Day 2 - I found Christopher Fairley, Melbourne Sexual Health Centre, Alfred Health, VIC, Australia witty and captivating!

He gave a quick talk on Pharyngeal Gonorrhoea questioning WHY is it SO common in MSM - why not Chlamydia or HPV??

Are they kissing more partners? 

As there's no difference in rates of oral sex between MSM and MSW or the rate of transmission if they only kiss or kiss plus have sex.....it doesn't make sense!!

He suggests that gonorrhoea is transmitted in saliva and saliva is used as a lube when rimming and that the penis is irrelavant to transmission of gonorhoea in MSM.

He also spoke about using an antibacterial mouthwash such as Listerine to substantially reduce transmission of gonorrhoea 

Day 2 started off really well with a great presentation from Rebeca Guy, Associate Professor, The Kirby Institute, UNSW, Australia about using New Technology in STI clinics.....IT! Young people have access to IT 24/7

Basically, when someones at risk of an STI, they want an appointment ASAP so why not use electronic self registration and appointments, they can then use a computer assisted survey instrument (CASI) to input their sexual history = cuts down time, avoids awkward questions and more honest answers are given!

CASI can also be used for self collection of samples with Enrolled Nurse staffing = increase in clinic capacity, halves waiting time and process, therefore more clients seen!

In GP clinics there's a problem with low rate of Chlamydia testing in 15-29 years. Studies show that 73.4% of CT cases are asymptomatic and are attending the GP clinic for a non sexual health problem! Computer prompts could help and in a trial of 68 clinics using computer prompts there was a 30% increase in testing!

Having these computer prompts for STI screening can also be helpful in Aboriginal Adult health checks = 10% +ve STI's found using very little resources.

SMS reminders for treatment and recall in remote areas = quicker and higher numbers treated. Also SMS reminders for TORI /POC shows 64% of clients attending for recall but only 30% without SMS reminder.

Point of care technology gives results for CT/NG in 90 minutes, with high accuracy = quick treatment

Websites such as "Let them know" allow clients to notify partners by SMS, email, letter and has high usage, around 20,000 SMS's sent/year.

Online education can be used for parents and kids.

When a 2013 study asked secondary school age kids about reasons for not using condoms, one of the answers was "sex just happened and we didn't have a condom" But there's even an APP for condom delivery! Mind you it takes 1 hour and costs $15!!

Online resources for meeting people like Tinder would be a great opportunity to provide information on STI clinics, where to get tested, postal test kits etc

I'll definitely take back some of these ideas to Sexual Health Quarters in Perth (SHQ) especially CASI which would be so good to use in our extremely busy drop in STI clinics.

Gemma Sharp from the School of Psychology, Flinders University,S.A talked to us about the project she's involved in looking at Labiaplasty. I found this really interesting but results were pretty predictable.

She told us it's the most popular form of genital cosmetic surgery and Australia has seen a 3-fold increase from 2000-2014. It involves the reduction of the labia minora.

She was looking at the factors that motivate women to undergo labiaplasty and the psychological outcomes using two studies.

In study 1 (qualitative study) She interviewed 14 Australian women 5-16 months post surgery and identified five themes:

1 Media influence - comparing themselves with online genital images

2 Negative comments about genital appearance

3 Physical discomfort over aesthetic concerns

4 Satisfaction with surgery

5 Sexual wellbeing

86% of the women expressed concerns with labial appearance, large labia impacting their sex lives and feeling ashamed about how their labia looks.

After labiaplasty 71% of the women stated an improvement in self- consciousness, feeling more comfortable having sex and feeling more free. But 29% still had concerns after labiaplasty. 

She concluded that psychosexual counselling might be an option for these women.

In study 2 (quantitative study) she looked at the effects on intimate relationships and psychological well being, using 29 labiaplasty patients compared to 22 general gyne patients.

She found that overall the labiaplasty patients were satisfied >80% and only 35% reported complications (infections/severe discomfort) but there were no significant changes in relationship quality, sexual confidence, psychological distress, self-esteem or life satisfaction.

She concluded that although labiaplasty improves genital appearance, it has no effect on psychological factors and preoperative relationship status and psychological distress predict dissatisfaction with outcomes.

Again she thought it was important to think about psychological treatment.

Amber D'Souza, Associate Professor, Johns Hopkins Bloomberg School of Public Health, USA gave a fantastic talk in the opening plenary today in Adelaide.

She talked about HPV causing >5% of cancers worldwide, >600,000 globally mainly cervical cancer.

12/100,000 - Cervical

8/100,000 - Oral

2/100,000 - Anal

She told us that the uptake of the HPV vaccine in Australia is 71.2%, UK is 60.4% but only 33.4% in US were there is no school based program and in 2014 the vaccine was available in over 75 countries but many low income countries are still missing the vaccine program.

Interestingly in the US they've seen a growing number of HPV positive oropharyngeal cancers especially in men. 2.4% per year in men 45 years and older but only 1% per year in women 45-64 years but all other head and neck squamous cell carcinomas have reduced ?due to reduction in smoking.

She said the lifetime risk of oral HPV infections in men was 3-30% but only 1-8% in women and one of the reasons why could be that cervical fluid has a higher viral load than the throat?

Risk factors were recent oral sex in last 3 months and the risk increased if the man had performed oral sex on a woman rather than a man. But interestingly, HPV is low in lesbian women which suggests that women get an auto immune response to previous HPV infections.

Gender - there is a 5 fold infection rate in men compared to women.

Race - HPV is higher  in white men compared to black or Mexican American men, does this mean that white men have more oral sex?

So with the same number of lifetime partners, men have a higher risk of orophryngeal HPV and a lower rate of clearing the virus.

Then she told us about Anal cancer that effects 2/100,000

Risk factors include receptive anal sex and in MSM 10-20/100,000 are +ve for anal HPV, that number is higher in HIV+ve MSM and these figures are increasing by 4-5% per year in US and Australia

Clearance usually takes 1-2 years 

She then went on to talk about the effects of HIV on HPV were the acquisition of HPV is higher in anyone with immuno suppression and clearance is less likely. The rate of HPV in people with HIV is 60%

In 2001-2005 29% of men with anal cancer also had HIV, making anal cancer the 4th most common type of cancer in HIV +ve men 

She summarized by saying that the changing landscape of HPV and related diseases needs to focus on prevention and screening for HPV DNA.