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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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Nutricia Australia Pty Ltd, Level 4 Building D, 12 – 24 Talavera Road, Macquarie Park NSW 2113. July 2017. ANZ / KC / 16 / 0053a. 14340-AD. two years to three, and stopped screening women younger than 21.
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.
6 | Australian Doctor | 28 July 2017 www. australiandoctor. com. au