The authors evaluated data from MSM testing for HIV at the Public Health—Seattle & King County (PHSKC) STD Clinic and Gay City Health Project (GCHP) and testing history data from MSM in PHSKC HIV surveillance. The intertest interval (ITI) was defined as the number of days between the last negative HIV test and the current testing visit or first positive test. Correlates of the log₁₀-transformed ITI were determined using generalised estimating equations linear regression.

Between 2003 and 2010, the median ITI among MSM seeking HIV testing at the STD Clinic and GCHP were 215 (IQR: 124–409) and 257 (IQR: 148–503) days, respectively. In multivariate analyses, younger age, having only male partners and reporting ≥10 male sex partners in the last year were associated with shorter ITIs at both testing sites (p<0.05). Among GCHP attendees, having a regular healthcare provider, seeking a test as part of a regular schedule and inhaled nitrite use in the last year were also associated with shorter ITIs (p<0.001). Compared with MSM testing HIV negative, MSM newly diagnosed with HIV had longer ITIs at the STD Clinic (median of 278 vs 213 days, p=0.01) and GCHP (median 359 vs 255 days, p=0.02).

Although MSM in King County appear to be testing at frequent intervals, further efforts are needed to reduce the time that HIV-infected persons are unaware of their status.

An online survey targeted towards women with desire, attraction or previous sexual behaviour with women was distributed globally. Women (N=3116) who engaged in at least one sexual act with a woman in the previous year and were currently living in the USA, UK, Canada or Australia were included in the present study. Questions were based upon previously validated items in nationally representative studies.

Participants indicated a wide diversity of sexual behaviours with the majority of women reporting a history of genital rubbing (99.8%), vaginal fingering (99.2%), genital scissoring (90.8%), cunnilingus (98.8%) and vibrator use (74.1%). Barrier use was reported by a minority (<25%) of the participants.

The variety of sexual acts reported by the sample points to the need for the development of more contextually appropriate sexual health guidelines for WSW.

Parallel POCT and laboratory CD4 testing were performed in newly diagnosed HIV patients and those with chronic infection attending routine or emergency clinics. Demographics, clinical status and time taken for CD4 results to be available were recorded. Patient acceptability was assessed using a five-point Likert scale. POCT and laboratory results were compared.

283 patients underwent POCT and laboratory CD4 testing. Paired laboratory and POCT results were available in 269 patients. After excluding 15 patients tested during the lead-in period, the test comparison was based on 254 results. Most patients were asymptomatic, male and white British reflecting this patient cohort. 236 patients were chronically infected and 47 were newly diagnosed HIV positive. The POCT result was available within 30 min (86%). The laboratory and POCT results were strongly correlated, r=0.93 (p<0.001), but were generally lower for the POCT (201/254 (79%): p<0.001). As a percentage of the laboratory count, the median (95% range) POCT was 87% (57%–126%). The difference between the POCT and laboratory result was greater for those patients attending the emergency clinic. The sensitivity and specificity of the POCT, to identify patients with laboratory CD4 below 350, were 95% (95% CI 88% to 98%) and 88% (95% CI 82% to 93%), respectively. 235 (83%) patients completed the questionnaire and the POCT was highly acceptable.

POCT CD4 was highly correlated with laboratory CD4 testing in this cohort, provided immediate results and was highly acceptable to patients.

The number of cases of the new variant of C trachomatis was followed from 2007 through 2011 from the laboratory records. Testing for C trachomatis is centralised to one laboratory with around 80–85 000 persons being tested annually in a population of 1.1 million.

During the 5-year period, 410 973 patients were tested of which 25 723 cases were positive. The proportion of the new variant of all positive cases declined from 30% in 2007 to 6% in 2011. While the number of the new variant of C trachomatis declined, the ordinary wild-type strains remained largely unchanged.

A selective decline of the new variant of C trachomatis has occurred after appropriate laboratory testing was introduced. A new balance point between 5% and 10% for the new variant seems to be gradually approached.

Surface contamination with CT and GC was assessed by systematically sampling 154 different sites within one clinic using transcription-mediated amplification (TMA), quantitative PCR and culture. The caps of containers used by patients to collect self-taken samples were also tested for CT and GC using TMA.

Of the 154 sites sampled, 20 (13.0%) tested positive on TMA. Of these, five (3.2%) were positive for CT alone, 11 (7.1%) for GC alone and four (2.6%) for both CT and GC. The proportion of GC TMA-positive test results differed by gender, with 11 (18.3%) positive results from the male patient clinic area compared with one (1.6%) from the female area (p=0.002). Positive samples were obtained from a variety of locations in the clinic, but the patient toilets were more likely to be contaminated than examination rooms (p=0.015). Quantitative PCR and culture assays were negative for all samples. 46 caps of the containers used for self-taken swabs were negative for both CT and GC on TMA testing.

Surface contamination with chlamydial and gonococcal rRNA can occur within sexual health clinics, but the quantity of nucleic acid detected is low and infection risk to patients and staff is small. There remains a potential risk of contamination of patient samples leading to false-positive results.

Data from the 2007 Cervical Cancer Screening Supplement (CCSS) administered with the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) were used to assess HPV vaccination recommendations. The CCSS investigates cervical cancer screening practices, HPV testing and HPV vaccine recommendations among PCPs. A summary measure of compliance with guidelines was defined as rarely or never using the number of sexual partners and HPV tests and Pap tests to determine vaccine receipt. A total of 421 PCPs completed the CCSS in 2007.

Among NAMCS and NHAMCS providers who recommend the HPV vaccine, only 53% (95% CI 42% to 63%) reported making guideline-consistent recommendations. The majority reported sometimes to always recommending the HPV vaccine to women with a history of an abnormal Pap result (85%; 95% CI 75% to 91%) and a positive HPV test (79%; 95% CI 70% to 86%).

A large proportion of providers report practices that are inconsistent with guidelines. Providers may also be recommending the vaccine to women who may receive little benefit from the vaccine. Provider and system-level efforts to improve guideline-consistent practices are needed.

Female students aged 18–24 years (n=606) completed a web-based survey and were randomised to receive (1) control information about cervical cancer; (2) details of the link between HPV and cervical cancer; (3) risk factor information or (4) details about the link with HPV + risk factor information. Risk perceptions for cervical cancer were assessed before and after reading the information.

There was a significant difference in perceived risk of cervical cancer between the four groups following information exposure (p=0.002). Compared with the control group, risk perceptions were significantly lower among women given risk factor information but not among those informed about HPV. There were significant group by risk factor interactions for smoking status (p<0.001), age of first sex (p=0.018) and number of sexual partners (p<0.001). Risk perceptions were lower among women considered at low risk and given risk factor information, but there was no association between information group and perceived risk for high-risk women.

Providing risk factor information appears to reduce cervical cancer risk perceptions, but learning about the aetiological role of HPV appears to have no impact on risk perceptions. Incorporating brief information about HPV as the cause of cervical cancer should be in addition to, rather than in place of, risk factor information.

Using a before-and-after study, the authors compared the proportion re-screened within 1–4 months of chlamydia infection in women and heterosexual men who were sent an SMS in January to December 2009 (intervention period) with a 18-month period before the SMS was introduced (before period). The authors used a ² test and multivariate regression. Visitors and sex workers were excluded.

In the intervention period, 141 of 343 (41%) patients were diagnosed with chlamydia and sent the SMS reminder. In the before period, 338 patients were diagnosed as having chlamydia and none received a reminder. The following baseline characteristics were significantly different between those sent the SMS in the intervention period and the before period: new patients (82% vs 72%, p=0.02), aged <25 years (51% vs 33% p<0.01), three or more sexual partners in the last 3 months (31% vs 27%, p<0.01) and anogenital symptoms (52% vs 38%, p<0.01). The proportion re-screened 1–4 months after chlamydia infection was significantly higher in people sent the SMS (30%) than the before period (21%), p=0.04, and after adjusting for baseline differences, the OR was 1.57 (95% CI 1.01 to 2.46).

SMS reminders increased re-screening in patients diagnosed as having chlamydia at a sexual health clinic. The clinic now plans to introduce electronic prompts to maximise the uptake of the initiative and consider strategies to further increase re-screening.

Aptima Combo 2 (Gen-Probe) was used to detect C trachomatis in swabs. Altogether 140 C trachomatis NAAT-positive rectal and pharyngeal samples were genotyped by pmpH and ompA real-time PCR.

Of the 140 NAAT-positive rectal and pharyngeal specimens, 114 (81%) were successfully typed by pmpH PCR. One hundred and four samples contained non-LGV, nine samples LGV and one sample both non-LGV and LGV C trachomatis types. The C trachomatis LGV types were mainly found in rectal samples. Six of the L types were confirmed to be genotype L2b and two were L2 with ompA PCR and sequencing.

Our experience suggests that genotyping C trachomatis by pmpH PCR can be introduced as a function of a diagnostic laboratory already using NAAT for detection of C trachomatis. The data show that LGV infections occur also in Finland. LGV should be taken into account when considering treatment and management of rectal C trachomatis infections.

To evaluate the efficacy of single-dose azithromycin compared with 1 week of doxycycline in the treatment of rectal C trachomatis.

Data were collected prospectively on all patients diagnosed with rectal C trachomatis who received azithromycin 1 g stat between 1 January and 30 June 2010 and between 1 October 2010 and 31 March 2011 following a local change in treatment protocol to 1 week of doxycycline 100 mg twice a day. Information was collected on gender, concurrent sexually transmitted infections, treatment received, re-infection risk, re-treatment and TOC at 6 weeks.

11 patients (26.2%) had a positive TOC following treatment with stat azithromycin. The risk of re-infection was excluded in two, identifying nine of the 11 (81.8%) as treatment failures. Two patients had a positive TOC following treatment with 1 week of doxycycline, both were found to have a risk of re-infection. There was a significantly higher treatment failure rate in patients receiving azithromycin (p=0.0025).

A higher treatment failure rate was found following azithromycin for rectal C trachomatis than previously published. If azithromycin is used for treatment of rectal C trachomatis, TOC may be required or alternative treatment with doxycycline may be preferable, but further data are required.

A stratified random probability survey of 411 (weighted n=632) men in Great Britain aged 18–35 years using computer-assisted personal and self-interviews.

Young men engaged well with healthcare with 93.5% registered with, and 75.3% having seen, a general practitioner in the last year. 28.7% and 19.8% had previously screened for STIs and HIV, respectively. Willingness to access self-collected tests for STIs (85.1%) and HIV (86.9%) was high. The most acceptable pick-up points for testing kits were general practice 79.9%, GUM 66.8% and pharmacy 65.4%. There was a low acceptability of sport venues as pick-up points in men as a whole (11.7%), but this was greater among those who participated in sport (53.9%).

Healthcare settings were the most acceptable places for accessing STI and HIV self-testing kits. Although young men frequently access general practice, currently little STI screening occurs in this setting. There is considerable potential to screen large numbers of men and find high rates of infection through screening in general practice. While non-clinical settings are acceptable to a minority of men, more research is needed to understand how these venues could be used most effectively.

In December 2009 postal questionnaires were sent to all lead clinicians in UK GUM clinics asking when they expected a young person would be offered an appointment and whether it could be outside school hours. Between January and March 2010 trained male and female medical students posing as 16 year olds telephoned all GUM clinics listed on the British Association for Sexual Health and HIV website with symptomatic and asymptomatic scenarios and requested an appointment after school hours.

99% of the 152 responding clinicians estimated that an appointment would be offered within 48 h for both male and female contacts and over 90% could be seen outside school hours whether symptomatic or not. Of the 666 clinic telephone contacts, 88% were offered an appointment within two working days, and 66% were offered an after school appointment within 2 days. There was no significant difference whether the ‘patient’ was symptomatic or not (87% vs 86%, respectively, p=0.784) in being offered an appointment within two working days. There was variation between countries, with England performing significantly better; 94% were offered an appointment within 2 days versus 58%, 55% and 67% for Wales, Scotland and Northern Ireland, respectively.

The findings would support the impact and value of process targets on service delivery.

The authors used a snowball sampling method to perform a 3-month cross-sectional study each year from 2006 to 2009. Every participant was asked to complete a questionnaire about demographic and behavioural characteristics, and blood samples were taken for antibody testing for HIV and syphilis.

A total of 953, 1015, 743 and 603 participants were investigated in 2006, 2007, 2008 and 2009, respectively. HIV prevalence rates were 10.9%, 12.8%, 10.6% and 19.1%, respectively. The rates increased by 2.3% averagely per year (p<0.001). The HIV prevalence rates were significantly higher than the total population in subjects who were aged more than 40 years, subjects with an educational background of a junior high school level or lower, subjects with a positive syphilis infection or subjects who were recruited from a public bath (p<0.01). The HIV prevalence rates increased on average per year more than 4% in subjects over 30, subjects who worked in the entertainment business, subjects who were married or divorced, subjects with a positive syphilis infection or subjects who were not informed HIV test results. Although most subjects had good HIV/AIDS knowledge awareness (90%), the rate of consistent condom use was low (<37%).

The prevalence of HIV is high and is rapidly growing among MSM in Chongqing, China. More appropriate responses are urgently needed to promote a change in the behaviour of MSM.

Chlamydia testing data for 15–44-year-old men and women in a single New Zealand district during February 2008 to January 2011 were analysed. Annual coverage of testing was estimated in two ways, using the number of tests and the number of individuals as the numerator. Rates of repeat testing were calculated using survival analysis.

There were 73 879 tests (12 251 men, 61 628 women) from 41 342 individuals (8437 men, 32 905 women) during 3 years. Coverage estimates in 2010 using the number of individuals as the numerator were 17% lower for men and 26% lower for women than when the number of tests was used (5.9% vs 4.9% for men and 28.7% vs 21.2% for women). The rate of repeat testing was 16.9 per 100 person-years among men (95% CI 16.2 to 17.7) and 31.6 among women (95% CI 31.1 to 32.2). Rates of repeat testing were higher among women, in younger age groups and following a positive rather than a negative baseline test (p<0.001).

Relatively high rates of repeat testing were observed among young women in Waikato district during 2008 to 2010. Estimates of population coverage by test for this group therefore considerably overestimate individual coverage. The findings will inform discussions about improving surveillance to capture more accurate chlamydia testing coverage rates in New Zealand.

Using data from the Prevention of Pelvic Infection (POPI) cohort, the authors aimed to:

Participants provided vaginal swabs and completed questionnaires on sexual health and quality of life at baseline and at a 12-month follow-up. The follow-up questionnaire also asked about healthcare attendances during the previous 12 months. Mann–Whitney tests were used to relate healthcare seeking behaviour and other characteristics to reported numbers of partners during follow-up.

Of 1865 women included in the analysis, 79% paid at least one visit to their general practice during follow-up, 23% attended an accident and emergency/walk-in clinic, 21% a family planning clinic and 14% a genitourinary medicine clinic. As the number of sexual partners increased (0–1, 2–3, 4+), women were more likely to have visited a genitourinary medicine clinic (10%, 16%, 30%, p<0.001) or accident and emergency/walk-in clinic (21%, 26%, 29%, p<0.002). Women with more sexual partners were also more likely to smoke, use condoms, be aged <16 years at sexual debut, have bacterial vaginosis, chlamydia or gonorrhoea at baseline and to have lower EQ5-D scores.

This is the first UK study of healthcare attendance in multiethnic female students recruited outside healthcare settings. The high attendance in general practice may represent a valuable opportunity for screening for sexually transmitted infections.

A prospective cohort analysis of pregnancy and contraceptive use was conducted in Tanzanian women enrolled in a randomised placebo-controlled trial of herpes simplex virus-suppressive therapy with acyclovir to measure the effect on HIV incidence in HIV-negative women and on genital and plasma HIV viral load in HIV-positive women. The cohort was followed every 3 months for 12–30 months. Women at each visit were categorised into users or non-users of contraception. Pregnancy rates and factors associated with pregnancy incidence and contraceptive use were measured.

Overall 254 of 1305 enrolled women became pregnant at least once during follow-up (pregnancy rate: 12.0/100 person-years). Younger age, being unmarried, higher baseline parity and changes in contraceptive method during follow-up were independently associated with pregnancy. Having paid sex and being HIV positive were associated with lower risk of pregnancy. Uptake of contraception was associated with young age, being unmarried, occupation, parity and the number and type of sexual partners.

Data on use of contraceptive methods and risk factors for pregnancy can help to guide decisions on trial eligibility and the need for additional counselling. Mandatory reliable contraceptive use in study participants may be required to reduce pregnancy rates in studies where pregnancy is contraindicated.

Online questionnaire on sex websites and gay and HIV community websites. A multivariate logistic regression for rare events was used to identify factors associated with accessing self-tests.

9169 MSM completed the questionnaire. 2748 (30%) were aware of online self-tests, but only 82 of those aware and not already HIV positive (3.5%) declared having accessed one and only 69 using it. In the multivariate model, living one's sex-life with men in absolute secrecy (odds ratio (OR)=3.90, 95% CI 1.73 to 8.76), knowing of the tests via a sex partner (OR=3.42, CI 1.39 to 8.41) or an internet search engine (OR=2.18, CI 1.26 to 3.74) but not through the general (OR=0.21, CI 0.11 to 0.42) or the gay press (OR=0.34, CI 0.16 to 0.73), having unprotected anal intercourse with a casual partner in the preceding year (OR=1.90, CI 1.17 to 3.06), using self-tests for other diseases (OR=2.66, CI 1.43 to 4.90), using poppers (OR=2.23, CI 1.35 to 3.67) and doping products (OR=3.53, CI 1.55 to 8) in the preceding year, having done a traditional HIV test but not in the preceding year (OR=1.93, CI 1.14 to 3.32), never having had suicidal thoughts (OR=0.54, CI 0.32 to 0.90) and living in the provinces (OR=1.80, CI 1.01 to 3.25) were all independently associated with accessing self-tests.

Although readiness to admit use of unauthorised medical products may have influenced results, few MSM aware of the existence of self-tests actually declared having accessed one. Accessing the self-test was independently associated with both living one's sex-life with men in total secrecy and having had unprotected anal intercourse in the last 12 months, indicating that autonomous self-testing may reduce barriers to testing for this vulnerable population.

Four English and four Chinese language databases were searched up to March 2011 to identify articles on PN of STIs including HIV in China. PN uptake was defined as the number of partners named, notified, evaluated or diagnosed per index patient.

A total of 11 studies met inclusion criteria. For STI (excluding HIV) PN, a median 31.6% (IQR 27.4%–65.8%) of named partners were notified, 88.8% (IQR 88.4%–90.8%) of notified partners were evaluated and 37.9% (IQR 33.1%–43.6%) of evaluated partners were diagnosed. For HIV PN, a median 15.7% (IQR 13.2%–36.5%) of named partners were notified, 86.7% (IQR 72.9%–90.4%) of notified partners were evaluated and 27.6% (IQR 24.1%–27.7%) of evaluated partners were diagnosed. A mean of 80.6% (SD=12.6%) of patients attempted PN, and 72.4% (IQR 63.8%–81.1%) chose self-referral when offered more than one method of PN. Perceived patient barriers included social stigma, fear of relationship breakdown, uncertainty of how to notify and lack of partner contact information. Perceived infrastructure barriers included limited time and trained staff, mistrust of health workers and lack of PN guidelines.

PN programmes are feasible in China. Further research on STI PN, particularly among men who have sex with men and other high-risk groups, is an important public health priority. PN policies and guidelines are urgently needed in China.

The authors calculated annual testing and positivity rates for 16–29-year-olds attending in 2008–2009, re-attendance and retesting rates within <6 weeks, 1.5–4 months and 1.5–12 months of a positive test in 2008–2009 and positivity at retest (where results were available).

There were 50 408 individuals (60.4% women) who attended in 2008–2009. Annually, 7.4% and 7.3% were tested for chlamydia, of whom 9.1% and 8.0% tested positive, respectively. Within 1.5–4 months of a positive test, 24.6% re-attended and were retested (19% tested positive), 31.6% re-attended and were not retested and 43.9% did not re-attend. Within 1.5–12 months, 40% re-attended and were retested (16% tested positive), 40% re-attended and were not retested and 20% did not re-attend. Of individuals re-attending in 1.5–12 months but not retested, 50% had re-attended three or more times in the period. Within 6 weeks of a positive test, 25% were retested.

A high proportion of 16–29-year-olds re-attended general practices in the recommended retest periods, but retesting rates were low and multiple missed opportunities were common. The findings highlight the need for strategies such as electronic clinician prompts, patient recall systems and promotion of retesting guidelines.

During 2010–2011, residents of six university dormitories were provided training sessions describing CT, the project and SoS kit use. Students in three dormitories were provided kits, and the remaining students directed to the website (http://www.iwantthekit.org).

Of 391 resident students, 163 were provided with kits and 175 were directed to the website. Of provided kits, 12 (8 women) were returned and 2 (16.7%; both women) were positive. Of only three internet-requested kits, all were returned (all women) and none were positive. In a post-project survey examining non-participation, 26.2% of students were unaware of the project (no difference by dormitory or gender) and 58.5% of women cited prior testing as part of a medical exam.

Though direct kit distribution was more effective in student screening engagement, overall participation was poor despite widespread advertising. The methodology of online testing and SoS kits has been well validated elsewhere, but research is needed to successfully engage university students in screening and refine SoS target populations in light of changing healthcare policies.

This study uses spatial analysis and multi-level generalised estimating equations to explore the spatial distribution of reported syphilis cases among individuals in Shenzhen, Guangdong Province, China. The spatial distribution of primary/secondary and latent cases was investigated using the Moran's I-statistic. Primary/secondary syphilis cases were compared with all syphilis cases using a three-level model with individual (n=6496), neighbourhood (n=55) and district (n=6) levels.

A total of 6496 syphilis cases were reported in 2009 with 35.8% primary and secondary syphilis cases. Both primary/secondary syphilis cases (Moran's I value=0.33, p<0.01) and latent syphilis cases (Moran's I value=0.19, p<0.01) showed significant spatial clustering at the neighbourhood level. Adjusting for the number of reporting hospitals, the best model found that the following characteristics were associated with primary/secondary syphilis infection: individuals who are younger in age (p=0.003), male (p<0.001), migrant labourers (p=0.047) and those who live in districts with a higher gross domestic product (p<0.001).

There is substantial clustering of primary and secondary syphilis cases at the neighbourhood level in Shenzhen, suggesting the need for greater STD health service provision in these clustered neighbourhoods. Spatially targeted syphilis control measures may be useful to optimise testing, treatment and partner services.

Individuals aged between 18 and 24 years, within the North East Essex Primary Care Trust, were identified for chlamydia screening by the service between 1 December 2008 and 31 January 2009. Associations between test uptake and positivity, and individuals' personal characteristics, were examined. The efficacy of partner notification was estimated, and the costs of screening were compared with the national average.

Uptake of chlamydia screening was 11.5%, with lower response rates among men, individuals older than 20 years and those living in more deprived areas. The chlamydia positivity was 4.4% and higher in those reporting multiple sexual partners, individuals older than 20 years and those living in more deprived areas. The proportion of partners notified per index case was 0.17. The service contributed to 3431 of the overall 11 209 annual chlamydia screens of the Primary Care Trust in 2008–2009, at a cost of £78 per screening test completed and £1764 per case detected.

Our evaluation shows that this service model can contribute substantially to the overall coverage of chlamydia screening tests. However, the costs of service provision per case detected and treated, using this model, were high compared to the National Chlamydia Screening Programme.

Secondary syphilis patients with the following criteria were analysed: (1) RPR titres declined fourfold within 3 months after therapy, (2) patients denied high-risk sexual behaviours following treatment, (3) RPR titre remained serofast 24 months after treatment, (4) reactive cerebrospinal fluid (CSF)–venereal disease research laboratory (VDRL) and CSF–Treponema pallidum Particle Agglutination Test (TPPA) and (5) HIV antibody negative.

14 male and three female patients met the criteria. 13 patients were asymptomatic. The CSF leucocyte count was elevated in 10 patients of whom nine also had elevated CSF–proteins. The RPR titres following secondary syphilis treatments were ≥1:32 in five cases, 1:16 in four cases, 1:8 in six cases and 1:4 in two cases. Following treatments for neurosyphilis, four cases with neurological or psychiatric manifestations resolved or improved, nine cases with raised CSF–white blood cells returned to normal and nine of 12 cases with raised CSF–protein declined to normal.

Neurosyphilis may be detected in immunocompetent patients despite appropriate therapy for early-stage syphilis and appropriate serological responses. Clinicians should consider a CSF examination in any treated patient with evidence of disease progression irrespective of prior treatment history and serological response.

To determine chlamydia incidence in MSM presenting at high caseload clinics and describe predictors of infection.

The Victorian Primary Care Network for Sentinel Surveillance of bloodborne viruses and STIs (VPCNSS) links testing, demographic and behavioural data from individual testers at participating clinics. Data from MSM with more than one chlamydia test at the VPCNSS site between April 2006 and June 2010 were included. Chlamydia incidence per 100 person-years (PY) was calculated and Cox regression used to examine predictors of incidence.

1206 positive tests for chlamydia were detected among 6333 MSM across 11 409 PY of follow-up. Overall chlamydia incidence was 10.6/100 PY (95% CI 10.0 to 11.2) and was highest among MSM aged 16–29 years (12.9/100 PY, 95% CI 11.7 to 14.1), presenting with STI symptoms (16.0/100 PY, 95% CI 14.2 to 18.0), HIV positive (18.5/100 PY, 95% CI 16.6 to 20.6) and self-identified sex workers (14.3/100 PY, 95% CI 10.0 to 20.6). Significant predictors of chlamydia infection among MSM were younger age (adjusted hazard ratio (aHR)=1.9, 95% CI 1.5 to 2.3), self-identifying as a sex worker (aHR=1.6, 95% CI 1.0 to 2.6), being HIV positive (aHR=2.6, 95% CI 1.8 to 3.8), presenting with STI symptoms (aHR=1.7, 95% CI 1.4 to 2.1) and reporting >10 sex partners in the past 6 months (aHR=2.5 95% CI 1.4 to 4.6).

These results show that MSM represent a key risk population for chlamydia in Australia and identify a number of high-risk MSM subpopulations for whom clinical and public health interventions are warranted.

Using time-venue sampling, a baseline survey of 425 male sex workers was conducted in late 2006, after which, 40 peer educators were trained in HIV prevention, basic counselling skills and distribution of condoms and lubricants. A follow-up time-venue survey of 442 male sex workers was conducted in early 2008, and pre- and post-intervention changes were examined. The impact of peer educator exposure on HIV knowledge and condom use was analysed.

Positive changes in HIV prevention behaviours were observed, including increases in consistent use of condoms with both male clients (35.9%–50.2%, p<0.001) and non-paying male partners (27.4%–39.5%, p=0.008). Exposure to peer educators (AOR=1.97, 95% CI 1.29 to 3.02) and ever having been counselled or tested for HIV (AOR=1.71, 95% CI 1.10 to 2.66) were associated with consistent condom use in multivariate analysis. Peer educator contact was also associated with improved HIV knowledge and use of water-based lubricants.

Peer outreach programming reached highly stigmatised male sex workers in Mombasa, resulting in significant, but limited, improvements in HIV knowledge and prevention behaviours. Improved peer coverage and additional prevention initiatives are needed to sufficiently mitigate HIV transmission.

The authors carried out a systematic review, random effects meta-analysis and meta-regression of studies reporting adherence to PEP among victims of sexual violence. Seven electronic databases were searched. Our primary outcome was adherence; secondary outcomes included defaulting, refusal and side effects.

2159 titles were screened, and 24 studies matching the inclusion criteria were taken through to analysis. The overall proportion of patients adhering to PEP (23 cohort studies, 2166 patients) was 40.3% (95% CI 32.5% to 48.1%), and the overall proportion of patients defaulting from care (18 cohorts, 1972 patients) was 41.2% (95% CI 31.1% to 51.4%). Adherence appeared to be higher in developing countries compared with developed countries.

Adherence to PEP is poor in all settings. Interventions are needed to support adherence.

A cohort of all women aged 10–49 years with a notification of genital chlamydia in the Australian state of New South Wales during 1999–2008 was defined. Probabilistic linkage was used to identify women with repeat notifications in the same period. The risk of repeat notification was examined according to age and other characteristics using proportional hazards regression.

Among 40 936 women in the cohort, 3236 had at least one repeat chlamydia notification over an average of 3.5 years of follow-up. The incidence of repeat notification was greatest in the first year after index notification (4.5 per 100 person-years) and decreased thereafter. The RR of repeat notification increased by 8% (95% CI 7% to 9%) for each year decrease in age. Compared with women aged 20–21 years at index chlamydia notification, women aged <16 years were twice as likely to have a repeat notification (adjusted HR 2.12, 95% CI 1.75 to 2.56), while women aged 26–27 years were half as likely (adjusted HR 0.53, 95% CI 0.43 to 0.66). Year of index notification, parity and concurrent or past gonorrhoeal infection were also significantly associated with the risk of repeat notification, but socioeconomic status and area of residence were not.

Younger age is a strong predictor of chlamydia re-infection in women. The results support targeting interventions to prevent re-infections to very young women.