HPV causes around 90% of anal cancer, and HPV16, causes 90% of HPV-positive cases. Morbidity and mortality from HPV-related diseases are markedly higher among homosexual men. We describe the prevalence of anal HPV, the potential predictors of anal high-risk (HR) HPV and HPV16, and incidence and clearance of HPV16, in a cohort of Australian homosexual men.
The Study for the Prevention of Anal Cancer is a three-year prospective study of HIV-negative and positive homosexual men aged ≥ 35 years. Participants complete behavioural questionnaires and undergo anal canal examination. An anal swab is analysed using liquid-based anal cytology (ThinPrep®). Thinprep® medium is used for HPV genotyping by Roche Linear Array.
By March 2013, 342 participants (median age 49 years; 28.7% HIV positive) had attended a baseline visit. Almost two thirds had at least one HR genotype (64.4%) and almost a third had HPV16 (30.3%) detected. HR-HPV detection was significantly associated with positive HIV status (p=0.010), younger age (p=0.007), more lifetime (p=0.013) and recent (p=0.005) male sexual partners, more receptive anal behaviours in the last 6 months, including unprotected (p=0.001) and protected (p=0.019) intercourse, rimming (p<0.001) and fingering (p=0.004). HPV16 detection was only associated with a recent history of receptive fisting (p=0.049). The incidence of anal HPV16 infection was 5.6 per 100PY (HIV negative 3.66 vs HIV positive 10.00 per 100PY, HR 2.74, 95% CI 0.73-10.27). Clearance of HPV16 (30.67 per 100 PY ) was similar among HIV positive and negative participants (27.69 vs 32.54 per 100 PY, HR 0.91, 95% CI 0.32-2.57).
HR anal HPV was extremely common in this cohort of homosexual men. Incident HPV16 infection was more frequent among HIV positive participants, however clearance was similar among all men. Receptive anal sexual practices and recent sexual activity were important predictors of HR-HPV detection.
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.