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.
Despite high rates of screening and treatment in many remote Indigenous communities in Australia, diagnosis rates for sexually transmitted infections (STI), chlamydia and gonorrhoea in particular, remain alarmingly high. One contributing factor may be the high rate of temporary mobility for residents of remote communities. We use mathematical modelling to explore the impact of mobility on STI transmission within remote communities.
In 2006 two new innovative features were added to the WhyTest website; the ‘Tell them’ service allowing visitors to forward anonymous e-postcard or short message services (SMS) to sexual partners who may have been exposed to an STI, and the ‘remind me’ service allowing visitors to register for a 3, 6 or 12 monthly SMS reminder for a sexual health check. We describe the usage of the new website functionality, and recognition of a health promotion campaign conducted in January-June 2007 to promote these new features.
This symposium presentation will discuss conceptual approaches to how processes underway to develop the Australian Curriculum might link to improved sexual health outcomes. It will also explore the assumptions underpinning the ‘partnership’ between health and education sectors to uncover both the opportunities and the pitfalls for those who want to promote young people’s learning.
Human papillomavirus (HPV) induced oropharyngeal squamous cell carcinoma is a unique subtype of oropharyngeal cancer. It has a significantly better prognosis than that caused by tobacco and/ or alcohol. The incidence of HPV related oropharyngeal cancer is raising in the western countries.
ACCEPt is a multi-state cluster randomised trial that aims to increase annual chlamydia testing in 16-29 year olds attending general practice. 54 postcodes (80% in rural areas) are being randomised to a multi-faceted intervention and GP clinics within each postcode enrolled. The primary outcome is change in chlamydia prevalence, and a prevalence study is being conducted at the beginning and end of the trial. We report on the findings of the baseline prevalence study.
Surgery for gender dysphoria was not routinely available prior to the 80’s, surgery and psychiatry having had an unhappy liaison. While gender dysphoria is DSM classified it’s not because it is deemed to be an illness, rather than to give guidelines as to establishing a diagnosis, and surgery is now deemed to be an appropriate activity.