tag:theconversation.com,2011:/global/topics/chlamydia-1029/articlesChlamydia – The Conversation2023-09-14T02:49:04Ztag:theconversation.com,2011:article/2116102023-09-14T02:49:04Z2023-09-14T02:49:04ZKoalas need their booster shots too. Here’s a way to beat chlamydia with just 1 capture and less trauma<p>Chlamydia is a major threat to koala populations across Australia. This bacterial disease infects between 20% and 90% of individuals in koala populations. It’s a <a href="https://www.nature.com/articles/srep42587">major cause</a> of the rapid decline of many wild populations, particularly in South-East Queensland and northern New South Wales. </p>
<p>Our group at Queensland University of Technology (QUT) has developed two vaccines to target chlamydial infections. One of these vaccines, now being trialled in collaboration with Dr Michael Pyne and his staff at Currumbin Wildlife Hospital, has recently had some <a href="https://currumbinsanctuary.com.au/wildlife-hospital/koala-chlamydia-vaccine-research-trial">outstanding results</a> in a wild koala population on the Gold Coast. This population had been declining rapidly due to high rates of the disease. </p>
<p>Two years into the five-year trial, we have seen more than 25 joeys born to vaccinated females. The program involved vaccinating, collaring and releasing 10-20% of young animals each year. All joeys and mums were chlamydia-free. In addition, 11 out of 13 young males vaccinated remain negative at 12–24 months after vaccination. </p>
<p>Like most vaccines, however, this vaccine requires two shots, 30 days apart. This means wild animals must be held in captivity for a month, which many don’t like, or released and recaptured for the booster dose. This is both expensive and <a href="https://theconversation.com/testing-the-stress-levels-of-rescued-koalas-allows-us-to-tweak-their-care-so-more-survive-in-the-wild-196224">traumatic</a> for the animals. </p>
<p>It was during a chat over coffee a few years ago that we first pondered the question, “Could we develop a delayed-release vaccine implant that is given at the same time as the first vaccine and releases the booster vaccine dose 30 days later?”</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/testing-the-stress-levels-of-rescued-koalas-allows-us-to-tweak-their-care-so-more-survive-in-the-wild-196224">Testing the stress levels of rescued koalas allows us to tweak their care so more survive in the wild</a>
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</em>
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<h2>Why vaccination is the best approach</h2>
<p>Chlamydia is spread by <a href="https://www.livescience.com/62517-how-koalas-get-chlamydia.html">direct physical contact</a> between koalas. Symptoms include blindness, urinary tract infections (wet bottom), infertility in females and sperm damage in males. </p>
<p>While antibiotics can be used to treat the eye disease, they cannot be used to treat infertility. This is because antibiotics can destroy the gut bacteria essential for koalas to digest their food, eucalypt leaves. </p>
<p>The vaccine is the best option and is also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6955670/">very safe</a>. We detected no adverse side-effects across multiple studies. The only complication is the need for a booster shot.</p>
<p>So are implants a solution? Our recent <a href="https://academic.oup.com/biolreprod/article/108/5/758/7044671">research</a> suggests the answer is yes, at least in a sheep model. We have now received a grant from the federal <a href="https://www.dcceew.gov.au/environment/biodiversity/threatened/species/koalas/saving-koalas-fund">Saving Koalas Fund</a> to develop this implant technology for a koala vaccine against the <em>Chlamydia</em> bacterium. </p>
<p>In our sheep trial of a first-generation implant, animals that received the primary vaccination by injection plus a booster implant developed immune T cell numbers equivalent to animals receiving two vaccinations by injection, together with slightly reduced antibody levels. </p>
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<a href="https://images.theconversation.com/files/547927/original/file-20230913-21-o53nya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/547927/original/file-20230913-21-o53nya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/547927/original/file-20230913-21-o53nya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/547927/original/file-20230913-21-o53nya.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/547927/original/file-20230913-21-o53nya.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/547927/original/file-20230913-21-o53nya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/547927/original/file-20230913-21-o53nya.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/547927/original/file-20230913-21-o53nya.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The implant (shown next to a 10-cent coin for a size comparison) is inserted into a koala when it receives its first vaccination, meaning the animal has to be captured only once.</span>
<span class="attribution"><span class="source">Kenneth Beagley</span></span>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-cull-could-help-save-koalas-from-chlamydia-if-we-allowed-it-49195">A cull could help save koalas from chlamydia, if we allowed it</a>
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</em>
</p>
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<h2>How does the implant work?</h2>
<p>The implant is a polymer tube developed by the QUT team. It borrows from technology already used by the group for making polymer scaffolds to support tissue growth. The team screened a range of biodegradable polymers for ones that would degrade over just a few weeks. They also had to be flexible enough to not break prematurely when implanted beneath the skin. </p>
<p>Manufacturing the polymer pellets into tubes allows the booster vaccine to be filled into the tube. It’s similar in size to the human <a href="https://www.healthdirect.gov.au/contraceptive-implant">Implanon contraceptive implant</a>. </p>
<p>When the koala is injected with the first dose, the implant is also inserted under the skin. This starts a process of slow degradation of the implant until the walls of the tube fail and the vaccine is released as a burst. What is left of the implant dissolves as chemicals naturally found in the body. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1698848485875880339"}"></div></p>
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Read more:
<a href="https://theconversation.com/a-new-3d-koala-genome-will-aid-efforts-to-defend-the-threatened-species-153873">A new 3D koala genome will aid efforts to defend the threatened species</a>
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<h2>What’s the next step?</h2>
<p>To scale up the implants we are working with a company in the United States to develop methods to manufacture thousands of implants at once. Our federal funding will allow us to fine-tune a second-generation implant to deliver the chlamydia vaccine to koalas. We will test it for safety in sheep and then evaluate the implant in captive-bred koalas at Currumbin Wildlife Sanctuary. </p>
<p>Our ultimate aim is to be able to capture a wild koala once only and test it for chlamydia. This would be done using a rapid test we have developed. The test can be done in the back of a 4WD vehicle and takes 20–30 minutes.</p>
<p>If the koala is chlamydia-free, we would then vaccinate with the implant and release the animal back into the wild.</p><img src="https://counter.theconversation.com/content/211610/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ken Beagley receives funding from the Saving Koalas fund, the ARC and owns shares in PolVax Pty Ltd </span></em></p><p class="fine-print"><em><span>Tim Dargaville receives funding from the Saving Koalas Fund, the Australian Research Council and owns shares in PolVax Pty Ltd. </span></em></p>Chlamydia is devastating for koalas, but the vaccine to prevent infection requires a booster shot. Recapturing the animals for their booster shot is costly and stresses them, but there’s a solution.Kenneth W Beagley, Professor of Immunology, Queensland University of TechnologyTim Dargaville, Professor of Polymer Chemistry, Queensland University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1934632022-11-03T04:01:35Z2022-11-03T04:01:35ZDoes picking your nose really increase your risk of dementia?<figure><img src="https://images.theconversation.com/files/492900/original/file-20221102-25-w2yeid.jpg?ixlib=rb-1.1.0&rect=41%2C792%2C3981%2C3391&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/man-in-blue-denim-button-up-shirt-picking-nose-4584166/">Ketut Subiyanto/Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p><em><a href="https://theconversation.com/au/topics/research-check-25155">Research Checks</a> interrogate newly published studies and how they’re reported in the media. The analysis is undertaken by one or more academics not involved with the study, and reviewed by another, to make sure it’s accurate.</em></p>
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<p>No matter your age, we all pick our nose. </p>
<p>However, if gripping headlines around the world are a sign, this habit could increase your risk of Alzheimer’s disease, the most common form of dementia.</p>
<p>One international news report <a href="https://www.the-sun.com/health/6565520/common-habit-increase-risk-alzheimers-dementia/">said</a>:</p>
<blockquote>
<p>‘SCARY EVIDENCE’ How a common habit could increase your risk of Alzheimer’s and dementia</p>
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<p>Another <a href="https://www.mirror.co.uk/news/health/alzheimers-disease-risk-increased-picking-28378042">ran with</a>:</p>
<blockquote>
<p>Alzheimer’s disease risk increased by picking your nose and plucking hair, warns study</p>
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<p>An Australian news article <a href="https://www.sbs.com.au/news/article/could-picking-your-nose-lead-to-dementia-australian-researchers-are-digging-into-it/rn7xqef2w">couldn’t resist a pun</a>:</p>
<blockquote>
<p>Could picking your nose lead to dementia? Australian researchers are digging into it.</p>
</blockquote>
<p>Yet if we look at the research study behind these news reports, we may not need to be so concerned. The evidence connecting nose picking with the risk of dementia is still rather inconclusive.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-causes-alzheimers-disease-what-we-know-dont-know-and-suspect-75847">What causes Alzheimer’s disease? What we know, don’t know and suspect</a>
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<h2>What prompted these headlines?</h2>
<p>Queensland researchers published <a href="https://www.nature.com/articles/s41598-022-06749-9">their study</a> back in February 2022 in the journal Scientific Reports. </p>
<p>However, the results were not widely reported in the media until about eight months later, following a <a href="https://news.griffith.edu.au/2022/10/28/new-research-suggests-nose-picking-could-increase-risk-for-alzheimers-and-dementia/">media release</a> from Griffith University in late October. </p>
<p>The media release had a similar headline to the multiple news articles that followed:</p>
<blockquote>
<p>New research suggests nose picking could increase risk for Alzheimer’s and dementia</p>
</blockquote>
<p>The media release clearly stated the research was conducted in mice, not humans. But it did quote a researcher who described the evidence as “potentially scary” for humans too.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/is-this-study-legit-5-questions-to-ask-when-reading-news-stories-of-medical-research-117836">Is this study legit? 5 questions to ask when reading news stories of medical research</a>
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</em>
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<h2>What the study did</h2>
<p>The researchers wanted to learn more about the role of <em>Chlamydia pneumoniae</em> bacteria and Alzheimer’s disease.</p>
<p>These bacteria have been found in brains of people with Alzheimer’s, although <a href="https://academic.oup.com/femspd/article/48/3/355/506227?login=true">the studies</a> were completed more than <a href="https://doi.org/10.1007/s004300050071">15 years ago</a>.</p>
<p>This bacteria species can cause respiratory infections such as pneumonia. It’s not to be confused with the chlamydia species that causes sexually transmitted infections (that’s <em>C. trachomatis</em>).</p>
<p>The researchers were interested in where <em>C. pneumoniae</em> went, how quickly it travelled from the nose to the brain, and whether the bacteria would create a hallmark of Alzheimer’s disease found in brain tissue, the amyloid β protein.</p>
<p>So they conducted a small study in mice.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/493175/original/file-20221103-22-znvia5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="White mouse in open cage with raised nose" src="https://images.theconversation.com/files/493175/original/file-20221103-22-znvia5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/493175/original/file-20221103-22-znvia5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=432&fit=crop&dpr=1 600w, https://images.theconversation.com/files/493175/original/file-20221103-22-znvia5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=432&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/493175/original/file-20221103-22-znvia5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=432&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/493175/original/file-20221103-22-znvia5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=543&fit=crop&dpr=1 754w, https://images.theconversation.com/files/493175/original/file-20221103-22-znvia5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=543&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/493175/original/file-20221103-22-znvia5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=543&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The study, which was conducted in mice, didn’t mention nose picking.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/funny-curious-white-rat-looking-out-402796495">Shutterstock</a></span>
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<p>The researchers injected <em>C. pneumoniae</em> into the noses of some mice and compared their results to other mice that received a dose of salty water instead.</p>
<p>They then waited one, three, seven or 28 days before euthanising the animals and examined what was going on in their brains.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/of-mice-and-men-why-animal-trial-results-dont-always-translate-to-humans-73354">Of mice and men: why animal trial results don’t always translate to humans</a>
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</em>
</p>
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<h2>What the study found</h2>
<p>Not surprisingly, the researchers detected more bacteria in the part of the brain closest to the nose in mice that received the infectious dose. This was the olfactory brain region (involved in the sense of smell). </p>
<p>Mice that had the bacteria injected into their noses also had clusters of the amyloid β protein around the bacteria. </p>
<p>Mice that didn’t receive the dose <em>also</em> had the protein present in their brains, but it was more spread out. The researchers didn’t compare which mice had more or less of the protein. </p>
<p>Finally, the researchers found that gene profiles related to Alzheimer’s disease were more abundant in mice 28 days after infection compared with seven days after infection.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/when-you-pick-your-nose-youre-jamming-germs-and-contaminants-up-there-too-3-scientists-on-how-to-deal-with-your-boogers-185052">When you pick your nose, you're jamming germs and contaminants up there too. 3 scientists on how to deal with your boogers</a>
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</em>
</p>
<hr>
<h2>How should we interpret the results?</h2>
<p>The study doesn’t actually mention nose-picking or plucking nose hairs. But the media release quoted one of the researchers <a href="https://news.griffith.edu.au/2022/10/28/new-research-suggests-nose-picking-could-increase-risk-for-alzheimers-and-dementia/">saying</a> this was not a good idea as this could damage the nose:</p>
<blockquote>
<p>If you damage the lining of the nose, you can increase how many bacteria can go up into your brain.</p>
</blockquote>
<p>The media release suggested you could protect your nose (by not picking) and so lower your risk of Alzheimer’s disease. Again, this was not mentioned in the study itself.</p>
<p>At best the study results suggest infection with <em>C. pneuomoniae</em> can spread rapidly to the brain – in mice. </p>
<p>Until we have more definitive, robust studies in humans, I’d say the link between nose picking and dementia risk remains low. <strong>– Joyce Siette</strong></p>
<hr>
<h2>Blind peer review</h2>
<p>Nose picking is a life-long common human practice. <a href="https://pubmed.ncbi.nlm.nih.gov/7852253/">Nine in ten people</a> admit doing it. </p>
<p>By the age of 20, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6345537/">some 50% of people</a> have evidence of <em>C. pneumoniae</em> in their blood. That rises to 80% in people aged 60-70. </p>
<p>But are these factors connected? Does one cause the other?</p>
<p>The study behind these media reports raises some interesting points about <em>C. pneumoniae</em> in the nasal cavity and its association with deposits of amyloid β protein (plaques) in the brain of mice – not humans. </p>
<p>We cannot assume what happens in mice also applies to humans, for a number of reasons.</p>
<p>While <em>C. pneumoniae</em> bacteria may be <a href="https://academic.oup.com/femspd/article/48/3/355/506227?login=true">more common</a> in people with late-onset Alzheimer’s disease, association with the hallmark amyloid plaques in the mouse study does not necessarily mean one causes the other. </p>
<p>The mice were also euthanised at a maximum of 28 days after exposure, long before they had time to develop any resultant disease. This is not likely anyway, because mice do not naturally get Alzheimer’s.</p>
<p>Even though mice can accumulate the plaques associated with Alzheimer’s, they <a href="https://www.nature.com/articles/d41586-018-07484-w#:%7E:text=Alzheimer's%20is%20marked%20by%20cognitive,not%20occur%20naturally%20in%20mice">do not display</a> the memory problems seen in people.</p>
<p>Some researchers have also argued that amyloid β protein deposits in animals are different to humans, and therefore <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813509/">might not be suitable</a> for comparison.</p>
<p>So what’s the verdict? </p>
<p>Looking into risk factors for developing Alzheimer’s is worthwhile. </p>
<p>But to suggest picking your nose, which introduces <em>C. pneumoniae</em> into the body, may raise the risk of Alzheimer’s in humans – based on this study – is overreach. <strong>– Mark Patrick Taylor</strong></p><img src="https://counter.theconversation.com/content/193463/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mark Patrick Taylor works for the Environment Protection Authority (EPA) Victoria. He is the Executive Director of EPA Science and is also Victoria's Chief Environmental Scientist.
</span></em></p><p class="fine-print"><em><span>Joyce Siette does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We dug into what was behind the headlines on nose-picking and dementia so you don’t have to. Here’s what the study really says.Joyce Siette, Research Theme Fellow, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1573182021-03-18T01:32:42Z2021-03-18T01:32:42ZWhat is Mycoplasma genitalium, the common STI you’ve probably never heard of<figure><img src="https://images.theconversation.com/files/390232/original/file-20210317-21-14e4lym.jpg?ixlib=rb-1.1.0&rect=0%2C1%2C998%2C661&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-man-hands-holding-his-crotch-769304695">from www.shutterstock.com</a></span></figcaption></figure><p><em><a href="https://www.fpv.org.au/for-you/sexually-transmissible-infections-blood-borne-viruses/mycoplasma-genitalium">Mycoplasma genitalium</a></em> (MG) is a sexually transmitted infection (STI) with many of the hallmarks of its better-known counterpart, <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/chlamydia">chlamydia</a>.</p>
<p>You can have MG without knowing it, or have symptoms; it can affect men and women, and it can be treated with antibiotics. </p>
<p>However, unlike chlamydia, we only have a limited number of antibiotics to treat it, due to a quirk in its cellular structure and the growing threat of antibiotic resistance. The antibiotics we need to use with resistant MG can also, uncommonly, have serious side-effects.</p>
<p>Here’s what you need to know about this common STI.</p>
<h2>What is it? How do I get it? How common is it?</h2>
<p>MG can affect both men and women, and is passed from person to person via their body fluids when they have sex. That can be via penile-vaginal sex or via penile-anal sex. Transmission via oral sex isn’t thought to be a big factor.</p>
<p>Several studies tell us MG is common, perhaps as common as chlamydia.</p>
<p>UK and US <a href="https://pubmed.ncbi.nlm.nih.gov/26534946/">data</a> <a href="https://pubmed.ncbi.nlm.nih.gov/33560093/">show</a> 1-2% of the adult population have it (making it about <a href="https://pubmed.ncbi.nlm.nih.gov/31794495/">as common as chlamydia</a>), and it is as common in men as in women. </p>
<p>In research yet to be published, when we tested women who walked through the door of our sexual health service in Melbourne, 6% had MG, which was as common as chlamydia (7%) in women in the same study. Of women with MG, roughly the same number had symptoms compared to no symptoms. When we tested <a href="https://pubmed.ncbi.nlm.nih.gov/30882306/">gay men without symptoms</a> who attended our service, 10% had MG.</p>
<p>However, we’re not entirely sure how many people are infected with MG throughout Australia. That’s because Australia has yet to set up a formal surveillance network (we’re in the middle of setting that up at the moment). MG is also not a notifiable disease yet. That means doctors or laboratories don’t have to tell health authorities when they have a case.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/390234/original/file-20210317-21-1ghrluf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Mycoplasma genitalium, as 3D rendered image" src="https://images.theconversation.com/files/390234/original/file-20210317-21-1ghrluf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/390234/original/file-20210317-21-1ghrluf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=300&fit=crop&dpr=1 600w, https://images.theconversation.com/files/390234/original/file-20210317-21-1ghrluf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=300&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/390234/original/file-20210317-21-1ghrluf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=300&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/390234/original/file-20210317-21-1ghrluf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=377&fit=crop&dpr=1 754w, https://images.theconversation.com/files/390234/original/file-20210317-21-1ghrluf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=377&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/390234/original/file-20210317-21-1ghrluf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=377&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Mycoplasma genitalium is a sexually transmitted infection that affects men and women.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/bacteria-mycoplasma-genitalium-3d-illustration-causative-1415788364">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<h2>How do I know if I have it?</h2>
<p>If you do have symptoms, these can resemble those of chlamydia. So the best thing is to go to your GP or sexual health clinic for a checkup, as the treatments are different.</p>
<p>If you’re a man with symptoms, they can vary from mild to moderate and include:</p>
<ul>
<li><p>mild irritation, an itch, or a burning sensation when urinating</p></li>
<li><p>a penile discharge, which may be clear or more like pus.</p></li>
</ul>
<p>For women, symptoms may include:</p>
<ul>
<li><p>a vaginal discharge</p></li>
<li><p>bleeding or pain with sex</p></li>
<li><p>abdominal pain (which may be a sign of <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/pelvic-inflammatory-disease-pid">pelvic inflammatory disease</a>).</p></li>
</ul>
<p>For men or women who have anal sex, symptoms may include:</p>
<ul>
<li>an itch or pain inside the anus, anal discharge and sometimes anal bleeding.</li>
</ul>
<p>Your doctor will take a urine sample for men and a vaginal swab for women. For men or women who have anal sex, they will take a rectal swab, or you will be instructed how to take it yourself. Samples will then be sent for laboratory testing.</p>
<h2>How is it treated?</h2>
<p>Once diagnosed, you’ll be treated with a course of oral antibiotics for about two weeks. Unfortunately, you may need several courses to cure the infection due to <a href="https://pubmed.ncbi.nlm.nih.gov/32622378/">increasing antibiotic resistance</a>. And some of these antibiotics can have side-effects. Occasional, but serious, side-effects include an abnormal heart rhythm, rupture of tendons and nerve damage.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-im-taking-antibiotics-when-will-they-start-working-107528">Health Check: I’m taking antibiotics – when will they start working?</a>
</strong>
</em>
</p>
<hr>
<h2>What happens if I leave it untreated?</h2>
<p>If the infection is left untreated in women, it can cause similar complications to chlamydia. Some women go on to develop <a href="https://pubmed.ncbi.nlm.nih.gov/32701123/">pelvic inflammatory disease</a>, although less commonly than with chlamydia. Pelvic inflammatory disease could, in turn, lead to infertility. If you’re pregnant, it can, uncommonly, lead to premature birth or miscarriage.</p>
<p>If left untreated in men there are no apparent complications but the main risk is men can infect new partners and reinfect treated partners. And for gay men, there’s <a href="https://pubmed.ncbi.nlm.nih.gov/19194271/">some data</a> to suggest a link between MG and HIV, although further studies are needed.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-make-your-next-sexual-health-check-less-erm-awkward-72498">How to make your next sexual health check less, erm ... awkward</a>
</strong>
</em>
</p>
<hr>
<h2>Can I still be tested even if I don’t have symptoms?</h2>
<p>Current guidelines both <a href="http://www.sti.guidelines.org.au/sexually-transmissible-infections/mycoplasma-genitalium">in Australia</a> and <a href="https://www.bashhguidelines.org/current-guidelines/urethritis-and-cervicitis/mycoplasma-genitalium-2018/">internationally</a> recommend testing people with symptoms, or sexual contacts of known cases. They <a href="https://www.thelancet.com/action/showPdf?pii=S2589-5370%2821%2900059-6">don’t recommend doctors screen</a> people <a href="https://www.theguardian.com/australia-news/2021/mar/17/gps-urged-not-to-test-gay-men-for-sti-super-bug-over-fears-it-will-become-more-antibiotic-resistant">without symptoms</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1371870337932132352"}"></div></p>
<p>When you screen, you have to be confident you have access to highly effective treatments, the treatments do not cause more harm than the condition itself and you have a good understanding of how often the condition progresses to cause complications.</p>
<p>For MG that balance is against screening currently. That’s because there are often no symptoms and we don’t yet fully understand how often the infection progresses to cause harm, although it seems to do so less often than chlamydia. The microorganism has also rapidly become so resistant to antibiotics we are having to use stronger and stronger ones, and multiple courses, to cure. This contrasts to chlamydia, which is easy to cure. </p>
<p>Not only do many antibiotics have side-effects, they affect the bacteria in people’s gut. These bacteria are important to keep us healthy, and if we bombard them with antibiotics it can affect our health and also lead to antibiotic resistance in a whole range of other bacteria, not just MG.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-know-why-bacteria-become-resistant-to-antibiotics-but-how-does-this-actually-happen-59891">We know _why_ bacteria become resistant to antibiotics, but _how_ does this actually happen?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/157318/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catriona Bradshaw receives funding from the NHMRC and ARC (government funding). Melbourne Sexual Health Centre has also received research support from Speedx Pty Ltd and Hologic Pty Ltd which are manufacturers of diagnostic assays for Mycoplasma genitalium. </span></em></p>You can have this STI without knowing it, or have symptoms, it can affect men and women, and it can be treated with antibiotics. Left untreated, it may cause complications.Catriona Bradshaw, Professor, Head of Research Translation and Head of the Genital Mycoplasma and Microbiota Group, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1115462019-02-13T13:22:47Z2019-02-13T13:22:47ZPreventing sexually transmitted infections: why South Africa isn’t winning<figure><img src="https://images.theconversation.com/files/258722/original/file-20190213-181619-mhgs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">STIs are a serious health threat. </span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Sexually transmitted infections (STIs) are a serious public health issue. It’s estimated that globally, more than a <a href="https://www.who.int/news-room/fact-sheets/detail/sexually-transmitted-infections-(stis)">million people</a> are diagnosed with one or more sexually transmitted infections like gonorrhoea, chlamydia or syphilis every day. What’s more concerning is that the prevalence of infection with chlamydia for example, have remained unchanged <a href="https://www.thelancet.com/commissions/sexually-transmitted-infections?dgcid=homepage-tile_banner_STI">over the past 10 years</a> despite better screening in developed countries.</p>
<p>As the name suggests, STIs are spread mainly through sexual contact. This includes vaginal, anal and oral sex; some infections can also be spread by non-sexual means – for example, from mother to child during pregnancy or childbirth. </p>
<p>STIs can have devastating effects on sexual, reproductive and general health. They can also lead to a number of complications. If left untreated chlamydia and gonorrhoea can cause damage to reproductive organs and result in long term complications such as infertility. People can even die if certain STIs such as syphilis are left untreated, or if they have complications such as pelvic inflammatory disease in the case of chlamydia. </p>
<p>To make matters worse, STIs increase the risk of <a href="https://www.catie.ca/en/pif/spring-2012/stis-what-role-do-they-play-hiv-transmission">HIV infection and transmission</a>. This is because the body’s response, which is meant to help fight the sexually transmitted infection, causes a concentration of “activated” immune cells in the infected area. It then becomes easy for HIV to infect and replicate in the immune cells that are “activated”.</p>
<p>So it’s cause for concern that South Africa, with – <a href="http://www.hsrc.ac.za/uploads/pageContent/9234/SABSSMV_Impact_Assessment_Summary_ZA_ADS_cleared_PDFA4.pdf">7.9 million people living with HIV in 2017</a> – also has a high volume of STIs.</p>
<p>In <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0205863">2017</a> there were an estimated 2.3 million new cases of gonorrhoea, 1.9 million new chlamydia cases and 23,175 new syphilis cases among women aged between 15 and 49. Among men of the same age there were an estimated 2.2 million new cases of gonorrhoea, 3.9 million new cases of chlamydia and 47,500 new cases of syphilis. </p>
<p>These high numbers of STI cases in South Africa have partly been due to inadequate prevention and treatment gaps. Some people with STIs such as chlamydia, may go untreated because they don’t show any symptoms. </p>
<p>Better STI screening for high risk clients – regardless of symptoms – and better training of healthcare workers is necessary. In addition, structural problems such as limited access to client-friendly STI detection and treatment services need to be addressed. Of course, all of this costs money, which is in short supply. That’s why the need for better prevention cannot be overstated. </p>
<h2>STI prevention in the past</h2>
<p>Prevention of STIs other than HIV has largely taken a backseat while the country focused on HIV prevention. HIV prevention concentrated on reducing the number of sexual partners people have, increasing the correct and consistent use of condoms, early detection and treatment, and promotion of male circumcision. These measures were of some benefit in preventing other STIs. </p>
<p>But the increasing availability of <a href="http://www.unaids.org/en/resources/presscentre/featurestories/2018/july/undetectable-untransmittable">antiretroviral drugs and advances in research</a> have brought a new message to people living with HIV: an HIV positive person with an undetectable viral load can’t transmit the virus to their HIV negative partner. </p>
<p>This message, however, does not directly address the transmission of STIs other than HIV. It focuses on HIV and how to manage it, but forgets that people with HIV may be vulnerable to other STIs. </p>
<p>Pre-exposure prophylaxis – another HIV prevention tool – involves taking antiretroviral medication to prevent HIV infection. <a href="https://prepfacts.org/prep/the-research/">Research</a> has shown that, if taken consistently and as intended, it can reduce the risk of acquiring HIV. But pre-exposure prophylaxis doesn’t protect people from other STIs. </p>
<p>Services to test for and treat STIs are included in pre-exposure prophylaxis services as a way of assessing levels of unprotected sex and sexual risk taking among users. But the take home message about the prevention of STIs in these settings is not clear. What counselling on STIs are pre-exposure prophylaxis clients receiving or should they be receiving? How should pre-exposure prophylaxis be promoted without compromising STI prevention? </p>
<h2>Renewed focus on STI prevention</h2>
<p>Strategies to prevent STIs must take into account the changes and advances in HIV prevention and treatment. Policies must answer a number of questions.</p>
<p>For instance, how can having fewer sexual partners, the correct and consistent use of condoms, the early STI detection and treatment of oneself and one’s partners, and male circumcision be made “fashionable” when HIV is not the death sentence that it used to be? </p>
<p>And what’s the best way to communicate that the knowledge of infections in oneself and the partner are key to preventing both HIV and other STIs? </p>
<p>It’s also important to explore how best to design prevention services that communicate how STIs and HIV happen in the context of transient, short-term or longer relationships. Policy makers need to understand, too, how people can be empowered to form, maintain or terminate relationships in a manner that does not place them in harm’s way with respect to HIV, STIs or intimate partner violence.</p>
<p>All of these issues must be urgently considered if South Africa is to tackle its STI problem as effectively as it’s been able to deal with HIV.</p><img src="https://counter.theconversation.com/content/111546/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tendesayi Kufa-Chakezha does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>STI prevention was largely driven by HIV prevention. With changes in HIV prevention initiatives that don’t really take into account other STIs, there’s need to refocus STI prevention.Tendesayi Kufa-Chakezha, Epidemiologist and Public Health Specialist, National Institute for Communicable DiseasesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/842102017-09-21T03:00:01Z2017-09-21T03:00:01ZPunishing one person for STI transmission weakens public health efforts<figure><img src="https://images.theconversation.com/files/186712/original/file-20170920-895-18as0ho.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In most Australian states, if you have certain STIs, you have a legal responsibility to notify your potential sexual partners.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>Is one person to blame if another gets a sexually transmissible infection (STI)? In most Australian states, if you have certain STIs, you have a legal responsibility to notify your potential sexual partners. </p>
<p>The NSW government <a href="http://www.news.com.au/national/nsw-act/con-or-condom-uproar-over-changes-to-hiv-and-sti-disclosure-law/news-story/7e07c4f76526d4073f5f423e3303da07">last week</a> passed an amendment to the state’s <a href="https://www.parliament.nsw.gov.au/bills/Pages/bill-details.aspx?pk=3426">Public Health Act</a> that increased the associated penalties by doubling the maximum fines and adding potential jail time. </p>
<p>Section 79 (1) of the Act <a href="https://www.parliament.nsw.gov.au/bills/DBAssets/bills/BillText/3426/b2016-144-d26_House.pdf">now reads</a>:</p>
<blockquote>
<p>A person who knows that he or she has a notifiable disease, or a scheduled
medical condition, that is sexually transmissible is required to take reasonable
precautions against spreading the disease or condition.</p>
<p>Maximum penalty: 100 penalty units or imprisonment for 6 months, or both.</p>
</blockquote>
<p>In addition to increasing potential penalties, the amendment removed an earlier provision mandating disclosure of STI status, replacing it instead with the need for “reasonable precautions”. </p>
<p>This is a positive change for the law that reflects the best available research on STIs and transmission. Yet its coupling with increased penalties has sent a mixed message about sexual health in the state. </p>
<p>Further, the idea that punishing STI exposure or transmission will decrease rates of infection is <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2128015">not supported by global research</a> on HIV, and there is no reason to believe this would be any different for other STIs. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/moral-responsibilities-to-disclose-your-hiv-status-to-partners-arent-so-clear-cut-51383">Moral responsibilities to disclose your HIV status to partners aren't so clear-cut</a>
</strong>
</em>
</p>
<hr>
<h2>Laws across Australia</h2>
<p>Health law is pretty complex and mainly left up to each state and territory. Generally speaking, across Australia you risk some kind of punishment for knowingly infecting another person with what are often referred to as “<a href="http://www.health.gov.au/internet/main/publishing.nsf/content/cda-pubs-cdi-2000-cdi2408-cdi2408g.htm">notifiable diseases</a>”. This list covers a range of infections but STIs include chlamydia, gonorrhoea, syphilis, HIV, shigella, donovanosis, and hepatitis a, b and c. </p>
<p>In some states, notably <a href="https://www.legislation.nsw.gov.au/#/view/act/2010/127">New South Wales</a>, <a href="https://www.legislation.tas.gov.au/view/whole/html/inforce/current/act-1997-086">Tasmania</a> and <a href="https://www.health.qld.gov.au/publichealthact">Queensland</a>, it’s an offence just to knowingly expose someone to an infection, even if they don’t actually become infected. While in other states, like <a href="https://www.google.com.au/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwiou86chLPWAhXDTbwKHbZXAYUQFggoMAA&url=http%3A%2F%2Fwww.legislation.vic.gov.au%2FDomino%2FWeb_Notes%2FLDMS%2FPubStatbook.nsf%2Ff932b66241ecf1b7ca256e92000e23be%2F8B1B293B576FE6B1CA2574B8001FDEB7%2F%24FILE%2F08-46a.pdf&usg=AFQjCNHWftaXq4M2CKSHQw-mCoyIC_27lw">Victoria</a> and <a href="https://www.legislation.sa.gov.au/LZ/C/A/SOUTH%20AUSTRALIAN%20PUBLIC%20HEALTH%20ACT%202011.aspx">South Australia</a>, health acts do not specify penalties for exposure or transmission, referring instead to the respective crime acts. For the most part, curable STIs do not rank as serious enough for criminal prosecution.</p>
<p>What is unique about NSW is that it uses the Public Health Act to single out STIs and describe specific punishments above and beyond other infections. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/186724/original/file-20170920-927-cnybuc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/186724/original/file-20170920-927-cnybuc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/186724/original/file-20170920-927-cnybuc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/186724/original/file-20170920-927-cnybuc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/186724/original/file-20170920-927-cnybuc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/186724/original/file-20170920-927-cnybuc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/186724/original/file-20170920-927-cnybuc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/186724/original/file-20170920-927-cnybuc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Moving away from mandating disclosure of a person’s STI status to their partner is actually positive.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/search/photos/partners?photo=p3UCTiZIU6M">Photo by Gerrit Vermeulen on Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Although laws in NSW seem unusually fixated on STIs, the move away from mandated disclosure in favour of “reasonable precautions” is a positive step. While disclosure may seem sensible on the surface, it’s not the most effective at preventing transmission. This is because disclosure requires that someone be aware of an infection and many people with an STI don’t realise they are infected. For example, <a href="https://kirby.unsw.edu.au/report/annual-surveillance-report-hiv-viral-hepatitis-stis-2016">it’s estimated</a> nearly three quarters of chlamydia infections in young people in Australia go undiagnosed every year. Relying on disclosure can, therefore, give people a false sense of security. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sexually-transmissible-infections-on-the-rise-in-australia-a-snapshot-68681">Sexually transmissible infections on the rise in Australia: a snapshot</a>
</strong>
</em>
</p>
<hr>
<p>There are other more effective strategies than disclosure for protecting someone from infection. With HIV, for example, <a href="https://hptn.org/research/studies/hptn052">successful treatment</a> means the risks of transmitting the virus to another person are virtually nonexistent. Under the amended NSW law, treatment could quite rightly be considered a reasonable precaution to avoid transmitting HIV.</p>
<p>But the state’s Public Health Act is relevant to all STIs, not just HIV. For other infections, it’s less clear what precautions might be seen as reasonable. Condoms can offer protection from some infections, but not all, and they are <a href="http://onlinelibrary.wiley.com/doi/10.1363/3800606/full">rarely used</a> for oral sex. Given more and more chlamydia and gonorrhoea cases are <a href="https://kirby.unsw.edu.au/report/annual-surveillance-report-hiv-viral-hepatitis-stis-2016">identified in the throat</a>, this is potentially problematic.</p>
<h2>Punishment doesn’t help</h2>
<p>Every year, there are over 100,000 STI <a href="https://kirby.unsw.edu.au/report/annual-surveillance-report-hiv-viral-hepatitis-stis-2016">diagnoses across Australia</a>, the vast majority of which can be cured using antibiotics. Ultimately, public health initiatives aim to reduce new cases and lower the overall amount of infection.</p>
<p>It’s been suggested by public health experts that criminalising transmission can <a href="http://www.tandfonline.com/doi/full/10.1080/09581596.2015.1052731">undermine public health efforts</a> by reinforcing stigma and causing people to delay accessing testing, treatment and care. </p>
<p>And in <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2128015">a review</a> of legal conditions around the world, researchers found that there was no link between laws criminalising HIV transmission and lower infection rates. The review also found such laws disproportionately impacted those who may experience marginalisation, such as young people and women. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/stigma-and-lack-of-awareness-stop-young-people-testing-for-sexually-transmitted-infections-80265">Stigma and lack of awareness stop young people testing for sexually transmitted infections</a>
</strong>
</em>
</p>
<hr>
<p>In reality, situations where an individual recklessly or wilfully places another at risk of an STI are <a href="http://www.hivmediaguide.org.au/media-tool-kit/hiv-in-the-news/criminal-cases-involving-hiv-transmission-or-exposure/">incredibly rare</a> and health officials have many options besides punishment. </p>
<p>As part of their core work, doctors and clinics counsel on and work with people to prevent onward transmission, and in some cases public health orders can be used to compel people to, among other actions, attend counselling and refrain from activities that might spread an infection. In the most extreme situations, criminal charges can be brought on the basis of grievous bodily harm.</p>
<p>Overall, a special and punitive focus to STIs risks further entrenching stigma and undermining the Act’s intent, which is to manage and reduce infection. If there is any hope of reducing STIs in Australia, laws must aim to foster an environment where people feel comfortable, able and willing to get tested and engaged with their sexual health. </p>
<p>While it seems unlikely a rush to prosecute those who expose others to STIs will spring up from this amendment, the law as it is currently written leaves open that rather serious possibility. In NSW and across Australia, health law consistently places the burden of prevention on one partner. In an ideal world, all parties to a sexual encounter take “reasonable precautions” to protect themselves and each other from infection.</p><img src="https://counter.theconversation.com/content/84210/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Denton Callander receives funding from the Australian Department of Health, the Australian Research Council, the National Health and Medical Research Council, and the New South Wales Ministry of Health. </span></em></p>NSW has changed its laws imposing criminal penalties on someone with an STI who doesn’t take “reasonable precautions” to not infect their sexual partner.Denton Callander, Research fellow, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/695392016-11-30T08:27:43Z2016-11-30T08:27:43ZWhy over 45s are at risk of sexually transmitted infections – new findings<figure><img src="https://images.theconversation.com/files/147944/original/image-20161129-10973-1jq9c0v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It's not all ha ha hee hee hee. </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-498122908/stock-photo-olderly-couple-happiness-romantic-holding-hand-concept.html?src=KkrtiFyAdjdk-6Imgqmt9Q-1-76">Rawpixel.com</a></span></figcaption></figure><p>One consequence of our <a href="http://www.bbc.co.uk/news/uk-34666382">ageing population</a> is that people are now sexually active <a href="https://www.ncbi.nlm.nih.gov/pubmed/20215365">later</a> in life. Combined with a <a href="http://www.telegraph.co.uk/news/uknews/12011714/Divorce-rate-at-lowest-level-in-40-years-after-cohabitation-revolution.html">high rate</a> of older adults divorcing and changing partners, this has created a conducive environment for sexually transmitted infections (STIs) among those in middle age and beyond. </p>
<p>While the under 25s and gay men remain most at risk from STIs, heterosexual adults over 45 have recently seen <a href="https://www.gov.uk/government/statistics/sexually-transmitted-infections-stis-annual-data-tables">increases</a> in <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/401662/2014_PHE_HIV_annual_report_draft_Final_07-01-2015.pdf">HIV</a>, gonorrhoea, herpes, syphilis, chlamydia and genital warts. In England, <a href="https://www.gov.uk/government/statistics/sexually-transmitted-infections-stis-annual-data-tables">rates for chlamydia</a>, the commonest STI, rose 63% among 45-64s between 2011 and 2015 while falling for 15-24s. Yet this is an area of public health that has so far been ignored. </p>
<p>Knowledge about STIs plays a contributing role in reducing the spread of infection. Recent evidence about older adults’ knowledge has largely been confined to HIV, so our understanding of this age group’s knowledge of STIs in general is limited. </p>
<p>In <a href="http://www.rhm-elsevier.com/article/S0968-8080(16)30035-0/abstract">research</a> that I have just co-published, we sought to address this deficiency. By carrying out in-depth interviews with 31 heterosexual men and women in Glasgow aged between 45 and 65, we explored not only what middle-aged adults know about HIV and other STIs but also the social circumstances surrounding that knowledge. </p>
<p>Most of the study participants lived in the most deprived areas in Scotland and had been through divorce, separation or the death of their partner. The interviews led us to four main observations. </p>
<h2>1. STI knowledge is limited</h2>
<p>Most participants had heard about gonorrhoea, syphilis, chlamydia, herpes, general warts and HIV, but beyond recognising the names they were often unsure about any further detailed information. They tended to know more about HIV, often remembering the <a href="http://news.bbc.co.uk/1/hi/programmes/panorama/4348096.stm">national HIV/AIDS campaign</a> in the 1980s and the <a href="http://www.nydailynews.com/entertainment/gossip/celebrities-hiv-positive-aids-article-1.2436964">celebrity deaths</a> in the years before treatment improved. </p>
<p>In keeping with the association of early HIV epidemic with specific risk groups such as gay men and intravenous drug users, the participants often viewed STIs as riskier for other people than for themselves. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/147945/original/image-20161129-10949-15sf73k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/147945/original/image-20161129-10949-15sf73k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/147945/original/image-20161129-10949-15sf73k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/147945/original/image-20161129-10949-15sf73k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/147945/original/image-20161129-10949-15sf73k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/147945/original/image-20161129-10949-15sf73k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/147945/original/image-20161129-10949-15sf73k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/147945/original/image-20161129-10949-15sf73k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Is ignorance bliss?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/pic-1216477/stock-photo-older-couple-in-love-kisses.html?src=xXtNcIpATQgFNHt5v1eCAQ-1-4">Cate Frost</a></span>
</figcaption>
</figure>
<h2>2. Old stigmas have endured</h2>
<p>The participants had first learned about STIs as teenagers and young adults between the 1960s and 1980s. Most said their sex education at home had been very limited and unclear, with overtones of moral disapproval, and that school sex education was extremely basic and did not cover STIs. As one put it:</p>
<blockquote>
<p>And it was always make sure you don’t get into trouble and I didn’t know what the hell getting into trouble was so that was that.</p>
</blockquote>
<p>The little they had learned about STIs was usually in the context of promiscuous sexual behaviour being condemned and disease being seen as a consequence – with worse stigma where women were concerned. As a result, many participants had gone through life regarding STIs as something to be ashamed of. </p>
<p>During the years when they were in long-term relationships, several participants also did not see it as relevant to improve their knowledge about STIs. And now in middle age, several continued to prefer not to engage with the subject. In the words of one person: </p>
<blockquote>
<p>None of them are anything that I’d want to trawl the internet to find out more about you know; don’t know anybody that’s ever had them or even if they’d admit to it.</p>
</blockquote>
<h2>3. Parents learn about STIs from their children</h2>
<p>We found that parenting had the capacity to influence how much participants knew about STIs. Women in particular had sometimes learned about STIs either to find out about the risks to their children or because their children had been diagnosed with one. </p>
<p>Studies have <a href="http://bmjopen.bmj.com/content/5/3/e007834">previously shown</a> that it is women who mostly provide sex education to their children. Our study is the first to indicate that parenting can also be a source of sex education for the parents themselves. </p>
<h2>4. Knowledge is not the only problem</h2>
<p>Participants who were well informed about STIs did not necessarily practice safer sexual behaviour. Despite the lack of discernible symptoms with many STIs, several participants said they had not sought a test after having unprotected sex with a new partner. Instead they had waited to see if symptoms would appear:</p>
<blockquote>
<p>She’s been sleeping with other people and I let her sleep with me and never used a condom and … then you worry that something happens, that something’s going to come out of it, or are you lucky and I was just praying that something didnae happen.</p>
</blockquote>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/147946/original/image-20161129-10957-1qiigxs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/147946/original/image-20161129-10957-1qiigxs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/147946/original/image-20161129-10957-1qiigxs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/147946/original/image-20161129-10957-1qiigxs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/147946/original/image-20161129-10957-1qiigxs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/147946/original/image-20161129-10957-1qiigxs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/147946/original/image-20161129-10957-1qiigxs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/147946/original/image-20161129-10957-1qiigxs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Here’s Johnny!</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/pic-58634179/stock-photo-man-hand-holding-a-condom.html?src=K0L1ZLFWx3G-jHbaMq8omA-2-11">focal point</a></span>
</figcaption>
</figure>
<h2>Next steps</h2>
<p>These findings should be useful for developing interventions for middle-aged adults that help them to learn more about STIs and to make wiser decisions in relation to their sexual health. Public <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/142592/9287-2900714-TSO-SexualHealthPolicyNW_ACCESSIBLE.pdf">health policy</a> in the UK makes <a href="http://www.gov.scot/Resource/0048/00484414.pdf">reference</a> to the life-long nature of sexual health, but few health promotion programmes <a href="https://www.ncbi.nlm.nih.gov/pubmed/25921479">directly address</a> older adults taking risks with STIs.</p>
<p>Public health officials need to be aware that people emerging from lengthy relationships often know little about STIs and are poorly equipped to make good decisions about their sexual health. The sense of stigma around STIs with this age group is a barrier that needs to be addressed. Policymakers need to fully engage with gendered attitudes to older women’s sexuality, as well as the full range of lengths and varieties of relationships that people get involved in regardless of their stage in life.</p><img src="https://counter.theconversation.com/content/69539/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jenny Dalrymple is a part-time sexual health nurse for NHS Greater Glasgow and Clyde.</span></em></p>When it comes to sexual health, public information has tended to focus on the young. Time for a change.Jenny Dalrymple, Clinical Academic Research Fellow, Glasgow Caledonian UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/635262016-09-13T20:18:42Z2016-09-13T20:18:42ZWhy is trachoma blinding Aboriginal children when mainstream Australia eliminated it 100 years ago?<figure><img src="https://images.theconversation.com/files/136397/original/image-20160902-20232-1mhv37j.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Trachoma disappeared from most of Australia 100 years ago as individual and community hygiene improved.</span> <span class="attribution"><span class="license">Author provided</span></span></figcaption></figure><p><em>This article is one in our <a href="https://theconversation.com/au/topics/indigenous-health-package-31054">three-part series</a> on blinding, deafening and sometimes deadly conditions in Indigenous Australian children that have little to no impact on their non-Indigenous counterparts.</em></p>
<hr>
<p>Many people don’t know this, but Indigenous Australian children are <a href="http://www.ncbi.nlm.nih.gov/pubmed/20230347">born with much better eyesight</a> than non-Indigenous children.</p>
<p>Yet, at the population level, Indigenous people at the age of 40 <a href="https://www.mja.com.au/journal/2010/192/6/prevalence-and-causes-vision-loss-indigenous-australians-national-indigenous-eye">have rates of vision loss</a> three times that of non-Indigenous Australians. Rates of blindness are six times higher among Indigenous adults. </p>
<p>The prevalence of vision problems in Indigenous people is a result of cataracts, diabetic eye disease and a disease non-Indigenous children don’t get – trachoma. In fact, trachoma disappeared from mainstream Australia more than 100 years ago with improved hygiene facilities, water infrastructure and living conditions.</p>
<p>Yet, in some areas, 4% of Indigenous children aged from five to nine years old <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-cdi4002j.htm">have an active trachoma infection</a>. In the Northern Territory, that rate is 5%, which is considered an endemic level.</p>
<h2>What is trachoma?</h2>
<p>We used to call trachoma sandy blight (the eyes feel gritty, as if full of sand). It is the world’s <a href="http://www.who.int/mediacentre/factsheets/fs382/en/">leading cause of infectious blindness</a>.</p>
<p>Trachoma is caused by the bacterium <em>Chlamydia trachomatis</em>, which <a href="http://www.who.int/mediacentre/factsheets/fs382/en/">creates swelling under the inner eyelid</a> leading to scarring. The scars cause the eyelashes to turn inward and scratch the eye, which is intensely painful and made worse by blinking. </p>
<p>Eventually, if left untreated, all the scratching from the lashes will result in the cornea – the transparent layer at the front of the eye – going cloudy and the person having irreversible blindness.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/136234/original/image-20160901-13449-1tlr1eq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/136234/original/image-20160901-13449-1tlr1eq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/136234/original/image-20160901-13449-1tlr1eq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=386&fit=crop&dpr=1 600w, https://images.theconversation.com/files/136234/original/image-20160901-13449-1tlr1eq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=386&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/136234/original/image-20160901-13449-1tlr1eq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=386&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/136234/original/image-20160901-13449-1tlr1eq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=485&fit=crop&dpr=1 754w, https://images.theconversation.com/files/136234/original/image-20160901-13449-1tlr1eq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=485&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/136234/original/image-20160901-13449-1tlr1eq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=485&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Trachoma leads to eyelashes turning inwards and scratching the eye, leading to blindness.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/communityeyehealth/8489112594/in/photolist-dW9Vqf-9yyAVm-9yvAMi-dWa7C7-dWa7zd-9yyBq3-dW4vNv-9EAybm-dW4vvH-9wqCPE-njvJid-9yvA22-nAHyF8-nAHu42-9yyBE1-dW4vH8-dWa7SL-9yyB9Y-dQpK97-nB1t5h-njvTie-njvHVj-dW4w8T-dW4jzi-nALUhs-dWa7Vw-dW4vnv-nCMwvt-dWa7Gw-dWa7e3-njvHNK-dW9VqU-9A85We-nB1s3Y-njvBK2-dW4vAD-dWuo2J-9yvAqM-9yvA88-nCMuJx-D4iE3F-CuLJV4-dWdto5-nB1v48-dW4vs2-njvRh1-nB1vCy-nB1rmh-9yyB1w-njvW2k#undefined">Community Eye Health/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Trachoma easily spreads from one child to another through infected eye and nose secretions. </p>
<p>Unlike other infectious diseases, a single episode of trachoma is often not uncomfortable or noticed as being any different from just a runny nose. Nor is a single episode such a problem for the individual child. </p>
<p>The main issue is that children <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2691478/">keep getting reinfected</a>, which keeps the inflammation present. A child may have <a href="http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0000462">between 30 and 40 episodes</a> of reinfection during their childhood and around 160 to 180 infections until the resultant scarring causes blindness.</p>
<p>Each episode of infection <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2691478/">may last a few months</a>, but repeated reinfection turns into a continuing infection and disease. The longer the inflammation goes on, the worse the discomfort and more severe the scarring. And the more severe the scarring the greater the risk of blindness.</p>
<h2>Where does trachoma exist?</h2>
<p>Australia remains the only high-income country to still have trachoma. Although it doesn’t exist in mainstream Australia, trachoma persists in remote Aboriginal communities that still lack safe washing facilities and have notoriously poor and chronically overcrowded housing. </p>
<p>Young children with constant eye and nose secretions in remote endemic communities <a href="http://iehu.unimelb.edu.au/__data/assets/pdf_file/0009/719649/Trachoma_Book_HRTaylor.pdf">sometimes go unnoticed</a> and washing a child’s face whenever it’s dirty (with eye and nose secretions) is not common.</p>
<p>But Australia is making progress. In 2009, the Australian government committed to eliminating trachoma by 2020. At that time, <a href="http://www.ncbi.nlm.nih.gov/pubmed/20043598">disease rates ranged</a> between 15% and 20%. Data from 2015 show a massive drop, <a href="http://kirby.unsw.edu.au/surveillance/australian-trachoma-surveillance-report-2014">with the national average for children</a> in endemic areas at 4.6%.</p>
<iframe src="https://datawrapper.dwcdn.net/GKWxR/1/" frameborder="0" allowtransparency="true" allowfullscreen="allowfullscreen" webkitallowfullscreen="webkitallowfullscreen" mozallowfullscreen="mozallowfullscreen" oallowfullscreen="oallowfullscreen" msallowfullscreen="msallowfullscreen" width="100%" height="400"></iframe>
<p>Of equal importance is the dramatic reduction in the number of communities with trachoma. More than 150 of the 200 or so at-risk communities no longer have trachoma and there are only a small number with high rates. These hotpots are mainly in and around Central Australia.</p>
<p>Globally, trachoma affects people <a href="http://www.trachomaatlas.org">in remote and rural communities</a> with poor personal and community hygiene. In 2016, an <a href="http://www.trachomacoalition.org/GET2020/">estimated 200 million people</a> are at risk of trachoma in 42 countries – mainly in sub-Saharan Africa, but also in countries such as Afghanistan, India, Brazil, Colombia and some Pacific Island nations. </p>
<p>The World Health Organisation has set the goal of <a href="http://www.trachomacoalition.org/GET2020/">eliminating blinding trachoma</a> by 2020. Countries such as Morocco, Ghana, Iran, Mexico, Nepal, China and Cambodia have eliminated trachoma over the last ten years.</p>
<hr>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/137315/original/image-20160912-13348-1jnvvfv.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/137315/original/image-20160912-13348-1jnvvfv.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/137315/original/image-20160912-13348-1jnvvfv.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/137315/original/image-20160912-13348-1jnvvfv.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/137315/original/image-20160912-13348-1jnvvfv.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=500&fit=crop&dpr=1 754w, https://images.theconversation.com/files/137315/original/image-20160912-13348-1jnvvfv.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=500&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/137315/original/image-20160912-13348-1jnvvfv.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=500&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<hr>
<h2>What are the treatments?</h2>
<p>The World Health Organisation <a href="http://www.who.int/blindness/causes/trachoma/en/">developed the SAFE strategy</a> to eliminate trachoma. This includes: surgery to correct the inward eye lashes (S); antibiotics to reduce levels of infection (A); promotion of facial cleanliness to stop transmission (F); and environmental improvements in water and sanitation (E).</p>
<p>In Australia, the antibiotic <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-trachoma.htm">azithromycin is given every six to 12 months to all household members</a> of someone with trachoma, or everybody in affected communities. </p>
<p>This brings down the level of infection, but without stopping the possibility of transmission, trachoma will bounce back. This is why keeping every child’s face clean is so important. The essential and sustainable strategy of maintaining trachoma elimination comes down to having clean faces, which goes with access to safe and functional bathrooms and washing facilities.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/136993/original/image-20160908-25257-18bzp5s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/136993/original/image-20160908-25257-18bzp5s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/136993/original/image-20160908-25257-18bzp5s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=762&fit=crop&dpr=1 600w, https://images.theconversation.com/files/136993/original/image-20160908-25257-18bzp5s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=762&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/136993/original/image-20160908-25257-18bzp5s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=762&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/136993/original/image-20160908-25257-18bzp5s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=958&fit=crop&dpr=1 754w, https://images.theconversation.com/files/136993/original/image-20160908-25257-18bzp5s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=958&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/136993/original/image-20160908-25257-18bzp5s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=958&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Milpa the Trachoma Goanna mascot features in the materials and is involved in community activities.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Improved hygiene will also help reduce other common and very serious infections in remote Indigenous communities.</p>
<p>There are currently effective health promotion activities in Australia such as “Clean Faces, Strong Eyes”. Bodies such as the Indigenous Eye Health group at the University of Melbourne continue to work closely with community groups to build on this work. </p>
<p>Milpa the Trachoma Goanna mascot features in educational materials and is involved in community activities, such as the development of music videos, roadshows and football clinics.</p><img src="https://counter.theconversation.com/content/63526/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hugh Taylor receives funding from the Department of Health.</span></em></p><p class="fine-print"><em><span>Emma Stanford receives funding from the Department of Health.</span></em></p><p class="fine-print"><em><span>Fiona Lange is affiliated with The Australian Health Promotion Association. </span></em></p>Trachoma easily spreads from one child to another through infected eye and nose secretions. A person may have up to 40 episodes of reinfection during childhood.Hugh Taylor, Melbourne Laureate Professor, Harold Mitchell Chair of Indigenous Eye Health, Melbourne School of Population and Global Health, The University of MelbourneEmma Stanford, Academic Specialist, The University of MelbourneFiona Lange, Academic Specialist, Indigenous Eye Health Unit, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/458222016-02-09T19:06:23Z2016-02-09T19:06:23ZChronic pain and infertility: the trauma of untreated pelvic inflammatory disease<figure><img src="https://images.theconversation.com/files/110093/original/image-20160203-28554-uvg76l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Some women have experienced relationship conflict or breakdown over how the STI that led to their PID was acquired.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p><em>This article is part of our series examining hidden women’s conditions. You can read about bacterial vaginosis, chronic thrush and other pieces in the series <a href="https://theconversation.com/au/topics/womens-health-series">here</a>.</em></p>
<hr>
<p>Pelvic inflammatory disease (PID) is an infection of a woman’s reproductive organs, which include the uterus, fallopian tubes and ovaries. </p>
<p>The condition’s often distressing consequences are unmatched by the low level of awareness about it. Left untreated, <a href="http://www.racgp.org.au/afpbackissues/2006/200611/20061103dayan.pdf">PID can cause infertility</a>, chronic pelvic pain and ectopic pregnancy (where the fetus develops outside the womb, usually in the fallopian tube). The psychological impact of these experiences can be severe.</p>
<p>PID is <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Pelvic_inflammatory_disease">referred to</a> as the “silent epidemic” because it can have mild or no symptoms and often goes unrecognised by women and their doctors. But <a href="http://www.cdc.gov/std/tg2015/pid.htm">delays in diagnosis</a> put women at greater risk of long-term complications.</p>
<h2>Physical impacts</h2>
<p><a href="http://www.cdc.gov/std/pid/stdfact-pid-detailed.htm">Pelvic inflammatory disease</a> comes from an infection that travels up the cervix or vagina to infect the uterus, fallopian tubes and other reproductive organs. </p>
<p>A number of harmful organisms can cause the disease, but sexually transmitted infections (STIs) – <a href="http://www.ncbi.nlm.nih.gov/pubmed/16597205">specifically chlamydia and gonorrhoea</a> – are responsible <a href="http://kirby.unsw.edu.au/publications/genital-chlamydia-review-evidence">for about one-third</a> to half of known cases. </p>
<p>PID <a href="http://www.fpnsw.org.au/PID.pdf">can also be caused</a> by other infections, including overgrowth of normal vaginal bacteria. It can follow procedures such as having an abortion and/or having an intrauterine device (IUD) inserted.</p>
<p>While PID can be treated with antibiotic therapies, this can’t reverse the scarring of the reproductive organs that the infection may have already caused.</p>
<p>Sometimes there are no symptoms. When they are present they <a href="http://www.cdc.gov/std/pid/stdfact-pid-detailed.htm">may include</a>: </p>
<ul>
<li>lower abdominal or pelvic pain</li>
<li>abnormal vaginal discharge </li>
<li>irregular menstrual bleeding </li>
<li>fever </li>
<li>pain during sexual intercourse </li>
<li>painful or increased urination.</li>
</ul>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/110099/original/image-20160203-5830-14qjrz8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/110099/original/image-20160203-5830-14qjrz8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=386&fit=crop&dpr=1 600w, https://images.theconversation.com/files/110099/original/image-20160203-5830-14qjrz8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=386&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/110099/original/image-20160203-5830-14qjrz8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=386&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/110099/original/image-20160203-5830-14qjrz8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=486&fit=crop&dpr=1 754w, https://images.theconversation.com/files/110099/original/image-20160203-5830-14qjrz8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=486&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/110099/original/image-20160203-5830-14qjrz8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=486&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">PID comes from an infection that travels up the cervix or vagina.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>The risk of <a href="http://www.cdc.gov/std/pid/stdfact-pid-detailed.htm">long-term complications</a> from PID depends on its severity and number of repeat occurrences.</p>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/1411832">Research</a> shows tubal scarring caused by PID can lead to tubal factor infertility (a condition in which the fallopian tubes are blocked or damaged) in between 8% (after one PID occurrence) and 40% of women (after three or more occurrences). </p>
<p>Ectopic pregnancy occurs in around 9% of women with PID and about 18% experience chronic pelvic pain.</p>
<h2>Psychological impacts</h2>
<p>We <a href="http://hpq.sagepub.com/content/19/5/618.abstract">explored</a> the psychological and social impacts of PID on women’s sense of self and their relationships. We also questioned women about their health care experiences in relation to their diagnosis.</p>
<p>We found being diagnosed with PID was a distressing experience for most women, with fears focused mostly on future fertility. </p>
<p>Infertility worries influenced the way women viewed themselves. Many thought they might be abnormal, inadequate, or damaged. Some believed they would be incapable of fulfilling traditional female roles of “normal” wife and mother. </p>
<p>The disease negatively impacted the level of intimacy and emotional closeness many women shared with their partner. Some experienced relationship conflict or breakdown over how the STI that led to their PID was acquired. </p>
<p>Almost all women felt their diagnosis had negatively affected sexual aspects of their relationships. Many had pain or discomfort during intercourse, which caused general anxiety about sex and made them engage in it less.</p>
<h2>Under-diagnosed</h2>
<p>Partly because PID is difficult to diagnose definitively, and due to a lack of routine data collection, it’s difficult to accurately estimate its prevalence. </p>
<p>It’s <a href="http://www.sexualhealthaustralia.com.au/page/pelvic_inflammatory_disease.html">estimated around 10,000</a> are treated for pelvic inflammatory disease in hospitals each year. Ten to 30 times that number are treated as outpatients.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/110094/original/image-20160203-28538-qbsdxf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/110094/original/image-20160203-28538-qbsdxf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=899&fit=crop&dpr=1 600w, https://images.theconversation.com/files/110094/original/image-20160203-28538-qbsdxf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=899&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/110094/original/image-20160203-28538-qbsdxf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=899&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/110094/original/image-20160203-28538-qbsdxf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1129&fit=crop&dpr=1 754w, https://images.theconversation.com/files/110094/original/image-20160203-28538-qbsdxf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1129&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/110094/original/image-20160203-28538-qbsdxf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1129&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Infertility worries influenced the way women viewed themselves.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>As women with pelvic inflammatory disease often show either mild or no symptoms, it isn’t surprising the condition often goes unrecognised. </p>
<p>Prompt treatment of chlamydia and gonorrhoea infections is essential for the prevention of potential PID.</p>
<p>In Australia, <a href="http://www.sti.guidelines.org.au/">rates of chlamydia and gonorrhoea diagnoses</a> are highest among 15- to 24-year-olds. The Royal Australian College of General Practitioners recommends annual <a href="http://www.racgp.org.au/your-practice/guidelines/redbook/">chlamydia testing</a> for all sexually active people between 15 and 29 and for any person at high risk. </p>
<p>High-risk <a href="http://www.sti.guidelines.org.au/">groups include</a> men who have sex with men and young heterosexual Aboriginal and Torres Strait Islanders.</p>
<p>Laparoscopic surgery, which uses a camera to examine inside the pelvis, is the best way to <a href="http://www.cdc.gov/std/tg2015/pid.htm">diagnose</a> PID. But its cost and limited availability means it’s not easily justifiable for women with mild or vague symptoms.</p>
<p>Both <a href="http://www.cdc.gov/std/tg2015/default.htm">international</a> and <a href="http://www.sti.guidelines.org.au/syndromes/pid-pelvic-inflammatory-disease">national</a> guidelines encourage doctors to treat for PID when a woman presents with lower abdominal pain and all other causes have been excluded. </p>
<p>But research shows large numbers of Australian women have a diagnosis <a href="http://www.ncbi.nlm.nih.gov/pubmed/18723585">missed</a> or <a href="https://www.mja.com.au/journal/2012/197/11/frequent-occurrence-undiagnosed-pelvic-inflammatory-disease-remote-communities">inadequately treated</a>. </p>
<p>In our research, <a href="https://www.mja.com.au/journal/2012/197/11/frequent-occurrence-undiagnosed-pelvic-inflammatory-disease-remote-communities">women with PID often described</a> experiences of incorrect diagnoses, incorrect prescriptions and inadequate medical care. Some women also reported receiving inadequate information from their health care provider about the diagnosis and management of their condition. </p>
<p>Women may also delay seeking treatment. We found the majority of women had symptoms for longer than four weeks before they sought medical care. Several reported having symptoms for more than six months before they saw a medical professional. </p>
<p>A major contributor to this delay was a lack of awareness. Many women had never heard of PID prior to their diagnosis.</p>
<p>Community education emphasising the importance of safe sex and STI screening must include information about PID and its symptoms. And early presentation for the diagnosis and treatment of pelvic pain should be a key message of all sexual health promotion programs.</p><img src="https://counter.theconversation.com/content/45822/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Danielle Newton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Pelvic inflammatory disease’s traumatic consequences are unmatched by the low level of awareness around it. Left untreated, it can cause chronic pelvic pain, ectopic pregnancy and infertility.Danielle Newton, Research Fellow, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/491952015-10-15T19:18:27Z2015-10-15T19:18:27ZA cull could help save koalas from chlamydia, if we allowed it<figure><img src="https://images.theconversation.com/files/98466/original/image-20151015-15135-1idsxkz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Koalas are again in the firing line. But should diseased animals be culled for the greater good?</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/moon-dog/2476981414">moon-dog/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Whether it’s <a href="https://theconversation.com/au/topics/wa-shark-cull">sharks</a>, <a href="https://theconversation.com/crocodile-culls-wont-solve-crocodile-attacks-11203">crocodiles</a> or <a href="https://theconversation.com/new-evidence-culling-kangaroos-could-help-the-environment-30795">kangaroos</a>, culling animals is always a contentious topic. But when the iconic koala is the species for which culling is being advocated, it sparks even more interest and debate.</p>
<p>Such was the case this week when researchers from Queensland and New South Wales <a href="http://www.jwildlifedis.org/doi/abs/10.7589/2014-12-278?journalCode=jwdi">published a study</a> recommending that koalas be culled in the name of conservation.</p>
<p>Their proposal is for the selective culling of individual koalas suffering from chlamydia in an attempt to reverse the disease’s impact on vulnerable populations.</p>
<h2>Koala chlamydia</h2>
<p>Chlamydia is a sexually transmitted bacterial disease (a different strain to that which afflicts humans) that causes infertility and blindness in koalas, and is one of several factors thought to be behind the decline of koala populations in the eastern states. Koalas suffering the disease gradually become weak, stop eating, and die.</p>
<p>Although affected koalas sometimes may be found and taken into care, to date there have not been any systematic programs to combat the disease in wild populations. Given the negative effects of chlamydia on koala populations in some regions there is an urgent need to look at management options, including one that may seem quite radical – culling diseased individuals.</p>
<p>The current study considered a declining population on the “Koala Coast” of south-east Queensland. The researchers used computer simulations to model several disease management scenarios. The simulation that had the most positive effect on long-term population growth involved culling chlamydia-infected koalas that were already sterile and dying, and treating other infected koalas with antibiotics.</p>
<p>The study found that, to grow the Koala Coast population, around 10% (or 140 individuals) of koalas would need to be captured and culled or treated each year.</p>
<h2>Killing for conservation</h2>
<p>The idea of culling diseased individuals to manage disease and its impacts on wildlife populations is not new, and has met with both <a href="http://www.sciencedirect.com/science/article/pii/S0167587713002894">success</a> (such as with Chronic Wasting Disease in deer in North America) and <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2664.2011.02060.x/abstract">dismal failure</a> (in the case Devil Facial Tumour Disease in Tasmanian Devils).</p>
<p>The effectiveness of these programs depends largely on the behaviour and ecology of the host species, and the distribution and nature of the disease. When enough is known about these aspects, computer modelling is useful for determining the potential effectiveness of a selective culling approach and for helping guide management actions.</p>
<p>But while modelling may inform us that culling is <em>scientifically</em> the best management approach, deciding whether and how to go ahead is complex, even more so when koalas are involved. </p>
<p>Koala management is closely scrutinised both nationally and internationally. The koala is the only native Australian species for which culling has been consistently dismissed as a management option (for overabundant populations in the southern states).</p>
<p>Although the current proposal for selectively culling diseased koalas isn’t “culling” as defined in the <a href="http://www.environment.gov.au/biodiversity/threatened/publications/national-koala-conservation-mgt-strategy-2009-2014">National Koala Conservation and Management Strategy</a>, it still raises a question about killing koalas for conservation.</p>
<p>In 1997, culling was proposed as a component of an integrated strategy to manage high density populations of koalas on <a href="http://www.adelaidenow.com.au/news/south-australia/mps-want-to-kill-koalas/story-e6frea83-1111117042447">Kangaroo Island</a>, South Australia. Despite having a sound scientific basis and the endorsement of many experts, it sparked much outrage and ultimately led to a decision at the Commonwealth level that culling will not be considered for management of koalas.</p>
<p>This decision has resulted in millions of dollars being spent on fertility control and translocation programs in Victoria and South Australia over the last two decades. These programs attempt to address situations where overpopulation of koalas is causing significant damage to local ecosystems.</p>
<p>Although some have brought positive outcomes after many years of intensive effort (for instance at Kangaroo Island and Mount Eccles in Victoria), these interventions are logistically challenging, extremely costly, and sometimes may have <a href="http://onlinelibrary.wiley.com/doi/10.1002/jwmg.401/abstract">poor welfare outcomes</a> for individual koalas.</p>
<p>Consequently, “do nothing” is the default management approach for many situations. But this can have drastic consequences for koalas, their habitats, and the other species that rely on those habitats.</p>
<p>Such was the <a href="https://theconversation.com/victorian-koalas-are-eating-themselves-out-of-house-and-home-38585">case at Cape Otway</a> in late 2013 when the Victorian government’s “do nothing” approach led to unsustainably high koala population densities, causing widespread defoliation of trees and the starvation of thousands of koalas. Around 700 koalas in irreversibly poor condition were killed when the government <a href="http://www.theage.com.au/victoria/killing-of-700-otway-koalas-the-right-thing-to-do-scientists-say-20150304-13v25p.html">finally intervened</a> on animal welfare grounds. Meanwhile, thousands of koalas likely suffered a slow death out-of-sight.</p>
<p>Although some trees recovered following the dramatic decline in koala numbers, high fertility has resulted in the population increasing again, and another imminent starvation event.</p>
<h2>We do it for other animals, why not koalas?</h2>
<p>Many wildlife researchers and managers would argue that a better approach for these situations would be to cull some koalas when it is clear that even more koalas will die if no action is taken.</p>
<p>This is not to suggest that culling be undertaken indiscriminately, nor in all situations. But it should be considered in circumstances where science indicates that it is the most effective approach to maintaining a healthy ecosystem and population of koalas. </p>
<p>It is the same approach that is used for numerous other native species in Australia and worldwide, so why shouldn’t it be considered for koalas, too?</p>
<p>Considering the <a href="http://www.natureworldnews.com/articles/13200/20150305/secret-koala-culling-results-700-deaths-australia.htm">outrage</a> over killing Cape Otway’s starving koalas to reduce suffering, it seems that there may be little public support for culling koalas for any reason. It will be interesting to see how this new proposal to cull diseased koalas in Queensland and New South Wales will be received.</p>
<p>There likely will be opposition to culling and more support for a “treatment only” approach, despite its lower predicted effectiveness. However, one would hope that decision-makers place more weight on the scientific rigour of the research behind the proposal rather than the emotive argument that it is wrong to cull koalas.</p><img src="https://counter.theconversation.com/content/49195/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Desley Whisson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Research has shown that culling koalas could help stop the spread of deadly chlamydia. But how open will Australians be to killing one our favourite animals?Desley Whisson, Lecturer in Wildlife and Conservation Biology, School of Life and Environmental Sciences, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/474072015-09-13T20:17:30Z2015-09-13T20:17:30ZGood news and bad in latest annual report on HIV, hepatitis and STI rates<figure><img src="https://images.theconversation.com/files/94473/original/image-20150911-1551-tm9k8p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The biggest growth in sexually transmitted infections is for chlamydia and gonorrhoea.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/lazyartist/15141070532/">J. Michel (aka: Mitch) Carriere/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>The latest instalment of Australia’s annual report card on HIV, hepatitis and sexually transmissible infections has been released this morning. Here’s what experts who work in these areas make of the results.</p>
<hr>
<h2>HIV</h2>
<p>The number of newly diagnosed HIV infections in Australia has been stable over the past three years, with 1,081 HIV infections newly diagnosed in 2014. This represents an important deflection from previous trends showing year-on-year increases in new HIV diagnoses since 1999, when 714 HIV infections were newly diagnosed (the lowest annual number to date). In Australia, gay men and other men who have sex with men remain most affected by HIV; in 2014, 70% of HIV diagnoses were in men who had sex with men.</p>
<p>Condomless anal intercourse is a main risk factor for HIV infection among men who have sex with men. Previously, increases in such sex coincided with an increasing number of HIV cases being reported to the authorities. But HIV notifications are now stable, despite continuing increases in condomless anal intercourse. </p>
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<p>In 2014, <a href="http://kirby.unsw.edu.au/projects/gay-community-periodic-surveys">Gay Community Periodic Surveys</a> in the main urban areas across Australia found 39% of participants had condomless anal intercourse with casual partners. The stable number of new HIV cases notified to health authorities despite decreasing condom use reflects that HIV risk is being offset by other prevention strategies, such as the well-established “serosorting”, whereby men have condomless sex only with a partner of the same HIV-status. Other new HIV-prevention strategies may also be having effect.</p>
<p>These’s strong evidence that combination antiretroviral therapy (cART) reduces HIV transmission to an uninfected partner by as much as 96%. Early initiation of cART is now recommended as it also benefits the health outcomes of people with HIV. </p>
<p>In Australia, uptake of cART has increased substantially. In 2014, 84% of HIV-positive Gay Community Periodic Survey participants were taking ART, up from 60% in 2005. This increased treatment uptake has resulted in a decrease in the HIV viral load at the individual and community level, and reduced the likelihood of HIV transmission. It may have also offset the risks of increased rates of condomless anal intercourse. </p>
<p>The current stable number of newly diagnosed HIV infections in Australia is encouraging and highlights the success of a continued HIV response that remains one of the best in the world. Evidence is emerging that the increase in treatment uptake may also benefit prevention of HIV infections in Australia. </p>
<p>There’s now a real possibility of reducing new HIV infections through a combination of established and new HIV prevention tools. </p>
<h2>Chlamydia and gonorrhoea</h2>
<p>Chlamydia remains the most frequently reported notifiable sexually transmissible infection in Australia with 86,136 diagnoses in 2014. The majority (78%) of cases occurred among 15- to 29-year-olds. </p>
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<p>Increases in testing – 91% in the past seven years – likely account for the steady increases in chlamydia diagnoses. But the vast majority of infections (76%) remain undiagnosed and hence untreated. This emphasises the need for testing to be routinely offered to sexually active adolescents, young adults and other at-risk populations. </p>
<p>New gonorrhoea infections have been detected more frequently in the past five years, with 15,786 cases notified in 2014. Gonorrhoea in Australia continues to be an infection primarily of men who have sex with men, and of young Aboriginal people living in remote areas of Australia. The rate of diagnosis of gonorrhoea in the Aboriginal population was 18 times that in the non‑Indigenous population. </p>
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<p>Increased testing for this infection may explain much of this increase in gonorrhoea diagnoses, but whether transmission itself has increased remains unclear. Over the past five years, most pathology laboratories in Australia have adopted dual testing, whereby if a clinician orders a test for either chlamydia or gonorrhoea, both tests are automatically performed. </p>
<p>The emphasis on testing for chlamydia in young people has therefore led to a substantial rise in the number of tests conducted for gonorrhoea. That may explain the increase in diagnoses.</p>
<h2>Hepatitis C</h2>
<p>The hepatitis C epidemic in Australia has reached a crucial crossroads. The age of people with chronic hepatitis C means that thousands of Australians each year are now progressing to advanced liver disease, with a risk of liver failure, primary liver cancer and liver-related death. </p>
<p>Current interferon-containing hepatitis C treatments have had minimal impact on the rising burden of hepatitis C-related liver disease. This is due to low uptake rates and sub-optimal response rates. The advent of interferon-free hepatitis C treatments, with simple delivery (some are one pill per day for 12 weeks), minimal side effects and high cure rates (above 90%), provides one of the greatest advances in clinical medicine in recent decades.</p>
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<p>The Pharmaceutical Benefits Advisory Committee has <a href="http://www.pbs.gov.au/industry/listing/elements/pbac-meetings/pbac-outcomes/2015-07/web-outcomes-july-2015-positive-recommendations.pdf">recommended that these new hepatitis C treatments be listed</a> on the Pharmaceutical Benefits Scheme, which means they will be subsidised by the government. But price negotiations have not been completed and federal cabinet approval will be required before the medicines are subsidised. </p>
<p>The listing of these drugs would increase treatment rates several-fold and turn around the enormous and rising burden of hepatitis C liver disease in Australia. Australia has the potential to be an international leader in its response to hepatitis C, if these treatments are made broadly available. </p>
<h2>Syphilis</h2>
<p>Syphilis is a less common sexually transmissible infection compared with chlamydia and gonorrhoea. It continues to be an infection primarily of men who have sex with men and of young Aboriginal people. At 1,999 cases in 2014, the number of syphilis notifications has reached its highest level since recording began in 2004. The vast majority (92%) of cases are among men. </p>
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<p>There were 235 infectious syphilis diagnoses in Aboriginal and Torres Strait Islander people in 2014. A roughly equal number of diagnoses among males and females indicates predominantly heterosexual transmission. About half (46%) resided in remote or very remote areas and 38% in outer regional areas. Notifications of congenital syphilis declined from 16 in 2005 to three in 2009, then increased to five in 2014. </p>
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<p>Efforts to increase syphilis testing and treatment in men who have sex with men need to be strengthened. The resurgence of infection in young Aboriginal people in remote communities after years of declining rates, bringing with it cases of congenital syphilis, emphasises the need for testing and treatment in this population, particularly in antenatal settings so we can prevent more cases of congenital syphilis.</p><img src="https://counter.theconversation.com/content/47407/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John de Wit is one of the authors of the Annual Report of Trends in Behaviour (ARTB) 2015.</span></em></p><p class="fine-print"><em><span>Gregory Dore is an advisory board member and receives honorarium from Gilead, Merck, Abbvie, Bristol-Myers Squibb, Janssen. He has received research grant funding from Gilead, Merck, Abbvie, Bristol-Myers Squibb, Janssen, and travel sponsorship from Gilead, Merck, Abbvie, and Bristol-Myers Squibb. Gilead, Bristol-Myers Squibbe, and Abbvie manufacture hepatitis drugs currently in price negotiations for being listed on the PBS.</span></em></p><p class="fine-print"><em><span>Rebecca Guy receives funding from the NHMRC.</span></em></p><p class="fine-print"><em><span>Skye McGregor receives funding from the Department of Health.</span></em></p>The latest instalment of Australia’s annual report card on HIV, hepatitis and sexually transmissible infections has been released this morning. Here’s what experts make of the results.John de Wit, Professor and Director of the Centre for Social Research in Health, UNSW SydneyGregory Dore, Professor of Medicine, Clinical Researcher and Epidemiologist, UNSW SydneyRebecca Guy, Associate Professor of Epidemiology & Program Head of Surveillance Evaluation and Research, UNSW SydneySkye McGregor, Epidemiologist, The Kirby Institute, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/449862015-07-28T20:06:52Z2015-07-28T20:06:52ZLet’s talk about sex over 60: condoms, casual partners and the ageing body<figure><img src="https://images.theconversation.com/files/89885/original/image-20150728-7665-1crqcmz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-19730155/stock-photo-happy-senior-adult-couple-kissing.html?src=iuJk2rIBZnXwZ3yXytVmZg-3-123">Andy Dean Photography/Shutterstock</a></span></figcaption></figure><p>Over the past few years we’ve seen a dramatic rise in the rates of sexually transmitted infections (STIs) among Australians aged 60 years and older. Rates of gonorrhoea <a href="http://kirby.unsw.edu.au/surveillance/2012-annual-surveillance-report-hiv-viral-hepatitis-stis">more than doubled</a> in this age group between 2007 and 2011. Rates of chlamydia also rose significantly during this time, mirroring similar <a href="http://sti.bmj.com/content/early/2008/06/27/sti.2007.027847.full.pdf">trends internationally</a>.</p>
<p>STIs can be accompanied by some <a href="http://www.sciencedirect.com/science/article/pii/S0378512210002100">unpleasant symptoms</a> and health complications, or lead to major chronic conditions, in the case of HIV. It’s therefore important STIs are diagnosed and treated, regardless of age. </p>
<p>To understand why STIs are on the rise, we need to know more about older people’s sexual and romantic relationships, their knowledge of STIs and safe sex, and the safe sex practices that they use. However, older people are routinely <a href="https://theconversation.com/invisible-sexuality-older-adults-missing-in-sexual-health-research-34078">excluded</a>
from research on sex and relationships. Here’s what we know so far. </p>
<h2>Changing sexual and relationship patterns</h2>
<p>The Baby Boomer generation is renowned for challenging norms around <a href="https://theconversation.com/sex-desire-and-pleasure-in-later-life-australian-womens-experiences-35725">sex and age</a> and this has continued in recent decades.</p>
<p>Improvements to life expectancy and overall health in later life mean that older people may be more willing and able to engage in varying kinds of sexual activity. In fact, there is some evidence to suggest that remaining sexually active is associated with <a href="http://link.springer.com/article/10.1007/s12126-011-9110-7">better health in older age</a>.</p>
<p>Changes in the social acceptability of divorce and dating in later life have also opened up the possibility of entering in to a new sexual relationship. With new sexual partners comes an <a href="http://www.maturitas.org/article/S0378-5122(12)00405-7/abstract?rss=yes">increased possibility</a> of contracting an STI. </p>
<p>Alongside this, internet dating has increased the opportunities to meet <a href="http://apo.org.au/research/love-actually-older-adults-and-their-romantic-internet-relationships-0">new sexual or romantic partners</a>. And medical advances such as Viagra have made (penetrative) sex in later life more of a possibility for older men than was previously the case.</p>
<p>However, this does not mean that all older people are sexually active, or that they are sexually active in the same ways as younger people. Instead, <a href="http://www.tandfonline.com/doi/full/10.1080/14681994.2014.936722#abstract">research suggests</a> that older people engage in a diverse range of sexual practices, and may have to adjust to ageing bodies. </p>
<h2>Let’s (not) talk about sex</h2>
<p>Despite these changes, and increasing <a href="https://theconversation.com/britons-have-sex-sooner-older-but-less-often-20735">evidence</a> that older people continue to be sexually active, there’s a reluctance to acknowledge this shift. Many in the community continue to cling to outdated and ageist assumptions that older people are asexual.</p>
<p>As a result, medical professionals can be reluctant to talk to their older patients about sex. <a href="http://www.sciencedirect.com/science/article/pii/S0277953603004490">Research in the United Kingdom</a>
shows GPs assume the topic of sexual health is not relevant to older people, and fail to proactively raise this issue with their older patients. This is often based on an <a href="https://theconversation.com/a-ripe-old-age-the-joy-of-sex-later-in-life-just-dont-forget-the-condoms-1969">incorrect assumption</a> that older people are no longer sexual.</p>
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<img alt="" src="https://images.theconversation.com/files/89888/original/image-20150728-7668-191s5jk.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/89888/original/image-20150728-7668-191s5jk.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=298&fit=crop&dpr=1 600w, https://images.theconversation.com/files/89888/original/image-20150728-7668-191s5jk.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=298&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/89888/original/image-20150728-7668-191s5jk.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=298&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/89888/original/image-20150728-7668-191s5jk.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=375&fit=crop&dpr=1 754w, https://images.theconversation.com/files/89888/original/image-20150728-7668-191s5jk.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=375&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/89888/original/image-20150728-7668-191s5jk.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=375&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">How do you negotiate condom use and an ageing body?</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-298213292/stock-photo-two-open-condoms-and-sealed-condoms.html?src=otN1pL8KgmCMUv71EspmGg-2-20">Studio KIWI/Shutterstock</a></span>
</figcaption>
</figure>
<p>This reluctance can have direct and negative implications for the sexual health of older people. It becomes less likely that older patients will be offered <a href="https://theconversation.com/health-check-the-sti-check-up-warts-and-all-32160">routine sexual health screenings</a>
, or have the opportunity to ask their GP questions about sexual health.</p>
<h2>Learning about safe sex is a life-long endeavour</h2>
<p>When we talk about safe sex and STIs, our focus tends to be on <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1741-6612.2008.00336.x/full">younger people</a>. In some ways this makes sense: many younger people are entering their first sexual relationships and need to learn how to have sex safely. </p>
<p>There is also an assumption that older people already know about safe sex. Yet, many older people grew up in a time when comprehensive sex education wasn’t provided in school. For those who have been in long-term, monogamous relationships, using condoms may have seemed irrelevant.</p>
<p>Older Australians need different types of information at different stages in the life course. Those reentering the dating or casual sex scenes, for instance, might benefit from a refresher on safe sex. </p>
<p>Older people might also have unique or different safe sex needs to their younger counterparts. For example, how does one negotiate condom use and an ageing body? How can issues around increased friction and pain that can be associated with condom use (particularly for postmenopausal women) be managed? </p>
<p>We need age-specific education and resources.</p>
<h2>Don’t delay treatment</h2>
<p>STIs can be costly to treat, and the economic burden of STIs increases with delayed diagnosis and treatment. Delayed treatment can result in more <a href="http://link.springer.com/article/10.1007/s11908-006-0010-z">severe symptoms</a> and <a href="http://www.sciencedirect.com/science/article/pii/S0197457211003363">complications</a>. Ignoring older people as sexual beings may contribute towards poorer overall health and deny their sexual agency.</p>
<p>We need to be more proactive in engaging older Australians around their sexual health. This could start with providing education, access to testing, and opportunities for discussions about sex, relationships, and sexual health. </p>
<p>We also need to know more about sex and relationships among older Australians and what they already know or don’t know about STIs and safe sex. This week we launched <a href="http://sexagemesurvey.org.au">SexAge&Me</a>, the first national study of older Australians’ sexual and romantic relationships, to help answer these questions and inform future approaches to sexual health policy and health care responses. </p>
<p><em>If you’re an Australian resident aged over 60 and want to take part in the survey, <a href="http://www.demographix.com/surveys/N5FZ-LWS6/8XQ4JKG3/">click here</a>.</em></p><img src="https://counter.theconversation.com/content/44986/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bianca Fileborn receives funding from the Australian Research Council to undertake research on STIs and ageing.</span></em></p><p class="fine-print"><em><span>Anthony Lyons receives funding from the Australian Research Council to undertake research on the sexual health of older Australians. </span></em></p>Over the past few years we’ve seen a dramatic rise in the rates of sexually transmitted infections (STIs) among Australians aged 60 years and older.Bianca Fileborn, Research Officer at the Australian Research Centre for Sex, Health & Society, La Trobe UniversityAnthony Lyons, Senior Research Fellow, Australian Research Centre in Sex, Health and Society, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/321602014-10-27T03:31:36Z2014-10-27T03:31:36ZHealth Check: the STI check-up – warts and all<figure><img src="https://images.theconversation.com/files/62613/original/99xp9hch-1414044091.jpg?ixlib=rb-1.1.0&rect=0%2C267%2C5760%2C3095&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Technology has done away with the need to insert swabs into the male urethra and speculums into the vagina. Instead, blood and urine are tested.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-216141157/stock-photo-medical-urine-test-close-up.html?src=pp-same_artist-216145360-_cx5M619eKLmHluUfhtomw-3">In Tune/Shutterstock</a></span></figcaption></figure><p>Sexuality is a means of pleasure, fulfilment and intimate connection with other humans. But it can also be a source of anguish. So it’s perhaps no surprise that of all the areas in health care, the “STI check” is one of the most fraught. </p>
<p>An STI check is one or more tests performed on a person who has no symptoms but is potentially at risk of having one or more sexually transmitted infections. </p>
<p>If you have symptoms – such as vaginal or urethral discharge; lower abdominal, pelvic, testicular or genital pain or itch; lumps, warts or ulcers in the genital area; unusual vaginal bleeding; painful urination; or anal symptoms if you have had anal sex – then the context changes to being a diagnostic assessment. </p>
<p>STI checks for asymptomatic people fall into the realm of “opportunistic health screening” – think blood pressure checks for hypertension, blood sugar tests for diabetes and other scenarios where you’re offered a test but have no symptoms. However, the STI check is not one-size-fits-all, nor does a “full STI check” actually test for all possible STIs.</p>
<p>So, which STIs are relevant to your own personal STI check? These are determined by your sexual history, what is known about the patterns of STIs in different populations, as well as the technical reliability of the tests. </p>
<p>The STIs tested include one or more of the following: <a href="https://playsafe.health.nsw.gov.au/sti/chlamydia">chlamydia</a>, <a href="https://playsafe.health.nsw.gov.au/sti/gonorrhoea">gonorrhoea</a>, <a href="https://playsafe.health.nsw.gov.au/sti/syphilis">syphilis</a>, <a href="https://playsafe.health.nsw.gov.au/sti/hepatitis-b">hepatitis B</a> and <a href="https://playsafe.health.nsw.gov.au/sti/hiv-aids">HIV</a> (human immunodeficiency virus). In some populations, it might also include <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Hepatitis_C_the-facts">hepatitis C</a>, <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Trichomoniasis?open">trichomoniasis</a> or <a href="https://playsafe.health.nsw.gov.au/sti/bacterial-vaginosis">bacterial vaginosis</a>. </p>
<p>Here’s what your doctor or nurse might ask you to help guide the STI check: </p>
<ul>
<li>your age and gender</li>
<li>whether you are Aboriginal or Torres Strait Islander, or a recent migrant (if so, from where), or travelled recently</li>
<li>your recent sexual encounters, including the number of partners you have had in the past three months</li>
<li>the gender of your sexual partners ever (male, female, both)</li>
<li>the nature of your sexual practices (vaginal intercourse, anal intercourse, oral sex)</li>
<li>whether and how often you have used condoms</li>
<li>whether you’ve had an STI check before and when</li>
<li>whether you’ve ever been diagnosed with an STI. </li>
</ul>
<p>To give a fuller picture of STI risk, you could be asked whether you have ever paid or been paid for sex, been in gaol, injected substances, or had tattoos or piercings done overseas or at home.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/62705/original/d4h8d7p3-1414125623.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/62705/original/d4h8d7p3-1414125623.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/62705/original/d4h8d7p3-1414125623.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/62705/original/d4h8d7p3-1414125623.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/62705/original/d4h8d7p3-1414125623.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/62705/original/d4h8d7p3-1414125623.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/62705/original/d4h8d7p3-1414125623.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">For heterosexuals up to 29 years, an annual chlamydia test is recommended.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-177322637/stock-photo--young-woman-reading-brochure-in-doctor-s-waiting-room.html?src=B0L3JUlROUvWFrA1eqQqMQ-1-27">diplomedia/Shutterstock</a></span>
</figcaption>
</figure>
<p>Although potentially daunting, most people believe that their GP is the right person with whom to discuss their sexual health. A GP or nurse who makes you feel comfortable is likely to be one who explains confidentiality, asks questions sensitively and gives you clear explanations of what the STI check will involve. They will also explain that choosing whether to answer questions is up to you. </p>
<p>When it comes to the tests, the good news is that technology has done away with the once-uncomfortable, or downright painful, swab up into the urethra of men, or the need for a woman to have a speculum inserted into her vagina.</p>
<p><a href="https://playsafe.health.nsw.gov.au/sti/chlamydia">Chlamydia</a> and <a href="https://playsafe.health.nsw.gov.au/sti/gonorrhoea">gonorrhoea</a> tests can be done on urine samples in men and women or self-collected vaginal swabs in women. If there is a concern about anal sex transmission, you can collect your own swab from your rectum. Gay men having unprotected oral sex are advised to allow the doctor or nurse to collect a throat swab.</p>
<p><a href="https://playsafe.health.nsw.gov.au/sti/syphilis">Syphilis</a>, <a href="https://playsafe.health.nsw.gov.au/sti/hepatitis-b">hepatitis B</a> and <a href="https://playsafe.health.nsw.gov.au/sti/hiv-aids">HIV</a> are tested for on blood samples, as is <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Hepatitis_C_the-facts">hepatitis C</a> (this is an infection mainly passed on through sharing needles).</p>
<p><a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Trichomoniasis?open">Trichomoniasis</a> mainly affects Aboriginal and Torres Strait Islander women living in remote and regional Australia and can be tested for on a urine sample or vaginal swab.</p>
<p><a href="https://playsafe.health.nsw.gov.au/sti/bacterial-vaginosis">Bacterial vaginosis</a> (BV) is not strictly an STI but is much more prevalent in women who have sex with women. BV is diagnosed via a vaginal swab, usually collected by the doctor or nurse.</p>
<p>If you need an examination, it should be explained beforehand that you can request a chaperone in the room (such as a nurse present while the doctor examines you). A curtain and sheet for privacy are standard. </p>
<p>The recommended frequency of STI checks also varies. In heterosexuals up to 29 years, an annual chlamydia test alone is recommended. In men who have sex with men who have additional risk factors (such as any unprotected anal sex, ten or more partners in six months) testing every three months is recommended. Some people want an STI check when they embark on a new relationship and can request one.</p>
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<figcaption>
<span class="caption">Your doctor or nurse will ask you whether and how often you have used condoms.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-168231869/stock-photo-safe-sex-concept-hand-with-condom.html?src=iLU5QfWoUDMCZ-e1aawxng-1-118">chingyunsong/Shutterstock</a></span>
</figcaption>
</figure>
<p>It might be helpful to know that two of the most common STIs are <em>not</em> included in the STI check: <a href="http://www.health.gov.au/internet/immunise/publishing.nsf/Content/immunise-hpv">human papillomavirus</a> (HPV) and <a href="http://www.cdc.gov/std/herpes/stdfact-herpes.htm">herpes simplex virus</a> (HSV). This is related to the reliability of the tests and the way in which these infections spread in populations, making routine test unhelpful. If you have particular concerns about these infections, because of a known contact for example, it’s best to discuss this specifically with your doctor.</p>
<p>Follow-up is an important part of the STI check. Discussing the most reliable way of contacting you is part of pre-STI check counselling. You might opt for an SMS, or prefer a return appointment to go through everything. </p>
<p>If you do have a positive test, appropriate treatment will be recommended, supportive counselling provided, and notifying sexual partners will be discussed. Depending on the STI, you will be asked to try to contact sexual partners from the past two to 12 months. Your doctor, or a public health unit, can help and it can be done anonymously. </p>
<p>For some STIs, including the most common – chlamydia – you will be asked to re-test some time after treatment to make sure it has cleared and you are not reinfected. Many STIs are notified to central health surveillance units, an important part of managing communicable diseases.</p>
<p>STI checks are a way of being proactive and preventive when it comes to health. If sex and health are an important part of your life, then try to think of the STI check as something that will contribute to your enjoyment of both.</p><img src="https://counter.theconversation.com/content/32160/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Melissa Kang does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Sexuality is a means of pleasure, fulfilment and intimate connection with other humans. But it can also be a source of anguish. So it’s perhaps no surprise that of all the areas in health care, the “STI…Melissa Kang, Senior Lecturer, Department of General Practice, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/288302014-07-07T10:08:40Z2014-07-07T10:08:40ZTeenage banter about sexual infections is not a #fail<figure><img src="https://images.theconversation.com/files/53173/original/xf8sq9gf-1404725252.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Tongue tied now, chat later. </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-61901365/stock-photo-kissing-teenage-couple.html?src=cwYg0o3W8C2uLEGyzBej0w-1-62">Kissing by Shutterstock</a></span></figcaption></figure><p>A recent TV programme on “<a href="http://www.channel4.com/programmes/the-secret-life-of-students">the secret life of students</a>” followed a group of students in their first undergraduate year at Leicester University, including 18-year-old Aiden who was informed on screen that he had chlamydia. Aiden texted his friends about it before calling Josie, a previous sexual partner. Josie told her flatmates that it sounded “like a girl’s name” and then proceeded to text her friends about it too.</p>
<p>All of this information sharing led to a disparaging article under the headline <a href="http://www.telegraph.co.uk/women/sex/10938182/Got-chlamydia.-Banter-Who-knew-students-found-STIs-so-funny.html">‘Got chlamydia. Banter!’ Who knew students found STIs so funny?</a> in which the programme was described as “a shocking - but honest - picture of student life”, where STIs were seen as funny. </p>
<p>But in the desire to be outraged, the article ignored at least six positives that I saw happening: people discussing chlamydia and everyone knowing what it was; Aiden attending the clinic after two instances of unprotected sex, which is what we want young people to do, and getting tested, which may help to demystify the process for other young people anxious about going. He also notified previous partners when he discovered an STI, including Josie. Josie said she wanted to have kids one day and understood the possible risks associated with chlamydia and infertility – so she was not completely trivialising it – and Aiden seemed to adhere to advice to avoid having sex for one week to avoid STI transmission. </p>
<p>All these points were all ignored in favour of the shock narrative about STIs not being taken seriously.</p>
<h2>Banter isn’t a dirty word</h2>
<p>As a sexual health researcher, I’ve talked to young men and women aged between 16 and 24 about chlamydia. In <a href="http://jfprhc.bmj.com/content/35/1/21.short">one study</a> I offered screening in non-medical settings including further education colleges in Scotland to explore the feasibility of such an approach. </p>
<p>I certainly heard “banter” being used by (mostly) men as a way of dealing with awkward conversations about chlamydia. They were often embarrassed to talk about it, especially within mixed-sex groups in colleges. I also used banter myself when approaching young men to talk about chlamydia, as this was a key way for me to help diffused tensions and put them at ease. I never trivialised chlamydia, but I certainly haven’t always used the “serious” tones that a sexual health adviser at a clinic might. </p>
<p>Many young men I spoke to preferred this approach to a clinic-based approach precisely because of this, supported <a href="http://sti.bmj.com/content/85/3/201.short">by the findings</a> another paper we published. </p>
<p>There is no chlamydia screening programme in Scotland, where I am based, but most tests are carried out with women <a href="http://www.isdscotland.org/Health-Topics/Sexual-Health/Publications/">27% of tests in 2010</a> were performed on men’s samples. In my study the majority of the men had never had a chlamydia test before, and indeed had never been asked. I achieved <a href="http://jfprhc.bmj.com/content/35/1/21.short">a 60% uptake</a> of chlamydia screening among men in one setting. Many said they did not want to attend a clinic as they thought them to be stigmatising and embarrassing.</p>
<p>In <a href="http://www.jmir.org/2013/12/e265/?utm_source=rss&utm_medium=rss&utm_campaign=young-mens-views-toward-the-barriers-and-facilitators-of-internet-based-chlamydia-trachomatis-screening-qualitative-study">another study</a>, published in the Journal of Medical Internet Research, I invited young heterosexual men aged 16-24 to help design a way of screening chlamydia via the internet, including a website. Many of them didn’t want a website that conveyed chlamydia as a joke. As adults, they wanted it to be presented in an adult way. They were also unsure whether text on existing sites was written by young people, so they were not sure about the authenticity. They were essentially wary of adults intruding into their world and masquerading as youth. </p>
<p>The men in this study had differences including being from mixed backgrounds – from middle-class to more disadvantaged groups. But the issue of embarrassment clearly emerged in both – even doctors and nurses have <a href="http://www.biomedcentral.com/1471-2296/15/127/abstract">reported being embarrassed</a> to talk to men about chlamydia.</p>
<h2>Moral outrage is pointless</h2>
<p>We need to set aside our moral outrage and <a href="http://bit.ly/1kmAWuS">dig a bit deeper</a> into why STIs can sometimes be discussed in a way that can appear trivial. </p>
<p>Cultural forces influence young people’s sexual behaviour and we now have a wealth of research evidence which shows just how much reputations and social displays of sexual activity – or inactivity – matter. And social expectations hamper communication about sex. There is no point getting worked up when young people apparently “fail” in their behaviour and communication as this helps no one. Instead of condemning young people we should seek to see the positives wherever possible. </p>
<p>All young people need good quality sex education, which they are still not getting. This is not a call to ignore risky behaviour but about building a narrative that is based less on fear and disease and more on positive conversations with young people.</p><img src="https://counter.theconversation.com/content/28830/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karen Lorimer received funding from the Chief Scientist Office (CSO) for her PhD research CZS/1/25 and recent study CZG/2/515. She receives funding from the CSO for current work on men, masculinities and sexual health CZG/4/925.</span></em></p>A recent TV programme on “the secret life of students” followed a group of students in their first undergraduate year at Leicester University, including 18-year-old Aiden who was informed on screen that…Karen Lorimer, Senior Research Fellow , Glasgow Caledonian UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/37812013-09-15T20:41:36Z2013-09-15T20:41:36ZA new approach to stopping the silent chlamydia epidemic<figure><img src="https://images.theconversation.com/files/31343/original/g9f26cxx-1379235989.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A new approach that
involves treating both partners is crucial to tackling escalating
rates of the often-asymptomatic disease of chlamydia</span> <span class="attribution"><span class="source">Pedro Figueiredo</span></span></figcaption></figure><p>A “Perspective” published in the <a href="https://www.mja.com.au/journal/2013/199/6/legislate-patient-delivered-partner-therapy-chlamydia?utm_source=MJA+news+alerts&utm_campaign=b18a2a56f3-Volume_199_6_16_September_20139_13_2013&utm_medium=email&utm_term=0_8c7e70a099-b18a2a56f3-31403861">Medical Journal of Australia</a> today calls for patient-delivered partner therapy for chlamydia to be made legal across Australia. This approach could be just the right way to tackle the growing problem posed by this sexually transmitted infection.</p>
<p>Patient-delivered partner therapy entails the person being treated for chlamydia receiving antibiotics for her partner (for reasons you will learn below, it’s usually a woman who is being treated for the infection). Chlamydia is a bacterial infection that can damage a woman’s reproductive organs; it can result in a discharge through the urethra for men. </p>
<p>It’s not a “one-off” infection, so people can be reinfected a number of times. Chlamydia is transmitted through sexual contact – vaginal, oral or anal – and can also be passed to a baby by an infected mother during vaginal birth.</p>
<p>Reinfection from partners is common for the illness but providing patients with medication for their partner has uncertain legal status in most Australian states and territories.</p>
<h2>Upward trajectory of harms</h2>
<p>Chlamydia has become the most common sexually transmissible infection in Australia; nearly 80,000 infections were reported in 2011, compared to only around 17,000 in 2001. </p>
<p>In women aged between 15 and 19 years, the rate increased fivefold over this period, while for the same male age group, it increased fourfold.</p>
<p>Chlamydia is often asymptomatic, which means people with the disease may not know they have it, even though it’s easily detectable through a urine test and treatable with antibiotics.</p>
<p>Because it is often asymptomatic, chlamydia causes little immediate pain and discomfort. But it can cause pelvic inflammatory disease in women, which can be painful and damage the uterus and fallopian tubes through scarring of tissue. And this can lead to tubal infertility and ectopic pregnancy. </p>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/14681509">Research evidence suggests</a> that around two-thirds of cases of tubal infertility and one-third of ectopic pregnancy cases could be linked to past chlamydial infection. </p>
<p>While pelvic inflammatory disease can be treated with antibiotics, it’s better to prevent it by screening for, and treating, chlamydia. </p>
<p>With more women waiting until they are older to have their first child, some are finding that undiagnosed chlamydia has had a negative impact on their fertility and are faced with undergoing difficult and expensive IVF treatment.</p>
<h2>Why no treatment?</h2>
<p>There are three big problems when it comes to detecting and treating chlamydia. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/31342/original/4pfd5j87-1379235767.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/31342/original/4pfd5j87-1379235767.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/31342/original/4pfd5j87-1379235767.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/31342/original/4pfd5j87-1379235767.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/31342/original/4pfd5j87-1379235767.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/31342/original/4pfd5j87-1379235767.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/31342/original/4pfd5j87-1379235767.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Chlamydia infection caused by the bacteria Chlamydia trachomatis.</span>
<span class="attribution"><span class="source">AJ Cann</span></span>
</figcaption>
</figure>
<p>The first is the “silent” nature of the infection, which means it’s not easily detected because there are no symptoms. This also means that there’s a lack of awareness among young people (in particular) about chlamydia and its potential impact. </p>
<p>The second issue is the limited nature of screening options. Although screening is available at doctors’ clinics, women are most often screened when they go for a script for the pill or for a Pap test. </p>
<p>Very few men, particularly young men, ever go to a doctor or a sexual health clinic for a test, so their chlamydial infection often goes undetected. This means they can infect any woman or man they have unprotected sex with. </p>
<p>Research has shown that screening for chlamydia <a href="http://www.publish.csiro.au/paper/SHv4n4Ab8.htm">where young people congregate</a>, such as higher education institutions, can be effective. Other venues, such as <a href="http://www.biomedcentral.com/1471-2334/9/73">car rallies and sporting clubs</a> have also been shown to be feasible when targeting young men for chlamydia screening. </p>
<p>Other research suggests community pharmacies may be effective for screening high-risk groups and those who do not regularly see a doctor.</p>
<h2>A possible solution</h2>
<p>The third difficulty is providing treatment for the sexual partners of people getting treatment. Treating chlamydia in one sexual partner and not the other will lead to reinfection or the infection of future sexual partners. </p>
<p>And here’s where the Perspectives piece in the MJA is interesting. In 2006, the US Centers for Disease Control and Prevention <a href="http://www.cdc.gov/std/treatment/EPTFinalReport2006.pdf">recommended partner-delivered therapy</a> and it’s now legal in most US states. </p>
<p>But it’s either illegal or has an ambiguous legal status in Australian states and territories. Even though a <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1801006/">2007 meta-analysis</a> of five studies of the approach showed it was effective.</p>
<p>There are guidelines for the approach endorsed by the <a href="http://www.racp.edu.au/index.cfm?objectid=2559E099-C37A-98A1-117CDED895CFF46C">Australasian Chapter of Sexual Health Medicine</a> (a chapter of the Royal Australasian College of Physicians), and the <a href="http://www.asid.net.au/">Australasian Society for Infectious Diseases.</a> </p>
<p>Partner-delivered therapy has the potential to treat more people infected with chlamydia and help curtail the infection rate in the population.</p>
<p>We need a multi-faceted approach to deal with the chlamydia epidemic. Educating young people and providing screening in accessible and places that are convenient for them is a start. </p>
<p>But we also need to keep in mind that, for every notified infection, there’s probably at least one infected sexual partner.</p>
<p>The longer we fail to provide treatment for both patients and partners, the greater the burden of infection we will have in the community. And the more we risk chlamydia impacting the fertility of young women, both in terms of private pain and the cost of infertility treatment.</p><img src="https://counter.theconversation.com/content/3781/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rhian Parker has conducted funded research on chlamydia. The views expressed here are not necessarily those of the organisations that have funded these research projects</span></em></p>A “Perspective” published in the Medical Journal of Australia today calls for patient-delivered partner therapy for chlamydia to be made legal across Australia. This approach could be just the right way…Rhian Parker, Associate Professor and Senior Research Fellow, Centre for Research and Action in Public Health, University of CanberraLicensed as Creative Commons – attribution, no derivatives.