BackgroundChlamydia is a sexually transmitted infection that can cause serious upper genital tract infections, however, in Australia there are limited population data for chlamydia. Understanding the incidence of chlamydia will be important in the design of a chlamydia screening program in Australia.MethodWomen aged 16–25 years were recruited from sexual health clinics (SHC) and general practice clinics (GP) in South-Eastern Australia and consented to participate in longitudinal study over a 12-month period. Participants were requested to send back questionnaires and self-collected vaginal swabs through the post which were tested for chlamydia.ResultsOverall, 1116 women were recruited from 29 clinics; with a 79% retention rate.C trachomatisprevalence at baseline was 4.9% (95% CI: 2.9% to 7.0%) and incidence rate for the 12-month study period was 4.4 per 100 women-years (95% CI: 3.3% to 5.9%). PrevalentC trachomatiswas associated with having hadC trachomatispreviously [AOR: 2.0 (95% CI: 1.1% to 3.9%)], increased numbers of sexual partners [AOR: 6.4 (95% CI: 3.6% to 11.3%)] and unprotected sex [AOR: 3.1 (95% CI: 1.0% to 9.5%)]. Antibiotic use and older age were protective against having a prevalent infection ([AOR: 0.4 (95% CI: 0.2% to 1.0%)] and [AOR: 0.9 (95% CI: 0.8% to 1.0%)] respectively) and an incident infection ([AHR: 0.1 (95% CI: 0.0% to 0.6%)] and [AHR: 0.4 (95% CI: 0.2% to 0.8%)] respectively). IncidentC trachomatiswas also associated with more partners [AHR: 4.0 (95% CI: 1.9% to 8.6%)]. More than 20% of women withC trachomatishad a re-infection during the study [20.3% (95% CI: 11.6% to 31.7%)] with an infection rate of 20.0 (95% CI: 11.9% to 33.8%) per 100 women years. The median chlamydia organism load was 1.4×105/5цl and the most common serovar identified was serovar E (51.9%).ConclusionChlamydia is a common STI in young Australian women, and an incidence of 4.9 per 100 women years for chlamydia suggests annual testing is appropriate for a chlamydia screening program. The high re-infection rate indicates the importance of partner notification and re-testing 3 months after treatment.

IntroductionTo determine the efficacy of pristinamycin-based regimens for M. genitalium-infections failing prior regimens and to examine the presence of 23S rRNA and ribosomal protein gene mutations and their association with treatment failure.MethodsIn 2013 M. genitalium-infected men and women attending Melbourne Sexual Health Centre who failed azithromycin and moxifloxacin were treated with pristinamycin 1g qid for 10 days with a test-of-cure (TOC) 3–4 weeks post-pristinamycin. From December 2014 pristinamycin was prescribed 1g bid for 10 days second-line following azithromycin failure. Pre- and post-treatment samples were stored and sequenced to detect 23S rRNA and ribosomal protein gene mutations, as potential markers of pristinamycin resistance.ResultsBy March 2015 37 M. genitalium-infected patients had received pristinamycin: 32 males (10 rectal; 22 urine samples) and 5 females (1 rectal; 3 urine; 1 cervical). TOC data are available on 25 patients at abstract submission: 20 were cured (80%; 95% CI 61–92%) and 5 (20%; 8–39%) failed pristinamycin. Failure rates in the 16 patients treated with 1g qid 10 days were 12% (n = 2), and 33% (n = 3) in the 9 treated with 1g bd 10 days, p = 0.23. Of the 5 pristinamycin failures; 2 were cured with moxifloxacin, 3 failed moxifloxacin and are awaiting TOCs following solithromycin or combined doxycycline/pristinamycin. Mutations in 23S rRNA and ribosomal protein genes were associated with failure of pristinamycin.ConclusionIncreasing reports of azithromycin and moxifloxacin failure for M. genitalium-infections necessitates evaluation of new agents. We present some of the earliest data on the use of pristinamycin for M. genitalium. Treatment failure occurred when delivered as monotherapy following failure of prior regimens. Current data on use of combined pristinamycin and doxycycline as a second line regimen after azithromycin failure will be available for presentation. Resistance mutations in the 23S rRNA and ribosomal protein genes are associated with pristinamycin failure.Disclosure of interest statementNo pharmaceutical grants were received in the development of this study.

Methods We undertook a study of MSM who presented to Melbourne Sexual Health Centre with symptomatic proctitis between March 2003 and December 2011. Men with proctitis were tested for gonorrhoea by culture, chlamydia by strand displacement assay, and herpes simplex virus (HSV) by PCR. Chlamydia positive specimens were genotyped for lymphogranuloma venereum (LGV). Results Among the 279 men in the study, 141 were HIV positive and 138 were HIV negative. The median CD4 count among HIV positive men was 423 (range 189-1026). The prevalence of infections among HIV positive and HIV negative men respectively was: chlamydia (23.4% versus 21.7%, p = 0.7); gonorrhoea (13.4% versus 10.8%, p = 0.5); HSV-1 (14.2% versus 6.5%, p = 0.04); HSV-2 (22% versus 12.3%, p = 0.03); and LGV (7.8% versus 0.7%, p = 0.004). HIV positive men were more likely to have multiple infections (17.7% versus 8.6%, p = 0.017). Only 32% of men with HSV associated proctitis had visible anal ulceration. Conclusion Among MSM presenting with proctitis, HSV, LGV and multiple infections are more common among HIV positive men than among HIV negative men. MSM presenting with proctitis require comprehensive testing and treatment for possible pathogens including herpes in the absence of anal ulceration. Background Despite receipt of combination antiretroviral therapy (cART) and subsequent viral suppression some 15-30% of treated HIV infected patients fail to achieve optimal CD4 T-cell reconstitution. Sub-optimal CD4 recovery has been associated with unfavourable outcomes for patients on cART. We assessed markers of immune activation, microbial translocation and patient baseline characteristics for associations with sub-optimal CD4 T-cell recovery post cART initiation. Methods This was a retrospective case control analysis of CD4 T-cell recovery from a completed (2002)(2003)(2004)(2005)(2006)(2007) clinical trial, the Adult Antiretroviral Treatment and Drug Resistance ("Tshepo") Trial, in Gaborone, Botswana. Cases (sub-optimal CD4 response) were defined as CD4 ≤ 200 cells/µl at 12 months post ART initiation, with virologic suppression achieved within 6 months. Microbial translocation (sCD14) and immune activation (interferon-gamma) markers were quantified using Enzyme Linked Immuno-Sorbent Assays on a subset of 30 cases and 30 controls gender matched baseline and 12 month plasma samples. Univariate and logistic regression analysis were used to assess predictors of suboptimal CD4 T-cell recovery. Results Fifty-one cases (21%) from 249 virologically suppressed patients had sub-optimal CD4 recovery. The median age was 33.39 years and 69.9% were female. Baseline CD4 count < 100cells, haemoglobin and aspartate transaminase were associated with suboptimal CD4 recovery (adjusted OR (aOR) = 3.03 95% CI [1. 65, 5.57], p < 0.001; aOR = 0.81 [0.67, 0.99], p = 0.038 and aOR = 1.03 [1.00, 1.05], respectively). sCD14 levels were significantly different between cases and controls, p = 0.0011, at 12 months. Baseline Tuberculosis infection, body-mass-index, interferon-gamma, ala...