Anal cancer is more common in MSM and even more common if they have HIV. Anal intra-epithelial neoplasia (AIN) appears to be the precursor and considerable effort is being directed toward evaluating the effectiveness of screening for and treating AIN to prevent anal cancer. This is analogous to the cervical screening programs in wealthy countries. But AIN screening and treatment differs from cervical screening and treatment in several key ways that may delay its introduction into routine clinical care.
First we do not fully understand the natural history of AIN, and particularly why AIN is so prevalent (20 to 50% of HIV+ MSM) when anal cancer is relatively rare. Second, the process of screening for AIN is troubled by problems with non-specific cytology and a resulting high demand for uncomfortable high-resolution anoscopy. Third, there is no consensus on the ideal treatment for AIN; most treatments involve high rates of recurrence, complications, or both.
While we await resolution of these uncertainties, some guidelines recommend regular digital rectal examination (DRE) for early detection of anal cancer. Anal cancers smaller than 3cm when they are treated, have significantly lower recurrence rates and higher five-year survival, suggesting that regular digital examinations will be beneficial. Interim data from a retrospective analysis of anal tumour size will be presented. An ongoing study of routine DRE at Melbourne Sexual Health Centre suggests that the rate of referral for non-cancer diagnoses (false positives) is low and the examination is acceptable to MSM in the HIV clinic.
Over the past 20-30 years, the Premature Ejaculation (PE) treatment paradigm, previously limited to behavioural psychotherapy, has expanded to include drug treatment. Animal and human sexual psychopharmacological studies have demonstrated that serotonin and 5-HT receptors are involved in ejaculation and confirm a role for SSRIs in the treatment of PE. Multiple well-controlled evidence-based studies have demonstrated the efficacy and safety of SSRIs in delaying ejaculation, confirming their role as first-line agents for the medical treatment of lifelong and acquired PE. Daily dosing of SSRIs is associated with superior fold increases in IELT compared to on-demand SSRIs.
Western Australia’s (WA) Online Chlamydia Program was launched in February 2010 as a case-finding vehicle aimed to address increasing rates of genital Chlamydia trachomatis (CT). The free test can be accessed via two websites (http://www.getthefacts.health.wa.gov.au & http:// www.couldihaveit.com.au). Participants must be 16 years or older, have a mobile telephone, access to a computer with printer and the ability to visit a PathWest specimen collection site. Specimens are tested for both chlamydia and gonorrhoea. All results are faxed to Fremantle’s B2 sexual Health Clinic. Positive results are actioned, negative results are available via a toll-free number.
The concerning high prevalence of Chlamydia within the population of young people aged 16 – 25 in Australia has been well established. Creative strategies are required to overcome barriers to screening for this population, as improved screening rates will promote better understanding and management of this condition. Various initiatives have been designed to increase access to screening for young people, from awareness and education campaigns, to mail out home testing kits. Many initiatives have had limited success in overcoming inherent barriers to testing for this important population.
In the Plenary session ‘Communicating Healthy Sexuality’ I focused on the ways in which sexuality is represented in entertainment media. In this session I explore how an understanding of entertainment as a form can inform our interactions with media.
There have been many recent media debates and controversies in Australia over what sexuality education in schools should constitute. Concerns for sexual health can inform pushes for educating young people on topics such as hygiene, biology or safe sex. Yet other agendas privilege censorship, the teaching of abstinence, a focus on sexual morality or the inclusion of gay rights and other diverse perspectives. A review of the literature uncovered the key approaches to sexuality education, and 14 specific messages they offer young people about their sexuality. This presentation considers the relevance of these messages for gay, lesbian, bisexual, transgender and intersex students.
Repeat infection with Chlamydia trachomatis is common. If left untreated it can lead to onward transmission and in females it increases the risk of pelvic inflammatory disease by four-fold. In late 2008, Sydney Sexual Health Centre implemented a reminder system using short message service (SMS) to improve re-testing rates following treatment of chlamydial infection. Clinicians were advised to set up SMS reminders to be sent out at 3 months after the visit. We compared the frequency of re-screening within 1-4 months of the initial infection in women and heterosexual men who received the SMS in the 12 month period of January-December 2009 (intervention group) to a 18-month period before the SMS was introduced (historical control group) using a Chi-square test, and multivariate regression.