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Christopher K Fairley

Publications and source records attributed to Christopher K Fairley.

At least 19 recordsLinked to original sources
PubMed2025

Selecting candidate Neisseria gonorrhoeae strains for oropharyngeal gonorrhoea human challenge: a genomics-based analysis of clinical isolates.

BACKGROUND: Neisseria gonorrhoeae is a human pathogen of major public health importance due to its increasing global prevalence and antimicrobial resistance (AMR). Evidence suggests that oropharyngeal infection plays a key role in N gonorrhoeae transmission and AMR; however, our understanding of oropharyngeal gonorrhoea pathogenesis is poor. A controlled human infection model (CHIM) for oropharyngeal gonorrhoea will improve understanding of infection and accelerate urgently needed novel gonorrhoea prevention and therapeutic strategies. As the first step in the development of this CHIM, we describe a systematic approach to CHIM strain selection that leverages genomics and clinical data. METHODS: In this genomics-based analysis, we applied a systematic N gonorrhoeae challenge strain selection strategy incorporating genomic and clinical data to a primary dataset of clinical isolates of N gonorrhoeae collected from adult patients in Victoria, Australia, between Jan 1 and Dec 31, 2017, and July 1, 2019, and June 30, 2021. This selection strategy used clinical, phenotypic, and genomic characteristics to define a set of eight criteria that aimed to ensure the contemporary global clinical relevance of the candidate strains; select strains that would be applicable for the assessment of current and future gonorrhoea vaccines; and maximise participant safety by reducing the risk of disseminated gonococcal infection and clinically significant AMR. We applied these criteria to our primary dataset to generate a panel of potential challenge strains. From this final dataset of potential challenge strains, we predetermined that we would select up to ten isolates to proceed to the next stage of detailed phenotypic characterisation for final N gonorrhoeae CHIM strain selection. FINDINGS: 5881 isolates comprised the primary dataset. After application of the selection criteria, most of the isolates (5795 [98·6%] of 5881) were excluded, mostly due to having clinically significant AMR and poor contemporary global clinical relevance. The remaining 86 N gonorrhoeae challenge strain candidates comprised five multilocus sequence types and six N gonorrhoeae multiantigen sequence types, many of which were represented by a single isolate. Of these 86 strains, five isolates were selected to maximise coverage of the phylogenetically distinct groups within the 86 candidate challenge strains and ensure representation of strains collected from various anatomical sites. INTERPRETATION: We transparently describe a novel, systematic, and rational genomics-based strategy for oropharyngeal gonorrhoea CHIM strain selection that improves the efficiency and transparency of CHIM strain selection and enables identification of contemporary and clinically relevant potential challenge strains. A final N gonorrhoeae challenge strain will be selected from the subset of five shortlisted candidates after detailed phenotypic assessment. FUNDING: Medical Research Future Fund, Australian National Health and Medical Research Council and Australian Government Research Training Program.

Humans↗
PubMed2006

Implementing chlamydia screening: what do women think? A systematic review of the literature.

BACKGROUND: Chlamydia trachomatis is a common sexually transmitted infection that can have serious consequences. It is universally agreed that screening for chlamydia infection should be offered to sexually active young women. We undertook a literature review to document the views, attitudes and opinions of women about being screened, tested and diagnosed with Chlamydia trachomatis. METHODS: Online databases (MEDLINE, Meditext, PsycINFO, Web of Science) and reference lists searched up to August 2005. Search terms: chlamydia, attitude, attitude to health, interview, qualitative, women. ELIGIBILITY CRITERIA: about chlamydia, included women, involved interviews/surveys/focus groups, looked at women's views/opinions/attitudes, published in English. Thematic analysis identified the main and recurrent themes emerging from the literature. We compared our thematic analysis with the Theory of Planned Behaviour to provide a model that could assist in planning chlamydia screening programs. RESULTS: From 561 identified articles, 25 fulfilled inclusion criteria and were reviewed. 22: USA, UK; 3: Holland, Sweden, Australia. Major themes identified: need for knowledge and information, choice and support; concerns about confidentiality, cost, fear, anxiety and stigma. Women are more likely to find chlamydia screening/testing acceptable if they think chlamydia is a serious, common condition which can cause infertility and if they understand that chlamydia infection can be asymptomatic. Women want a range of options for chlamydia testing including urine tests, self-administered swabs, pelvic exams and clinician-collected swabs, home-testing and community-based testing. Tests should be free, easy and quick. Women want support for dealing with the implications of a chlamydia diagnosis, they feel chlamydia diagnoses need to be normalised and destigmatised and they want assistance with partner notification. Women need to know that their confidentiality will be maintained. CONCLUSION: Our review found that women from various countries and ethnic backgrounds share similar views regarding chlamydia screening, testing and diagnosis. The acknowledged importance of women's views in planning an effective chlamydia screening program is expanded in this review which details the nature and complexity of such views and considers their likely impact.

Attitude to Health↗
PubMed2006

High recurrence rates of bacterial vaginosis over the course of 12 months after oral metronidazole therapy and factors associated with recurrence.

BACKGROUND: We wished to determine recurrences of bacterial vaginosis (BV) after treatment over the course of 12 months and to establish factors associated with recurrence. METHODS: Women with symptomatic BV (a Nugent score [NS] of 7-10 or of 4-6 with >or=3 Amsel criteria) were enrolled. BV was treated with 400 mg of oral metronidazole twice a day for 7 days. Participants completed a questionnaire and vaginal swabs were collected at 1, 3, 6, and 12 months; the study end point was an NS of 7-10. RESULTS: A total of 121 (87%) women with an NS of 7-10 and 18 (13%) with an NS of 4-6 and >or=3 Amsel criteria were enrolled; 130 (94%) returned >or=1 vaginal samples. Sixty-eight women (58% [95% confidence interval {CI}, 49%-66%]) had a recurrence of BV (NS 7-10), and 84 (69% [95% CI, 61%-77%]) had a recurrence of abnormal vaginal flora (NS 4-10) by 12 months. A past history of BV, a regular sex partner throughout the study, and female sex partners were significantly associated with recurrence of BV and abnormal vaginal flora by multivariate analysis; the use of hormonal contraception had a negative association with recurrence. CONCLUSION: Current recommended treatment is not preventing the recurrence of BV or abnormal vaginal flora in the majority of women; factors associated with recurrence support a possible role for sexual transmission in the pathogenesis of recurrent BV.

Adult↗
PubMed2006

A survey of partner notification practices among general practitioners and their use of an internet resource for partner notification for Chlamydia trachomatis.

OBJECTIVES: To determine in which circumstances Victorian general practitioners (GPs) offer chlamydia testing to patients, the attitudes of GPs in relation to contact tracing, how often GPs use a pre-printed partner letter and patient brochure and what proportion of GPs have immediate internet access in their consulting rooms. METHODS: This study involved two parts, an initial survey of a sample of GPs in Victoria and a study of GP use of a website that provided treatment guidelines, a printable client brochure and a partner letter. RESULTS: Of 418 eligible GPs, 221 (53%, 48-58%, 95% CI) returned completed surveys. Of these, 213 (97%, 93-99%, 95% CI) GPs believed that patients were largely responsible for notifying partners. Partner letters were rarely used: 167 (76%, 70-81%, 95% CI) GPs reported they never used partner letters, 18 (8%, 5-13%, 95% CI) GPs reported rare use and 23 (10%, 7-15%, 95% CI) GPs reportedusing them sometimes. Of the GPs, 181 (82%, 77-87%, 95% CI) reported they would find a partner letter and patient brochure on a website helpful. During the study, the website was accessed by 28 GPs (25%, 17-34%, 95% CI) in Gippsland and 17 GPs (8%, 5-13%, 95% CI) in Geelong who received positive chlamydia results on 110 and 208 clients respectively. CONCLUSIONS: GPs mostly considered patients responsible for partner notification but uncommonly used partner letters or an information brochure to assist them. Importantly, GPs reported that they could improve partner notification if further support was provided. In addition, when a website was provided with useful documents on it, up to 25% of GPs used it. This indicates that simple and inexpensive interventions can support GPs with strategies that may improve the control of chlamydia.

Adult↗
PubMed2006

Antibiotic consumption and chlamydia prevalence in international studies.

BACKGROUND: To determine whether there is an ecological association between antibiotic use and chlamydia prevalence. METHODS: A systematic review was undertaken of international studies on chlamydia prevalence among women aged 15-25 years published between 2000 and 2005. Preference was given to studies using nucleic acid testing and representative population-based sampling methods. Data were obtained on per capita antibiotic consumption according to the defined daily dose. RESULTS: For the 12 countries for which both antibiotic consumption and relevant prevalence data for chlamydia were available, a non-significant negative correlation was found between total antibiotic consumption per capita and chlamydia prevalence among younger women according to country (r(s) = -0.242, P = 0.449). When an outlier (from the Netherlands) was excluded, the correlation was significant (r(s) = -0.615, P = 0.044). Combined use of tetracyclines and macrolides was also associated with lower chlamydia prevalence (r(s) = -0.697, P = 0.017). CONCLUSIONS: It is possible that antibiotics used for other reasons may have unexpectedly reduced the prevalence of chlamydia.

Adolescent↗
PubMed2006

Changes in the diagnosis and management of bacterial vaginosis following clinical research.

BACKGROUND: It has become common practice to offer patients attending public sexual health clinics participation in research studies. We investigated the premise that clinician involvement in research leads to improvements in clinical practice within a sexual health service in Melbourne, Australia. METHODS: Retrospective case note reviews were conducted of 100 cases of bacterial vaginosis (BV) during three time periods; 2000, 2002 and 2004. The first and second reviews were conducted 2 years before and immediately prior to a cross-sectional study of BV at Melbourne Sexual Health Centre. The third review was conducted immediately after study completion. Diagnostic criteria and treatment for BV were recorded. Clinicians were divided into high and low recruiters, according to the percentage of eligible patients that they recruited into the cross-sectional study. No audited cases were enrolled in the study. RESULTS: Significant improvements in the use of Amsel's criteria occurred between the second and third audit periods (51 to 65%, P = 0.04) but not between the first and second audits (51% for both, P = 1.0). The improvement was seen in high-recruiting clinicians (P = 0.02) but not low-recruiting clinicians (P = 0.75). Although treatment with 7 days of metronidazole or vaginal clindamycin increased for all clinicians between the first and second audit periods (8 to 18%, P = 0.04), it was greater between the second and third audit periods (18 to 72%, P < 0.01). No difference was observed between high- and low-recruiting clinicians. CONCLUSION: Introduction of research was temporally associated with improved clinical practice in high-recruiting clinicians only.

Clinical Competence↗
PubMed2006

Anorectal lymphogranuloma venereum in a Melbourne man.

We report the first case of anorectal lymphogranuloma venereum (LGV) in a man who has sex with men (MSM) in Australia in the setting of the recent emergence of LGV among MSM in Europe and the USA. A 33-year-old man presented with a 2 month history of mild external anal discomfort. He gave a history of unprotected receptive and insertive anal intercourse with one partner in Europe during the preceding 6 months. No symptoms suggested proctitis and examination revealed two small anal fissures. An anal swab was positive for Chlamydia trachomatis; investigation for other STIs including HIV were negative. On review 6 days later, he was investigated and treated presumptively for LGV. The LGV diagnosis was confirmed by identifying the L2 serovar of C. trachomatis using a genotype test on the original anal specimen. This case is in keeping with the more recent reports of LGV from Europe, and has demonstrated the need for a high index of suspicion for asymptomatic or minimally symptomatic anorectal LGV.

Adult↗
PubMed2006

A chlamydia prevalence survey of young women living in Melbourne, Victoria.

BACKGROUND: To estimate the population-based chlamydia prevalence among women aged 18 to 35 years living in Melbourne, Victoria, and to assess the feasibility of using mailed urine specimens to test women. METHODS: A simple random sample of 11,001 households in Melbourne was selected from the telephone directory. Participants completed telephone interviews and provided urine specimens through the mail for chlamydia testing. Urines were tested using polymerase chain reaction. RESULTS: 11,001 households were contacted, with 1532 households identified as including eligible women; telephone interviews were completed, with 979 women giving a response rate of 64%. Six hundred and fifty-seven women provided a urine specimen with a response rate of 43%. Among sexually active women aged 18-24 years, the chlamydia prevalence was 3.7% (95% CI: 1.2%, 8.4%) and 0.2% (95% CI: 0.0%, 1.1%) among 25-35 year olds. Chlamydia prevalence increased significantly with an increasing number of male sexual partners. CONCLUSIONS: This is the first study of its kind in Australia and shows that chlamydia prevalence increases with an increasing number of male sexual partners in the last 12 months. Mailed urine specimens are feasible for conducting population-based chlamydia-prevalence surveys but it is difficult to obtain high response rates with this methodology. Public health resources should now be directed towards investigating how to reach young women at increased risk of infection, ensuring that they are tested for chlamydia.

Adolescent↗
PubMed2006

Associations between condom use and rectal or urethral chlamydia infection in men.

OBJECTIVE: To investigate the association of condom use with chlamydia infection in men attending a large sexually transmitted infection (STI) clinic in Australia. STUDY: Computerized records for all attendances between July 2002 and June 2003 were included and separate analyses were performed for men reporting male-to-male sexual contact (MSM) and for men reporting heterosexual contact only (non-MSM). Associations among age, condom use, and number of partners with chlamydia infection were assessed. RESULTS: Chlamydia was diagnosed at a rate of 8.6 cases per 100 consultations (95%CI: 7.1, 10.3) among MSM and at a rate of 6.8 cases per 100 consultations (95%CI: 5.9, 7.8) among non-MSM. Condom use was associated with a lower odds of rectal chlamydia but not urethral infection in MSM. Condom use was associated with lower odds of urethral chlamydia among non-MSM. CONCLUSIONS: The findings suggest that condoms do provide some protection against rectal chlamydia infection in MSM and chlamydial urethritis in non-MSM, but other factors may play an important role in the transmission of chlamydial urethritis in MSM.

Adult↗
PubMed2006

Prevalence of Gardnerella vaginalis and Atopobium vaginae in virginal women.

OBJECTIVES: The objectives of this study was to determine the prevalence of Gardnerella vaginalis and Atopobium vaginae in virginal women and to establish if nonpenetrative sexual activity is associated with these organisms. GOAL: The goal of this study was to assess prevalence of G. vaginalis and A. vaginae in virginal women. STUDY DESIGN: Forty-four virginal female patients self-collected tampon specimens, which were tested for G. vaginalis and A. vaginae by polymerase chain reaction, and provided either brief or detailed information regarding sexual practices by self-administered questionnaire. RESULTS: Twenty women (45%) had G. vaginalis and 3 (7%) A. vaginae detected. Among the 27 who provided detailed information, 12 (46%) had G. vaginalis and none had A. vaginae detected. G. vaginalis was significantly more likely to be detected in those who had participated in oral sex (odds ratio = 22; 95% confidence interval = 2.2-222) and hand-genital contact without penetration (P = 0.02), but not genital-genital contact. CONCLUSION: This study shows that nonpenetrative intimate sexual contact is associated with carriage of G. vaginalis in virginal women.

Actinobacteria↗
PubMed2006

What can prevalence studies tell us about female sexual difficulty and dysfunction?

INTRODUCTION: Many recent studies have investigated the prevalence of female sexual difficulty/dysfunction. AIM: Investigate female sexual difficulty/dysfunction using data from prevalence studies. METHODS: We reviewed published prevalence studies excluding those that had not included each category of sexual difficulty (desire, arousal, orgasm, and pain), were based on convenience sampling, or had a response rate <50% or a sample size <100. Main Outcome Measures. For each study we used the prevalence of any sexual difficulty as the denominator and calculated the proportion of women reporting each type of difficulty. For each category of sexual difficulty we used the prevalence of that difficulty lasting 1 month or more as the denominator and calculated the proportion of difficulties lasting several months or more and 6 months or more. RESULTS: Only 11 of 1,248 studies identified met our inclusion criteria. These studies used different measures of sexual dysfunction, so generating a simple summary prevalence was not possible. However, we observed consistent patterns in the published data. Among women with any sexual difficulty, on average, 64% (range 16-75%) experienced desire difficulty, 35% (range 16- 48%) experienced orgasm difficulty, 31% (range 12-64%) experienced arousal difficulty, and 26% (range 7-58%) experienced sexual pain. Of the sexual difficulties that occurred for 1 month or more in the previous year, 62-89% persisted for at least several months and 25-28% persisted for 6 months or more. Two studies investigated distress. Only a proportion of women with sexual difficulty were distressed by it (21-67%). CONCLUSIONS: Desire difficulty is the most common sexual difficulty experienced by women. While the majority of difficulties last for less than 6 months, up to a third persist for 6 months or more. Sexual difficulties do not always cause distress. Consequently, prevalence estimates will vary depending on the time frame specified by researchers and whether distress is included in these estimates.

Attitude to Health↗
PubMed2006

Use of the Delphi sorting technique to establish a core sexual history.

The objective of this study was to develop a core sexual history to be used as a supplementary tool to assist sexual health physicians assess new clients attending a sexual health centre. Eight experts in sexual health medicine employed the Delphi technique and sexual history items from a previous study to generate a core sexual history. The core history contained 15 questions for men and women, with three additional specific questions for men and five for women. The current state of the clients' sexual health was explored (rather than a client's history of sexual behaviour) and three months (compared with 12 months and lifetime) came out strongly as the preferred timeframe for asking clients' behavioural questions. This core history may be useful in many clinics in Australia and New Zealand as its development was based on expert clinical experience of respected authorities within the field of sexual health medicine.

Delphi Technique↗
PubMed2006

Azithromycin failure in Mycoplasma genitalium urethritis.

We report significant failure rates (28%, 95% confidence interval 15%-45%) after administering 1 g azithromycin to men with Mycoplasma genitalium-positive nongonococcal urethritis. In vitro evidence supported reduced susceptibility of M. genitalium to macrolides. Moxifloxacin administration resulted in rapid symptom resolution and eradication of infection in all cases. These findings have implications for management of urethritis.

Adult↗
PubMed2005

Etiologies of nongonococcal urethritis: bacteria, viruses, and the association with orogenital exposure.

BACKGROUND: The purpose of the present study was to determine pathogens and behaviors associated with nongonococcal urethritis (NGU) and the usefulness of the urethral smear in predicting the presence of pathogens. METHODS: We conducted a case-control study of men with and without symptoms of NGU. Sexual practices were measured by questionnaire. First-stream urine was tested for Chlamydia trachomatis, Mycoplasma genitalium, Ureaplasma parvum, U. urealyticum, herpes simplex virus (HSV)-1, HSV-2, adenoviruses, and Gardnerella vaginalis by polymerase chain reaction. RESULTS: C. trachomatis (20%), M. genitalium (9%), adenoviruses (4%), and HSV-1 (2%) were more common in cases with NGU (n = 329) after age and sexual risk were adjusted for (P< or =.01); U. urealyticum, U. parvum, and G. vaginalis were not. Infection with adenoviruses or HSV-1 was associated with distinct clinical features, oral sex, and male partners, whereas infection with M. genitalium or C. trachomatis was associated with unprotected vaginal sex. Oral sex was associated with NGU in which no pathogen was detected (P < or = .001). Fewer than 5 polymorphonuclear leukocytes (PMNLs) per high-power field (HPF) on urethral smear were present in 32%, 37%, 38%, and 44% of cases with C. trachomatis, M. genitalium, adenoviruses, and HSV, respectively. CONCLUSION: We identified adenoviruses and HSV-1 as significant causes of NGU with distinct clinical and behavioral characteristics and highlighted the association between insertive oral sex and NGU. A urethral PMNL count of > or =5 PMNLs/HPF is not sufficiently sensitive to exclude pathogens in men with urethral symptoms.

Adenovirus Infections, Human↗
PubMed2005

Protective immunity associated with a strong serological response to a Cryptosporidium-specific antigen group, in HIV-infected individuals.

This study assessed whether serological responses to Cryptosporidium antigens are associated with a reduced risk of diarrheal illness in cases of infection with human immunodeficiency virus (HIV). The association between serological responses to the Cryptosporidium 15/17-kDa and 27-kDa antigen groups and reported diarrheal illness was examined by use of data from a previously published study of cases of HIV infection. In immunosuppressed individuals, a strong serological response to the 27-kDa antigen group was associated with a reduced risk of diarrhea without weight loss. This finding suggests that acquired protective immunity to cryptosporidiosis may be important in controlling the burden of cryptosporidiosis in immunosuppressed individuals.

AIDS-Related Opportunistic Infections↗
PubMed2005

Introduction of screening guidelines for men who have sex with men at an STD clinic, the Melbourne Sexual Health Centre, Australia.

BACKGROUND: A recent audit indicated that a substantial proportion of men who have sex with men (MSM) were not screened for rectal gonorrhoea and chlamydia at the Melbourne Sexual Health Clinic, Melbourne, Australia. In response, screening guidelines for MSM were introduced at the clinic using a computer reminder. The aim of this study was to evaluate the impact of the guidelines and alert on screening MSM for gonorrhoea and chlamydia. METHODS: The medical records of MSM were reviewed for gonorrhoea and chlamydia screening by site (pharyngeal, urethral and rectal), four months before the implementation of the guidelines and alert (July to October 2002), and one year thereafter (beginning November 2002). RESULTS: After the introduction of the guidelines there was a significant increase in rectal chlamydia testing (55% to 67%, P < 0.001), and significant reduction in pharyngeal chlamydia and gonorrhoea testing (65% to 28%, P < 0.001, and 83% to 76%, P = 0.015 respectively). The proportion of tests that were positive by any site did not change (7% to 7%). CONCLUSIONS: The introduction of a computer reminder for new guidelines was temporally associated with screening that conformed more closely to clinical guidelines.

Adult↗