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Update in the management of Hepatitis C

Update in the management of Hepatitis C

With over 200 000 hepatitis C-infected individuals in Australia, many within the 20-40 year age group, HCV infection is a major public health problem and is likely to be so for several decades. Currently, of the estimated 5900 individuals with HCV-related cirrhosis, a significant proportion are likely to develop hepatic decompensation and hepatocellular carcinoma in the absence of effective treatment. There is now better understanding of factors that are associated with progressive liver disease or with poor treatment outcomes. These include well-recognised host characteristics such as older age, duration of infection, excessive alcohol use, immunosuppression and co-infections with HIV and other hepatitis viruses as well as more recently identified features including hepatic steatosis, insulin resistance and certain genetic polymorphisms (e.g. PNPLA3, IL-28B).

The treatment of chronic hepatitis C has evolved from interferon monotherapy through to the current standard of care, pegylated interferon with ribavirin. While the sustained viral response rates (SVR) of 75-80% for those infected with HCV genotypes 2 and 3 have been encouraging, the SVR rates for individuals with genotype 1 (~40-50%) have been less impressive. However, this is set to change with the introduction of the newer directly acting antiviral agents that target specific points within the virus lifecycle. Of these, telaprevir and boceprevir which are inhibitors of the HCV NS3/4A protease have been recently approved by the US FDA. Phase III studies using these drugs have shown higher SVR (~65-70%) rates in both treatment-naive as well as for treatment-experienced individuals with genotype 1 HCV infections. Improved SVR rates have also documented with difficultto- subgroups: persons with cirrhosis, African-Americans, null-responders. However, these intensive treatment regimes will incur greater cost and will place greater demands on treating healthcare professionals due to the complexity of the treatment schedules and for the management of side-effects.

Australasian Sexual Health Conference 2011

Current Medical Treatment of Premature Ejaculation

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.

The importance of mobility in sustaining high STI prevalence in remote indigenous communities

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.

Gay men prefer partner notification by short message service (SMS) rather than e-postcards: a web-based evaluation

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.

Lighting the fire, not filling the pail - positioning sexuality in the Australian curriculum

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. 

Oropharyngeal carcinoma related to human papillomavirus

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.

High chlamydia prevalence found among young Australian men and women - results from the Australian Chlamydia Control Effectiveness Pilot (ACCEPt).

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.

Surgical Aspects of Transgender Medicine

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.