Australian Doctor Australian Doctor 28th July 2017 | Page 6

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STI concerns over Pap test changes

GPs will need to get creative about testing , says Dr Bateson .
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RADA ROUSE EARLY detection rates of STIs could slip with Australia ’ s imminent cervical screening changes unless new strategies are developed , says a reproductive expert .
Dr Deborah Bateson , medical director of Family Planning NSW , says GP reminder systems , greater utilisation of practice nurses and better access to online testing will be needed to engage young ,

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Monday to Friday , from 6:30am – 5:00pm ( AEST ) sexually active women when they are no longer presenting for biennial Pap smear tests from the age of 18 .
In December , Australia will switch to HPV DNA testing from the age of 25 , with five-year test intervals .
Dr Bateson was commenting on a study that showed chlamydia testing rates dropped by 26 % in Canada , two years after it extended the screening interval from
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Dr Bateson said that in Australia , Pap smear visits had been useful for GPs to raise the issue of chlamydia screening , and “ creative thinking ” was now needed to empower young women who might be nervous or ashamed about STI tests .
“ When women present for contraception is another
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obvious time for GPs to add [ chlamydia testing ] into the conversation , but we are also moving to increased uptake of long-acting reversible contraceptives , so women won ’ t come back for three or five years ,” she told Australian Doctor .
A recent study from Tasmania found that the rate of annual chlamydia testing for sexually active people aged between 15 and 29 was estimated to be about 18 %. The recommendation is that everyone in the cohort should be tested annually . Rates were only slightly higher ( 20 %) for those aged between 15 and 24 .
Testing rates were higher for females than males ( 21 % vs 6 %), but positivity rates were higher for males than females ( 16 % vs 10 %). Annals of Family Medicine 2017 ; online .

Floaters fixed by lasers

JOCELYN WRIGHT LASER treatment may help dispel vitreous floaters in the ageing eye but more work is needed to rule out potentially catastrophic adverse effects , ophthalmologists say .
More than half of 36 people who underwent laser vitreolysis for the collagen-like specks showed significant improvement or resolution of symptoms after a single treatment , a US study found .
Comparatively , little improvement was seen in a control cohort of 16 people who received sham laser vitreolysis , found the trial of people with Weiss ring-related vitreous floaters .
“ The current study revealed modest improvement in floater symptoms with a single laser session by postoperative month six … supporting the efficacy of ... vitreolysis ,” the researchers concluded .
But an accompanying commentary sounded a note of caution over laser treatment for what is essentially a bothersome condition , noting that it could potentially lead to serious ocular complications .
“ Our enthusiasm must be tempered by the fact that this study addressed only symptomatic Weiss rings and not floaters in general ,” it said .
The success of laser treatment depended on selecting low-risk patients whose opacities were not close to sensitive areas such as the lens or retina , wrote ophthalmologist Dr Jennifer Lim from the Illinois Eye And Ear Infirmary , Chicago .
The energy level of the laser was also crucial , with higher levels risking potential problems , particularly when there was vitreous haze that could scatter energy and cause damage , she concluded . “ Vaporisation ... is an alluring idea , [ but ] as with any new procedure , an open mind with a healthy dose of scepticism is necessary ,” she wrote . JAMA Ophthalmology 2017 ; online .
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