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Biomedical subjects

Basil Donovan

Publications and source records attributed to Basil Donovan.

At least 19 recordsLinked to original sources
PubMed2007

Risk factors for genital and anal warts in a prospective cohort of HIV-negative homosexual men: the HIM study.

OBJECTIVE: The objective of this study was to determine the prevalence, incidence, and risk factors for genital and anal warts in HIV-negative homosexual men in Sydney. STUDY DESIGN: The authors conducted a prospective cohort study. Participants were asked whether they had had genital and anal warts at each interview. Details of lifetime sexual contacts and sexual behaviors in the last 6 months were collected. RESULTS: Among 1,427 men recruited, 8.9% and 19.6% reported a history of genital and anal warts at baseline, respectively. Incidence rates for genital and anal warts were 0.94 and 1.92 per 100 person-years, respectively. In multivariate analysis, both incident genital and anal warts were associated with younger age. In addition, incident genital warts was associated with insertive fingering (P trend = 0.018), whereas incident anal warts was associated with insertive fingering (P trend = 0.007) and insertive fisting (P trend = 0.039). CONCLUSIONS: Anal warts were twice as common as genital warts. Fingering and other manual sexual practices may be an important transmission route for both.

Adolescent↗
PubMed2006

Do condoms cause rape and mayhem? The long-term effects of condoms in New South Wales' prisons.

BACKGROUND: Concerns raised by opponents to condom provision in prisons have not been objectively examined and the issue continues to be debated. The long-term effects of the introduction of condoms and dental dams into New South Wales (NSW) prisons in 1996 was examined, focusing on particular concerns raised by politicians, prison officers, prison nurses and prisoners. These groups were worried that (a) condoms would encourage prisoners to have sex, (b) condoms would lead to an increase in sexual assaults in prisons, (c) prisoners would use condoms to hide and store drugs and other contraband and (d) prisoners would use condoms as weapons. METHOD: Data sources included the NSW Inmate Health Survey (IHS) from 1996 and 2001 and official reports from the NSW Department of Corrective Services. The 1996 IHS involved 657 men and 132 women randomly selected from all prisons, with a 90% response rate. The 2001 survey involved 747 men and 167 women inmates, with an 85% response rate. RESULTS: There was a decrease in reports of both consensual male-to-male sex and male sexual assaults 5 years after the introduction of condoms into prisons in 1996. The contents of condom kits were often used for concealing contraband items and for other purposes, but this was not associated with an increase in drug injecting in prison. Only three incidents of a condom being used in assaults on prison officers were recorded between 1996 and 2005; none was serious. CONCLUSIONS: There exists no evidence of serious adverse consequences of distributing condoms and dental dams to prisoners in NSW. Condoms are an important public health measure in the fight against HIV and sexually transmitted diseases; they should be made freely available to prisoners as they are to other high-risk groups in the community.

Attitude to Health↗
PubMed2006

Who declines to give a name at a sexual health service?

OBJECTIVE: To characterise patients who decline to provide their surname at a public sexual health centre. METHODS: A case-control study of all patients first attending the Sydney Sexual Health Centre from 1998 to 2004, using proforma-collected electronic data to compare patients who did not provide their surname with those who did. In addition, the frequencies of the 10 most common surnames in the Sydney telephone directory were compared with the frequency of those names in the patient database. RESULTS: Of 27 241 patients, 1350 (5%) declined to provide their surname. The most common surnames were also over-represented, suggesting that aliases remained pervasive among the centre's patients. Sex workers, married people and people requesting HIV, hepatitis or sexually transmissible infection (STI) screening were all more likely to decline to provide a surname. By contrast, patients with symptoms, patients who were referred with a prior STI diagnosis and patients with a new bacterial or non-HIV viral STI or were a known contact with STI were all significantly more likely to provide a surname. Among patients who declined to provide a surname, 20 tested HIV positive. CONCLUSION: The anonymous option did not seem to eliminate the use of aliases. Although limited, there seems to be a market for anonymous sexual health screening, particularly for the asymptomatic.

Adult↗
PubMed2006

Transmission of herpes simplex virus types 1 and 2 in a prospective cohort of HIV-negative gay men: the health in men study.

BACKGROUND: Despite increasing reports of herpes simplex virus (HSV) type 1 (HSV-1)-associated anogenital herpes, there are very limited data comparing the seroepidemiological profile of and risk factors for HSV-1 and HSV type 2 (HSV-2) infection. METHODS: Sexual behaviors were examined as risk factors for prevalent and incident HSV-1 and HSV-2 infections in a community-based cohort of 1,427 HIV-negative gay men in Australia. RESULTS: The prevalence of HSV-1 and HSV-2 at baseline was 75% and 23%, respectively. The rate of prevalent infection with HSV-1, as well as the rate of prevalent infection with HSV-2, was much lower in individuals <25 years of age, and each type of infection was associated with a higher number of both male and female sex partners. The median duration of follow-up of the cohort was 2.0 years. Among participants who were susceptible to infection, the incidence rates for HSV-1 and HSV-2 infection were 5.58 and 1.45 cases per 100 person-years, respectively. In multivariate analysis, incident infection with HSV-1 was significantly associated with younger age (P=.027) and reports of frequent insertive oral sex with casual partners (hazard ratio, 3.91 [95% confidence interval, 1.23-12.44]; P=.021). Incident infection with HSV-2 was significantly associated with a variety of anal sex practices with casual partners. CONCLUSIONS: Both HSV-1 and HSV-2 were commonly sexually transmitted, and there were more HSV-1 than HSV-2 seroconversions. Public-health strategies targeted against anogenital herpes increasingly need to take into account the importance of HSV-1 infection.

Adult↗
PubMed2006

The cost effectiveness of screening for genital Chlamydia trachomatis infection in Australia.

BACKGROUND: In Australia, there is no published study on the cost effectiveness of screening for chlamydia. The aim of this study was to examine the cost effectiveness of a hypothetical screening programme for chlamydia based on annual opportunistic testing of all women 25 years of age or younger consulting a general practitioner, compared with no screening. METHODS: A decision-analytic modelling approach was used to determine the incremental cost effectiveness ratio (ICER) of screening compared with no screening over 25 years. The analysis measured Australian health-care costs and benefits were assessed in terms of quality-adjusted life years (QALYs). RESULTS: The analysis resulted in a cost per QALY of 2968 dollars for screening. One-way sensitivity analyses on all variables, and multi-way sensitivity analyses on some variables, showed a wide range for the cost effectiveness, from dominance (where screening is effective and saves money overall) to an ICER of 67,715 dollars per QALY. CONCLUSIONS: The results indicate that annual opportunistic screening for chlamydia in women under 25 is a potentially worthwhile undertaking. However, the analysis also highlights uncertainties around the natural history of chlamydia and the effectiveness of chlamydia screening. Given these uncertainties, the need for further primary data collection in these areas becomes apparent.

Adolescent↗
PubMed2006

Trends in clinical encounters for pelvic inflammatory disease and epididymitis in a national sample of Australian general practices.

Trends in the frequency of clinical encounters for pelvic inflammatory disease (PID) and epididymitis in Australian general practice were determined via a national representative study of general practice activity between 1998 and 2003. Information was derived from 502,100 general practice encounters that occurred during the study period. An estimated 59,200 encounters for PID and 54,200 encounters for epididymitis took place in Australian general practice each year. Despite increases in national notification rates for Chlamydia trachomatis, over the study period overall encounter rates did not change significantly for either condition, and a fall in encounter rates for PID of about 50% occurred among women aged 15-34 years (P=0.02). Only 0.3% of encounters for PID and 1.9% of those for epididymitis resulted in hospital referral. On a population level, trends in the incidence of chlamydia-related diseases do not necessarily parallel those of reported chlamydia rates.

Adolescent↗
PubMed2005

Changes in testing methods for genital Chlamydia trachomatis in New South Wales, Australia, 1999 to 2002.

BACKGROUND: Over the last decade, significant advances have occurred in the area of chlamydia diagnostics. The relative frequency of different testing methods employed in the diagnosis of Chlamydia trachomatis infection in New South Wales has not been previously reported. METHODS: Testing methods--both laboratory method and specimen type--employed in the diagnosis of chlamydia cases notified in New South Wales between 1999 and 2002 were collated from Health Department records. RESULTS: During a period of increasing notifications, the proportion of men diagnosed with C. trachomatis using nucleic acid tests (NATs) increased from 36% in 1999 to 90% in 2002. Among women, the proportion diagnosed using NATs increased from 42% in 1999 to 92% in 2002. Urine samples were consistently used in the diagnosis of two-thirds of the men, and one-third of the women. CONCLUSION: Between 1999 and 2002, a rapid shift towards NATs for genital C. trachomatis took place in New South Wales.

Chlamydia Infections↗
PubMed2005

Sex work and the law.

We reviewed publications, websites, and field observations to explore the health and welfare impacts and administrative effectiveness of different legal approaches to sex work. We identified three broad legal approaches: (1) prohibition, including the unique Swedish law criminalising sex workers' clients; (2) licensing; and (3) decriminalisation. Each of these models is employed under one or more jurisdictions in Australia. We make preliminary observations on their consequences and conclude that, on initial impression, decriminalisation may offer the best outcomes. However, more rigorous population-based research is needed to properly assess the health and welfare impacts of legal approaches to sex work.

Australia↗
PubMed2005

Nowhere near the point of diminishing returns: correlations between chlamydia testing and notification rates in New South Wales.

OBJECTIVE: To examine the relationship between chlamydia testing and chlamydia detection rates in New South Wales, Australia, from 1999 to 2001. METHODS: Correlations between population-based chlamydia testing and notification rates--stratified by age group, area of residence, and year--were determined by linear regression. RESULTS: Strong positive correlations between chlamydia testing and notification rates were observed for both women (r = 0.91, p < 0.001) and men (r = 0.94, p < 0.001). Between 1999 and 2001, the chlamydia test positivity rate increased from 4.3% to 7.3% for women (p < 0.0001) and from 7.8% to 10.5% for men (p < 0.0001). CONCLUSIONS AND IMPLICATIONS: This study suggests that Australia could benefit from a major chlamydia screening program.

Adolescent↗
PubMed2005

Chlamydia trachomatis infection in Sydney women.

BACKGROUND: In Australia, reported rates of Chlamydia trachomatis infection have been rising progressively since the mid-1990s. Opportunistic testing of sexually active young women attending clinical services for other reasons has already been implemented in a number of other countries. AIMS: To help guide chlamydia testing of women, this study aimed to establish factors predictive of chlamydial infection in an Australian clinical setting. METHODS: Women attending a sexual health service in Sydney who tested positive for C. trachomatis by polymerase chain reaction and who did not have any concurrent urogenital infections (n = 170) were compared with chlamydia-negative controls (n = 170). Factors independently associated with chlamydia were determined using logistic regression. RESULTS: Although they were present in only a minority of infected women, symptoms of dysuria [adjusted odds ratio (AOR) = 3.2 (95% CI: 1.2-9.1), P = 0.03] and postcoital bleeding [AOR = 2.7 (95% CI: 1.0-7.1), P < 0.05] were each independently associated with chlamydia. Symptoms of vaginal discharge (P = 0.3), abdominal pain (P = 0.2), or intermenstrual bleeding (P = 0.1) did not help to discriminate between infected and uninfected women. The following factors were independently associated with chlamydia: younger age (P = 0.003); being overseas-born [AOR = 2.3 (95% CI: 1.3-4.0), P = 0.005]; sex with a partner from overseas [AOR = 2.0 (95% CI: 1.3-12.3), P = 0.01]; and sex with a partner known or suspected to be chlamydia-infected [AOR = 7.4 (95% CI: 3.6-15.0), P < 0.001]. CONCLUSIONS: Chlamydia testing is clinically indicated in sexually active young women with dysuria, postcoital bleeding or contact with a suspected chlamydia-infected partner. Consideration should be given to enhanced screening programs for travelling and migrant men and women in Australian cities.

Adult↗
PubMed2004

Sexually transmissible infections other than HIV.

Sexually transmitted infections (STIs) are notable for their fastidious requirements for transmission and growth in the laboratory and for their high physical and psychosocial morbidity. The combination of subtle or absent symptoms and stigma preventing the seeking of health care, leaves many infections undiagnosed. The development of nucleic-acid amplification tests heralded a new era in sensitive and robust diagnostic procedures for STIs. Unfortunately, many of these tests are not commercially available or are too expensive for the populations that need them most. Single-dose oral azithromycin has improved the treatment of several bacterial STIs, but quinolones are rapidly becoming ineffective for gonorrhoea. Self-treatment of genital warts with podophyllotoxin or imiquimod preparations is attractive to patients and might be cost effective for health services. The prospect of effective vaccines against genital papillomaviruses in the near future is real. Such vaccines could reduce the global incidence of some anogenital cancers. Episodic treatment of genital herpes is getting easier and cheaper, and suppressive treatment can reduce transmission to regular sexual partners. A vaccine against herpes simplex virus type 2 has shown some limited efficacy. Ultimately, better control of STIs, and reduction of their contribution to the spread of HIV, will require a broad health-sector response with adequate resourcing, and a change in social and political attitudes.

Contact Tracing↗
PubMed2004

Evaluation of an ethnic media campaign on patterns of HIV testing among people from culturally and linguistically diverse backgrounds in Australia.

OBJECTIVE: To evaluate a 2-week pilot ethnic media campaign that was implemented in 14 languages to promote awareness of HIV/AIDS and HIV testing among selected non-English speaking populations in Australia in November/December 2000. METHODS: The main outcome measure was clinic attendances for the purpose of HIV testing by individuals from the target populations at one ofthree public sexual health clinics in Sydney and Melbourne prior to and immediately after the campaign. RESULTS: The number of HIV tests on members of the 14 target language communities attending the clinics almost doubled from 66 to 122 tests. However, as a proportion of the total number of HIV tests performed at the three clinics this increase was not significant (16.3-18.8%; P = 0.31). For both periods in 2000 the proportion of HIV tests that were performed on members of the target language group were higher than during a 1999 comparison period (10.5%, both P < 0.01). CONCLUSIONS AND IMPLICATIONS: This study did not demonstrate a significant increase in testing attributable to the pilot intervention. A larger campaign, with a more extensive evaluation, would probably be needed to demonstrate a measurable effect.

Adult↗
PubMed2004

Genital injuries in women reporting sexual assault.

BACKGROUND: The likelihood of genital injury following sexual assault remains unclear. Genital injury related to sexual assault is often an issue in court proceedings, with the expectation that injuries will be found in 'genuine' cases. Conviction rates are higher when the complainant has genital injuries. OBJECTIVES: To determine the type, frequency and severity of genital and non-genital injuries of women following alleged sexual assault and, in addition, to determine factors associated with the presence of injuries. METHODS: The assault records and forensic examination findings of 153 consecutive women who attended a sexual assault service in Newcastle, Australia, between 1997 and 1999 were reviewed. All of the women were examined within 72 h of the assault. Associations were sought between victim and reported assault variables and the presence of injury using multiple logistic regression analysis. RESULTS: Of the women, 111 (73%) were aged under 30 years and only 4% were over 50 years. Penile-vaginal penetration was the most common type of sexual assault (86%). Non-genital injuries were found in 46% of the women examined (mostly minor) and genital injury in only 22%. Genital injury in the absence of non-genital injury was rare (3%). Independent risk factors for the detection of non-genital injuries were reported threats of violence (OR 5.7, 95% CI; 2.2-14.6). Risk factors for genital injury were the presence of non-genital injury (OR 19, 95% CI; 6.0-63.0), threats of violence (OR 3.7, 95% CI; 1.5-8.9) and being over the age of 40 years (OR 5.6, 95% CI; 1.6-20.3). If the alleged assailant was known to the woman this was protective for both non-genital (OR 0.3, 95% CI; 0.1-0.5) and genital (OR 0.4, 95% CI; 0.2-0.9) injury. CONCLUSIONS: The presence of genital injury should not be required to validate an allegation of sexual assault, particularly in the absence of non-genital injuries.

Adolescent↗
PubMed2004

Hepatitis A and B infection and vaccination in a cohort of homosexual men in Sydney.

OBJECTIVES: To determine the prevalence and incidence of hepatitis A (HAV) and B (HBV) infection and vaccination in HIV-negative homosexual men in Sydney, and associated risk factors. METHODS: An open prospective cohort study was conducted among a community-based sample of HIV-negative homosexual men in Sydney in 2001-02. Participants underwent a face-to-face interview, regarding demographics, sexual behavioural risk factors and sexually transmitted infections, and blood samples were collected. They were followed annually. RESULTS: Nine hundred and three men completed a baseline interview by the end of 2002. Among them, 68% were seropositive to hepatitis A. The seroprevalence of prior hepatitis B infection was 19%, and 53% had serological evidence of HBV vaccination. Younger men were much more likely to be seronegative, with 48% and 46% of <25-year-olds being seronegative to HAV and HBV respectively. In multivariate analysis HAV and HBV infection were associated with increasing age, greater number of lifetime sex partners and HBV infection was also associated with previous sexually transmitted infections. HAV vaccination was associated with increasing age, greater number of lifetime sex partners, overseas travel in the last year and self-reported anogenital warts. HBV vaccination was associated with higher occupational status, greater lifetime number of sex partners and previous sexually transmitted infections. CONCLUSION: Substantial proportions of gay community-attached young homosexual men are still at risk of HAV and HBV infection. This study points to a need for vaccination strategies which ensure high levels of hepatitis A and B immunity in young sexually active gay men.

Adult↗
PubMed2004

Genital Chlamydia trachomatis infection in Australia: epidemiology and clinical implications.

Over the last decade, notification rates for genital Chlamydia trachomatis infection in Australia have been rising progressively. While chlamydia is common and possibly increasing in the general population, heterosexual adolescents, indigenous Australians in remote settings, and homosexually active men are at particular risk of infection. Few studies are available on the extent of morbidity from chlamydia-associated diseases. Australia urgently needs a national strategy to control chlamydia, with widespread, selective screening as a key component. As general practitioners have an important role to play, we proffer guidelines for selective testing in primary care.

Australia↗