Medline, 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 (symptomatic versus other) and microbial cure were extracted. The primary outcome was efficacy difference (ED=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.
Of 692 references identified, 23 trials met the inclusion criteria. 1099 individuals were treated with azithromycin and 876 with doxycycline; all studies reported efficacy within 6 weeks follow-up. Pooled cure rates were 94.4% (95%CI:91.9%, 96.9%) for azithromycin and 97.5% (95%CI:96.3%,98.8%) for doxycycline. The pooled efficacy difference was 2.7% (95%CI:0.7%,4.8%) showing a significant difference in favour of doxycycline; there was negligible heterogeneity between studies (I2 = 0.0%, p=0.46). There was no significant efficacy difference in men (ED=4.3%;95%CI:- -0.2%, 8.9%) or women (ED=1.0%;95%CI: -4.4%, 6.5%). When stratified by type (ED=4.3%;95%CI:- -0.2%, 8.9%) or women (ED=1.0%;95%CI: -4.4%, 6.5%). When stratified by type of test, efficacy was significantly higher for doxycycline in NAAT-based studies (ED=5.4%;95%CI: 0.6%, 10.2%), but not in culture-based studies (ED=1.9%;95%CI: -0.4%, 4.1%). Efficacy was higher for doxycycline in symptomatic individuals (ED=5.8%;95%CI: 1.0%, 10.5.%)
Conclusion: These results suggest that doxycycline may be more effective than azithromycin for the treatment of urethral or cervical chlamydia infection, especially for symptomatic individuals. Efficacy however needs to be balanced against compliance, with a 7-day course of doxycycline.
Background: STI prevalence is changing. With society aging, life expectancy increasing and changes in sexual practices, STIs in senior citizens are of interest from economic, health related and social burden perspectives. Few studies on STIs in older men greater than 60 years of age exist, hence, a need to obtain further information about this subpopulation.
Conducting clinical audits in the context of continuous quality improvement (CQI) programs in Aboriginal Community Controlled Health Services (ACCHS) has provided valuable information regarding what factors facilitate or create challenges to improving outcomes in sexual health service delivery.
Homosexual men are at increased risk of anal cancer. Screening and treatment of the precursor, HSIL, has been advocated by some, but screening is not recommended in widely-accepted guidelines. We aimed to describe the prevalence, incidence, and clearance rates of anal HSIL, and association with human papillomavirus (HPV) status, in a community-recruited cohort of homosexual men.
HIV positive gay men have high rates of cigarette smoking. The risks of smoking in addition to the elevated risk of cardiovascular disease and some malignancies in people with HIV means smoking cessation interventions should be prioritised.
We investigated the association between chlamydia detection and stage in the menstrual cycle to investigate whether chlamydia detection was higher at different stages of the cycle. Electronic medical records for women attending Melbourne Sexual Health Centre March 2011 - 31st December 2012, who were tested for chlamydia by nucleic acid amplification of high vaginal, cervical, or urinary samples, and who recorded a date of last normal menstrual period (LNMP) between 0-28 days were included in the analysis. Logistic regression was used to calculate OR (95%CI) for the association of chlamydia with menstrual cycle adjusted by demographics and behavioural variables.
Chlamydia is prevalent among young Australians. The latest national surveillance report (2011) shows a rate of diagnosis of 1400 per 100,000 population aged 15-29 years. In Victoria, the number of notifications in 2011 was 19,238; 81% in 15-29 year olds; however notifications continue to rise in all age groups. International evidence suggests chlamydia reinfection is responsible for a substantial burden of infections. Given the associated health risks, monitoring reinfection in the population is important to understand disease burden and evaluate interventions. We describe the rate of reinfection and time between infections in Victoria, 2004-2011.
This presentation, "Responding to the needs of consumers with complex trauma histories a consumer perspective" focuses on the needs of adult survivors of child abuse, highlighting the frequent