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Mulhall BP, Wright S, Allen D, Brown K, Dickson B, Grotowski M, Jackson E, Petoumenos K, Read P, Read T, Russell D, Smith DJ, Templeton DJ, Fairley CK, Law MG. High rates of sexually transmissible infections in HIV-positive patients in the Australian HIV Observational Database: a prospective cohort study. Sex Health 2019; 11:291-7. [PMID: 25109880 DOI: 10.1071/sh13074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 05/19/2014] [Indexed: 01/24/2023]
Abstract
UNLABELLED Background In HIV-positive people, sexually transmissible infections (STIs) probably increase the infectiousness of HIV. METHODS In 2010, we established a cohort of individuals (n=554) from clinics in the Australian HIV Observational Database (AHOD). We calculated retrospective rates for four STIs for 2005-10 and prospective incidence rates for 2010-11. RESULTS At baseline (2010), patient characteristics were similar to the rest of AHOD. Overall incidence was 12.5 per 100 person-years. Chlamydial infections increased from 3.4 per 100 person-years (95% confidence interval (CI): 1.9-5.7) in 2005 to 6.7 per 100 person-years (95% CI: 4.5-9.5) in 2011, peaking in 2010 (8.1 per 100 person-years; 95% CI: 5.6-11.2). Cases were distributed among rectal (61.9%), urethral (34%) and pharyngeal (6.3%) sites. Gonococcal infections increased, peaking in 2010 (4.7 per 100 person-years; 95% CI: 5.6-11.2; Ptrend=0.0099), distributed among rectal (63.9%), urethral (27.9%) and pharyngeal (14.8%) sites. Syphilis showed several peaks, the largest in 2008 (5.3 per 100 person-years; 95% CI: 3.3-8.0); the overall trend was not significant (P=0.113). Genital warts declined from 7.5 per 100 person-years (95% CI: 4.8-11.3) in 2005 to 2.4 per 100 person-years (95% CI: 1.1-4.5) in 2011 (Ptrend=0.0016). CONCLUSIONS For chlamydial and gonococcal infections, incidence was higher than previous Australian estimates among HIV-infected men who have sex with men, increasing during 2005-2011. Rectal infections outnumbered infections at other sites. Syphilis incidence remained high but did not increase; that of genital warts was lower and decreased.
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Affiliation(s)
- Brian P Mulhall
- The Kirby Institute for Infection and Immunity in Society, Wallace Wurth Building, University of New South Wales, Sydney, NSW 2052, Australia
| | - Stephen Wright
- The Kirby Institute for Infection and Immunity in Society, Wallace Wurth Building, University of New South Wales, Sydney, NSW 2052, Australia
| | - Debbie Allen
- Holden Street Sexual Health Clinic, PO Box 361, Gosford, NSW 2250, Australia
| | | | | | - Miriam Grotowski
- Clinic 468, Tamworth Sexual Health, Hunter New England Area Health Service, NSW 2340, Australia
| | - Eva Jackson
- Nepean/Blue Mountains Sexual Health, Nepean Hospital, Kingswood NSW 2747, Australia
| | - Kathy Petoumenos
- The Kirby Institute for Infection and Immunity in Society, Wallace Wurth Building, University of New South Wales, Sydney, NSW 2052, Australia
| | - Phillip Read
- The Kirby Institute for Infection and Immunity in Society, Wallace Wurth Building, University of New South Wales, Sydney, NSW 2052, Australia
| | - Timothy Read
- Melbourne Sexual Health Centre, Alfred Hospital, Prahran, Vic. 3181, Australia
| | - Darren Russell
- Cairns Sexual Health Service, PO Box 902, Cairns, Qld 4214, Australia
| | - David J Smith
- Lismore Sexual Health Services, 4 Shepherd Lane, Lismore, NSW 2480, Australia
| | - David J Templeton
- The Kirby Institute for Infection and Immunity in Society, Wallace Wurth Building, University of New South Wales, Sydney, NSW 2052, Australia
| | | | - Matthew G Law
- The Kirby Institute for Infection and Immunity in Society, Wallace Wurth Building, University of New South Wales, Sydney, NSW 2052, Australia
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Mulhall BP, Mulhall RM. Patrick Plunkett Mulhall. Assoc Med J 2019. [DOI: 10.1136/bmj.l225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mulhall BP, Wright ST, De La Mata N, Allen D, Brown K, Dickson B, Grotowski M, Jackson E, Petoumenos K, Foster R, Read T, Russell D, Smith DJ, Templeton DJ, Fairley CK, Law MG. Risk factors associated with incident sexually transmitted infections in HIV-positive patients in the Australian HIV Observational Database: a prospective cohort study. HIV Med 2016; 17:623-30. [PMID: 27019207 DOI: 10.1111/hiv.12371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We established a subcohort of HIV-positive individuals from 10 sexual health clinics within the Australian HIV Observational Database (AHOD). The aim of this study was to assess demographic and other factors that might be associated with an incident sexually transmitted infection (STI). METHODS The cohort follow-up was from March 2010 to March 2013, and included patients screened at least once for an STI. We used survival methods to determine time to first new and confirmed incident STI infection (chlamydia, gonorrhoea, syphilis or genital warts). Factors evaluated included sex, age, mode of HIV exposure, year of AHOD enrolment, hepatitis B or C coinfection, time-updated CD4 cell count, time-updated HIV RNA viral load, and prior STI diagnosis. RESULTS There were 110 first incident STI diagnoses observed over 1015 person-years of follow-up, a crude rate of 10.8 [95% confidence interval (CI) 9.0-13.0] per 100 person-years. Factors independently associated with increased risk of incident STI included younger age [≥ 50 vs. 30-39 years old, adjusted hazards ratio (aHR) 0.4; 95% CI 0.2-0.8; P < 0.0001]; prior STI infection (aHR 2.5; 95% CI 1.6-3.8; P < 0.001), and heterosexual vs. men who have sex with men (MSM) as the likely route of exposure (aHR 0.2; 95% CI 0.1-0.6; P < 0.001). CONCLUSIONS In this cohort of individualsbeing treated with antiretroviral drugs, those who were MSM, who were 30-39 years old, and who had a prior history of STI, were at highest risk of a further STI diagnosis.
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Affiliation(s)
- B P Mulhall
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.,University of Sydney, Camperdown, NSW, Australia
| | - S T Wright
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - N De La Mata
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - D Allen
- Holden Street Sexual Health Clinic, Gosford, NSW, Australia
| | - K Brown
- University of Sydney, Camperdown, NSW, Australia.,Illawarra Sexual Health Services, Warrawong, NSW, Australia.,University of Wollongong, Wollongong, NSW, Australia
| | - B Dickson
- Caradata, Arundel DC, Qld, Australia
| | - M Grotowski
- Tamworth Sexual Health, Clinic 468, HNEAHS, NSW, Australia
| | - E Jackson
- Nepean/Blue Mountains Sexual Health, Nepean Hospital, Kingswood, NSW, Australia
| | - K Petoumenos
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - R Foster
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.,Sydney Sexual Health Centre, Sydney, NSW, Australia
| | - T Read
- Melbourne Sexual Health Centre, Alfred Hospital, Prahran, Vic., Australia
| | - D Russell
- Cairns Sexual Health Service, Cairns, Qld, Australia.,Central Clinical School Monash University, Alfred Hospital, Melbourne, Vic., NSW, Australia
| | - D J Smith
- Lismore Sexual Health Services, Lismore, NSW, Australia
| | - D J Templeton
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.,RPA Sexual Health, Camperdown, NSW, Australia
| | - C K Fairley
- Melbourne Sexual Health Centre, Alfred Hospital, Prahran, Vic., Australia.,Central Clinical School Monash University, Alfred Hospital, Melbourne, Vic., NSW, Australia
| | - M G Law
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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Mulhall BP, Sti-working-group A. P3.245 Sexually Transmitted Infections (STI) in HIV-Positive Patients in the Australian HIV Observational Database (AHOD)- a Prospective Cohort Study - Rationale and Results at Baseline. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Tran TTH, Mulhall BP, Macaskill P, Nguyen TQ. Risk factors for HIV infection in a gynaeco - obstetric population in Vietnam — a case-control study. Sex Health 2005; 2:71-5. [PMID: 16335744 DOI: 10.1071/sh04034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Vietnam has an emerging HIV epidemic, particularly in male drug injectors. Data on HIV infections in women in the general population, and their risk factors, are scanty. Methods: A case-control study was performed in a large gynaeco–obstetric hospital in Haiphong city in 1998–2001. The sample was 22000 attendees. The medical records of 58 HIV-seropositive cases were compared with 422 randomly chosen HIV-seronegative controls for potential risk factors. Results: A multivariate analysis found that HIV infection was associated with young age, past/current history of sexually transmitted infections (STI) and being unemployed. Patients aged 21–30 years were 10-fold less likely to be infected than women aged <20 years (OR 0.11, 95%CI 0.04–0.33). Women with a past/current history of STI had over 20 times the risk of those who did not (95% CI 6.7–62.3). Unemployed women had at least twice the risk of infection of any other occupational group. Conclusions: We have identified risk factors in women that have not been highlighted previously in Vietnam. Our study suggests that all antenatal women, especially those who are young or unemployed (or, with a current/past history of STI), should be offered free HIV tests, counselling and management.
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Abstract
Nearly 4 million people in the United States have evidence of hepatitis C infection (HCV), representing a significant cause of cirrhosis and liver cancer as well a major burden to our healthcare systems and society. Antiviral therapy can successfully eradicate HCV over the long term, potentially reducing the risk of progression and improving patients' quality of life. The currently preferred HCV treatment is a combination of pegylated interferon alfa and ribavirin, which can achieve an overall sustained viral eradication rate of 55%. The duration of this treatment is typically determined by HCV genotype and the patient's early virologic response to the antiviral regimen. Evidence has accumulated over the past few years to indicate that close adherence to the optimal antiviral regimen can enhance sustained virologic response. But optimal treatment outcomes require diligence and careful management of side effects related to combination therapy. Although reducing the dose of pegylated interferon alfa, ribavirin, or both can effectively treat side effects, suboptimal doses of this regimen, especially ribavirin, may negatively affect virologic response. An alternative strategy is to use growth factors to treat cytopenias. This strategy can obviate dose reductions while potentially improving patients' quality of life. Patient support seems especially important early after the initiation of antiviral therapy. Encouraging study findings involving the growth factors, epoetin alfa and darbepoetin alfa, suggest improved anemia and quality of life while maintaining the optimal ribavirin dose. Future work should be aimed at providing stronger evidence for the use of these "supportive products" during anti-HCV therapy. As we strive to develop better treatment options for our HCV patients, the importance of adhering to the treatment regimen continues to play a central role. Effective side effect management is crucial for the success of this treatment because adherence is negatively affected by side effects related to the antiviral regimen. By identifying and addressing the important side effects of combination therapy for HCV, adherence to treatment can be improved and optimal outcomes can be achieved.
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Affiliation(s)
- Brian P Mulhall
- Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, VA 22042, USA
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Affiliation(s)
- Ganesh R Veerappan
- Department of Gastroenterology, Walter Reed Army Medical Center, Washington, DC 20307, USA.
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Abstract
Nonalcoholic steatohepatitis (NASH) is an important medical condition and there is great public health concern related to its increasing incidence and potential implications for the development of end-stage liver disease. NASH represents a progression beyond simple lipid deposition in the liver parenchyma, requiring histologic evidence for hepatocyte injury such as ballooning degeneration, Mallory bodies, and/or pericellular fibrosis that can potentially lead to progressive liver injury and eventually cirrhosis. It is believed that several insults contribute to the evolution of hepatic injury such as insulin dysregulation, lipid deposition, oxidative free radicals, and lipid perioxidation. Initial treatment protocols for NASH focus on various aspects of injury in an attempt to control insulin imbalances, improve lipid regulation, reduce free radicals, and ameliorate the inflammatory process. No therapy is conclusively beneficial in all individuals, but preliminary data suggest several approaches that hold promise.
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Affiliation(s)
- Brian P Mulhall
- Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA
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Veerappan GR, Mulhall BP. Forty-two-year-old active duty Marine presents with hematemesis. Mil Med 2004; 169:406-9. [PMID: 15186011 DOI: 10.7205/milmed.169.5.406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
A 42-year-old active duty marine presented to the emergency room with hematemesis. This article describes the appropriate step-by-step management for this individual with an upper gastrointestinal bleed, and we discuss potential differential diagnoses and update readers on the current aspects of managing his final diagnosis. Through questions and discussions, we will cover various diagnostic modalities and management strategies related to this case and provide some insight on the military relevance of his final condition.
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Affiliation(s)
- Ganesh R Veerappan
- Department of Internal Medicine, Walter Reed Army Medical Center, Washington, DC, USA
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Abstract
Exchange of accurate information between patients and medical providers is imperative for appropriate medication prescribing. We performed an evaluation of medication regimens of patients with information obtained independently from patient-completed surveys and nursing and provider interviews. The actual medication regimen was determined after the clinic encounter via mail-in forms or telephone interviews with patients reporting current medications directly from prescription bottles. Two hundred thirteen patients taking an average of 3.8 prescription medications were enrolled. Patients, nurses, and primary care providers were modestly accurate in reporting the number of medications being taken (kappa, 0.57,0.51, and 0.58, respectively); however, they performed poorly in reporting complete medication regimens as defined by the correct names, doses, and frequencies with 100% accuracy (34%, 26.7%, and 29.3%, respectively). Patients who created their own lists were more accurate than those who relied on memory, lists provided by providers, or discharge summaries. These findings indicate a significant difference between intended versus actual medication regimens at home.
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Affiliation(s)
- Brian T McKinley
- Department of Medicine, Madigan Army Medical Center, Tacoma, WA 98431, USA
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Affiliation(s)
- Brian P Mulhall
- Walter Reed Army Medical Center, Gastroenterology Service, Department of Medicine, Washington, DC 20307, USA
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Abstract
Infectious esophagitis can have significant implications in an impaired host. Described most commonly in immunocompromised patients, infectious esophagitis can also occasionally be discovered in immunocompetent individuals in several unique clinical settings. Evaluation of the typical presenting complaints, such as dysphagia or odynophagia, are especially important in immunocompetent patients, and therapy should be directed at the appropriate predisposing condition and resultant infectious agent. In immunocompromised patients, however, clinical experience supports the use of empiric therapy in patients without concomitant systemic complaints. Especially in AIDS patients or those with lymphoma or leukemia, the initial approach to infectious esophagitis complaints (ie, dysphagia or odynophagia) is to begin an empiric trial of oral systemic fluconazole for presumed candidal esophagitis. If the individual remains symptomatic after 3 to 7 days or has any associated systemic complaints or concerning clinical findings (eg, hematemesis), then upper endoscopy with biopsies is indicated. If an etiologic agent other than Candida is defined by histologic, immunohistochemical, or culture methods, then appropriate therapy can be initiated. There are many important and pathologic agents implicated in infectious esophagitis. Thus, directed therapy needs to be administered appropriately and in a timely fashion to avoid poor short-term problems or long-term sequelae.
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Affiliation(s)
- Brian P. Mulhall
- Gastroenterology Service, Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Washington, DC 20307-5000, USA.
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Abstract
Non-alcoholic fatty liver disease (NAFL) includes a spectrum of clinicopathological conditions with increasing prevalence in the developed world. Although steatosis alone seems to have a benign course, those patients with the diagnosis of non-alcoholic steatohepatitis (NASH) can have a progressive course. Additionally, there is now evolving, indirect evidence that some of the patients with cryptogenic cirrhosis may be the result of 'burned-out' NASH. Although NAFL and NASH are associated with insulin-resistance syndrome, some patients with NAFL may have no obvious risk factors. Despite preliminary data from a number of pilot studies, no established therapies can be offered to patients with NASH. Over the next few years, a number of exciting research projects dealing with the epidemiology as well as the pathogenesis of NAFL are expected to be completed. It is anticipated that, through a better understanding of NAFL, more effective treatment protocols can be developed targeting only those patients with NASH that are at the highest risk for progression to cirrhosis and liver failure.
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Affiliation(s)
- Brian P Mulhall
- Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, Virginia 22042, USA
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Abstract
Autoimmune enteropathy is an increasingly recognized cause of severe protracted diarrhea, usually affecting infants and children predisposed to autoimmune phenomena. Although this may be a common cause of diarrheal illness, it is scarcely recognized in the American literature. In association with thymoma, a case of so-called graft-vs-host-like colitis and 2 cases of chronic diarrhea associated with thymoma were reported, but, to our knowledge, no cases of autoimmune enteropathy have been reported as such. We describe 2 adults with autoimmune enteropathy found in association with a thymoma.
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Affiliation(s)
- D D Mais
- Department of Pathology, Madigan Army Medical Center, Tacoma, WA 98431-5000, USA
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Affiliation(s)
- B Donovan
- Sydney Sexual Health Centre, Sydney Hospital, NSW, Australia.
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Tapsall JW, Shultz TR, Limnios EA, Donovan B, Lum G, Mulhall BP. Failure of azithromycin therapy in gonorrhea and discorrelation with laboratory test parameters. Sex Transm Dis 1998; 25:505-8. [PMID: 9858344 DOI: 10.1097/00007435-199811000-00002] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Azithromycin is efficacious in the treatment of chlamydial genital tract infection but less so in gonorrhea. However, MICs of azithromycin for gonococci from previously reported azithromycin treatment failures were consistently below the 'susceptible' MIC level of 2 mg/L. GOAL OF THIS STUDY To examine gonococci not eliminated with 1 g azithromycin therapy to establish treatment outcome/MIC correlates in gonorrhea. STUDY DESIGN The MICs and phenotypes of gonococci isolated from five cases of treatment failure after 1 g azithromycin therapy were determined and compared with the MICs of a systematic sample of routine isolates. RESULTS Azithromycin MICs of gonococci from five cases of failed 1 g azithromycin treatment were 0.125 or 0.25 mg/L, well within the current 'susceptible' MIC range. None of the isolates were of the mtr phenotype. The MIC90 of a systematic sample of 219 gonococcal isolates was 0.25 mg/L. CONCLUSION The antibiotic MIC/treatment outcome correlates that are usually found in gonorrhea do not apply for azithromycin. Current MIC criteria do not accurately define susceptibility or resistance of gonococci to azithromycin and by themselves do not predict the likely outcome of therapy. Pharmacokinetic factors may decrease the predictive value of MIC data.
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Affiliation(s)
- J W Tapsall
- Department of Microbiology, The Prince of Wales Hospital, Randwick, Sydney, Australia
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Wong EK, Bodsworth NJ, Slade MA, Mulhall BP, Donovan B. Response to hepatitis B vaccination in a primary care setting: influence of HIV infection, CD4+ lymphocyte count and vaccination schedule. Int J STD AIDS 1996; 7:490-4. [PMID: 9116065 DOI: 10.1258/0956462961918563] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Factors affecting the response to hepatitis B vaccination in a primary care setting were examined by means of a review of case notes of patients attending 22 sexually transmissible disease services. Where not available from the notes, presence of antibody to hepatitis B surface antigen (anti-HBs) was determined by testing available stored serum. One hundred and ninety-five patients completed a course of 3 injections and had an anti-HBs assay performed. The highest response rate (anti-HBs > or = 10 IU/L) was found in human immunodeficiency virus (HIV)-negative heterosexual women (16 of 17, 94.1%) followed by HIV-negative heterosexual men (11 of 12, 91.7%); HIV-negative homosexual men (105 of 120, 87.5%); and HIV-positive homosexual men (6 of 14, 42.9%). (For HIV-positive vs HIV-negative homosexual men, P = 0.0003). Eleven of 14 (78.6%) homosexual men of unknown HIV status responded to vaccination. There was a trend to lower CD4+ lymphocyte counts among HIV-infected patients who responded to hepatitis B vaccination (mean 482 cells/cm2) when compared to those that did not respond (632 cells) but this difference was not statistically significant (P = 0.330). Neither the type of vaccine (recombinant, plasma-derived or mixed) nor the length of vaccination course (mean 6.2 months; range 2 to 18) affected response. This study confirmed that vaccination against hepatitis B is much less effective in HIV-infected homosexual men and marginally less effective for HIV-negative homosexual men, though the mechanism for this reduced response is uncertain. Reassuringly vaccine response was not affected by common variables in primary care settings such as vaccine type or delays in the vaccine schedule.
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Affiliation(s)
- E K Wong
- Department of Public Health and Community Medicine, University of Sydney, Australia
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Abstract
Sexually transmitted diseases (STDs) continue to be the most common notifiable infectious conditions worldwide. Their unacceptably high incidence is underlined by the recent emergence of a (presently) incurable and lethal STD--human immunodeficiency virus (HIV) infection--which merits its description as a pandemic, and with which other STDs interact in an epidemiological synergy. Data that quantify the association between STDs/HIV infection with travel and difficult to obtain; nevertheless figures are presented that reveal the lower limit to be large enough to be of considerable concern. Studies from around the world show, overall, although knowledge of STDs is increasing amongst travellers, the level of knowledge has little to do with actual behaviour, with a modest increase in the use of condoms, but abundant evidence that a wide variety of sexual behaviours take place among travellers and with local inhabitants. Certain travellers, by virtue of their behavioural interactions with 'core-groups' of efficient transmitters, may have a high risk of acquisition of an STD/HIV. Worldwide, sexual health promotion for travellers is in its infancy; indeed, it could more accurately be merely described as 'sexual education'. A fresh approach is recommended, which includes comprehensive programme planning and outcome, impact, and process evaluations.
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Mulhall BP, Hart G, Harcourt C. Sexually transmitted diseases in Australia: a decade of change. Epidemiology and surveillance. Ann Acad Med Singap 1995; 24:569-78. [PMID: 8849191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Survival data in the last decade for sexually transmitted diseases (STDs) other than human immunodeficiency virus (HIV) are uneven across the states/territories. The incidence of gonorrhoea decreased by more than 80%, but at different times in different patient groups, different states, and different anatomical sites. There was a resurgence of rectal gonorrhoea in homosexual men in 1989-1991. Resistance to penicillin steadily increased, and partial resistance to quinolones has emerged. There was a marked decline in syphilis in most states. Lymphogranuloma venereum is rare, and chancroid seen mostly in returning travellers from Southeast Asia; however, hundreds of cases of donovanosis are seen annually among rural Aborigines. The prevalence of genital infections with Chlamydia trachomatis remained stable at 2.5%-14% in STD clinics, and 5% in family planning clinics. The numbers of cases of clinical genital herpes and warts are mostly unavailable. However, specific serology for herpes simplex virus type 2 (HSV-2) indicates that 14% of antenatal clinic patients, and 40%-60% of STD patients have been exposed. Pap smears have detected the presence of human papilloma virus (HPV) in 14%-40% of various clinic populations. Exposure to hepatitis B in the non-Aboriginal population decreased markedly. Hepatitis C infection occurred in a high percentage of injecting drug users; the evidence for sexual transmission is not strong. An epidemic of hepatitis A infection occurred in male homosexuals in 1989-1991. Changes in the Australian sex industry resulted in marked improvements in the sexual health of local (but not international) sex workers. The high levels of STDs in Aboriginal communities continues to cause concern.
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Affiliation(s)
- B P Mulhall
- Academic Unit of Sexual Health Medicine, Sydney Hospital, NSW, Australia
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Mulhall BP, Anderson B, Venables S, Donovan B. Venereology as a specialty in Australia. Ann Acad Med Singap 1995; 24:644-7. [PMID: 8849204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The development of venereology as a medical specialty began in 1979-1981 with the formation of multidisciplinary venereology societies in each state, followed by annual convention of an advocacy body, the National Venereology Council of Australia, which also included governmental representatives. In 1988 the Australian College of Venereologists was incorporated as a professional training body, and in 1992, the first Chair in Sexual Medicine was established by the Universities of Sydney and New South Wales. In parallel, the role of the nursing profession as active participants evolved dramatically: nurses work within the context of the health care team, with clinical, teaching, and outreach responsibilities, and by collaborating or initiating research. Sexual and Reproductive Health nursing is recognised as a specialist area, and the Australian Sexual Health Nurses Association (ASHNA) was inaugurated in 1991. Sexual Health Counselors come from a range of disciplines which represent the shift in focus from disease control to education and prevention, and which encompass sexual dysfunction, gender identity issues, sexual assault, and the empowerment of clients. Within the repertoire of many health care workers in sexually transmissable disease services are skills in the ¿new¿ public health (particularly health promotion), and an understanding of cultural influences on sexuality. ¿Sexual Health¿ has become the preferred name for such services.
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Affiliation(s)
- B P Mulhall
- Academic Unit of Sexual Health Medicine, Sydney Hospital, NSW, Australia
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Affiliation(s)
- B P Mulhall
- Academic Unit of Sexual Health Medicine, Sydney Hospital, NSW
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Mulhall BP, Wilde H, Sitprija V. Japanese B encephalitis vaccine: Time for a reappraisal? Med J Aust 1994. [DOI: 10.5694/j.1326-5377.1994.tb125949.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Brian P Mulhall
- Academic Unit of Sexual Health MedicineSydney HospitalDepartment of Public HealthUniversity of Sydney
| | - Henry Wilde
- Queen Saovabha Memorial InstituteDepartment of MedicineChulalongkorn UniversityBangkokThailand
| | - Visith Sitprija
- Queen Saovabha Memorial InstituteDepartment of MedicineChulalongkorn UniversityBangkokThailand
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Abstract
OBJECTIVE To research the knowledge of AIDS and other sexually transmitted diseases among young Australian tourists to Thailand, and their intended sexual behaviour. DESIGN AND SETTING A cross-sectional survey by anonymous, self-administered questionnaire, of persons seeking pre-travel medical advice in private clinics in five Australian cities. PARTICIPANTS 213 consecutive patients travelling to Thailand without a spouse or partner. RESULTS Only 34% of the sample reported a definite intention not to have sex in Thailand. Regarding choice of potential partners: 24.5% more men than women said they would have sex with a Thai national; 13.7% of men said they would have sex with a "bar girl"; and 21.7% more women than men said they would choose a fellow Australian traveller. Eighty-two per cent of the sample reported that they would use condoms 100% of the time, and there was no significant difference between the number of men and women who expressed this intention. CONCLUSIONS Although not obviously "sex tourists", many young Australian travellers are likely to have sex while visiting Thailand. These data have important implications for education and prevention programs to control the spread of human immunodeficiency virus (HIV) and other sexually transmitted diseases.
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Affiliation(s)
- B P Mulhall
- Department of Public Health, University of Sydney, NSW
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Mulhall BP, Brown GV. Perspectives on tropical health. Med J Aust 1993; 158:442-3. [PMID: 8469189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Abstract
Sexually transmissible diseases (STDs) continue to be the most common notifiable infectious conditions worldwide. Their unacceptably high incidence is underlined by the recent emergence of a (presently) incurable and lethal STD, human immunodeficiency virus (HIV) infection, which merits its description as a pandemic, and with which other STDs interact in an epidemiological synergy. Certain travellers, by virtue of their behavioural interactions with 'core-groups' of efficient transmitters, may have a high relative risk of acquisition of an STD. This risk can be virtually eliminated by avoiding penetrative sexual intercourse with casual partners, especially injecting drug users and persons who have had multiple sexual partners (particularly prostitutes), or reduced by the use of condoms. The risk of parenteral exposure can be reduced by avoiding parenteral drug use and behaviour that is likely to lead to injury and by seeking facilities with adequate capabilities to screen blood donors and to sterilize instruments.
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Donovan B, Rohrsheim R, Bassett I, Mulhall BP. Bullous impetigo in homosexual men--a risk marker for HIV-1 infection? Genitourin Med 1992; 68:159-61. [PMID: 1607190 PMCID: PMC1194846 DOI: 10.1136/sti.68.3.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To determine the incidence of bullous impetigo in a group of homosexual men at high risk of HIV-1 infection. DESIGN A longitudinal descriptive study (1984-9). SETTING A private primary care and STD clinic in Sydney, Australia. SUBJECTS 88 homosexual men documented to seroconvert to HIV-1, and 37 homosexual controls who had practised unprotected anal intercourse with another man known to be HIV-1 positive but who remained HIV-1 negative. MAIN OUTCOME MEASURE Incidence of bullous impetigo. RESULTS The crude annual incidence of bullous impetigo was 0.015 in subjects while they remained HIV-1 negative (10 cases) and 0.045 in early HIV-1 positive subjects (2 cases). Overall, 9% of the HIV-1 seroconverters and 9% of the HIV-1 negative controls were documented as suffering bullous impetigo over a mean of 29.2 and 39.3 months, respectively. CONCLUSIONS Bullous impetigo in an adult could prove to be a clinical indication that a person is either infected with HIV-1 or is in close (possibly sexual) contact with a person with HIV-1 infection. If true, the recognition of bullous impetigo could provide an opportunity for behavioural intervention to limit the spread of HIV-1.
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Affiliation(s)
- B Donovan
- Sydney Sexual Health Centre, Sydney Hospital, Australia
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Mulhall BP, Fieldhouse S, Clark S, Carter L, Harrison L, Donovan B, Short RV. Anti-sperm antibodies in homosexual men: prevalence and correlation with sexual behaviour. Genitourin Med 1990; 66:5-7. [PMID: 2312123 PMCID: PMC1194431 DOI: 10.1136/sti.66.1.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The sera of 60 homosexual males were examined for the presence of antibodies to sperm using an indirect immunobead test (IBT). Six of 60 (10%) had antibodies of IgG isotype; in addition two of the six had antibodies of IgA isotype. The presence of antibodies was associated with the practice of unprotected receptive anal intercourse in the previous six months. Antibodies were not found in homosexual men who were celibate, or who practised only oral intercourse during the same period. There was no correlation between the presence of anti-sperm antibodies and antibodies to human immunodeficiency virus (HIV), or numbers of T lymphocytes. These preliminary results lend support to the hypothesis that antigen presentation in the lower gut may be a source of sensitisation against sperm. The possibility that anti-sperm antibodies may be a marker of receptive anal intercourse merits further investigation.
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Affiliation(s)
- B P Mulhall
- Burnet Clinical Research Unit, Walter and Eliza Hall Institute of Medical Research, Melbourne
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Mulhall BP, Naselli G, Whittingham S. Anticardiolipin antibodies in homosexual men: prevalence and lack of association with human immunodeficiency virus (HIV) infection. J Clin Immunol 1989; 9:208-13. [PMID: 2768431 DOI: 10.1007/bf00916816] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Tests for anticardiolipin antibodies (ACL) on sera from 100 male homosexuals and 60 male heterosexuals showed that 57% of the homosexuals, in contrast to none of the heterosexuals, were ACL positive. The ACL were predominantly of the immunoglobulin G isotype and, in a high proportion of cases tested (82%), were reactive with other phospholipids, especially those with a negative charge. ACL were not related to the clinical status of the homosexuals, being evenly distributed among 40 with acquired immunodeficiency syndrome (AIDS), 20 with AIDS-related complex (ARC), 20 with asymptomatic infection with human immunodeficiency virus (HIV) and/or lymphadenopathy syndrome, and 20 who were HIV-antibody negative. Nor were they associated with thrombocytopenia, thrombosis, neurologic disease, a biological false-positive test for syphilis (BFP), or antibodies to DNA. It is concluded that factors other than infection with HIV are responsible for ACL positivity in homosexual males and that the epitopes recognized by ACL in this group are distinct from those associated with thromboembolism or the BFP reaction or cross-reactive with DNA.
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Affiliation(s)
- B P Mulhall
- Burnet Clinical Research Unit, Walter and Eliza Hall Institute of Medical Research, Royal Melbourne Hospital, Victoria, Australia
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Deam DR, Byron KA, Ratnaike S, Campbell DG, Mulhall BP, Mackay IR. Alpha 1-antitrypsin phenotypes in homosexual men. Pathology 1989; 21:91-2. [PMID: 2812882 DOI: 10.3109/00313028909059542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The alpha 1-antitrypsin (AAT) phenotype was determined by isoelectric focusing in 215 male homosexuals and compared with those in 208 male heterosexuals. The incidence of abnormal phenotypes was 16.3% in the homosexual group which was significantly different (p less than 0.03) than the 8.7% in the heterosexual group. There was no difference in the phenotype distribution between homosexuals who were anti-human immunodeficiency virus reactive and those who were non-reactive. It suggests that investigation into the interplay of factors associated with homosexuality could include genetic as well as psychological and social factors.
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Affiliation(s)
- D R Deam
- Biochemistry Department, Royal Melbourne Hospital
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Mulhall BP, Doherty RR, Mijch AJ. Third International Conference on the acquired immunodeficiency syndrome. Med J Aust 1987; 147:396-402. [PMID: 3309594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- B P Mulhall
- Burnet Clinical Research Unit, Walter and Eliza Hall Institute of Medical Research, Parkville, Vic
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Mulhall BP, Doherty RR, Mijch AJ. Third International Conference on the acquired immunodeficiency syndrome. Med J Aust 1987. [DOI: 10.5694/j.1326-5377.1987.tb133561.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Brian P. Mulhall
- Burnet Clinical Research Unit, The Walter and Eliza Hall Institute of Medical Research, and the AIDS Service, The Royal Melbourne Hospital, Parkville, VIC 3052
| | - Richard R. Doherty
- Fairfield Hospital for Infectious Diseases, Yarra Bend Road, Fairfield, VIC 3078
| | - Ann J. Mijch
- Fairfield Hospital for Infectious Diseases, Yarra Bend Road, Fairfield, VIC 3078
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Frazer IH, Mulhall BP. Second International Conference on the acquired immune deficiency syndrome. Med J Aust 1986; 145:524-9. [PMID: 3640196 DOI: 10.5694/j.1326-5377.1986.tb139458.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Abstract
A case report is presented of a diabetic patient who vomited unsuspected stomach contents peri-operatively due to gastroparesis. A short review of this condition is presented, together with suggestions for pre-operative management.
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