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.
Methods: The SPANC study is a three-year prospective study of the natural history of anal HPV infection and cancer precursors in HIV-negative and -positive homosexual men aged ≥ 35 years. At each visit all men undergo an anal swab for cytology and HPV genotyping (Roche Linear Array), followed by high resolution anoscopy-aided biopsy. Anal HSIL was defined as having either anal intraepithelial neoplasia grade 2/3 on histology and/or HSIL/possible HSIL on cytology.
Results: A total of 342 men were recruited by March 2013. Median age was 49 years (range: 35-79) and 28.7% were HIV-positive. At baseline, the prevalence of anal HSIL was 50.0% and 43.9% in the HIV-positive and HIV-negative respectively (p=0.303). Among those free of HSIL at baseline, HSIL incidence was 27.8 and 27.6 cases per 100 person-years in the HIV-positive and HIV-negative (p=0.920). Among those with HSIL at baseline, the clearance rate was 41.0 and 42.7 cases per 100 person-years in the HIV-positive and HIV-negative (p=0.851). Men who tested HPV16 positive on their anal swabs at baseline were significantly more likely to develop incident HSIL (57.1 vs 23.0 per 100 person-years, p=0.010), and less likely to clear prevalent HSIL (17.6 vs. 61.3 per 100 person-years, p=0.001).
Conclusion: Anal HSIL was highly prevalent in homosexual men. Both incidence and clearance of HSIL were common, and were closely associated with HPV16 status. The high rates of clearance are consistent with the observation that anal HSIL progresses to cancer less commonly than high-grade cervical lesions.
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.
Since 2009, the Victorian syphilis enhanced surveillance system has been collecting HIV status and syphilis re-infection status for infectious syphilis cases. Baseline data from 2009 showed that 31% of the infectious syphilis cases were HIV positive and 18% reported were re-infections. This suggested that syphilis transmission among a pool of HIV positive MSM was making a considerable contribution to the syphilis epidemic in Victoria. We analysed the data from 2009 to 2012 to determine whether this pattern of transmission is continuing. Notification data for infectious syphilis between 2009 and 2012 were reviewed by HIV infection status, syphilis re-infection status and risk factor exposures.
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.