Description of the case: JH was a 26 year old male presenting with a clear urethral discharge and dysuria after recent azithromycin treatment (1 gm stat po) for a urethral Chlamydia trachomatis (CT) infection (First void urine (FVU) PCR positive). His proof of cure (POC) FVU at four weeks was CT negative. Two weeks later he presented to B2 Clinic visit with persistent non-specific urethritis (NSU) (discharge and dysuria) and was treated empirically with doxycycline 100mg bd for ten days, advised to abstain from sex and booked for follow-up in two weeks.
Subsequent laboratory results showed Mycoplasma genitalium (FVU-PCR) (Neisseria gonorrhoea/CT PCR negative) with a negative urethral smear (no white cells/organisms, culture negative). At two weeks his symptoms had improved and he was booked for POC. His subsequent POC FVU PCR was positive for M. genitalium. He was seen one week later and the treating clinician discussed the persisting M.genitalium infection and treatment options, viz Moxifloxacin versus an extended azithromycin regime. As a keen sportsman, the patient was very cautious about using Moxifloxacin and the risk of archilles tendinitis.
Despite concerns of selective macrolide resistance given his azithromycin pre-treatment, the patient preferred to trial the extended Azithromycin regime. Four weeks after ceasing treatment he completed a proof of cure (FVU-PCR) for M. genitalium; it was positive. One week later he was commenced on moxifloxacin 400mg od for 7 days. We are currently awaiting his proof of cure.
Questions for discussion: 1) How common is M. genitalium macrolide resistance and what are its drivers? 2) Is moxifloxacin appropriate for widespread use as a second line treatment? 3) What impact will M. genitalium macrolide resistance have on current empiric non-specific urethritis (NSU) treatment protocols?
Literature review: The literature review will focus on current treatment data for M. genitalium urethral infections including azithromycin 1g stat, extended azithromycin (500gm stat then four days of 250mg od) and moxifloxacin and the impact of pre-treatment on drug resistance development. Fluoroquinolone resistance and cost will also be reviewed, as well as moxifloxacin side effects. Literature deficits will also be discussed in the context of changing empiric NSU protocols.
The case is of a 30 year-old HIV positive Zimbabwean woman (UK resident) who arrived in Australia in January 2011 on a one-year working visa. She was diagnosed with HIV in 2003 in the UK and commenced on Atripla® in 2005. She was first seen in Adelaide in May 2011, requesting a script for Atripla.®.
Background: Liquid based anal Papanicolaou smears, followed by High Resolution Anoscopy (HRA) guided biopsies are increasingly being advocated to identify areas of High Grade Anal Intraepithelial Neoplasia (HGAIN). We hypothesized that the ability to identify HGAIN would increase with experience of the anoscopist, and that comparison with contemporary Papanicolaou smears might yield insights into technical abilities.
Indigenous Australians experience a greater burden of sexually transmitted infections, however are less likely than the general population to access sexual health services. We examined the effectiveness of an Indigenous cultural appropriateness audit in assessing a sexual health clinic with low rates of Indigenous clients.
Despite the high proportion of young people annually accessing general practices, including Aboriginal Medical Services (AMS), testing for Chlamydia trachomatis remains relatively low in urban areas. A project officer was employed within the Institute of Urban Indigenous Health (IUIH) to serve a mentoring and facilitation role for the SE Queensland network of AMS and their sexual health workers, with a view to improving testing, management and follow-up of chlamydia and other STIs by community controlled medical services.
Monocytes are a heterogeneous cell population having specialised functions and differing phenotype. They are a link between innate immune system and adaptive immune system therefore, to identify if immune activation exists in HIV-1 individuals with controlled virema and recovered CD4 T cell counts, we assessed cell surface monocyte activation markers (MAM) within the monocyte subsets.
Involving consumers in healthcare decisions is important for high quality care. We previously tested a brief, consumer-led intervention consisting of three questions in a trial employing trained, standardized patients. The intervention enhanced discussion of evidence and increased patient involvement. We now report a research translation study which tested implementation with real patients at a reproductive and sexual health clinic.