.52]). Additionally, there were 54 cases of chlamydia detected (5.09% [95% CI 3.77-6.42]). As chlamydia is effectively diagnosed and managed from self-collected samples, patient review is not always required. This study provides evidence for an express testing service for chlamydia to streamline the screening of low-risk, asymptomatic heterosexual patients as identified by CASI without the need to for a traditional face-to-face consultation.

IntroductionThere has been considerable debate questioning the efficacy of azithromycin for the treatment of genital chlamydia. We conducted a meta-analysis to compare the efficacy of 1 gramme azithromycin with 100mg doxycycline twice daily for seven days for the treatment of genital chlamydia infection.MethodsMedline, PubMed, Embase and the Cochrane Controlled Trials Register were searched till end 2012. Inclusion criteria included (1) randomised controlled trial of azithromycin versus doxycycline for the treatment of urethral or cervical chlamydia, and; (2) evaluation of microbial cure within 3 months of treatment. Type of diagnostic test, duration of follow up, gender, patient status (all symptomatic versus both symptomatic/asymptomatic) and microbial cure were extracted. The primary outcome was difference in efficacy (doxycycline efficacy minus azithromycin efficacy) at final follow up. Meta-analysis calculated a pooled efficacy for each treatment and the difference in efficacy between treatments.ResultsOf 692 references identified, 23 trials met the inclusion criteria. 1065 individuals were treated with azithromycin and 850 with doxycycline; all studies reported efficacy within 6 weeks follow-up. Pooled cure rates were 96.2%(95% CI: 94.2%, 98.3%) for azithromycin and 98.1%(95% CI: 96.6%, 99.7%) for doxycycline. The pooled efficacy difference was 1.9%(95% CI: 0.4%, 3.4%) showing a small but significant difference in favour of doxycycline; there was negligible heterogeneity between studies (I2 = 1.9%, p = 0.44). There was no difference in efficacy in men (3.8%; 95% CI:-1.2%, 8.8%) or women (–0.9%; 95% CI: –5.3%, 3.6%). When stratified by type of test, efficacy was significantly higher for doxycycline in culture-based studies (1.8%; 95% CI: 0.4%, 3.3%), but not in NAAT-based studies (5.5%; 95% CI: –2.1%, 13.1%). Efficacy was higher for doxycycline in symptomatic men (6.3%; 95% CI: 3.0%, 12.3%), but not in symptomatic women (–4.5%; 95% CI: –14.9%, 5.9%).ConclusionThese results suggest that doxycycline may be more effective than azithromycin for the treatment of urethral or cervical chlamydia infection, especially in symptomatic men.

BackgroundGenome-wide average DNA methylation (GWAM) and epigenetic age acceleration have been suggested to predict breast cancer risk. We aimed to investigate the relationships between these putative risk-predicting measures and environmental breast cancer risk factors. MethodsUsing the Illumina HumanMethylation450K assay methylation data, we calculated GWAM and epigenetic age acceleration for 132 female twin pairs and their 215 sisters. Linear regression was used to estimate associations between these risk-predicting measures and multiple breast cancer risk factors.Within-pair analysis was performed for the 132 twin pairs. ResultsGWAM was negatively associated with number of live births, and positively with age at first live birth (both P<0.05). Epigenetic age acceleration was positively associated with body mass index (BMI), smoking, alcohol drinking and age at menarche, and negatively with age at first live birth (all P<0.05), and the associations with BMI, alcohol drinking and age at first live birth remained in the within-pair analysis. ConclusionsThis exploratory study shows that lifestyle and hormone-related breast cancer risk factors are associated with DNA methylation-based measures that could predict breast cancer risk. The associations of epigenetic age acceleration with BMI, alcohol drinking and age at first live birth are unlikely to be due to familial confounding.

and treatment failure among men who have sex with men (MSM), heterosexual men and women, diagnosed with repeat chlamydia infection within 1-4 months after treatment with azithromycin. Methods Participants completed an online survey capturing treatment and sexual behaviour data since initial diagnosis. Specimens from initial and repeat infections were included in the study. Chlamydia serovars were determined using quantitative PCR assays. When the same serovar was detected in both specimens for participants, MLST was used to further discriminate between genotypes. An algorithm based on genotype and sexual behaviour data was used to differentiate treatment failure from reinfection. Results There were 600 participants (200 MSM, 200 heterosexual males, 200 females) diagnosed with chlamydia. Of 301/600 who retested between 1-4 months: 258/301 (85.7%) were cured (treated and negative on retest); 4/301 (1.3%) had a definite reinfection (positive retest and different genotype); 19/301 (6.3%) had probable reinfection (positive retest, same genotype and reported unprotected sex with the same or a different partner); 17/301 (5.6%) had possible treatment failure (positive retest, same genotype and reported not having sex or always using condoms); 1/301 (0.3%) had a persistent infection (positive retest, same genotype and no documented treatment); and 2/301 (0.7%) could not be categorised due to insufficient information. Possible treatment failures were more common in MSM (11.3%, 12/106) vs other groups (2.6%, 5/195; p < 0.01). Among the possible treatment failures in MSM, 10/12 (83.3%) were initial rectal samples. Conclusion Treatment failure was common in MSM with rectal chlamydia, suggesting the need for treatment efficacy trials. Disclosure of interest statement No conflict of interest is declared.

estimated the rate of lost to follow up cases (visitors with a false negative Gram result who did not come back for treatment) in the 2 periods. Results Gram strain microscopy had a high specificity, in both time periods regardless of sex (> = 99.8). Sensitivity decreased overall comparing years before and after 2010, from 87.2 to 84.8. This was mainly due to a sharp reduction of the already low sensitivity in women after 2010 from 32.0 to 23.1. Sensitivity in men remained high at 95.9 before 2010 and 95.4 thereafter. Loss to follow-up was estimated at 4.3% (2/47) before 2010 and 5.9% (8/135) after 2010. Overall, over 99% of all culture positive patients were treated. Discussion The low sensitivity of Gram stain microscopy in females is known, but our results show that sensitivity to diagnose gonorrhoea is even lower when offered solely to symptomatic women. Although it did not have an impact on the number of treated infections, this counter-intuitive result could potentially lead to undertreatment and to be considered syndromic treatment policies. Introduction Commercial biochemical tests are typically used for the identification of N. gonorrhoeae isolates, however certain methods can exhibit specificity problems when testing commensal Neisseria strains. The aim of this study was to assess rates of phenotypic misidentification of N. gonorrhoeae in Australia. Methods A total of 2373 isolates were received from reference laboratories throughout Australia in the first half of 2012, and comprised 98% of all gonococci isolated in Australia during this period. A NAtioNAl QuAlityTo confirm organism identity, all isolates were tested using in-house N. gonorrhoeae real-time PCR assays targeting multicopy opa, porA pseudogene and cppB genes. ResultsThe results showed that 98.5% (2336/2373) of isolates were positive for all three gene targets, 31 positive for two targets (3 porA-negative, 1 opa negative and 27 cppB-negative) and 6 were negative by all 3 PCR targets. Using 16S rDNA sequencing, 4 of the latter 6 isolates were determined to be non-gonococcal species (Moraxella and commensal Neisseria) whereas two isolates could not be identified. (GEN-PROBE). In addition swabs are collected from a limited number of high risk patients for culture and susceptibility testing. The isolates can also be used for molecular characterization of resistance determinants and strain typing. In order to gain a better understanding of the circulating sequence types (STs) and resistance determinants in cases where specimens are not collected for culture, such as community patients, a more practical approach would be to test the original sample submitted for Aptima testing by molecular methods. Methods Sample pairs (specimen submitted for Aptima testing and culture within one day) from 26 patients including 22 males and 4 females ranging in age from 20 to 59 years were extracted using the QIAamp DNA mini kit and compared for direct molecular characterization. Samples were analysed for antimicrobial susceptibility based on mosiac changes tha...

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