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.
Sydney Sexual Health Centre (SSHC) commenced an express STI clinic (Xpress) for asymptomatic clients in March 2010, utilising CASI and self-collected samples. Client feedback and satisfaction was assessed over 6 months and comparisons made between priority groups. This was a cross sectional study questionnaire. Results were stratified by gender, MSM status, age (<25/>25) and sex work.
Since young adults and high-risk populations with health inequities bear the significant portion of infections, more acceptable tests such as point of care tests (POCT) and more easily available techniques for diagnosing STIs, are required in order to address the epidemic of STDs. Molecular tests for the detection of STIs are now the gold standard for diagnosing Chlamydia trachomatis infections, such assays are becoming increasing available, and are now recommended as the tests of choice by the Centers for Disease Control and Prevention.
Antenatal testing for STIs and BBVs has been recommended by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) since 1992. In 2007, the Department of Health, Western Australia (DoH) issued an Operational Directive (OD) recommending additional testing for chlamydia, repeat testing at 28-36 weeks gestation if at high risk and further testing, including gonorrhoea, for those in the STI-endemic region of WA.
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.