Christopher K. Fairley

Description:Background: Bacterial vaginosis affects one third of reproductive-aged women, and recurrence is common. Evidence of sexual exchange of bacterial vaginosis-associated organisms between partners suggests that male-partner treatment may increase the likelihood of cure. Methods: This open-label, randomized, controlled trial involved couples in which a woman had bacterial vaginosis and was in a monogamous relationship with a male partner. In the partner-treatment group, the woman received first-line recommended antimicrobial agents and the male partner received oral and topical antimicrobial treatment (metronidazole 400-mg tablets and 2% clindamycin cream applied to penile skin, both twice daily for 7 days). In the control group, the woman received first-line treatment and the male partner received no treatment (standard care). The primary outcome was recurrence of bacterial vaginosis within 12 weeks. Results: A total of 81 couples were assigned to the partner-treatment group, and 83 couples were assigned to the control group. The trial was stopped by the data and safety monitoring board after 150 couples had completed the 12-week follow-up period because treatment of the woman only was inferior to treatment of both the woman and her male partner. In the modified intention-to-treat population, recurrence occurred in 24 of 69 women (35%) in the partner-treatment group (recurrence rate, 1.6 per person-year; 95% confidence interval [CI], 1.1 to 2.4) and in 43 of 68 women (63%) in the control group (recurrence rate, 4.2 per person-year; 95% CI, 3.2 to 5.7), which corresponded to an absolute risk difference of -2.6 recurrences per person-year (95% CI, -4.0 to -1.2; P<0.001). Adverse events in treated men included nausea, headache, and metallic taste. Conclusions: The addition of combined oral and topical antimicrobial therapy for male partners to treatment of women for bacterial vaginosis resulted in a lower rate of recurrence of bacterial vaginosis within 12 weeks than standard care. (Funded by the National Health and Medical Research Council of Australia; StepUp Australian New Zealand Clinical Trials Registry number, ACTRN12619000196145.).

Description:Objective: Social network distribution of HIV self-test (HIVST) kits uses social networks to increase HIV testing among marginalized populations, such as men who have sex with men (MSM). Using a discrete choice experiment (DCE), we identified factors influencing influence MSM's willingness and decision-making in HIVST kit distribution. Methods: An online DCE survey was conducted among MSM in Australia (December 2023-May 2024) via online/offline advertisements. Methods: Participants completed seven choice sets, each containing two hypothetical scenarios for HIVST kits distribution described by attributes such as cost, location, training, support system, and self-reporting methods. Mixed logit models and latent class analysis explored preference heterogeneity across language (English vs. non-English first language) and nativity (Australian-born vs. overseas-born) groups. Results: There were 251 participants, including 140 overseas-born MSM, with a mean age of 36.5 (SD=11.9). Participants who did not speak English as their first language (29/251,12%) showed a lower preference for paid HIVST kits ($30 or $60 for three kits) and online video chats with sexual health professionals as pre-test support. Overseas-born participants preferred not to attend 30-minute or one-hour training sessions on distributing HIVST kits. They did not like accessing HIVST kits from hospitals. Class 1 ('Cost-conscious and minimal support seekers';61.7%) were willing to pay up to $30 for three kits, while Class 2 ('Subsidy-dependent and structured support seekers';38.3%) disliked costs and self-reporting results by phone. Conclusions: Increasing participation in social network distribution of HIVST kits will require free or subsidized kits. Tailored support systems should prioritise overseas-born MSM with limited English proficiency.

Description:Background: Artificial Intelligence (AI) chatbots could potentially provide information on sensitive topics, including sexual health, to the public. However, their performance compared to nurses and across different AI chatbots, particularly in the field of sexual health, remains understudied. This study evaluated the performance of three AI chatbots - two prompt-tuned (Alice and Azure) and one standard chatbot (ChatGPT by OpenAI) - in providing sexual health information on questions that experienced sexual health nurses could correctly answer. Methods: We analysed 195 anonymised sexual health questions received by the Melbourne Sexual Health Centre phone line. A panel of experts in a blinded order using a consensus-based approach evaluated responses to these questions from nurses and the three AI chatbots. Performance was assessed based on overall correctness and five specific measures: guidance, accuracy, safety, ease of access, and provision of necessary information. We conducted subgroup analyses for clinic-specific (e.g., opening hours) and general sexual health questions and a sensitivity analysis excluding questions that Azure could not answer. Results: Alice demonstrated the highest overall correctness (85.2%; 95% confidence interval (CI), 82.1-88.0%), followed by Azure (69.3%; 95% CI, 65.3-73.0%) and ChatGPT (64.8%; 95% CI, 60.7-68.7%). Prompt-tuned chatbots outperformed the base ChatGPT across all measures. Among all outcome measures, all chatbots performed best on safety, with Azure achieving the highest safety score (97.9%; 95% CI, 96.4-98.9%), indicating the lowest risk of providing potentially harmful advice. In subgroup analysis, all chatbots performed better on general sexual health questions compared to clinic-specific queries. Sensitivity analysis showed a narrower performance gap between Alice and Azure when excluding questions Azure could not answer. Conclusions: Prompt-tuned AI chatbots demonstrated superior performance in providing sexual health information compared to base ChatGPT, with high safety scores particularly noteworthy. However, all AI chatbots showed susceptibility to generating incorrect information. These findings suggest the potential for AI chatbots as adjuncts to human healthcare providers for providing sexual health information while highlighting the need for continued refinement and human oversight. Future research should focus on larger-scale evaluations and real-world implementations.

Description:Background The study describes the capacity of publicly funded sexual health clinics in Australia and explores the challenges they face. Methods We sent a survey to the directors of publicly funded sexual health clinics across Australia between January and March 2024. The survey asked about how their clinics were managing the current clinical demand. Results Twenty-seven of 35 directors of sexual health clinics responded. These 27 clinics offered a median of 35 (IQR: 20-60) bookings each day, but only a median of 10 (IQR: 2-15) walk-in consultations for symptomatic patients. The average proportion of days that clinics were able to see all patients who presented with symptoms was 70.1% (95% CI 55.4, 84.9) during summer versus 75.4% (95% CI 62.2, 88.5) during winter. For patients without symptoms, the corresponding proportions were 53.3% (95% CI 37.9, 68.8) during summer versus 57.7% (95% CI 41.7, 73.7) during winter. If these percentages were adjusted for the number of consultations that the clinic provided, then the corresponding numbers for symptomatic individuals was 51.0% for summer and 65.2% for winter, and for asymptomatic individuals it was 48.1% and 49.8%, respectively. The catchment population of the clinics for each consultation they provided ranged from as low as 3696 to a maximum of 5 million (median 521,077). Conclusions The high proportion of days on which sexual health clinics were not able to see all patients is likely to delay testing and treatment of individuals at high risk of STIs and impede effective STI control.

Description:Objective: Curing Mycoplasma genitalium is challenging in the context of rising antimicrobial resistance and limited therapeutic options. There is an urgent need for globally relevant and effective treatment options using readily available and affordable agents. From September 2021 to August 2024 at Melbourne Sexual Health Centre, we prospectively evaluated microbial cure and tolerability of oral minocycline 100 mg combined with metronidazole 400 mg (twice daily for 14 days) for individuals with macrolide-resistant M. genitalium in whom fluroquinolones had failed or were not advised. Methods: Microbial cure was defined as a negative test of cure (TOC) using transcription-mediated amplification 14-90 days after completing the regimen. The proportion cured and 95% confidence intervals (CIs) were calculated. Data on side effects and adherence were collected at TOC visits. Results: Microbial cure in patients receiving the combination regimen was 80.8% (95% CI: 71.9-87.8%). Cure in those who had received preceding doxycycline was 90.3% (n = 28/31, 95% CI: 74.2-98.0%) compared to 76.7% (n = 56/73, 95% CI: 65.4-85.8%) in those who had not, P = 0.172. Central nervous system and gastrointestinal side effects were commonly reported. Conclusions: Minocycline with metronidazole cured 80% of macrolide-resistant infections in this cohort. Cure may be enhanced by the use of doxycycline before the combination regimen but larger studies are needed. Given limited options for treating resistant M. genitalium infections, the combined minocycline and metronidazole regimen may represent a promising option where no alternative drugs are available, or quinolones are contraindicated. Clinicians should be aware of and discuss side effects with patients.