Community event-based outreach screening for syphilis and other sexually transmissible infections among gay men in Sydney, Australia
Phillip J. Read A B D , Vickie Knight A , Christopher Bourne A C , Rebecca Guy B , Basil Donovan A B , Warwick Allan A and Anna M. McNulty A CA Sydney Sexual Health Centre, Sydney Hospital, GPO Box 1614, Sydney, NSW 2001, Australia.
B The Kirby Institute, University of New South Wales, Sydney, NSW 2031, Australia.
C School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
D Corresponding author. Email: phillip.read@sesiahs.health.nsw.gov.au
Sexual Health 10(4) 357-362 https://doi.org/10.1071/SH13012
Submitted: 18 January 2013 Accepted: 4 May 2013 Published: 28 June 2013
Abstract
Objectives: Increased testing frequency is a key strategy in syphilis control, but achieving regular testing is difficult. The objective of this study is to describe a sexually transmissible infection (STI) testing outreach program (the Testing Tent) at a gay community event. Methods: Gay men attending the testing tent in 2010–11 completed a computer-assisted self-interview and were screened for STIs. Clinical, demographic, behavioural and diagnostic data were compared with gay men attending a clinic-based service during 2009. The Testing Tent was marketed on social media sites and data were extracted on the number of times the advertisements were viewed. Staffing, laboratory, marketing and venue hire expenses were calculated to estimate the cost of delivering the service. Results: Ninety-eight men attended the Testing Tent. They were older (median age: 42 years v. 30 years; P < 0.001), had more sex partners (median: five in 3 months v. two; P < 0.001) and more likely to inject drugs (9% v. 4%; P = 0.034) than the 1006 clinic attendees, but were more likely to have previously tested for STIs (81% v. 69%; P = 0.028) and to always use condoms for anal sex (59% v. 43%; P = 0.005). Five cases of STIs were detected; the diagnostic yield was not significantly different from that of the clinic. The cost of the Testing Tent was A$28 440. Conclusion: Nonclinical testing facilities are an acceptable option and are accessed by gay men requiring regular testing, and may be an important addition to traditional testing environments.
Additional keywords: Mardi Gras, men who have sex with men, point of care, testing tent, sexually transmissible infections.
References
[1] Kirby Institute. HIV/AIDS, hepatitis C and sexually transmissible infections in Australia report 2011. Sydney: University of New South Wales; 2011.[2] Vodstrcil L, Fairley C, Fehler G, Leslie D, Walker J, Bradshaw C, et al Trends in chlamydia and gonorrhea positivity among heterosexual men and men who have sex with men attending a large urban sexual health service in Australia, 2002–2009. BMC Infect Dis 2011; 11 158
| Trends in chlamydia and gonorrhea positivity among heterosexual men and men who have sex with men attending a large urban sexual health service in Australia, 2002–2009.Crossref | GoogleScholarGoogle Scholar | 21639943PubMed |
[3] McDonagh P, Ryder N, McNulty AM, Freedman E. Neisseria gonorrhoeae infection in urban Sydney women: prevalence and predictors. Sex Health 2009; 6 241–4.
| Neisseria gonorrhoeae infection in urban Sydney women: prevalence and predictors.Crossref | GoogleScholarGoogle Scholar | 19653962PubMed |
[4] Wasserheit JN. Epidemiological synergy: interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases. Sex Transm Dis 1992; 19 61–77.
| 1:STN:280:DyaK383nvFymsA%3D%3D&md5=f8af52a4212e4cf4b30ac9ba69c0fecfCAS | 1595015PubMed |
[5] Buchacz K, Patel P, Taylor M, Kerndt P, Byers R, Holmberg S, et al Syphilis increases HIV viral load and decreases CD4 cell counts in HIV-infected patients with new syphilis infections. AIDS 2004; 18 2075–9.
| Syphilis increases HIV viral load and decreases CD4 cell counts in HIV-infected patients with new syphilis infections.Crossref | GoogleScholarGoogle Scholar | 15577629PubMed |
[6] Gray RT, Hoare A, Prestage GP, Donovan B, Kaldor J, Wilson D. Frequent testing of highly sexually active gay men is required to control syphilis. Sex Transm Dis 2010; 37 298–305.
| 20393383PubMed |
[7] Guy R, Wand H, Holt M, Mao L, Wilson D, Bourne C, et al High annual syphilis testing rates among gay men in Australia, but insufficient retesting. Sex Transm Dis 2012; 39 268–75.
| High annual syphilis testing rates among gay men in Australia, but insufficient retesting.Crossref | GoogleScholarGoogle Scholar | 22421692PubMed |
[8] Guy R, Goller J, Spelman T, El-Hayek C, Gold J, Lim L, et al Does the frequency of HIV and STI testing among men who have sex with men in primary care adhere with Australian guidelines? Sex Transm Infect 2010; 86 371–6.
| Does the frequency of HIV and STI testing among men who have sex with men in primary care adhere with Australian guidelines?Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3cflsVyjug%3D%3D&md5=c91a50c213e7dceb7630e3b0e0ff2670CAS | 20460263PubMed |
[9] Prestage GP, McCann PD, Hurley M, Bradley J, Down I, Brown G. Pleasure and sexual health “The PASH study”. Sydney: The Kirby Institute, University of New South Wales; 2009. Available online at: http://www.med.unsw.edu.au/NCHECRweb.nsf/resources/TOMS/$file/PASH2009-final.pdf [verified 22 October 2012].
[10] Debattista J, Dwyer J, Anderson R, Rowling D, Patten J, Mortlock M. Screening for syphilis among men who have sex with men in various clinical settings. Sex Transm Infect 2004; 80 505–8.
| Screening for syphilis among men who have sex with men in various clinical settings.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2crpvFGrsw%3D%3D&md5=529eae80fe2999f22cab4e59038e153fCAS | 15572624PubMed |
[11] Lee D, Fairley C, Cummings R, Bush M, Read T, Chen M. Men who have sex with men prefer rapid testing for syphilis and may test more frequently using it. Sex Transm Dis 2010; 37 557–8.
| Men who have sex with men prefer rapid testing for syphilis and may test more frequently using it.Crossref | GoogleScholarGoogle Scholar | 20803780PubMed |
[12] Lambert NL, Fisher M, Imrie J, Watson R, Mercer C, Parry J, et al Community based syphilis screening: feasibility, acceptability, and effectiveness in case finding. Sex Transm Infect 2005; 81 213–6.
| Community based syphilis screening: feasibility, acceptability, and effectiveness in case finding.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2M3nvFyjtA%3D%3D&md5=9953092ff2fb5e87098a14e89d1abfa1CAS | 15923287PubMed |
[13] Ciesielski C, Kahn R, Taylor M, Gallagher K, Prescott L, Arrowsmith S. Control of syphilis outbreaks in men who have sex with men: the role of screening in nonmedical settings. Sex Transm Dis 2005; 32 S37–42.
| Control of syphilis outbreaks in men who have sex with men: the role of screening in nonmedical settings.Crossref | GoogleScholarGoogle Scholar | 16205290PubMed |
[14] Bourne C, Edwards B, Shaw M, Gowers A, Rodgers C, Ferson F. Sexually transmissible infection testing guidelines for men who have sex with men. Sex Health 2008; 5 189–91.
| Sexually transmissible infection testing guidelines for men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 18588782PubMed |
[15] Jin F, Prestage G, Mao L, Kippax S, Pell C, Donovan B, et al Incidence and risk factors for urethral and anal gonorrhoea and chlamydia in a cohort of HIV-negative homosexual men: the Health in Men study. Sex Transm Infect 2007; 83 113–9.
| Incidence and risk factors for urethral and anal gonorrhoea and chlamydia in a cohort of HIV-negative homosexual men: the Health in Men study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2s3it12ltQ%3D%3D&md5=7fb7394fc966663c81cbc8ee2a8772b8CAS | 17005541PubMed |
[16] Jin F, Prestage GP, Zablotska I, Rawstorne P, Imrie J, Kippax S, et al High incidence of syphilis in HIV-positive homosexual men: data from two community-based cohort studies. Sex Health 2009; 6 281–4.
| High incidence of syphilis in HIV-positive homosexual men: data from two community-based cohort studies.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3cXhsFyqu7fK&md5=3abfbecf263029e2d1914225b8834d27CAS | 19917195PubMed |
[17] Templeton D, Jin F, McNally LP, Imrie J, Prestage G, Donovan B, et al Prevalence, incidence and risk factors for pharyngeal gonorrhoea in a community-based HIV-negative cohort of homosexual men in Sydney, Australia. Sex Transm Infect 2010; 86 90–6.
| Prevalence, incidence and risk factors for pharyngeal gonorrhoea in a community-based HIV-negative cohort of homosexual men in Sydney, Australia.Crossref | GoogleScholarGoogle Scholar | 19841003PubMed |
[18] Jin F, Prestage GP, Kaldor J, Grulich A, Kippax S, Pell C, et al Epidemic syphilis among homosexually active men in Sydney. Med J Aust 2005; 183 179–83.
| 16097913PubMed |
[19] Morris S, Bauer H, Chartier M, Howard H, Watson S, Yokotobi J, et al Relative efficiency of chlamydia screening in non-clinical settings in two California counties. Int J STD AIDS 2010; 21 52–6.
| Relative efficiency of chlamydia screening in non-clinical settings in two California counties.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD1MfktVektw%3D%3D&md5=592b9012cfecefe4630915c63c453677CAS | 20029065PubMed |
[20] Arumainayagam J, Grimshaw R, Acharya S, Chandramani S, Morrall I, Pugh R. Value of targeting at-risk populations at outreach venues: findings from a local sauna. Int J STD AIDS 2009; 20 642–3.
| Value of targeting at-risk populations at outreach venues: findings from a local sauna.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD1Mrot12hsQ%3D%3D&md5=e932b4d62fcdd7eca5bf74311ed777d6CAS | 19710339PubMed |
[21] Hong FC, Zhou H, Cai YM, Pan P, Feng T, et al Prevalence of syphilis and HIV infections among men who have sex with men from different settings in Shenzen, China: implications for HIV/STD surveillance. Sex Transm Infect 2009; 85 42–4.
| Prevalence of syphilis and HIV infections among men who have sex with men from different settings in Shenzen, China: implications for HIV/STD surveillance.Crossref | GoogleScholarGoogle Scholar | 18653567PubMed |
[22] Richens J, Copas A, Sadiq S, Kingori P, McCarthy O, Jones V, et al A randomised controlled trial of computer assisted sexual history interviewing in a sexual health clinic. Sex Transm Infect 2010; 86 310–4.
| A randomised controlled trial of computer assisted sexual history interviewing in a sexual health clinic.Crossref | GoogleScholarGoogle Scholar | 20551234PubMed |
