A sexual health strategy for Australia--time for action.

Australia still does not have a national sexual health strategy. Sexually transmissible infections such as chlamydia continue to plague the community, and the incidence of HIV is increasing. But a cohesive sexual health strategy cannot merely be disease-focussed, it must include the broader social and cultural aspects of sexual behaviour and sexuality. We propose a public health framework for the development of a national sexual health strategy that will bring Australia in line with the United Kingdom and New Zealand.

Congenital syphilis: still a reality in 1996.

Despite the widespread use of penicillin for more than 50 years, syphilis continues to be a problematic health issue in many parts of the world. In Australia, congenital syphilis is again a significant cause of stillbirth, preterm labour and neonatal disease in some areas (including central and northern Australia). Control mechanisms based on screening, reliable treatment protocols, contact-tracing and adequate follow-up appear to be less effective than they were in the past. It is difficult to discuss such a socially stigmatizing disease when it is clear that some community groups are at high risk, and may be offended by and feel disempowered in the face of well-meaning medical debate. If congenital syphilis is to be eradicated, new approaches are required. These include public-awareness campaigns to stress the need for antenatal care in affected communities; involving the community in efforts to prevent syphilis; providing culturally appropriate services; improving notification and surveillance systems; improving the management of pregnant women who present to maternity units without prior booking; and improving the management of syphilis in pregnancy. There is a need to raise awareness that antenatal care is important not only for the mother's health but also for the wellbeing of the baby.

Sexually acquired herpes in general practice.

The lifelong nature of sexually acquired herpes and its tendency to recur create psychological distress out of all proportion to the actual physical discomfort. Good management rests on a sympathetic and open approach on the part of the clinician. Case histories highlight management issues.

Voluntary HIV antibody testing among STD clinic patients: a pilot study.

A pilot study was conducted with the aim of measuring the acceptability of voluntary testing for human immunodeficiency virus (HIV) antibody among patients attending sexually transmissible disease (STD) clinics. Three STD clinics, two public and one private, participated in the study which was conducted over a three-month period beginning in November 1988. For each patient attending the clinics, sex, date of birth, HIV transmission category and previous HIV test result were recorded. Patients who did not request the HIV antibody test were offered testing. Of the 2356 patients who were included in the analyses, 784 (34%) requested testing. For almost all patients (97%) who requested testing, a serum sample was collected and testing completed. Approximately half (55%) of those patients who were offered the test accepted testing. Overall, 70% of patients completed HIV antibody testing. Of the major transmission categories, the acceptance rate for those offered the test was lowest among homosexual men (45%), who also had the highest rate of HIV antibody seropositivity (11%) among those tested. Of patients who reported themselves to be HIV antibody seronegative prior to the pilot study, 78% were retested during the study and seven had a positive test for HIV antibody. We conclude that voluntary HIV antibody testing is acceptable in both public and private STD clinic settings, although a substantial amount of additional resources would need to be allocated to counselling if voluntary testing is to be introduced on a routine basis.

Syphilis case-finding in an Australian men's sauna club.

A survey of 623 volunteers from a popular sauna club for homosexual men in Melbourne was carried out over a 12-month period. Blood samples were taken for serological tests for syphilis from each subject; in 114 (18.3%) of these, the test results were positive. Thirty-four subjects with positive test results (5.4%) had no previous history of syphilis. Follow-up was possible in 22 of these (64.7%), which resulted in 17 new cases of syphilis being detected and treated (a case incidence of 2.7%). Blood testing at sauna clubs patronized by homosexuals is a productive and cost-effective way of detecting asymptomatic syphilis in individuals at high risk of infection.

A survey of sexually transmitted disease centres in Australia.

In a nationwide survey carried out in 1981 centres offering free treatment for sexually transmitted diseases (STD) were located and the facilities available to the public were assessed. At least one special centre was located in each of the eight states and territories of Australia, but not in all cases did the clinics meet the basic requirements recommended by the Australian National Health and Medical Research Council. The STD clinics were almost exclusively found in capital cities, leaving large populations with no locally available specialist advice. The major centres, with one or two notable exceptions, were open only during routine office hours. In several centres staffing levels were barely adequate to cope with patient loads let alone deal with other important work required of reference centres--the training of health care workers, education of high risk groups, and institution of STD control programmes. In several respects the sexually transmitted diseases services in Australia were found to be inadequate to meet the needs of the population.