ASHM Report Back
Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.
Day one of the Australasian Sexual Health Conference 2016
Day one of the Australasian Sexual Health Conference 2016 included presentations showing: advances in resistance testing and POCT for common STI’s, novel treatments of MG, possible reasons why Australia lags behind in LARC uptake, Australia-specific barriers to termination of pregnancy, as-well as issues such as the importance of a multi-layered representation of aboriginal men to aid with engagement around sexual health and how policy is protective of LGBTIQ young people in Australia.
Associate Professor Rebecca Guy discussed the challenges of STI testing amongst aboriginal communities in remote areas. She reported the average time to treatment being 21 days due to population mobility and distance to lab, with 1 in 5 not receiving treatment at all.
In 2011 12 rural health services trained aboriginal nurses and health-workers to perform a POCT for CT/NG (‘Xpert’). This meant results could be given within 90 minutes. Treatment uptake increased to 96.2% (treatment uptake for the standard was 88.3%). The mean time to treatment reduced from 19 to 4 days with 80% being treated within 7 days (compared with 48.5% previously). Future studies will look at POCT for NG/CT cost effectiveness.
MG remains a concern with increasing resistance to azithromycin and moxifloxacin. Associate Professor Catriona Bradshaw explained how Pristinamycin could not be considered an alternative treatment in those where azithromycin had already failed due to a disappointing cure rate of only 75%. However, Pristinamycin may have a role in special circumstances such as pregnancy as it is safe with few side effects.
Dr Elina Trembizki proposed PCR resistance testing could individualise NG treatment by accurately predicting ciprofloxacin susceptibility through TCC/ TTC wild type detection. It possible NG resistance to ciprofloxacin may by over represented through traditional culture methods though this should only be interpreted in an Australia context.
In the reproductive health lectures Mary Stewert highlighted the need for contraception education in men as although survey through a dating website revealed high rates of contraception use there was a lack of awareness of LARC’s and many believed hormonal contraception especially the ECP to be harmful which could negatively influence female partner decision.
Australia still lags behind in LARC with only a 3.2% uptake compared with 13.9% worldwide. Dr Amy Moten dispelled myths about IUDs explaining that PID rates are now <1-2% regardless of age and only in first 20 days post insertion after which time risks go back to baseline. Studies have even shown that there is no benefit of removing IUD in PID unless there is no improvement in clinical status after 48-72hours. Therefore PID should not be a barrier to IUD’s. Gabrielle Lodge looked at GP perspectives towards IUD insertion revealing barriers to include cost to train, minimal Medicare rebate and de-skilling due to small patient load.
There was a call to make MTOP de-centralised and so more accessible and affordable. As despite misoprostol being available on PBS professor Angela Taft found many women find cost a significant barrier. Spontaneous discussion highlighted women’s experiences can vary widely depending on the state. Lauren Coelli described a successful nurse-led approach used in Victoria and emphasised importance in training all members of the MDT including receptionist staff to de-stigmatise.
Other interesting lectures included Dr Deborah Bateson speaking about POP (75mcg desogesterol - not available in Australia) as a treatment for migraine possibly due to anovulation. Associate professor David Templeton who presented the increased follow up of victims of sexual assault due to improved relationship between sexual assault and sexual health services, councillors calling individuals to make appointment, separate waiting room, councillor obtaining sexual history, and personal phone call with negative results. >10% of these patients had an STI showing the importance and benefit of proactive follow up. Todd Fernando discussed how the media/ literature fuelled view of aboriginal men either being heterosexual or hyper-sexualised MSM needs to be remedied to aid engagement with sexual health services and Tiffany Jones talked about how policy made LGBTIQ young people feel safe. Lack of policy and poor education in schools around LGBTIQT leads to increased bullying, days off school, self harm and suicide whereas promoting activism can me protective.