td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30559 [post_author] => 3410 [post_date] => 2025-09-22 12:23:06 [post_date_gmt] => 2025-09-22 02:23:06 [post_content] => A new report lays bare the impact of chronic pain in young people. During Kids in Pain Week (22–28 September), an expert shares practical steps for pharmacists to improve care. Sydney-based Laura was just 10 years old when a bout of shingles left her with constant, debilitating pain. Laura went from being a fit and active middle sister to being unable to walk or move without a wheelchair at the age of 11, and completely reliant on her family for care. Doctors were stumped and investigations proved fruitless. ‘I was so sick of doctors – waiting for the doctors and waiting to do anything and just so ready to give up,’ Laura said. [caption id="attachment_30566" align="aligncenter" width="500"]Laura with her mum Michelle[/caption] When living with chronic pain, it’s easy to feel misunderstood and lonely, she shared. ‘Laura was having a really hard time, was depressed, barely talking and struggling. It was so hard to see her like that,’ Laura’s mum, Michelle said. ‘People underestimate how chronic pain may start as a physical issue but then becomes a mental health issue when everything is so uncertain and you aren’t sure if life will ever be what it was.’ Around one in five children aged 6–18 live with chronic pain, which equates to approximately 877,000 Australian kids – according to Australian Bureau of Statistics (ABS) data. The inaugural Kids in Pain Report from Chronic Pain Australia shows how pain affects every aspect of these children’s lives, as well as their families, and the many who are likely unaccounted for, said pharmacist and Chronic Pain Australia chairperson, Nicolette Ellis MPS. ‘In 2019 the World Health Organization recommended that chronic pain be recognised as a condition in its own right and provided a way to capture that in healthcare data with ICD-11 coding,’ she said. ‘But chronic pain isn’t recognised as a condition in Australia; it’s recognised only as a symptom of an injury or another condition.’ [caption id="attachment_30564" align="aligncenter" width="500"]
Nicolette Ellis MPS[/caption] Without robust prevalence data, chronic pain will remain missing from national policy – including the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme, Ms Ellis warned. ‘That cascades down into service planning and investment, which is not currently matched to need,’ she said. ‘For example, Australia only has nine specialist paediatric pain clinics; Tasmania and the Northern Territory have none, so families often travel 4–6 hours for specialist appointments.’
What does chronic pain look like in children?
Most (71%) of children experience musculoskeletal pain, typically due to rheumatoid arthritis and autoimmune conditions as well as lower-back pain, knee pain and other joint pain. Migraine and headaches, abdominal pain, connective-tissue disorders, neuropathic pain and pelvic pain are also prominent. ‘Most children have overlapping conditions – for example, migraine with abdominal pain, or musculoskeletal and neuropathic pain – so it’s rarely a single tidy diagnosis,’ Ms Ellis said. There is a high correlation between neurodivergence and pain, with almost three-quarters (72.9%) of children with chronic pain having at least one neurodivergent diagnosis. ‘Life can be more stressful for neurodivergent individuals, producing hormones that amplify pain signals,’ she said. About 60% of children with chronic pain also identified as female. ‘Women and girls have denser nerve networks and different immune systems,’ Ms Ellis said. ‘Fluctuations in oestrogen can also increase pain signals, while testosterone tends to reduce them.’Why is there such a long road to diagnosis?
For over 64% of children living with chronic pain, it took at least 3 years to receive a diagnosis. ‘Culturally, there’s a belief that persistent pain is an “older person’s condition”,’ Ms Ellis said. ‘So many children’s pain is dismissed.’ It’s often assumed there is another reason driving the symptoms. ‘Common explanations given to families are anxiety, a mental-health issue, “growing pains” that will resolve, or school avoidance,’ she said. ‘That invalidates the child and parent, and delays diagnosis.’ Children can face significant challenges navigating the healthcare system, getting answers, and accessing quality treatment, leading to cascading consequences. ‘Around 80% of children have a secondary mental health challenge, report sleep issues and forgo sport and similar activities,’ she said. ‘Over 80% miss school, about 1 day per week on average, with many finding the school system inflexible and invalidating, with pain dismissed or labelled as avoidance.’ Should a child experience ongoing, persistent pain, it should be taken ‘very seriously’ by health professionals – including pharmacists – with early intervention and thorough assessment ideally taking place within the first 3–6 months. ‘Early action reduces chronicity, helps build tools and confidence in self-management, and helps keep children in school and engaged socially,’ Ms Ellis said.What’s the pharmacist’s role?
Parents reported that they often see their pharmacist first to discuss their child's pain condition. To expedite diagnosis and ensure appropriate care, Chronic Pain Australia has released a Pharmacist Guide which includes language tips for discussing pain with children, ways to explain pain, and what good pain management looks like. ‘Pharmacists should ask how long the pain has been present and validate that it’s challenging to live with,’ Ms Ellis said. ‘Emphasise the importance of seeing a local GP for assessment and early diagnosis.’ Other key language tips include using ‘lives with pain’ over ‘suffers from’. Pharmacists should also describe ‘bad” or ‘challenging’ days rather than ‘flare-ups’. ‘Link with local providers, such as occupational therapists, physiotherapists and psychologists – who understand different communication and treatment needs, including for neurodivergent children who may express pain differently,’ she said. When addressing children with neurodivergence, pharmacists should inquire how best to communicate with them, what topics to avoid and what information would help. ‘Communication should always be age-appropriate and family-centred,’ Ms Ellis said. ‘The goal is to create a friendly, approachable environment where children feel comfortable sharing, while parents can help fill in the picture when needed.’How should symptom management be approached?
Management approaches for chronic pain depend on the child, condition, and whether function improves, Ms Ellis said. ‘In paediatric pain medicine we try to avoid medicines and use them sparingly, but if a non-functional child becomes functional on a medicine that may restore quality of life – that should be central to pain management.’ Ms Ellis recalls an example of a 14-year-old girl prescribed an opioid to be taken before menstruation for 4–5 days. While some healthcare professionals were quick to label this approach an addiction risk, it perhaps kept her in school during severe periods while investigations took place for endometriosis or polycystic ovarian syndrome. ‘Pharmacists concerned about higher-risk medicines should focus conversations on functional benefit, asking “Is this improving your ability to do things?”’ she said. ‘If not, initiate a discussion about whether to continue therapy, given the potential harms.’ With her mum’s support and extensive physical therapies, Laura was able to walk into her first day of high school without a walking stick. While she has good and bad days and constant flare ups, there are wins along the way – such as being able to start carrying a backpack rather than relying on a roller case. ‘It’s an invisible disability with constant pain that isn’t linear – there are different levels and sensations all the time and that changes the way I approach daily life,’ Laura said. ‘[But] when mum said I will keep fighting for you – it was almost like a promise, and she’s always kept it.’ [post_title] => Early action prevents lifelong chronic pain in children [post_excerpt] => A new report lays bare the impact of chronic pain in young people. An expert shares practical steps for pharmacists to improve care. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => early-action-prevents-lifelong-chronic-pain-in-children [to_ping] => [pinged] => [post_modified] => 2025-09-22 16:18:00 [post_modified_gmt] => 2025-09-22 06:18:00 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=30559 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Early action prevents lifelong chronic pain in children [title] => Early action prevents lifelong chronic pain in children [href] => https://www.australianpharmacist.com.au/early-action-prevents-lifelong-chronic-pain-in-children/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 30562 [authorType] => )
td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30152 [post_author] => 8451 [post_date] => 2025-09-22 09:00:34 [post_date_gmt] => 2025-09-21 23:00:34 [post_content] =>The various dementias are a huge cause of death in Australia. Despite some light on the horizon, there are still no effective treatments. AP explores the latest in dementia research.
Dementia is the second leading cause of death in Australia.1 The number of people living with the disease is expected to increase substantially as the population ages, potentially straining health systems.2
Despite accelerated research, including trials of more advanced compounds and recent Victorian Government grants supporting mRNA-based projects, effective treatments remain elusive.3
According to Dementia Australia's Executive Director of Services, Advocacy and Research, Dr Kaele Stokes (she/her), an estimated 433,000 Australians are currently living with dementia, including 29,000 people living with younger-onset dementia (when symptoms emerge before age 65).1
While there have been important advances in pharmaceutical research in the dementia field in recent years, Dr Stokes says, new medicines to date have limited application, availability and efficacy, and they do not stop the progression of dementia.
It is important to ensure health systems support everyone living with dementia now, she adds, noting that the new medicines may not work for many people with the condition, particularly patients who have lived with dementia for some time.
‘We don’t have an approach here in Australia that focuses on the importance of brain health across the life course,’ she says.
‘While we’re good at picking up other diseases, such as cardiovascular disease or diabetes, and putting steps in place to ensure the risks of severity in those conditions are minimised, we don’t really have conversations about brain health in a healthcare setting.’
Diagnosing dementia for younger and older people
Dr Stokes says while diagnostic tools are improving, diagnosing dementia is still a complex process.
Dementia is still seen as an older person’s disease, she adds, and it can be difficult for a person in their 40s or 50s to receive a dementia diagnosis.
According to a 2025 study in Translational Psychiatry, young-onset dementia in people aged under 65 years globally increased substantially in prevalence and incidence between 1990 and 2021 compared with overall people with dementia – and with a higher burden on women.4 The three highest risk factors were smoking, high body mass index and high fasting plasma glucose levels, while population growth was the largest contributor to the significant increase.4
‘There’s still a real fear and stigma around wanting to talk about brain health or talking to a healthcare professional about concerns around changes in cognition,’ Dr Stokes says.
‘But actually there are lots of reasons why it’s important to do that. A mix of pharmacological and non-pharmacological interventions can make a difference to quality of life and reduce the stress that somebody might be experiencing.’
It is important for people to focus on modifiable risk factors, potentially reducing the risk of developing dementia by about 45% by avoiding smoking or drinking too much and by maintaining a healthy diet, exercising regulary, and ensuring hearing and vision problems are identified and dealt with, Dr Stokes says.
For those at later stages of their lives, it’s important to avoid social isolation and to keep the brain active, she adds.
‘Learning new things can be really important – stretching the brain, firing up the neurons, to keep your brain active.’
Pharmacological advances
Healthcare professionals have high hopes for the potential benefits of newly available monoclonal antibody treatments for Alzheimer’s disease.5
University of Melbourne and Florey Institute Professor of Dementia Research Colin Masters, widely recognised as a world expert in the field of neurodegenerative diseases, estimates there are about 100 compounds in the pharmaceutical pipeline presently that are progressing through the trial stages.
‘Better forms, more effective forms, are coming within the next couple of years,’ he declares. ‘We’ve got to learn how to use them and manage all the adverse effects as well.’ He is optimistic about the future of dementia treatments – potentially including a routine vaccination.
‘The writing is on the wall,’ he says. ‘If the passive immunotherapies work, then everyone will be working on an active vaccination program. In other words, at age 50 or whatever, you just run up to your primary care physician, they do a blood test, you’re on the pathway – you get a shot of peptide in your arm.’
The most promising drug now on the horizon is trontinemab, Prof Masters says. It's a reinvented form of the monoclonal antibody gantenerumab – a drug that didn’t make it to market because of a lack of efficacy. Even so, he adds, gantenerumab has been found effective for certain conditions. ‘We’ve been trialling it for nearly 10 years now,’ Prof Masters says, ‘and we published in Lancet Neurology9 [in June 2025] that in early-onset familial types of Alzheimer’s disease, gantenerumab in high doses was effective in pre-clinical disease in young individuals who are at 100% risk of developing Alzheimer’s disease.’ Trontinemab, he adds, is the natural successor to gantenerumab.
In April, Roche announced the results of a phase II trial of trontinemab delivered via the “Brainshuttle” system, which found ‘rapid and deep, dose-dependent reduction of amyloid plaques in the brain’.10 At the same time, Roche announced it would begin a phase III trial of the drug later this year.10
‘It’s the next generation; it’s a major advance,’ Prof Masters says, explaining that the bispecific molecule of trontinemab is designed to go straight across the blood-brain barrier, so doses of the drug can be far smaller.
‘It’s the first antibody designed to do this, and a lot of companies are copying it right now, because it works so well.’
According to data released from the Roche trials, trontinemab causes far fewer and less severe adverse effects than gantenerumab, he points out.
Other promising Alzheimer’s disease treatments include the monoclonal antibody donanemab. It is marketed as Kisunla by Eli Lilly, and in May 2025 it was approved by the Therapeutic Goods Administration.11
Lecanemab, marketed as Leqembi, has not yet been approved in Australia, but Prof Masters says full results of a pre-clinical trial are expected by the end of 2027 and he and his colleagues expect a positive result.
All these monoclonal antibody drugs are most effective in the early stages of Alzheimer’s disease, so early diagnosis is critical.12 In July this year, the Victorian Government also announced more than $537,000 in grants to two Florey researchers for two Alzheimer’s research projects.
These are aimed at treating and preventing the disease with mRNA technology, which was developed during the pandemic for COVID-19 vaccines.13
Pharmacist dementia support in the community
PSA’s Dementia Support Pharmacist Project in South Australia is an innovative project and model of practice aimed at keeping people with dementia at home and in the community for longer.14
Two pharmacists are employed on the project. They job-share to support clients with dementia medication management needs, understanding and choices, says South Australia and Northern Territory PSA Manager Helen Stone FPS (she/her).
The pharmacists act as patient advocates, provide flexible care for patients with complex comorbidities, and work with other members of the care team, including GPs, community pharmacists, nursing and care workers and families, she adds. Initial appointments are held in the patient's home, preferably with follow-ups either personally, by telephone or collaboration application such as MS Teams. A report prepared by the pharmacist is shared with the patient and, with consent, to treating medical and care teams, which may recommend an action plan to change or deprescribe medicines. Education about medicine use in dementia is also provided to health professionals and community groups across regional areas of the state.
‘This is a much-needed service; it is accessible, but there are a lot more people we can’t yet support,’ Ms Stone says. PSA has demonstrated that pharmacists working directly with patients and liaising with the care team can provide valuable support for patients with complex conditions and multimorbidities.
The project began in May 2024 and has been extended to June 2026. Ms Stone recently submitted a proposal to SA Health to expand the program and include a further five FTE pharmacists to cover metropolitan Adelaide.
Dementia care pharmacists can help with complex deprescribing of medicines and tapering of antidepressants where needed. They can provide professional advice to family members caring for patients with dementia that can empower carers as advocates in cases, for instance, of inadequate pain management.
Medicine administration frustrations can be avoided when dose time changes can be suggested.
Project pharmacist Dee-Anne Hull MPS (she/her) says pharmacist dementia support work helps in areas where it is needed most. ‘It has shown us where gaps in health care are in rural and remote areas of our state, but also within the pharmacy profession itself,’ she says. ‘A lot of pharmacists openly admit that dementia scares them, and they don’t really know where to start.
‘My advice is to make this an area of focus for CPD activities; check out the numerous PSA resources available, particularly those on palliative care and deprescribing, but also check out websites like Dementia Australia, Dementia Training Australia and the Wicking Dementia Centre,’ she adds.
‘Think about ways that you could support someone who is caring for a person living with dementia and the carer’s burden that may be associated with this, because that’s often where the support is needed the most.’
Positive response
Dementia Support Pharmacist Project pharmacist Nicola Sander MPS (she/her) says she has seen ‘overwhelming support and positive feedback’ for the project.
‘We have seen considerable benefit for people who are still living at home and are trying to manage their medicines.
Ms Sander sees this dementia support career pathway as ideal for an early career pharmacist and suggests that training in deprescribing and dementia-specific areas would be useful.
After a lengthy consultation with one client living at home, the client’s family and her doctor, Ms Sander recommended medicine management changes. The doctor was reluctant, so the client’s daughter found a doctor who was willing to be part of a multidisciplinary team, Ms Sander says, which included deprescribing strategies and pain support management.
After a recent visit to the geriatrician, the client’s daughter reported that her mother’s Mini‐Mental State Examination had improved from 12/30 to 19/30.
The daughter and the geriatrician attributed the client’s improvement to ‘better control of pain and overall improvement to her mood, as she has felt more supported and less depressed' since.
Ms Stone, whose Churchill Fellowship palliative care research – To articulate a framework for the role of Palliative Care Pharmacist in community and aged care in Australia – Churchill Trust15 – informed the Dementia Support Pharmacist Project, says that education, training and curiosity help pharmacists to start understanding dementia care more fully.
She encourages everyone to complete a Program of Experience in the Palliative Approach (PEPA) placement.
‘A dementia diagnosis can be devastating for people and their families; medications can have a benefit but can also impair cognition, so support from a pharmacist can be very valuable.'
References
[post_title] => Advancing dementia care in pharmacy [post_excerpt] => The various dementias are a huge cause of death in Australia. Despite some light on the horizon, there are still no effective treatments. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => advancing-dementia-care [to_ping] => [pinged] => [post_modified] => 2025-09-22 16:18:21 [post_modified_gmt] => 2025-09-22 06:18:21 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=30152 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Advancing dementia care in pharmacy [title] => Advancing dementia care in pharmacy [href] => https://www.australianpharmacist.com.au/advancing-dementia-care/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 30558 [authorType] => )
- Australian Institute of Health and Welfare. Dementia In Australia. 2024. At: www.aihw.gov.au/reports/dementia/dementia-in-aus/contents/population-health-impacts-of-dementia/deaths-due-to-dementia
- Dementia Australia. Dementia facts and figures. 2024. At: www.dementia.org.au/about-dementia/dementia-facts-and-figures
- Florey Institute for Neuroscience and Mental Health. Harnessing mRNA to prevent and slow Alzheimer’s disease. 2025. At: https://florey.edu.au/news/2025/07/harnessing-mrna-to-prevent-and-slow-alzheimers-disease/
- He Q, Wang W, Zhang Y, et al. Global burden of young-onset dementia, from 1990 to 2021: an age-period-cohort analysis from the global burden of disease study 2021. Transl Psychiatry 2025. Epub 2025, 17 February.
- Ramanan VK, Armstrong MJ, Choudhury P, et al. Antiamyloid monoclonal antibody therapy for Alzheimer disease. Neurology 2023;101(19)842–52. At: www.neurology.org/doi/10.1212/WNL.0000000000207757
- World Health Organization. Dementia. 2025. At: www.who.int/en/news-room/fact-sheets/detail/dementia
- Mayo Clinic. Alzheimer’s disease. 2025. At: www.mayoclinic.org/diseases-conditions/alzheimers-disease/symptoms-causes/syc-20350447
- Eyting M, Xie M, Michalik F, et al. A natural experiment on the effect of herpes zoster vaccination on dementia. Nature 2025. Epub 2025 2 April. At www.nature.com/articles/s41586-025-08800-x
- Safety and efficacy of long-term gantenerumab treatment in dominantly inherited Alzheimer's disease: an open-label extension of the phase 2/3 multicentre, randomised, double-blind, placebo-controlled platform DIAN-TU trial. Bateman, Randall J et al. Lancet Neurology 2025; 24(4):316–30.
- Roche. Roche presents novel therapeutic and diagnostic advancements in Alzheimer’s at AP/PD 2025. 2025. At: www.roche.com/media/releases/med-cor-2025-04-03
- Burge K. Treatment to slow early Alzheimer’s gets TGA approval. newsGP 2025. At: www1.racgp.org.au/newsgp/clinical/treatment-to-slow-early-alzheimer-s-gets-tga-appro
- Promising results of new Alzheimer’s drug published – early diagnosis is key. 2023. At: www.dementia.org.au/media-centre/media-releases/promising-results-new-alzheimers-drug-published-early-diagnosis-key
- Victoria State Government. mRNA Victoria. Research. July 2025. At: https://djsir.vic.gov.au/mrna-victoria/research
- Sander N, Jull DA. Bridging the gap: how dementia support pharmacists are transforming care in rural South Australia. Issue 91. June 2, 2025. At: https://ruralhealth.org.au/partyline/bridging-the-gap-how-dementia-support-pharmacists-are-transforming-care-in-rural-south-australia/
- Stone H. To articulate a framework for the role of the palliative care pharmacist in community and aged care in Australia. Winston Churchill Trust 2025. At: www.churchilltrust.com.au/project/to-articulate-a-framework-for-the-role-of-palliative-care-pharmacist-in-community-and-aged-care-in-australia/
td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30542 [post_author] => 8451 [post_date] => 2025-09-17 11:29:30 [post_date_gmt] => 2025-09-17 01:29:30 [post_content] => Pharmacists are asked to lead the shift from reliever-only inhalers to inhaled corticosteroid-containing regimens and to minimise short courses of oral corticosteroids. Just under 3 million Australians live with asthma. The condition has the eighth-highest disease burden in the nation, and it is one of the most significant chronic conditions in children. Guided by the results of large trials, recommendations for asthma management in adults and adolescents are changing, and pharmacists need to be aware of updated guidelines. The Australian Asthma Handbook was updated yesterday (16 September 2025) to reflect new thinking on asthma care and management.What are the key updates?
Three key changes have been made to the Australian Asthma Handbook, including:
- All adults and adolescents with confirmed asthma should be taking inhaled corticosteroid-containing treatment and not as-needed short-acting beta2-agonists (SABAs) alone. Asthma can be well controlled with maintenance and reliever therapy, and a small proportion of patients with severe asthma may be eligible for biologics.
- An emphasis on the importance of limiting oral corticosteroids, which have been associated with a range of different harms, including damage to bone health, cataracts and type 2 diabetes.
- Health professionals should be aware the handbook has greater guidance for treating children aged 1–5 who are living with asthma and a recommendation that some older children should also be on low-dosage ICS maintenance therapy.
Why have the guidelines been updated?
Overuse of SABAs has been linked to poor asthma control and preventable hospitalisations. ‘The evidence is that the risks of SABA alone have become clearer and that we were overusing a not very effective and not very safe therapy,’ said Professor Nick Zwar, Executive Dean of Bond University’s Faculty of Health Sciences and Medicine, and Chair of the Australian Asthma Handbook Guidelines Committee. ‘Budesonide-formoterol, taken only as needed, is recommended in place of SABA. Maintenance and reliever therapy is now recommended as the next step up.’ The risks of SABA overuse include a lack of bronchodilator response over time, and the possibility that some people may have quite a severe asthma attack and end up in the hospital emergency department (ED), or hospitalised, when they don’t need to be. There is very strong evidence to demonstrate that all adolescents and adults living with asthma should be treated with ICS, said pharmacist and Clinical Executive Lead at the National Asthma Council Australia, Debbie Rigby FPS. ‘Just having the SABA alone only treats one component of asthma, which is the bronchoconstriction, whereas having the low-dose ICS helps manage the inflammation and mucus production,’ she said. ‘I think that’s the biggest shift for us, pharmacists and doctors: helping patients to understand that asthma is a chronic inflammatory condition.’What are the risks of poor asthma control?
Inadequately managed asthma can be a life-threatening condition, Ms Rigby stressed, noting there were 474 asthma-related deaths in Australia in 2023. ‘Those deaths shouldn’t be happening. Many of those people who did die from asthma or asthma-related causes would have been perceived as having mild, intermittent symptoms,’ she said. ‘Without wanting to scare patients, we should be really highlighting the consequences of not having good control of their asthma.’Why is SABA still overused?
Despite access to long-acting beta2 agonists (ICS–LABAs), SABA use remains high for a range of reasons. These include cost, convenience and patient reluctance to medicate every day when they are accustomed to using a reliever-only when they have an asthma attack, Ms Rigby said. Health professionals understand that many people are reluctant to use a preventer inhaler, but health professionals need to help them understand that they have a ‘chronic inflammatory condition, which may flare up from time to time’. Effects of the cost-of-living crisis should not be underestimated either. However, the price gap between over-the-counter salbutamol and prescription asthma medicines is now narrowing, with 60-day dispensing for patients who are stable and, from January 2026, the co-payment for medicines being reduced from $31.60 to $25 per prescription. The Australian uptake of Maintenance and Reliever Therapy (MART) has also been slow, despite strong evidence and subsidy on the Pharmaceutical Benefits Scheme. The evidence of large-scale trials has shown the importance of shifting patients with mild asthma onto anti-inflammatory reliever therapy on an as-needed basis, Ms Rigby said. ‘The evidence basically says it reduces the risk of severe exacerbations requiring ED or hospitalisation, or requiring oral corticosteroids,’ she said. For practical guidance on discussing the guideline changes with patients, the role of prescribing pharmacists, and how biologics fit into care, don’t miss the October cover story in Australian Pharmacist. [post_title] => New asthma guidelines released [post_excerpt] => Pharmacists are asked to lead the shift from reliever to inhaled corticosteroid regimens and to minimise use of oral corticosteroids. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => new-asthma-guidelines-released [to_ping] => [pinged] => [post_modified] => 2025-09-17 17:13:31 [post_modified_gmt] => 2025-09-17 07:13:31 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=30542 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => New asthma guidelines released [title] => New asthma guidelines released [href] => https://www.australianpharmacist.com.au/new-asthma-guidelines-released/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 30545 [authorType] => )
td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30154 [post_author] => 11158 [post_date] => 2025-09-17 08:26:54 [post_date_gmt] => 2025-09-16 22:26:54 [post_content] =>Case scenario
Ashley, a 23-year-old female, presents to your pharmacy with a prescription for a 7-day course of doxycycline 100 mg twice daily. She tells you she has had some mild vaginal discharge and that her STI screen has come back positive for vaginal chlamydia. You establish that she is currently taking ferrous sulfate 325 mg once daily as she is vegan, isotretinoin 30 mg once daily for acne, and has an etonogestrel implant in situ. She has no known allergies.
Note: The authors recognise that gender identity is fluid. In this article, the words and language we use to describe genitals and gender are based on the sex assigned at birth.
Learning objectivesAfter reading this article, pharmacists should be able to:
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Chlamydia and gonorrhoea are two of the most prevalent bacterial sexually transmitted infections (STIs) globally.1,2 They are preventable and curable infections that are usually transmitted through vaginal, oral or anal sex.1,2 Conjunctival infection can occur in neonates born to mothers carrying a chlamydia or gonorrhoea infection, or in adults via exposure to genital secretions.1–4 Both chlamydia and gonorrhoea can lead to serious health complications if left untreated, ranging from effects on fertility and pregnancy to blindness (in untreated ocular gonorrhoea infection).1,2
Chlamydia is caused by the gram-negative bacterium Chlamydia trachomatis.2 Gonorrhoea is caused by the gram-negative bacterium Neisseria gonorrhoeae.1
Chlamydia is relatively simple to treat, being susceptible to doxycycline and azithromycin.5 Gonorrhoea treatment may be more challenging due to emerging antimicrobial resistance to first-line treatments, particularly in urban Australia.6 All people diagnosed with chlamydia and gonorrhoea should be offered antibiotic treatment to resolve symptoms, prevent complications and to decrease transmission to others.1,2
Pharmacists can support patients by providing information on safe-sex practices, any prescribed medicines, in addition to providing advice or referring where appropriate.
The World Health Organization (WHO) estimates there were around 128.5 million new infections with C. trachomatis in 2020 among adults aged 15–49 years globally.2 In Australia, those under 30 years of age are at greatest risk of infection.5 There were 102,222* cases of chlamydia notified to the Australian government’s National Notifiable Diseases Surveillance System (NNDSS) in 2024, with an almost equal distribution of infection between males and females.7 This was an increase of almost 20% compared to the 86,810 case notifications in 2014.7 Across all ages, infections in females over this time period remained similar, however infections in males increased by approximately 40%.7
The WHO estimates that 82.4 million adults aged 15–49 years old acquired gonorrhoea worldwide in 2020.1 In Australia, gonorrhoea is most prevalent in men who have sex with men (MSM), remote Aboriginal and Torres Strait Islander communities, street-based sex workers, and returned travellers reporting sex overseas (in high prevalence countries).6,8 In recent years, there has been a rise in prevalence in the general population, especially in females of reproductive age.6 There were 44,547* cases of gonorrhoea notified to the NNDSS in 2024.7 This is almost triple the 15,674 cases notified in 2014.7
Co-infection with both chlamydia and gonorrhoea is relatively common.9 A study of high-prevalence Aboriginal communities in remote Australia found half of female and one-third of male participants aged 16–19 had one or more STIs.10 Chlamydia and gonorrhoea were the most common co-infections.10
*Figures correct as of May 2025.
Chlamydia
Chlamydia is often described as the “silent STI” because 85–90% of infections are asymptomatic.5 If symptoms do appear, they may not present until up to 3 weeks after sexual contact with an individual with chlamydia infection.2
Common chlamydia symptoms for males include2,5:
For females, symptoms include2,5:
Gonorrhoea
Gonorrhoea symptoms usually appear within 2 weeks of exposure.1 Infection is usually asymptomatic in females.1
If symptoms occur in females, they include1,4,6:
In contrast for males, penile urethral gonorrhoea is almost always symptomatic and symptoms may include1,6:
Complications
Untreated chlamydia and gonorrhoea can lead to various complications in both males and females, highlighting the need for prompt identification and treatment of infection.
Table 1 outlines some complications associated with untreated C. trachomatis and N. gonorrhoeae infection.
Molecular testing should be undertaken for those suspected of having chlamydia or gonorrhoea, or those at risk of infection. Certain groups (e.g. MSM, pregnant people, sex workers, Aboriginal and Torres Strait Islander people, gender diverse and transgender people) require special testing approaches due to increased risk of infection, adverse health outcomes or community prevalence.11 A full STI check-up including HIV and syphilis serology at initial presentation is recommended.11
Chlamydia is diagnosed via nucleic acid amplification tests (NAATs) (e.g. polymerase chain reaction [PCR]).5 NAATs are highly sensitive and the only recommended test for chlamydia.5 Microbiological culture of C. trachomatis is difficult and not routinely recommended.12
NAATs are also used to diagnose gonorrhoea.6 They are highly sensitive but do not provide any information on antibiotic susceptibility.6 Gonococcal microbiological culture has high specificity and allows for antibiotic susceptibility testing, but is less sensitive than NAATs.6
Some differential diagnoses for genital tract chlamydia infection may include lymphogranuloma venereum, gonorrhoea, bacterial vaginosis, vaginal candidiasis, trichomonas or Mycoplasma genitalium infection.13 For gonorrhoea, other conditions such as chlamydia, trichomonas, vaginal candidiasis, bacterial vaginosis or urinary tract infections may cause similar symptoms.14
Anatomical sites sampled for chlamydia and gonorrhoea testing will depend on the individual’s presentation, sexual history and risk factors.5,6 Self-collection of samples for testing by NAAT is common practice for asymptomatic patients.5 In symptomatic patients undergoing examination, a swab can be taken by the clinician (e.g. an endocervical swab if a speculum examination occurs).5,6 First-pass urine can be tested in people without a vagina (or if a vaginal swab cannot be taken) – it is less sensitive than a self-collected vaginal swab.5,6 An anorectal swab is recommended for all individuals who have anorectal symptoms, and for all MSM regardless of whether they are symptomatic.5,6 Similarly, a pharyngeal swab for NAAT is recommended for MSM for both gonorrhoea and chlamydia, even if asymptomatic.5,6
Gonococcal culture
Gonococcal cultures should be collected from all infected sites prior to commencing treatment to determine antibiotic susceptibility and to contribute to antimicrobial resistance surveillance.6 It is recommended that a culture is performed on a site if an individual is experiencing symptoms at that site.6 Pending culture results should not delay commencing treatment, and antibiotics can be administered prior to receiving the culture results.6
The goals of treatment for both chlamydia and gonorrhoea are to resolve symptoms, reduce complications and prevent transmission and reinfection. Sometimes a clinical diagnosis is made based on symptoms and risk factors. Certain presentations may warrant starting empiric treatment while awaiting confirmation of results. Examples include patients presenting with anorectal symptoms, symptoms of PID or epididymo-orchitis, where timely treatment is critical.15–17
Chlamydia
Doxycycline is the standard first-line therapy for chlamydia.5,18 Azithromycin is an alternative option if doxycycline is contraindicated (e.g. in pregnancy, if there are adherence or medicine interaction concerns).3,18
Previously, azithromycin was the first-line treatment, as it was a convenient single dose. However, a meta-analysis showed azithromycin 1 g orally may be up to 20% less efficacious than 7 days of doxycycline when treating anorectal chlamydia. A subsequent randomised trial of 625 Australian MSM with asymptomatic anorectal chlamydia demonstrated consistent findings.19,20 Azithromycin is also increasingly implicated in antimicrobial resistance for other STIs, therefore doxycycline is preferred.21
Gonorrhoea
The recommended treatment for gonorrhoea infection in Australia is ceftriaxone in combination with azithromycin.6 The recommended dose of oral azithromycin varies depending on the site of infection.4 The current combination treatment approach is highly effective and important in reducing the contribution to more widespread antimicrobial resistance.4,6 However, reduced susceptibility to these agents has been increasingly reported in urban Australia.6 Until recently, the combination of amoxicillin, probenecid and azithromycin was still recommended for gonorrhoea in some remote Australian areas. However, this changed to ceftriaxone with azithromycin, due to an increase in penicillin resistance in remote communities in the Northern Territory.22
Antimicrobial resistance is a growing problem in the treatment of gonorrhoea.1 Resistance to penicillin, tetracyclines, macrolides, sulphonamides and quinolones has been detected.23 Gonococcal surveillance programs are in place in some countries to track resistant strains.
Table 2 provides a summary of the current treatment approach for various presentations of chlamydia and gonorrhoea infection in Australia. Uncomplicated chlamydia or gonorrhoea infection refers to localised urogenital, anogenital, pharyngeal and ocular infections that are not associated with bacteraemia or ascending spread to other organs.24,25 Complicated infections and their treatment is beyond the scope of this article, as are other infections associated with C. trachomatis.
Consistent and correct condom use can prevent the transmission of chlamydia and gonorrhoea.1,2 There is currently no available vaccine to prevent either infection. The serogroup B meningococcal vaccine (4CMenB) is currently being investigated for its ability to provide cross-protection against N. gonorrhoeae.26
The use of doxycycline to prevent bacterial STIs (doxycycline post-exposure prophylaxis [doxy-PEP]) can offer protection against acquiring syphilis, chlamydia and, to a lesser extent, gonorrhoea, if taken within 72 hours of unprotected sexual intercourse.27 Controversy remains on whether the risk of changes to the microbiome and potential increased antimicrobial resistance as a result of using doxy-PEP outweighs the benefits of preventing these STIs, with research ongoing.27
Sexual contact should be avoided for 7 days after chlamydia and/or gonorrhoea treatment is commenced, or until the treatment course is completed and symptoms have resolved, whichever is later.5,6 Patients should be advised not to have sex with partners from the last 6 months for chlamydia, or the last 2 months for gonorrhoea, until partners have been tested and treated, if necessary.5,6 Notification of sexual partners is recommended and can be done anonymously by patients via websites such as Let Them Know (https://letthemknow.org.au/).5,6 With the consent of the patient, a clinician may support with contact tracing if necessary.
Reinfection with chlamydia and gonorrhoea is common.5,6 Retesting at 3 months is recommended to detect reinfection.5,6 A test of cure is not routinely recommended for chlamydia, except in specific circumstances (e.g. in pregnancy).5 A test of cure is recommended for gonorrhoea in cases where a culture was not collected before treatment, the culture indicated antimicrobial resistance or if a non-standard treatment regimen was used.6 Screening for other STIs should be performed if not done at the initial presentation.5,6
Patient-delivered partner therapy (PDPT) is where antibiotic treatment is prescribed or supplied for the sexual partner(s) of a patient diagnosed with chlamydia (index patient).5 The prescription or treatment is given directly to their partner(s) by the index patient.5 In jurisdictions where PDPT is approved, it can be considered for heterosexual index patients with anogenital or oropharyngeal chlamydia, whose partners are unlikely to seek chlamydia testing or treatment.5 PDPT can also be considered with cases of repeat infections where partners have not been treated.5 Guidance on PDPT for chlamydia is available in Victoria, New South Wales and the Northern Territory.5 The decision to use PDPT should be weighed against the potential to miss co-infections or complications in the partner(s) of the index patient.
Pharmacists may be among the first healthcare professionals that patients approach for guidance and treatment for STIs, particularly if presenting with symptoms of infection. Recognition of symptoms that may warrant onward referral to a medical practitioner is essential.
Pharmacists can support adherence to current recommended treatment regimens for STIs. This may include extended doxycycline courses, which ensures the resolution of infection and improves antibiotic efficacy.28 Pharmacists can also encourage patients to notify sexual partners regarding an STI diagnosis, enabling those partners to obtain timely treatment.
Doxy-PEP may be appropriate for some at-risk groups, providing an additional option to conventional STI prevention strategies. Evidence is building for doxy-PEP use and by following the Australasian Society for HIV, Viral Hepatitis & Sexual Health Medicine (ASHM) guidance, pharmacists can ensure they are providing evidence-based information to patients who wish to know more about this prevention strategy (see https://ashm.org.au/initiatives/doxy-pep-statement/).27
Chlamydia and gonorrhoea are two of the most prevalent bacterial STIs. Patients may be asymptomatic, and both can lead to serious complications if left untreated. Chlamydia is relatively easy to treat, however emerging antimicrobial resistance to first-line gonorrhoea treatments may complicate its management. Reinfection is common with both, and robust contact tracing of sexual partners is recommended.
Case scenario continuedAfter noting that doxycycline would need to be taken at least 2 hours before or after Ashley’s iron tablets, you also suspect an interaction with isotretinoin.28 You check the Australian Medicines Handbook (AMH), which highlights a risk of benign intracranial hypertension and that concurrent use should be avoided.29 You phone Ashley’s GP to recommend a safer, yet effective, alternative of azithromycin 1 g orally as a single dose. The GP and Ashley thank you for your help. |
Ivette Aguirre (she/her) BAppSc (MedLabSc), BPharm, GradCertPharmPrac, MClinPharm, FANZCAP (Inf Dis) is the senior clinical pharmacist at the Melbourne Sexual Health Centre (MSHC), a part of Alfred Health. She mentors pharmacists, technicians and pharmacy students during their rotations at MSHC, and is interested in the impact of pharmacist reviews in HIV clinics and emerging treatments for sexually transmissible infections such as Mycoplasma genitalium.
Kathryn (Kate) Mackie (she/her) BPharm, GradDipClinPharm, BCGP, FANZCAP (Inf Dis, Gen) is a senior clinical pharmacist at Alfred Health (including Melbourne Sexual Health Centre) and Barwon Health, working in infectious diseases, HIV, viral hepatitis and sexual health. With 20 years of experience in this area, she is engaged in clinical pharmacy research and contributes to undergraduate and health professional education.
Hana Numan (she/her) BPharm (NZ), PGDipClinPharm (NZ), MPS (NZ)
[post_title] => Chlamydia and gonorrhoea [post_excerpt] => Chlamydia and gonorrhoea are two of the most prevalent bacterial sexually transmitted infections (STIs) globally. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => chlamydia-and-gonorrhoea [to_ping] => [pinged] => [post_modified] => 2025-09-17 16:17:03 [post_modified_gmt] => 2025-09-17 06:17:03 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=30154 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Chlamydia and gonorrhoea [title] => Chlamydia and gonorrhoea [href] => https://www.australianpharmacist.com.au/chlamydia-and-gonorrhoea/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( [td_post_template] => single_template_4 ) [is_review:protected] => [post_thumb_id:protected] => 30528 [authorType] => )td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30516 [post_author] => 3387 [post_date] => 2025-09-15 12:20:04 [post_date_gmt] => 2025-09-15 02:20:04 [post_content] => Administered to the nasal mucosa, a spike-based formulation triggers rapid local defences that clear the COVID-19 virus where it enters. In 2022, a year after Australia’s longest COVID-19 lockdowns, researchers from the Centenary Institute and the University of Sydney received a grant of almost $1 million from the NSW COVID-19 Vaccine Acceleration Research Grants Program to develop an intranasal COVID-19 vaccine. Now, new research has been released by the team – finding that their formulation can stop infection in the nose before the virus spreads through the body, and to other people. [caption id="attachment_30517" align="alignright" width="150"]Dr Erica Stewart, Centenary Institute[/caption] Australian Pharmacist sat down with Dr Erica Stewart, first author and researcher at the Centenary Institute when the work was undertaken, to discuss how the vaccine works, its applications and why it could be the key to stopping the spread.
What is the vaccine’s mechanism of action?
By acting where the virus first enters, the nasal vaccine prompts a rapid, effective immune response that eliminates the virus, Dr Stewart said. ‘The adjuvant we used was Pam2Cys, a Toll-like receptor 2 (TLR2), and we showed that it was able to stimulate the immune response in the nasal passages,’ she said. ‘We formulated the SARS-CoV-2 spike protein with this adjuvant, which emulates bacteria to alert the immune system that there is a danger and it should respond.’ When administered as a booster after a standard injection, the treatment also provided additional protection to vital organs, including the lungs and brain – pointing to the benefits of focusing immune responses within the upper airways.Why target the nasal mucosa?
The nasal passage is an increasingly promising site for vaccine adjuvant formulation, Dr Stewart said. ‘It’s becoming more and more clear that the nasal passage is a very different immune environment to an injection in the muscle.’ Internationally, there are some other pre-clinical models of mucosal vaccines. ‘But most of those mucosal vaccines are viral vectors because there aren't a lot of vaccine adjuvants that have been found to be effective nasally, which is part of the novelty of this study,’ she said. The team had previously looked at intranasal vaccination in mice, using a model where the vaccine entered both the lungs and the nose. ‘However, the main takeaway from this research was, when [administering] a very small volume to just the nose, we still got a really strong immune response in the blood,’ she said. ‘We also looked into the nose itself, and we could see that the immune cells were retained for long periods in the nasal passages, where they will be able to respond to infection quickly.’ There’s hope that these vaccines can potentially prevent infection and transmission by building immune defences directly in the upper airways where the virus first takes hold – a frontier that traditional vaccines have yet to reach. ‘We currently reduce disease severity really well, but we're still trying to block transmission,’ Dr Stewart said. ‘That's what nasal vaccines are aiming to address.’Who would benefit most from a nasal COVID-19 vaccine?
Vulnerable populations who are more susceptible to severe disease, hospitalisations and death. ‘Sometimes you'll hear people say, “COVID-19 is over” – but people are still dying of it, including the elderly, immunocompromised people and those with other comorbidities,’ Dr Stewart said. Similar to how younger, healthy patients are advised to get the flu vaccine to protect more vulnerable members of the community – this vaccine offers an additional layer of protection. ‘It would be the vulnerable people who are benefiting, but the vaccine would be for everyone to try to reduce the circulation of the virus in our community,’ she said.How would the vaccine fit into the routine immunisation schedule?
With most people vaccinated against COVID-19 or exposed to the virus, the mucosal vaccines will likely be used as a booster. ‘In the mouse model, both the vaccine as a booster or as a primary vaccination induced nasal immunity,’ Dr Stewart said. It’s assumed that the nasal vaccine will be used as an annual seasonal dose, similar to the flu vaccine or COVID-19 boosters for certain populations. ‘We do have some evidence that the vaccine can neutralise against other variants, but [we need to explore] how well it protects people and for how long, because that would indicate whether continuous boosters are needed,’ she said. It’s also anticipated that the nasal vaccine will be self-administered. ‘There are studies looking into self-administration of nasal vaccines, which could really help with distribution and access to these vaccines in the community,’ she said. This mode of administration could be particularly beneficial for those who are needlephobic, including children. ‘For people who cannot stand getting a needle, this is a less invasive method of vaccination,’ Dr Stewart said. The researchers say that while more work is needed, the results show strong potential for nasal vaccines to complement existing COVID-19 vaccines and provide an extra layer of protection against the virus in the future. [post_title] => Intranasal vaccine stops infection at the source [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => intranasal-vaccine-stops-infection-at-the-source [to_ping] => [pinged] => [post_modified] => 2025-09-15 13:32:22 [post_modified_gmt] => 2025-09-15 03:32:22 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=30516 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Intranasal vaccine stops infection at the source [title] => Intranasal vaccine stops infection at the source [href] => https://www.australianpharmacist.com.au/intranasal-vaccine-stops-infection-at-the-source/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 30519 [authorType] => )
td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30559 [post_author] => 3410 [post_date] => 2025-09-22 12:23:06 [post_date_gmt] => 2025-09-22 02:23:06 [post_content] => A new report lays bare the impact of chronic pain in young people. During Kids in Pain Week (22–28 September), an expert shares practical steps for pharmacists to improve care. Sydney-based Laura was just 10 years old when a bout of shingles left her with constant, debilitating pain. Laura went from being a fit and active middle sister to being unable to walk or move without a wheelchair at the age of 11, and completely reliant on her family for care. Doctors were stumped and investigations proved fruitless. ‘I was so sick of doctors – waiting for the doctors and waiting to do anything and just so ready to give up,’ Laura said. [caption id="attachment_30566" align="aligncenter" width="500"]Laura with her mum Michelle[/caption] When living with chronic pain, it’s easy to feel misunderstood and lonely, she shared. ‘Laura was having a really hard time, was depressed, barely talking and struggling. It was so hard to see her like that,’ Laura’s mum, Michelle said. ‘People underestimate how chronic pain may start as a physical issue but then becomes a mental health issue when everything is so uncertain and you aren’t sure if life will ever be what it was.’ Around one in five children aged 6–18 live with chronic pain, which equates to approximately 877,000 Australian kids – according to Australian Bureau of Statistics (ABS) data. The inaugural Kids in Pain Report from Chronic Pain Australia shows how pain affects every aspect of these children’s lives, as well as their families, and the many who are likely unaccounted for, said pharmacist and Chronic Pain Australia chairperson, Nicolette Ellis MPS. ‘In 2019 the World Health Organization recommended that chronic pain be recognised as a condition in its own right and provided a way to capture that in healthcare data with ICD-11 coding,’ she said. ‘But chronic pain isn’t recognised as a condition in Australia; it’s recognised only as a symptom of an injury or another condition.’ [caption id="attachment_30564" align="aligncenter" width="500"]
Nicolette Ellis MPS[/caption] Without robust prevalence data, chronic pain will remain missing from national policy – including the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme, Ms Ellis warned. ‘That cascades down into service planning and investment, which is not currently matched to need,’ she said. ‘For example, Australia only has nine specialist paediatric pain clinics; Tasmania and the Northern Territory have none, so families often travel 4–6 hours for specialist appointments.’
What does chronic pain look like in children?
Most (71%) of children experience musculoskeletal pain, typically due to rheumatoid arthritis and autoimmune conditions as well as lower-back pain, knee pain and other joint pain. Migraine and headaches, abdominal pain, connective-tissue disorders, neuropathic pain and pelvic pain are also prominent. ‘Most children have overlapping conditions – for example, migraine with abdominal pain, or musculoskeletal and neuropathic pain – so it’s rarely a single tidy diagnosis,’ Ms Ellis said. There is a high correlation between neurodivergence and pain, with almost three-quarters (72.9%) of children with chronic pain having at least one neurodivergent diagnosis. ‘Life can be more stressful for neurodivergent individuals, producing hormones that amplify pain signals,’ she said. About 60% of children with chronic pain also identified as female. ‘Women and girls have denser nerve networks and different immune systems,’ Ms Ellis said. ‘Fluctuations in oestrogen can also increase pain signals, while testosterone tends to reduce them.’Why is there such a long road to diagnosis?
For over 64% of children living with chronic pain, it took at least 3 years to receive a diagnosis. ‘Culturally, there’s a belief that persistent pain is an “older person’s condition”,’ Ms Ellis said. ‘So many children’s pain is dismissed.’ It’s often assumed there is another reason driving the symptoms. ‘Common explanations given to families are anxiety, a mental-health issue, “growing pains” that will resolve, or school avoidance,’ she said. ‘That invalidates the child and parent, and delays diagnosis.’ Children can face significant challenges navigating the healthcare system, getting answers, and accessing quality treatment, leading to cascading consequences. ‘Around 80% of children have a secondary mental health challenge, report sleep issues and forgo sport and similar activities,’ she said. ‘Over 80% miss school, about 1 day per week on average, with many finding the school system inflexible and invalidating, with pain dismissed or labelled as avoidance.’ Should a child experience ongoing, persistent pain, it should be taken ‘very seriously’ by health professionals – including pharmacists – with early intervention and thorough assessment ideally taking place within the first 3–6 months. ‘Early action reduces chronicity, helps build tools and confidence in self-management, and helps keep children in school and engaged socially,’ Ms Ellis said.What’s the pharmacist’s role?
Parents reported that they often see their pharmacist first to discuss their child's pain condition. To expedite diagnosis and ensure appropriate care, Chronic Pain Australia has released a Pharmacist Guide which includes language tips for discussing pain with children, ways to explain pain, and what good pain management looks like. ‘Pharmacists should ask how long the pain has been present and validate that it’s challenging to live with,’ Ms Ellis said. ‘Emphasise the importance of seeing a local GP for assessment and early diagnosis.’ Other key language tips include using ‘lives with pain’ over ‘suffers from’. Pharmacists should also describe ‘bad” or ‘challenging’ days rather than ‘flare-ups’. ‘Link with local providers, such as occupational therapists, physiotherapists and psychologists – who understand different communication and treatment needs, including for neurodivergent children who may express pain differently,’ she said. When addressing children with neurodivergence, pharmacists should inquire how best to communicate with them, what topics to avoid and what information would help. ‘Communication should always be age-appropriate and family-centred,’ Ms Ellis said. ‘The goal is to create a friendly, approachable environment where children feel comfortable sharing, while parents can help fill in the picture when needed.’How should symptom management be approached?
Management approaches for chronic pain depend on the child, condition, and whether function improves, Ms Ellis said. ‘In paediatric pain medicine we try to avoid medicines and use them sparingly, but if a non-functional child becomes functional on a medicine that may restore quality of life – that should be central to pain management.’ Ms Ellis recalls an example of a 14-year-old girl prescribed an opioid to be taken before menstruation for 4–5 days. While some healthcare professionals were quick to label this approach an addiction risk, it perhaps kept her in school during severe periods while investigations took place for endometriosis or polycystic ovarian syndrome. ‘Pharmacists concerned about higher-risk medicines should focus conversations on functional benefit, asking “Is this improving your ability to do things?”’ she said. ‘If not, initiate a discussion about whether to continue therapy, given the potential harms.’ With her mum’s support and extensive physical therapies, Laura was able to walk into her first day of high school without a walking stick. While she has good and bad days and constant flare ups, there are wins along the way – such as being able to start carrying a backpack rather than relying on a roller case. ‘It’s an invisible disability with constant pain that isn’t linear – there are different levels and sensations all the time and that changes the way I approach daily life,’ Laura said. ‘[But] when mum said I will keep fighting for you – it was almost like a promise, and she’s always kept it.’ [post_title] => Early action prevents lifelong chronic pain in children [post_excerpt] => A new report lays bare the impact of chronic pain in young people. An expert shares practical steps for pharmacists to improve care. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => early-action-prevents-lifelong-chronic-pain-in-children [to_ping] => [pinged] => [post_modified] => 2025-09-22 16:18:00 [post_modified_gmt] => 2025-09-22 06:18:00 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=30559 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Early action prevents lifelong chronic pain in children [title] => Early action prevents lifelong chronic pain in children [href] => https://www.australianpharmacist.com.au/early-action-prevents-lifelong-chronic-pain-in-children/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 30562 [authorType] => )
td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30152 [post_author] => 8451 [post_date] => 2025-09-22 09:00:34 [post_date_gmt] => 2025-09-21 23:00:34 [post_content] =>The various dementias are a huge cause of death in Australia. Despite some light on the horizon, there are still no effective treatments. AP explores the latest in dementia research.
Dementia is the second leading cause of death in Australia.1 The number of people living with the disease is expected to increase substantially as the population ages, potentially straining health systems.2
Despite accelerated research, including trials of more advanced compounds and recent Victorian Government grants supporting mRNA-based projects, effective treatments remain elusive.3
According to Dementia Australia's Executive Director of Services, Advocacy and Research, Dr Kaele Stokes (she/her), an estimated 433,000 Australians are currently living with dementia, including 29,000 people living with younger-onset dementia (when symptoms emerge before age 65).1
While there have been important advances in pharmaceutical research in the dementia field in recent years, Dr Stokes says, new medicines to date have limited application, availability and efficacy, and they do not stop the progression of dementia.
It is important to ensure health systems support everyone living with dementia now, she adds, noting that the new medicines may not work for many people with the condition, particularly patients who have lived with dementia for some time.
‘We don’t have an approach here in Australia that focuses on the importance of brain health across the life course,’ she says.
‘While we’re good at picking up other diseases, such as cardiovascular disease or diabetes, and putting steps in place to ensure the risks of severity in those conditions are minimised, we don’t really have conversations about brain health in a healthcare setting.’
Diagnosing dementia for younger and older people
Dr Stokes says while diagnostic tools are improving, diagnosing dementia is still a complex process.
Dementia is still seen as an older person’s disease, she adds, and it can be difficult for a person in their 40s or 50s to receive a dementia diagnosis.
According to a 2025 study in Translational Psychiatry, young-onset dementia in people aged under 65 years globally increased substantially in prevalence and incidence between 1990 and 2021 compared with overall people with dementia – and with a higher burden on women.4 The three highest risk factors were smoking, high body mass index and high fasting plasma glucose levels, while population growth was the largest contributor to the significant increase.4
‘There’s still a real fear and stigma around wanting to talk about brain health or talking to a healthcare professional about concerns around changes in cognition,’ Dr Stokes says.
‘But actually there are lots of reasons why it’s important to do that. A mix of pharmacological and non-pharmacological interventions can make a difference to quality of life and reduce the stress that somebody might be experiencing.’
It is important for people to focus on modifiable risk factors, potentially reducing the risk of developing dementia by about 45% by avoiding smoking or drinking too much and by maintaining a healthy diet, exercising regulary, and ensuring hearing and vision problems are identified and dealt with, Dr Stokes says.
For those at later stages of their lives, it’s important to avoid social isolation and to keep the brain active, she adds.
‘Learning new things can be really important – stretching the brain, firing up the neurons, to keep your brain active.’
Pharmacological advances
Healthcare professionals have high hopes for the potential benefits of newly available monoclonal antibody treatments for Alzheimer’s disease.5
University of Melbourne and Florey Institute Professor of Dementia Research Colin Masters, widely recognised as a world expert in the field of neurodegenerative diseases, estimates there are about 100 compounds in the pharmaceutical pipeline presently that are progressing through the trial stages.
‘Better forms, more effective forms, are coming within the next couple of years,’ he declares. ‘We’ve got to learn how to use them and manage all the adverse effects as well.’ He is optimistic about the future of dementia treatments – potentially including a routine vaccination.
‘The writing is on the wall,’ he says. ‘If the passive immunotherapies work, then everyone will be working on an active vaccination program. In other words, at age 50 or whatever, you just run up to your primary care physician, they do a blood test, you’re on the pathway – you get a shot of peptide in your arm.’
The most promising drug now on the horizon is trontinemab, Prof Masters says. It's a reinvented form of the monoclonal antibody gantenerumab – a drug that didn’t make it to market because of a lack of efficacy. Even so, he adds, gantenerumab has been found effective for certain conditions. ‘We’ve been trialling it for nearly 10 years now,’ Prof Masters says, ‘and we published in Lancet Neurology9 [in June 2025] that in early-onset familial types of Alzheimer’s disease, gantenerumab in high doses was effective in pre-clinical disease in young individuals who are at 100% risk of developing Alzheimer’s disease.’ Trontinemab, he adds, is the natural successor to gantenerumab.
In April, Roche announced the results of a phase II trial of trontinemab delivered via the “Brainshuttle” system, which found ‘rapid and deep, dose-dependent reduction of amyloid plaques in the brain’.10 At the same time, Roche announced it would begin a phase III trial of the drug later this year.10
‘It’s the next generation; it’s a major advance,’ Prof Masters says, explaining that the bispecific molecule of trontinemab is designed to go straight across the blood-brain barrier, so doses of the drug can be far smaller.
‘It’s the first antibody designed to do this, and a lot of companies are copying it right now, because it works so well.’
According to data released from the Roche trials, trontinemab causes far fewer and less severe adverse effects than gantenerumab, he points out.
Other promising Alzheimer’s disease treatments include the monoclonal antibody donanemab. It is marketed as Kisunla by Eli Lilly, and in May 2025 it was approved by the Therapeutic Goods Administration.11
Lecanemab, marketed as Leqembi, has not yet been approved in Australia, but Prof Masters says full results of a pre-clinical trial are expected by the end of 2027 and he and his colleagues expect a positive result.
All these monoclonal antibody drugs are most effective in the early stages of Alzheimer’s disease, so early diagnosis is critical.12 In July this year, the Victorian Government also announced more than $537,000 in grants to two Florey researchers for two Alzheimer’s research projects.
These are aimed at treating and preventing the disease with mRNA technology, which was developed during the pandemic for COVID-19 vaccines.13
Pharmacist dementia support in the community
PSA’s Dementia Support Pharmacist Project in South Australia is an innovative project and model of practice aimed at keeping people with dementia at home and in the community for longer.14
Two pharmacists are employed on the project. They job-share to support clients with dementia medication management needs, understanding and choices, says South Australia and Northern Territory PSA Manager Helen Stone FPS (she/her).
The pharmacists act as patient advocates, provide flexible care for patients with complex comorbidities, and work with other members of the care team, including GPs, community pharmacists, nursing and care workers and families, she adds. Initial appointments are held in the patient's home, preferably with follow-ups either personally, by telephone or collaboration application such as MS Teams. A report prepared by the pharmacist is shared with the patient and, with consent, to treating medical and care teams, which may recommend an action plan to change or deprescribe medicines. Education about medicine use in dementia is also provided to health professionals and community groups across regional areas of the state.
‘This is a much-needed service; it is accessible, but there are a lot more people we can’t yet support,’ Ms Stone says. PSA has demonstrated that pharmacists working directly with patients and liaising with the care team can provide valuable support for patients with complex conditions and multimorbidities.
The project began in May 2024 and has been extended to June 2026. Ms Stone recently submitted a proposal to SA Health to expand the program and include a further five FTE pharmacists to cover metropolitan Adelaide.
Dementia care pharmacists can help with complex deprescribing of medicines and tapering of antidepressants where needed. They can provide professional advice to family members caring for patients with dementia that can empower carers as advocates in cases, for instance, of inadequate pain management.
Medicine administration frustrations can be avoided when dose time changes can be suggested.
Project pharmacist Dee-Anne Hull MPS (she/her) says pharmacist dementia support work helps in areas where it is needed most. ‘It has shown us where gaps in health care are in rural and remote areas of our state, but also within the pharmacy profession itself,’ she says. ‘A lot of pharmacists openly admit that dementia scares them, and they don’t really know where to start.
‘My advice is to make this an area of focus for CPD activities; check out the numerous PSA resources available, particularly those on palliative care and deprescribing, but also check out websites like Dementia Australia, Dementia Training Australia and the Wicking Dementia Centre,’ she adds.
‘Think about ways that you could support someone who is caring for a person living with dementia and the carer’s burden that may be associated with this, because that’s often where the support is needed the most.’
Positive response
Dementia Support Pharmacist Project pharmacist Nicola Sander MPS (she/her) says she has seen ‘overwhelming support and positive feedback’ for the project.
‘We have seen considerable benefit for people who are still living at home and are trying to manage their medicines.
Ms Sander sees this dementia support career pathway as ideal for an early career pharmacist and suggests that training in deprescribing and dementia-specific areas would be useful.
After a lengthy consultation with one client living at home, the client’s family and her doctor, Ms Sander recommended medicine management changes. The doctor was reluctant, so the client’s daughter found a doctor who was willing to be part of a multidisciplinary team, Ms Sander says, which included deprescribing strategies and pain support management.
After a recent visit to the geriatrician, the client’s daughter reported that her mother’s Mini‐Mental State Examination had improved from 12/30 to 19/30.
The daughter and the geriatrician attributed the client’s improvement to ‘better control of pain and overall improvement to her mood, as she has felt more supported and less depressed' since.
Ms Stone, whose Churchill Fellowship palliative care research – To articulate a framework for the role of Palliative Care Pharmacist in community and aged care in Australia – Churchill Trust15 – informed the Dementia Support Pharmacist Project, says that education, training and curiosity help pharmacists to start understanding dementia care more fully.
She encourages everyone to complete a Program of Experience in the Palliative Approach (PEPA) placement.
‘A dementia diagnosis can be devastating for people and their families; medications can have a benefit but can also impair cognition, so support from a pharmacist can be very valuable.'
References
[post_title] => Advancing dementia care in pharmacy [post_excerpt] => The various dementias are a huge cause of death in Australia. Despite some light on the horizon, there are still no effective treatments. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => advancing-dementia-care [to_ping] => [pinged] => [post_modified] => 2025-09-22 16:18:21 [post_modified_gmt] => 2025-09-22 06:18:21 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=30152 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Advancing dementia care in pharmacy [title] => Advancing dementia care in pharmacy [href] => https://www.australianpharmacist.com.au/advancing-dementia-care/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 30558 [authorType] => )
- Australian Institute of Health and Welfare. Dementia In Australia. 2024. At: www.aihw.gov.au/reports/dementia/dementia-in-aus/contents/population-health-impacts-of-dementia/deaths-due-to-dementia
- Dementia Australia. Dementia facts and figures. 2024. At: www.dementia.org.au/about-dementia/dementia-facts-and-figures
- Florey Institute for Neuroscience and Mental Health. Harnessing mRNA to prevent and slow Alzheimer’s disease. 2025. At: https://florey.edu.au/news/2025/07/harnessing-mrna-to-prevent-and-slow-alzheimers-disease/
- He Q, Wang W, Zhang Y, et al. Global burden of young-onset dementia, from 1990 to 2021: an age-period-cohort analysis from the global burden of disease study 2021. Transl Psychiatry 2025. Epub 2025, 17 February.
- Ramanan VK, Armstrong MJ, Choudhury P, et al. Antiamyloid monoclonal antibody therapy for Alzheimer disease. Neurology 2023;101(19)842–52. At: www.neurology.org/doi/10.1212/WNL.0000000000207757
- World Health Organization. Dementia. 2025. At: www.who.int/en/news-room/fact-sheets/detail/dementia
- Mayo Clinic. Alzheimer’s disease. 2025. At: www.mayoclinic.org/diseases-conditions/alzheimers-disease/symptoms-causes/syc-20350447
- Eyting M, Xie M, Michalik F, et al. A natural experiment on the effect of herpes zoster vaccination on dementia. Nature 2025. Epub 2025 2 April. At www.nature.com/articles/s41586-025-08800-x
- Safety and efficacy of long-term gantenerumab treatment in dominantly inherited Alzheimer's disease: an open-label extension of the phase 2/3 multicentre, randomised, double-blind, placebo-controlled platform DIAN-TU trial. Bateman, Randall J et al. Lancet Neurology 2025; 24(4):316–30.
- Roche. Roche presents novel therapeutic and diagnostic advancements in Alzheimer’s at AP/PD 2025. 2025. At: www.roche.com/media/releases/med-cor-2025-04-03
- Burge K. Treatment to slow early Alzheimer’s gets TGA approval. newsGP 2025. At: www1.racgp.org.au/newsgp/clinical/treatment-to-slow-early-alzheimer-s-gets-tga-appro
- Promising results of new Alzheimer’s drug published – early diagnosis is key. 2023. At: www.dementia.org.au/media-centre/media-releases/promising-results-new-alzheimers-drug-published-early-diagnosis-key
- Victoria State Government. mRNA Victoria. Research. July 2025. At: https://djsir.vic.gov.au/mrna-victoria/research
- Sander N, Jull DA. Bridging the gap: how dementia support pharmacists are transforming care in rural South Australia. Issue 91. June 2, 2025. At: https://ruralhealth.org.au/partyline/bridging-the-gap-how-dementia-support-pharmacists-are-transforming-care-in-rural-south-australia/
- Stone H. To articulate a framework for the role of the palliative care pharmacist in community and aged care in Australia. Winston Churchill Trust 2025. At: www.churchilltrust.com.au/project/to-articulate-a-framework-for-the-role-of-palliative-care-pharmacist-in-community-and-aged-care-in-australia/
td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30542 [post_author] => 8451 [post_date] => 2025-09-17 11:29:30 [post_date_gmt] => 2025-09-17 01:29:30 [post_content] => Pharmacists are asked to lead the shift from reliever-only inhalers to inhaled corticosteroid-containing regimens and to minimise short courses of oral corticosteroids. Just under 3 million Australians live with asthma. The condition has the eighth-highest disease burden in the nation, and it is one of the most significant chronic conditions in children. Guided by the results of large trials, recommendations for asthma management in adults and adolescents are changing, and pharmacists need to be aware of updated guidelines. The Australian Asthma Handbook was updated yesterday (16 September 2025) to reflect new thinking on asthma care and management.What are the key updates?
Three key changes have been made to the Australian Asthma Handbook, including:
- All adults and adolescents with confirmed asthma should be taking inhaled corticosteroid-containing treatment and not as-needed short-acting beta2-agonists (SABAs) alone. Asthma can be well controlled with maintenance and reliever therapy, and a small proportion of patients with severe asthma may be eligible for biologics.
- An emphasis on the importance of limiting oral corticosteroids, which have been associated with a range of different harms, including damage to bone health, cataracts and type 2 diabetes.
- Health professionals should be aware the handbook has greater guidance for treating children aged 1–5 who are living with asthma and a recommendation that some older children should also be on low-dosage ICS maintenance therapy.
Why have the guidelines been updated?
Overuse of SABAs has been linked to poor asthma control and preventable hospitalisations. ‘The evidence is that the risks of SABA alone have become clearer and that we were overusing a not very effective and not very safe therapy,’ said Professor Nick Zwar, Executive Dean of Bond University’s Faculty of Health Sciences and Medicine, and Chair of the Australian Asthma Handbook Guidelines Committee. ‘Budesonide-formoterol, taken only as needed, is recommended in place of SABA. Maintenance and reliever therapy is now recommended as the next step up.’ The risks of SABA overuse include a lack of bronchodilator response over time, and the possibility that some people may have quite a severe asthma attack and end up in the hospital emergency department (ED), or hospitalised, when they don’t need to be. There is very strong evidence to demonstrate that all adolescents and adults living with asthma should be treated with ICS, said pharmacist and Clinical Executive Lead at the National Asthma Council Australia, Debbie Rigby FPS. ‘Just having the SABA alone only treats one component of asthma, which is the bronchoconstriction, whereas having the low-dose ICS helps manage the inflammation and mucus production,’ she said. ‘I think that’s the biggest shift for us, pharmacists and doctors: helping patients to understand that asthma is a chronic inflammatory condition.’What are the risks of poor asthma control?
Inadequately managed asthma can be a life-threatening condition, Ms Rigby stressed, noting there were 474 asthma-related deaths in Australia in 2023. ‘Those deaths shouldn’t be happening. Many of those people who did die from asthma or asthma-related causes would have been perceived as having mild, intermittent symptoms,’ she said. ‘Without wanting to scare patients, we should be really highlighting the consequences of not having good control of their asthma.’Why is SABA still overused?
Despite access to long-acting beta2 agonists (ICS–LABAs), SABA use remains high for a range of reasons. These include cost, convenience and patient reluctance to medicate every day when they are accustomed to using a reliever-only when they have an asthma attack, Ms Rigby said. Health professionals understand that many people are reluctant to use a preventer inhaler, but health professionals need to help them understand that they have a ‘chronic inflammatory condition, which may flare up from time to time’. Effects of the cost-of-living crisis should not be underestimated either. However, the price gap between over-the-counter salbutamol and prescription asthma medicines is now narrowing, with 60-day dispensing for patients who are stable and, from January 2026, the co-payment for medicines being reduced from $31.60 to $25 per prescription. The Australian uptake of Maintenance and Reliever Therapy (MART) has also been slow, despite strong evidence and subsidy on the Pharmaceutical Benefits Scheme. The evidence of large-scale trials has shown the importance of shifting patients with mild asthma onto anti-inflammatory reliever therapy on an as-needed basis, Ms Rigby said. ‘The evidence basically says it reduces the risk of severe exacerbations requiring ED or hospitalisation, or requiring oral corticosteroids,’ she said. For practical guidance on discussing the guideline changes with patients, the role of prescribing pharmacists, and how biologics fit into care, don’t miss the October cover story in Australian Pharmacist. [post_title] => New asthma guidelines released [post_excerpt] => Pharmacists are asked to lead the shift from reliever to inhaled corticosteroid regimens and to minimise use of oral corticosteroids. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => new-asthma-guidelines-released [to_ping] => [pinged] => [post_modified] => 2025-09-17 17:13:31 [post_modified_gmt] => 2025-09-17 07:13:31 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=30542 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => New asthma guidelines released [title] => New asthma guidelines released [href] => https://www.australianpharmacist.com.au/new-asthma-guidelines-released/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 30545 [authorType] => )
td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30154 [post_author] => 11158 [post_date] => 2025-09-17 08:26:54 [post_date_gmt] => 2025-09-16 22:26:54 [post_content] =>Case scenario
Ashley, a 23-year-old female, presents to your pharmacy with a prescription for a 7-day course of doxycycline 100 mg twice daily. She tells you she has had some mild vaginal discharge and that her STI screen has come back positive for vaginal chlamydia. You establish that she is currently taking ferrous sulfate 325 mg once daily as she is vegan, isotretinoin 30 mg once daily for acne, and has an etonogestrel implant in situ. She has no known allergies.
Note: The authors recognise that gender identity is fluid. In this article, the words and language we use to describe genitals and gender are based on the sex assigned at birth.
Learning objectivesAfter reading this article, pharmacists should be able to:
|
Chlamydia and gonorrhoea are two of the most prevalent bacterial sexually transmitted infections (STIs) globally.1,2 They are preventable and curable infections that are usually transmitted through vaginal, oral or anal sex.1,2 Conjunctival infection can occur in neonates born to mothers carrying a chlamydia or gonorrhoea infection, or in adults via exposure to genital secretions.1–4 Both chlamydia and gonorrhoea can lead to serious health complications if left untreated, ranging from effects on fertility and pregnancy to blindness (in untreated ocular gonorrhoea infection).1,2
Chlamydia is caused by the gram-negative bacterium Chlamydia trachomatis.2 Gonorrhoea is caused by the gram-negative bacterium Neisseria gonorrhoeae.1
Chlamydia is relatively simple to treat, being susceptible to doxycycline and azithromycin.5 Gonorrhoea treatment may be more challenging due to emerging antimicrobial resistance to first-line treatments, particularly in urban Australia.6 All people diagnosed with chlamydia and gonorrhoea should be offered antibiotic treatment to resolve symptoms, prevent complications and to decrease transmission to others.1,2
Pharmacists can support patients by providing information on safe-sex practices, any prescribed medicines, in addition to providing advice or referring where appropriate.
The World Health Organization (WHO) estimates there were around 128.5 million new infections with C. trachomatis in 2020 among adults aged 15–49 years globally.2 In Australia, those under 30 years of age are at greatest risk of infection.5 There were 102,222* cases of chlamydia notified to the Australian government’s National Notifiable Diseases Surveillance System (NNDSS) in 2024, with an almost equal distribution of infection between males and females.7 This was an increase of almost 20% compared to the 86,810 case notifications in 2014.7 Across all ages, infections in females over this time period remained similar, however infections in males increased by approximately 40%.7
The WHO estimates that 82.4 million adults aged 15–49 years old acquired gonorrhoea worldwide in 2020.1 In Australia, gonorrhoea is most prevalent in men who have sex with men (MSM), remote Aboriginal and Torres Strait Islander communities, street-based sex workers, and returned travellers reporting sex overseas (in high prevalence countries).6,8 In recent years, there has been a rise in prevalence in the general population, especially in females of reproductive age.6 There were 44,547* cases of gonorrhoea notified to the NNDSS in 2024.7 This is almost triple the 15,674 cases notified in 2014.7
Co-infection with both chlamydia and gonorrhoea is relatively common.9 A study of high-prevalence Aboriginal communities in remote Australia found half of female and one-third of male participants aged 16–19 had one or more STIs.10 Chlamydia and gonorrhoea were the most common co-infections.10
*Figures correct as of May 2025.
Chlamydia
Chlamydia is often described as the “silent STI” because 85–90% of infections are asymptomatic.5 If symptoms do appear, they may not present until up to 3 weeks after sexual contact with an individual with chlamydia infection.2
Common chlamydia symptoms for males include2,5:
For females, symptoms include2,5:
Gonorrhoea
Gonorrhoea symptoms usually appear within 2 weeks of exposure.1 Infection is usually asymptomatic in females.1
If symptoms occur in females, they include1,4,6:
In contrast for males, penile urethral gonorrhoea is almost always symptomatic and symptoms may include1,6:
Complications
Untreated chlamydia and gonorrhoea can lead to various complications in both males and females, highlighting the need for prompt identification and treatment of infection.
Table 1 outlines some complications associated with untreated C. trachomatis and N. gonorrhoeae infection.
Molecular testing should be undertaken for those suspected of having chlamydia or gonorrhoea, or those at risk of infection. Certain groups (e.g. MSM, pregnant people, sex workers, Aboriginal and Torres Strait Islander people, gender diverse and transgender people) require special testing approaches due to increased risk of infection, adverse health outcomes or community prevalence.11 A full STI check-up including HIV and syphilis serology at initial presentation is recommended.11
Chlamydia is diagnosed via nucleic acid amplification tests (NAATs) (e.g. polymerase chain reaction [PCR]).5 NAATs are highly sensitive and the only recommended test for chlamydia.5 Microbiological culture of C. trachomatis is difficult and not routinely recommended.12
NAATs are also used to diagnose gonorrhoea.6 They are highly sensitive but do not provide any information on antibiotic susceptibility.6 Gonococcal microbiological culture has high specificity and allows for antibiotic susceptibility testing, but is less sensitive than NAATs.6
Some differential diagnoses for genital tract chlamydia infection may include lymphogranuloma venereum, gonorrhoea, bacterial vaginosis, vaginal candidiasis, trichomonas or Mycoplasma genitalium infection.13 For gonorrhoea, other conditions such as chlamydia, trichomonas, vaginal candidiasis, bacterial vaginosis or urinary tract infections may cause similar symptoms.14
Anatomical sites sampled for chlamydia and gonorrhoea testing will depend on the individual’s presentation, sexual history and risk factors.5,6 Self-collection of samples for testing by NAAT is common practice for asymptomatic patients.5 In symptomatic patients undergoing examination, a swab can be taken by the clinician (e.g. an endocervical swab if a speculum examination occurs).5,6 First-pass urine can be tested in people without a vagina (or if a vaginal swab cannot be taken) – it is less sensitive than a self-collected vaginal swab.5,6 An anorectal swab is recommended for all individuals who have anorectal symptoms, and for all MSM regardless of whether they are symptomatic.5,6 Similarly, a pharyngeal swab for NAAT is recommended for MSM for both gonorrhoea and chlamydia, even if asymptomatic.5,6
Gonococcal culture
Gonococcal cultures should be collected from all infected sites prior to commencing treatment to determine antibiotic susceptibility and to contribute to antimicrobial resistance surveillance.6 It is recommended that a culture is performed on a site if an individual is experiencing symptoms at that site.6 Pending culture results should not delay commencing treatment, and antibiotics can be administered prior to receiving the culture results.6
The goals of treatment for both chlamydia and gonorrhoea are to resolve symptoms, reduce complications and prevent transmission and reinfection. Sometimes a clinical diagnosis is made based on symptoms and risk factors. Certain presentations may warrant starting empiric treatment while awaiting confirmation of results. Examples include patients presenting with anorectal symptoms, symptoms of PID or epididymo-orchitis, where timely treatment is critical.15–17
Chlamydia
Doxycycline is the standard first-line therapy for chlamydia.5,18 Azithromycin is an alternative option if doxycycline is contraindicated (e.g. in pregnancy, if there are adherence or medicine interaction concerns).3,18
Previously, azithromycin was the first-line treatment, as it was a convenient single dose. However, a meta-analysis showed azithromycin 1 g orally may be up to 20% less efficacious than 7 days of doxycycline when treating anorectal chlamydia. A subsequent randomised trial of 625 Australian MSM with asymptomatic anorectal chlamydia demonstrated consistent findings.19,20 Azithromycin is also increasingly implicated in antimicrobial resistance for other STIs, therefore doxycycline is preferred.21
Gonorrhoea
The recommended treatment for gonorrhoea infection in Australia is ceftriaxone in combination with azithromycin.6 The recommended dose of oral azithromycin varies depending on the site of infection.4 The current combination treatment approach is highly effective and important in reducing the contribution to more widespread antimicrobial resistance.4,6 However, reduced susceptibility to these agents has been increasingly reported in urban Australia.6 Until recently, the combination of amoxicillin, probenecid and azithromycin was still recommended for gonorrhoea in some remote Australian areas. However, this changed to ceftriaxone with azithromycin, due to an increase in penicillin resistance in remote communities in the Northern Territory.22
Antimicrobial resistance is a growing problem in the treatment of gonorrhoea.1 Resistance to penicillin, tetracyclines, macrolides, sulphonamides and quinolones has been detected.23 Gonococcal surveillance programs are in place in some countries to track resistant strains.
Table 2 provides a summary of the current treatment approach for various presentations of chlamydia and gonorrhoea infection in Australia. Uncomplicated chlamydia or gonorrhoea infection refers to localised urogenital, anogenital, pharyngeal and ocular infections that are not associated with bacteraemia or ascending spread to other organs.24,25 Complicated infections and their treatment is beyond the scope of this article, as are other infections associated with C. trachomatis.
Consistent and correct condom use can prevent the transmission of chlamydia and gonorrhoea.1,2 There is currently no available vaccine to prevent either infection. The serogroup B meningococcal vaccine (4CMenB) is currently being investigated for its ability to provide cross-protection against N. gonorrhoeae.26
The use of doxycycline to prevent bacterial STIs (doxycycline post-exposure prophylaxis [doxy-PEP]) can offer protection against acquiring syphilis, chlamydia and, to a lesser extent, gonorrhoea, if taken within 72 hours of unprotected sexual intercourse.27 Controversy remains on whether the risk of changes to the microbiome and potential increased antimicrobial resistance as a result of using doxy-PEP outweighs the benefits of preventing these STIs, with research ongoing.27
Sexual contact should be avoided for 7 days after chlamydia and/or gonorrhoea treatment is commenced, or until the treatment course is completed and symptoms have resolved, whichever is later.5,6 Patients should be advised not to have sex with partners from the last 6 months for chlamydia, or the last 2 months for gonorrhoea, until partners have been tested and treated, if necessary.5,6 Notification of sexual partners is recommended and can be done anonymously by patients via websites such as Let Them Know (https://letthemknow.org.au/).5,6 With the consent of the patient, a clinician may support with contact tracing if necessary.
Reinfection with chlamydia and gonorrhoea is common.5,6 Retesting at 3 months is recommended to detect reinfection.5,6 A test of cure is not routinely recommended for chlamydia, except in specific circumstances (e.g. in pregnancy).5 A test of cure is recommended for gonorrhoea in cases where a culture was not collected before treatment, the culture indicated antimicrobial resistance or if a non-standard treatment regimen was used.6 Screening for other STIs should be performed if not done at the initial presentation.5,6
Patient-delivered partner therapy (PDPT) is where antibiotic treatment is prescribed or supplied for the sexual partner(s) of a patient diagnosed with chlamydia (index patient).5 The prescription or treatment is given directly to their partner(s) by the index patient.5 In jurisdictions where PDPT is approved, it can be considered for heterosexual index patients with anogenital or oropharyngeal chlamydia, whose partners are unlikely to seek chlamydia testing or treatment.5 PDPT can also be considered with cases of repeat infections where partners have not been treated.5 Guidance on PDPT for chlamydia is available in Victoria, New South Wales and the Northern Territory.5 The decision to use PDPT should be weighed against the potential to miss co-infections or complications in the partner(s) of the index patient.
Pharmacists may be among the first healthcare professionals that patients approach for guidance and treatment for STIs, particularly if presenting with symptoms of infection. Recognition of symptoms that may warrant onward referral to a medical practitioner is essential.
Pharmacists can support adherence to current recommended treatment regimens for STIs. This may include extended doxycycline courses, which ensures the resolution of infection and improves antibiotic efficacy.28 Pharmacists can also encourage patients to notify sexual partners regarding an STI diagnosis, enabling those partners to obtain timely treatment.
Doxy-PEP may be appropriate for some at-risk groups, providing an additional option to conventional STI prevention strategies. Evidence is building for doxy-PEP use and by following the Australasian Society for HIV, Viral Hepatitis & Sexual Health Medicine (ASHM) guidance, pharmacists can ensure they are providing evidence-based information to patients who wish to know more about this prevention strategy (see https://ashm.org.au/initiatives/doxy-pep-statement/).27
Chlamydia and gonorrhoea are two of the most prevalent bacterial STIs. Patients may be asymptomatic, and both can lead to serious complications if left untreated. Chlamydia is relatively easy to treat, however emerging antimicrobial resistance to first-line gonorrhoea treatments may complicate its management. Reinfection is common with both, and robust contact tracing of sexual partners is recommended.
Case scenario continuedAfter noting that doxycycline would need to be taken at least 2 hours before or after Ashley’s iron tablets, you also suspect an interaction with isotretinoin.28 You check the Australian Medicines Handbook (AMH), which highlights a risk of benign intracranial hypertension and that concurrent use should be avoided.29 You phone Ashley’s GP to recommend a safer, yet effective, alternative of azithromycin 1 g orally as a single dose. The GP and Ashley thank you for your help. |
Ivette Aguirre (she/her) BAppSc (MedLabSc), BPharm, GradCertPharmPrac, MClinPharm, FANZCAP (Inf Dis) is the senior clinical pharmacist at the Melbourne Sexual Health Centre (MSHC), a part of Alfred Health. She mentors pharmacists, technicians and pharmacy students during their rotations at MSHC, and is interested in the impact of pharmacist reviews in HIV clinics and emerging treatments for sexually transmissible infections such as Mycoplasma genitalium.
Kathryn (Kate) Mackie (she/her) BPharm, GradDipClinPharm, BCGP, FANZCAP (Inf Dis, Gen) is a senior clinical pharmacist at Alfred Health (including Melbourne Sexual Health Centre) and Barwon Health, working in infectious diseases, HIV, viral hepatitis and sexual health. With 20 years of experience in this area, she is engaged in clinical pharmacy research and contributes to undergraduate and health professional education.
Hana Numan (she/her) BPharm (NZ), PGDipClinPharm (NZ), MPS (NZ)
[post_title] => Chlamydia and gonorrhoea [post_excerpt] => Chlamydia and gonorrhoea are two of the most prevalent bacterial sexually transmitted infections (STIs) globally. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => chlamydia-and-gonorrhoea [to_ping] => [pinged] => [post_modified] => 2025-09-17 16:17:03 [post_modified_gmt] => 2025-09-17 06:17:03 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=30154 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Chlamydia and gonorrhoea [title] => Chlamydia and gonorrhoea [href] => https://www.australianpharmacist.com.au/chlamydia-and-gonorrhoea/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( [td_post_template] => single_template_4 ) [is_review:protected] => [post_thumb_id:protected] => 30528 [authorType] => )td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30516 [post_author] => 3387 [post_date] => 2025-09-15 12:20:04 [post_date_gmt] => 2025-09-15 02:20:04 [post_content] => Administered to the nasal mucosa, a spike-based formulation triggers rapid local defences that clear the COVID-19 virus where it enters. In 2022, a year after Australia’s longest COVID-19 lockdowns, researchers from the Centenary Institute and the University of Sydney received a grant of almost $1 million from the NSW COVID-19 Vaccine Acceleration Research Grants Program to develop an intranasal COVID-19 vaccine. Now, new research has been released by the team – finding that their formulation can stop infection in the nose before the virus spreads through the body, and to other people. [caption id="attachment_30517" align="alignright" width="150"]Dr Erica Stewart, Centenary Institute[/caption] Australian Pharmacist sat down with Dr Erica Stewart, first author and researcher at the Centenary Institute when the work was undertaken, to discuss how the vaccine works, its applications and why it could be the key to stopping the spread.
What is the vaccine’s mechanism of action?
By acting where the virus first enters, the nasal vaccine prompts a rapid, effective immune response that eliminates the virus, Dr Stewart said. ‘The adjuvant we used was Pam2Cys, a Toll-like receptor 2 (TLR2), and we showed that it was able to stimulate the immune response in the nasal passages,’ she said. ‘We formulated the SARS-CoV-2 spike protein with this adjuvant, which emulates bacteria to alert the immune system that there is a danger and it should respond.’ When administered as a booster after a standard injection, the treatment also provided additional protection to vital organs, including the lungs and brain – pointing to the benefits of focusing immune responses within the upper airways.Why target the nasal mucosa?
The nasal passage is an increasingly promising site for vaccine adjuvant formulation, Dr Stewart said. ‘It’s becoming more and more clear that the nasal passage is a very different immune environment to an injection in the muscle.’ Internationally, there are some other pre-clinical models of mucosal vaccines. ‘But most of those mucosal vaccines are viral vectors because there aren't a lot of vaccine adjuvants that have been found to be effective nasally, which is part of the novelty of this study,’ she said. The team had previously looked at intranasal vaccination in mice, using a model where the vaccine entered both the lungs and the nose. ‘However, the main takeaway from this research was, when [administering] a very small volume to just the nose, we still got a really strong immune response in the blood,’ she said. ‘We also looked into the nose itself, and we could see that the immune cells were retained for long periods in the nasal passages, where they will be able to respond to infection quickly.’ There’s hope that these vaccines can potentially prevent infection and transmission by building immune defences directly in the upper airways where the virus first takes hold – a frontier that traditional vaccines have yet to reach. ‘We currently reduce disease severity really well, but we're still trying to block transmission,’ Dr Stewart said. ‘That's what nasal vaccines are aiming to address.’Who would benefit most from a nasal COVID-19 vaccine?
Vulnerable populations who are more susceptible to severe disease, hospitalisations and death. ‘Sometimes you'll hear people say, “COVID-19 is over” – but people are still dying of it, including the elderly, immunocompromised people and those with other comorbidities,’ Dr Stewart said. Similar to how younger, healthy patients are advised to get the flu vaccine to protect more vulnerable members of the community – this vaccine offers an additional layer of protection. ‘It would be the vulnerable people who are benefiting, but the vaccine would be for everyone to try to reduce the circulation of the virus in our community,’ she said.How would the vaccine fit into the routine immunisation schedule?
With most people vaccinated against COVID-19 or exposed to the virus, the mucosal vaccines will likely be used as a booster. ‘In the mouse model, both the vaccine as a booster or as a primary vaccination induced nasal immunity,’ Dr Stewart said. It’s assumed that the nasal vaccine will be used as an annual seasonal dose, similar to the flu vaccine or COVID-19 boosters for certain populations. ‘We do have some evidence that the vaccine can neutralise against other variants, but [we need to explore] how well it protects people and for how long, because that would indicate whether continuous boosters are needed,’ she said. It’s also anticipated that the nasal vaccine will be self-administered. ‘There are studies looking into self-administration of nasal vaccines, which could really help with distribution and access to these vaccines in the community,’ she said. This mode of administration could be particularly beneficial for those who are needlephobic, including children. ‘For people who cannot stand getting a needle, this is a less invasive method of vaccination,’ Dr Stewart said. The researchers say that while more work is needed, the results show strong potential for nasal vaccines to complement existing COVID-19 vaccines and provide an extra layer of protection against the virus in the future. [post_title] => Intranasal vaccine stops infection at the source [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => intranasal-vaccine-stops-infection-at-the-source [to_ping] => [pinged] => [post_modified] => 2025-09-15 13:32:22 [post_modified_gmt] => 2025-09-15 03:32:22 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=30516 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Intranasal vaccine stops infection at the source [title] => Intranasal vaccine stops infection at the source [href] => https://www.australianpharmacist.com.au/intranasal-vaccine-stops-infection-at-the-source/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 30519 [authorType] => )
td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30559 [post_author] => 3410 [post_date] => 2025-09-22 12:23:06 [post_date_gmt] => 2025-09-22 02:23:06 [post_content] => A new report lays bare the impact of chronic pain in young people. During Kids in Pain Week (22–28 September), an expert shares practical steps for pharmacists to improve care. Sydney-based Laura was just 10 years old when a bout of shingles left her with constant, debilitating pain. Laura went from being a fit and active middle sister to being unable to walk or move without a wheelchair at the age of 11, and completely reliant on her family for care. Doctors were stumped and investigations proved fruitless. ‘I was so sick of doctors – waiting for the doctors and waiting to do anything and just so ready to give up,’ Laura said. [caption id="attachment_30566" align="aligncenter" width="500"]Laura with her mum Michelle[/caption] When living with chronic pain, it’s easy to feel misunderstood and lonely, she shared. ‘Laura was having a really hard time, was depressed, barely talking and struggling. It was so hard to see her like that,’ Laura’s mum, Michelle said. ‘People underestimate how chronic pain may start as a physical issue but then becomes a mental health issue when everything is so uncertain and you aren’t sure if life will ever be what it was.’ Around one in five children aged 6–18 live with chronic pain, which equates to approximately 877,000 Australian kids – according to Australian Bureau of Statistics (ABS) data. The inaugural Kids in Pain Report from Chronic Pain Australia shows how pain affects every aspect of these children’s lives, as well as their families, and the many who are likely unaccounted for, said pharmacist and Chronic Pain Australia chairperson, Nicolette Ellis MPS. ‘In 2019 the World Health Organization recommended that chronic pain be recognised as a condition in its own right and provided a way to capture that in healthcare data with ICD-11 coding,’ she said. ‘But chronic pain isn’t recognised as a condition in Australia; it’s recognised only as a symptom of an injury or another condition.’ [caption id="attachment_30564" align="aligncenter" width="500"]
Nicolette Ellis MPS[/caption] Without robust prevalence data, chronic pain will remain missing from national policy – including the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme, Ms Ellis warned. ‘That cascades down into service planning and investment, which is not currently matched to need,’ she said. ‘For example, Australia only has nine specialist paediatric pain clinics; Tasmania and the Northern Territory have none, so families often travel 4–6 hours for specialist appointments.’
What does chronic pain look like in children?
Most (71%) of children experience musculoskeletal pain, typically due to rheumatoid arthritis and autoimmune conditions as well as lower-back pain, knee pain and other joint pain. Migraine and headaches, abdominal pain, connective-tissue disorders, neuropathic pain and pelvic pain are also prominent. ‘Most children have overlapping conditions – for example, migraine with abdominal pain, or musculoskeletal and neuropathic pain – so it’s rarely a single tidy diagnosis,’ Ms Ellis said. There is a high correlation between neurodivergence and pain, with almost three-quarters (72.9%) of children with chronic pain having at least one neurodivergent diagnosis. ‘Life can be more stressful for neurodivergent individuals, producing hormones that amplify pain signals,’ she said. About 60% of children with chronic pain also identified as female. ‘Women and girls have denser nerve networks and different immune systems,’ Ms Ellis said. ‘Fluctuations in oestrogen can also increase pain signals, while testosterone tends to reduce them.’Why is there such a long road to diagnosis?
For over 64% of children living with chronic pain, it took at least 3 years to receive a diagnosis. ‘Culturally, there’s a belief that persistent pain is an “older person’s condition”,’ Ms Ellis said. ‘So many children’s pain is dismissed.’ It’s often assumed there is another reason driving the symptoms. ‘Common explanations given to families are anxiety, a mental-health issue, “growing pains” that will resolve, or school avoidance,’ she said. ‘That invalidates the child and parent, and delays diagnosis.’ Children can face significant challenges navigating the healthcare system, getting answers, and accessing quality treatment, leading to cascading consequences. ‘Around 80% of children have a secondary mental health challenge, report sleep issues and forgo sport and similar activities,’ she said. ‘Over 80% miss school, about 1 day per week on average, with many finding the school system inflexible and invalidating, with pain dismissed or labelled as avoidance.’ Should a child experience ongoing, persistent pain, it should be taken ‘very seriously’ by health professionals – including pharmacists – with early intervention and thorough assessment ideally taking place within the first 3–6 months. ‘Early action reduces chronicity, helps build tools and confidence in self-management, and helps keep children in school and engaged socially,’ Ms Ellis said.What’s the pharmacist’s role?
Parents reported that they often see their pharmacist first to discuss their child's pain condition. To expedite diagnosis and ensure appropriate care, Chronic Pain Australia has released a Pharmacist Guide which includes language tips for discussing pain with children, ways to explain pain, and what good pain management looks like. ‘Pharmacists should ask how long the pain has been present and validate that it’s challenging to live with,’ Ms Ellis said. ‘Emphasise the importance of seeing a local GP for assessment and early diagnosis.’ Other key language tips include using ‘lives with pain’ over ‘suffers from’. Pharmacists should also describe ‘bad” or ‘challenging’ days rather than ‘flare-ups’. ‘Link with local providers, such as occupational therapists, physiotherapists and psychologists – who understand different communication and treatment needs, including for neurodivergent children who may express pain differently,’ she said. When addressing children with neurodivergence, pharmacists should inquire how best to communicate with them, what topics to avoid and what information would help. ‘Communication should always be age-appropriate and family-centred,’ Ms Ellis said. ‘The goal is to create a friendly, approachable environment where children feel comfortable sharing, while parents can help fill in the picture when needed.’How should symptom management be approached?
Management approaches for chronic pain depend on the child, condition, and whether function improves, Ms Ellis said. ‘In paediatric pain medicine we try to avoid medicines and use them sparingly, but if a non-functional child becomes functional on a medicine that may restore quality of life – that should be central to pain management.’ Ms Ellis recalls an example of a 14-year-old girl prescribed an opioid to be taken before menstruation for 4–5 days. While some healthcare professionals were quick to label this approach an addiction risk, it perhaps kept her in school during severe periods while investigations took place for endometriosis or polycystic ovarian syndrome. ‘Pharmacists concerned about higher-risk medicines should focus conversations on functional benefit, asking “Is this improving your ability to do things?”’ she said. ‘If not, initiate a discussion about whether to continue therapy, given the potential harms.’ With her mum’s support and extensive physical therapies, Laura was able to walk into her first day of high school without a walking stick. While she has good and bad days and constant flare ups, there are wins along the way – such as being able to start carrying a backpack rather than relying on a roller case. ‘It’s an invisible disability with constant pain that isn’t linear – there are different levels and sensations all the time and that changes the way I approach daily life,’ Laura said. ‘[But] when mum said I will keep fighting for you – it was almost like a promise, and she’s always kept it.’ [post_title] => Early action prevents lifelong chronic pain in children [post_excerpt] => A new report lays bare the impact of chronic pain in young people. An expert shares practical steps for pharmacists to improve care. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => early-action-prevents-lifelong-chronic-pain-in-children [to_ping] => [pinged] => [post_modified] => 2025-09-22 16:18:00 [post_modified_gmt] => 2025-09-22 06:18:00 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=30559 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Early action prevents lifelong chronic pain in children [title] => Early action prevents lifelong chronic pain in children [href] => https://www.australianpharmacist.com.au/early-action-prevents-lifelong-chronic-pain-in-children/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 30562 [authorType] => )
td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30152 [post_author] => 8451 [post_date] => 2025-09-22 09:00:34 [post_date_gmt] => 2025-09-21 23:00:34 [post_content] =>The various dementias are a huge cause of death in Australia. Despite some light on the horizon, there are still no effective treatments. AP explores the latest in dementia research.
Dementia is the second leading cause of death in Australia.1 The number of people living with the disease is expected to increase substantially as the population ages, potentially straining health systems.2
Despite accelerated research, including trials of more advanced compounds and recent Victorian Government grants supporting mRNA-based projects, effective treatments remain elusive.3
According to Dementia Australia's Executive Director of Services, Advocacy and Research, Dr Kaele Stokes (she/her), an estimated 433,000 Australians are currently living with dementia, including 29,000 people living with younger-onset dementia (when symptoms emerge before age 65).1
While there have been important advances in pharmaceutical research in the dementia field in recent years, Dr Stokes says, new medicines to date have limited application, availability and efficacy, and they do not stop the progression of dementia.
It is important to ensure health systems support everyone living with dementia now, she adds, noting that the new medicines may not work for many people with the condition, particularly patients who have lived with dementia for some time.
‘We don’t have an approach here in Australia that focuses on the importance of brain health across the life course,’ she says.
‘While we’re good at picking up other diseases, such as cardiovascular disease or diabetes, and putting steps in place to ensure the risks of severity in those conditions are minimised, we don’t really have conversations about brain health in a healthcare setting.’
Diagnosing dementia for younger and older people
Dr Stokes says while diagnostic tools are improving, diagnosing dementia is still a complex process.
Dementia is still seen as an older person’s disease, she adds, and it can be difficult for a person in their 40s or 50s to receive a dementia diagnosis.
According to a 2025 study in Translational Psychiatry, young-onset dementia in people aged under 65 years globally increased substantially in prevalence and incidence between 1990 and 2021 compared with overall people with dementia – and with a higher burden on women.4 The three highest risk factors were smoking, high body mass index and high fasting plasma glucose levels, while population growth was the largest contributor to the significant increase.4
‘There’s still a real fear and stigma around wanting to talk about brain health or talking to a healthcare professional about concerns around changes in cognition,’ Dr Stokes says.
‘But actually there are lots of reasons why it’s important to do that. A mix of pharmacological and non-pharmacological interventions can make a difference to quality of life and reduce the stress that somebody might be experiencing.’
It is important for people to focus on modifiable risk factors, potentially reducing the risk of developing dementia by about 45% by avoiding smoking or drinking too much and by maintaining a healthy diet, exercising regulary, and ensuring hearing and vision problems are identified and dealt with, Dr Stokes says.
For those at later stages of their lives, it’s important to avoid social isolation and to keep the brain active, she adds.
‘Learning new things can be really important – stretching the brain, firing up the neurons, to keep your brain active.’
Pharmacological advances
Healthcare professionals have high hopes for the potential benefits of newly available monoclonal antibody treatments for Alzheimer’s disease.5
University of Melbourne and Florey Institute Professor of Dementia Research Colin Masters, widely recognised as a world expert in the field of neurodegenerative diseases, estimates there are about 100 compounds in the pharmaceutical pipeline presently that are progressing through the trial stages.
‘Better forms, more effective forms, are coming within the next couple of years,’ he declares. ‘We’ve got to learn how to use them and manage all the adverse effects as well.’ He is optimistic about the future of dementia treatments – potentially including a routine vaccination.
‘The writing is on the wall,’ he says. ‘If the passive immunotherapies work, then everyone will be working on an active vaccination program. In other words, at age 50 or whatever, you just run up to your primary care physician, they do a blood test, you’re on the pathway – you get a shot of peptide in your arm.’
The most promising drug now on the horizon is trontinemab, Prof Masters says. It's a reinvented form of the monoclonal antibody gantenerumab – a drug that didn’t make it to market because of a lack of efficacy. Even so, he adds, gantenerumab has been found effective for certain conditions. ‘We’ve been trialling it for nearly 10 years now,’ Prof Masters says, ‘and we published in Lancet Neurology9 [in June 2025] that in early-onset familial types of Alzheimer’s disease, gantenerumab in high doses was effective in pre-clinical disease in young individuals who are at 100% risk of developing Alzheimer’s disease.’ Trontinemab, he adds, is the natural successor to gantenerumab.
In April, Roche announced the results of a phase II trial of trontinemab delivered via the “Brainshuttle” system, which found ‘rapid and deep, dose-dependent reduction of amyloid plaques in the brain’.10 At the same time, Roche announced it would begin a phase III trial of the drug later this year.10
‘It’s the next generation; it’s a major advance,’ Prof Masters says, explaining that the bispecific molecule of trontinemab is designed to go straight across the blood-brain barrier, so doses of the drug can be far smaller.
‘It’s the first antibody designed to do this, and a lot of companies are copying it right now, because it works so well.’
According to data released from the Roche trials, trontinemab causes far fewer and less severe adverse effects than gantenerumab, he points out.
Other promising Alzheimer’s disease treatments include the monoclonal antibody donanemab. It is marketed as Kisunla by Eli Lilly, and in May 2025 it was approved by the Therapeutic Goods Administration.11
Lecanemab, marketed as Leqembi, has not yet been approved in Australia, but Prof Masters says full results of a pre-clinical trial are expected by the end of 2027 and he and his colleagues expect a positive result.
All these monoclonal antibody drugs are most effective in the early stages of Alzheimer’s disease, so early diagnosis is critical.12 In July this year, the Victorian Government also announced more than $537,000 in grants to two Florey researchers for two Alzheimer’s research projects.
These are aimed at treating and preventing the disease with mRNA technology, which was developed during the pandemic for COVID-19 vaccines.13
Pharmacist dementia support in the community
PSA’s Dementia Support Pharmacist Project in South Australia is an innovative project and model of practice aimed at keeping people with dementia at home and in the community for longer.14
Two pharmacists are employed on the project. They job-share to support clients with dementia medication management needs, understanding and choices, says South Australia and Northern Territory PSA Manager Helen Stone FPS (she/her).
The pharmacists act as patient advocates, provide flexible care for patients with complex comorbidities, and work with other members of the care team, including GPs, community pharmacists, nursing and care workers and families, she adds. Initial appointments are held in the patient's home, preferably with follow-ups either personally, by telephone or collaboration application such as MS Teams. A report prepared by the pharmacist is shared with the patient and, with consent, to treating medical and care teams, which may recommend an action plan to change or deprescribe medicines. Education about medicine use in dementia is also provided to health professionals and community groups across regional areas of the state.
‘This is a much-needed service; it is accessible, but there are a lot more people we can’t yet support,’ Ms Stone says. PSA has demonstrated that pharmacists working directly with patients and liaising with the care team can provide valuable support for patients with complex conditions and multimorbidities.
The project began in May 2024 and has been extended to June 2026. Ms Stone recently submitted a proposal to SA Health to expand the program and include a further five FTE pharmacists to cover metropolitan Adelaide.
Dementia care pharmacists can help with complex deprescribing of medicines and tapering of antidepressants where needed. They can provide professional advice to family members caring for patients with dementia that can empower carers as advocates in cases, for instance, of inadequate pain management.
Medicine administration frustrations can be avoided when dose time changes can be suggested.
Project pharmacist Dee-Anne Hull MPS (she/her) says pharmacist dementia support work helps in areas where it is needed most. ‘It has shown us where gaps in health care are in rural and remote areas of our state, but also within the pharmacy profession itself,’ she says. ‘A lot of pharmacists openly admit that dementia scares them, and they don’t really know where to start.
‘My advice is to make this an area of focus for CPD activities; check out the numerous PSA resources available, particularly those on palliative care and deprescribing, but also check out websites like Dementia Australia, Dementia Training Australia and the Wicking Dementia Centre,’ she adds.
‘Think about ways that you could support someone who is caring for a person living with dementia and the carer’s burden that may be associated with this, because that’s often where the support is needed the most.’
Positive response
Dementia Support Pharmacist Project pharmacist Nicola Sander MPS (she/her) says she has seen ‘overwhelming support and positive feedback’ for the project.
‘We have seen considerable benefit for people who are still living at home and are trying to manage their medicines.
Ms Sander sees this dementia support career pathway as ideal for an early career pharmacist and suggests that training in deprescribing and dementia-specific areas would be useful.
After a lengthy consultation with one client living at home, the client’s family and her doctor, Ms Sander recommended medicine management changes. The doctor was reluctant, so the client’s daughter found a doctor who was willing to be part of a multidisciplinary team, Ms Sander says, which included deprescribing strategies and pain support management.
After a recent visit to the geriatrician, the client’s daughter reported that her mother’s Mini‐Mental State Examination had improved from 12/30 to 19/30.
The daughter and the geriatrician attributed the client’s improvement to ‘better control of pain and overall improvement to her mood, as she has felt more supported and less depressed' since.
Ms Stone, whose Churchill Fellowship palliative care research – To articulate a framework for the role of Palliative Care Pharmacist in community and aged care in Australia – Churchill Trust15 – informed the Dementia Support Pharmacist Project, says that education, training and curiosity help pharmacists to start understanding dementia care more fully.
She encourages everyone to complete a Program of Experience in the Palliative Approach (PEPA) placement.
‘A dementia diagnosis can be devastating for people and their families; medications can have a benefit but can also impair cognition, so support from a pharmacist can be very valuable.'
References
[post_title] => Advancing dementia care in pharmacy [post_excerpt] => The various dementias are a huge cause of death in Australia. Despite some light on the horizon, there are still no effective treatments. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => advancing-dementia-care [to_ping] => [pinged] => [post_modified] => 2025-09-22 16:18:21 [post_modified_gmt] => 2025-09-22 06:18:21 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=30152 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Advancing dementia care in pharmacy [title] => Advancing dementia care in pharmacy [href] => https://www.australianpharmacist.com.au/advancing-dementia-care/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 30558 [authorType] => )
- Australian Institute of Health and Welfare. Dementia In Australia. 2024. At: www.aihw.gov.au/reports/dementia/dementia-in-aus/contents/population-health-impacts-of-dementia/deaths-due-to-dementia
- Dementia Australia. Dementia facts and figures. 2024. At: www.dementia.org.au/about-dementia/dementia-facts-and-figures
- Florey Institute for Neuroscience and Mental Health. Harnessing mRNA to prevent and slow Alzheimer’s disease. 2025. At: https://florey.edu.au/news/2025/07/harnessing-mrna-to-prevent-and-slow-alzheimers-disease/
- He Q, Wang W, Zhang Y, et al. Global burden of young-onset dementia, from 1990 to 2021: an age-period-cohort analysis from the global burden of disease study 2021. Transl Psychiatry 2025. Epub 2025, 17 February.
- Ramanan VK, Armstrong MJ, Choudhury P, et al. Antiamyloid monoclonal antibody therapy for Alzheimer disease. Neurology 2023;101(19)842–52. At: www.neurology.org/doi/10.1212/WNL.0000000000207757
- World Health Organization. Dementia. 2025. At: www.who.int/en/news-room/fact-sheets/detail/dementia
- Mayo Clinic. Alzheimer’s disease. 2025. At: www.mayoclinic.org/diseases-conditions/alzheimers-disease/symptoms-causes/syc-20350447
- Eyting M, Xie M, Michalik F, et al. A natural experiment on the effect of herpes zoster vaccination on dementia. Nature 2025. Epub 2025 2 April. At www.nature.com/articles/s41586-025-08800-x
- Safety and efficacy of long-term gantenerumab treatment in dominantly inherited Alzheimer's disease: an open-label extension of the phase 2/3 multicentre, randomised, double-blind, placebo-controlled platform DIAN-TU trial. Bateman, Randall J et al. Lancet Neurology 2025; 24(4):316–30.
- Roche. Roche presents novel therapeutic and diagnostic advancements in Alzheimer’s at AP/PD 2025. 2025. At: www.roche.com/media/releases/med-cor-2025-04-03
- Burge K. Treatment to slow early Alzheimer’s gets TGA approval. newsGP 2025. At: www1.racgp.org.au/newsgp/clinical/treatment-to-slow-early-alzheimer-s-gets-tga-appro
- Promising results of new Alzheimer’s drug published – early diagnosis is key. 2023. At: www.dementia.org.au/media-centre/media-releases/promising-results-new-alzheimers-drug-published-early-diagnosis-key
- Victoria State Government. mRNA Victoria. Research. July 2025. At: https://djsir.vic.gov.au/mrna-victoria/research
- Sander N, Jull DA. Bridging the gap: how dementia support pharmacists are transforming care in rural South Australia. Issue 91. June 2, 2025. At: https://ruralhealth.org.au/partyline/bridging-the-gap-how-dementia-support-pharmacists-are-transforming-care-in-rural-south-australia/
- Stone H. To articulate a framework for the role of the palliative care pharmacist in community and aged care in Australia. Winston Churchill Trust 2025. At: www.churchilltrust.com.au/project/to-articulate-a-framework-for-the-role-of-palliative-care-pharmacist-in-community-and-aged-care-in-australia/
td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30542 [post_author] => 8451 [post_date] => 2025-09-17 11:29:30 [post_date_gmt] => 2025-09-17 01:29:30 [post_content] => Pharmacists are asked to lead the shift from reliever-only inhalers to inhaled corticosteroid-containing regimens and to minimise short courses of oral corticosteroids. Just under 3 million Australians live with asthma. The condition has the eighth-highest disease burden in the nation, and it is one of the most significant chronic conditions in children. Guided by the results of large trials, recommendations for asthma management in adults and adolescents are changing, and pharmacists need to be aware of updated guidelines. The Australian Asthma Handbook was updated yesterday (16 September 2025) to reflect new thinking on asthma care and management.What are the key updates?
Three key changes have been made to the Australian Asthma Handbook, including:
- All adults and adolescents with confirmed asthma should be taking inhaled corticosteroid-containing treatment and not as-needed short-acting beta2-agonists (SABAs) alone. Asthma can be well controlled with maintenance and reliever therapy, and a small proportion of patients with severe asthma may be eligible for biologics.
- An emphasis on the importance of limiting oral corticosteroids, which have been associated with a range of different harms, including damage to bone health, cataracts and type 2 diabetes.
- Health professionals should be aware the handbook has greater guidance for treating children aged 1–5 who are living with asthma and a recommendation that some older children should also be on low-dosage ICS maintenance therapy.
Why have the guidelines been updated?
Overuse of SABAs has been linked to poor asthma control and preventable hospitalisations. ‘The evidence is that the risks of SABA alone have become clearer and that we were overusing a not very effective and not very safe therapy,’ said Professor Nick Zwar, Executive Dean of Bond University’s Faculty of Health Sciences and Medicine, and Chair of the Australian Asthma Handbook Guidelines Committee. ‘Budesonide-formoterol, taken only as needed, is recommended in place of SABA. Maintenance and reliever therapy is now recommended as the next step up.’ The risks of SABA overuse include a lack of bronchodilator response over time, and the possibility that some people may have quite a severe asthma attack and end up in the hospital emergency department (ED), or hospitalised, when they don’t need to be. There is very strong evidence to demonstrate that all adolescents and adults living with asthma should be treated with ICS, said pharmacist and Clinical Executive Lead at the National Asthma Council Australia, Debbie Rigby FPS. ‘Just having the SABA alone only treats one component of asthma, which is the bronchoconstriction, whereas having the low-dose ICS helps manage the inflammation and mucus production,’ she said. ‘I think that’s the biggest shift for us, pharmacists and doctors: helping patients to understand that asthma is a chronic inflammatory condition.’What are the risks of poor asthma control?
Inadequately managed asthma can be a life-threatening condition, Ms Rigby stressed, noting there were 474 asthma-related deaths in Australia in 2023. ‘Those deaths shouldn’t be happening. Many of those people who did die from asthma or asthma-related causes would have been perceived as having mild, intermittent symptoms,’ she said. ‘Without wanting to scare patients, we should be really highlighting the consequences of not having good control of their asthma.’Why is SABA still overused?
Despite access to long-acting beta2 agonists (ICS–LABAs), SABA use remains high for a range of reasons. These include cost, convenience and patient reluctance to medicate every day when they are accustomed to using a reliever-only when they have an asthma attack, Ms Rigby said. Health professionals understand that many people are reluctant to use a preventer inhaler, but health professionals need to help them understand that they have a ‘chronic inflammatory condition, which may flare up from time to time’. Effects of the cost-of-living crisis should not be underestimated either. However, the price gap between over-the-counter salbutamol and prescription asthma medicines is now narrowing, with 60-day dispensing for patients who are stable and, from January 2026, the co-payment for medicines being reduced from $31.60 to $25 per prescription. The Australian uptake of Maintenance and Reliever Therapy (MART) has also been slow, despite strong evidence and subsidy on the Pharmaceutical Benefits Scheme. The evidence of large-scale trials has shown the importance of shifting patients with mild asthma onto anti-inflammatory reliever therapy on an as-needed basis, Ms Rigby said. ‘The evidence basically says it reduces the risk of severe exacerbations requiring ED or hospitalisation, or requiring oral corticosteroids,’ she said. For practical guidance on discussing the guideline changes with patients, the role of prescribing pharmacists, and how biologics fit into care, don’t miss the October cover story in Australian Pharmacist. [post_title] => New asthma guidelines released [post_excerpt] => Pharmacists are asked to lead the shift from reliever to inhaled corticosteroid regimens and to minimise use of oral corticosteroids. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => new-asthma-guidelines-released [to_ping] => [pinged] => [post_modified] => 2025-09-17 17:13:31 [post_modified_gmt] => 2025-09-17 07:13:31 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=30542 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => New asthma guidelines released [title] => New asthma guidelines released [href] => https://www.australianpharmacist.com.au/new-asthma-guidelines-released/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 30545 [authorType] => )
td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30154 [post_author] => 11158 [post_date] => 2025-09-17 08:26:54 [post_date_gmt] => 2025-09-16 22:26:54 [post_content] =>Case scenario
Ashley, a 23-year-old female, presents to your pharmacy with a prescription for a 7-day course of doxycycline 100 mg twice daily. She tells you she has had some mild vaginal discharge and that her STI screen has come back positive for vaginal chlamydia. You establish that she is currently taking ferrous sulfate 325 mg once daily as she is vegan, isotretinoin 30 mg once daily for acne, and has an etonogestrel implant in situ. She has no known allergies.
Note: The authors recognise that gender identity is fluid. In this article, the words and language we use to describe genitals and gender are based on the sex assigned at birth.
Learning objectivesAfter reading this article, pharmacists should be able to:
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Chlamydia and gonorrhoea are two of the most prevalent bacterial sexually transmitted infections (STIs) globally.1,2 They are preventable and curable infections that are usually transmitted through vaginal, oral or anal sex.1,2 Conjunctival infection can occur in neonates born to mothers carrying a chlamydia or gonorrhoea infection, or in adults via exposure to genital secretions.1–4 Both chlamydia and gonorrhoea can lead to serious health complications if left untreated, ranging from effects on fertility and pregnancy to blindness (in untreated ocular gonorrhoea infection).1,2
Chlamydia is caused by the gram-negative bacterium Chlamydia trachomatis.2 Gonorrhoea is caused by the gram-negative bacterium Neisseria gonorrhoeae.1
Chlamydia is relatively simple to treat, being susceptible to doxycycline and azithromycin.5 Gonorrhoea treatment may be more challenging due to emerging antimicrobial resistance to first-line treatments, particularly in urban Australia.6 All people diagnosed with chlamydia and gonorrhoea should be offered antibiotic treatment to resolve symptoms, prevent complications and to decrease transmission to others.1,2
Pharmacists can support patients by providing information on safe-sex practices, any prescribed medicines, in addition to providing advice or referring where appropriate.
The World Health Organization (WHO) estimates there were around 128.5 million new infections with C. trachomatis in 2020 among adults aged 15–49 years globally.2 In Australia, those under 30 years of age are at greatest risk of infection.5 There were 102,222* cases of chlamydia notified to the Australian government’s National Notifiable Diseases Surveillance System (NNDSS) in 2024, with an almost equal distribution of infection between males and females.7 This was an increase of almost 20% compared to the 86,810 case notifications in 2014.7 Across all ages, infections in females over this time period remained similar, however infections in males increased by approximately 40%.7
The WHO estimates that 82.4 million adults aged 15–49 years old acquired gonorrhoea worldwide in 2020.1 In Australia, gonorrhoea is most prevalent in men who have sex with men (MSM), remote Aboriginal and Torres Strait Islander communities, street-based sex workers, and returned travellers reporting sex overseas (in high prevalence countries).6,8 In recent years, there has been a rise in prevalence in the general population, especially in females of reproductive age.6 There were 44,547* cases of gonorrhoea notified to the NNDSS in 2024.7 This is almost triple the 15,674 cases notified in 2014.7
Co-infection with both chlamydia and gonorrhoea is relatively common.9 A study of high-prevalence Aboriginal communities in remote Australia found half of female and one-third of male participants aged 16–19 had one or more STIs.10 Chlamydia and gonorrhoea were the most common co-infections.10
*Figures correct as of May 2025.
Chlamydia
Chlamydia is often described as the “silent STI” because 85–90% of infections are asymptomatic.5 If symptoms do appear, they may not present until up to 3 weeks after sexual contact with an individual with chlamydia infection.2
Common chlamydia symptoms for males include2,5:
For females, symptoms include2,5:
Gonorrhoea
Gonorrhoea symptoms usually appear within 2 weeks of exposure.1 Infection is usually asymptomatic in females.1
If symptoms occur in females, they include1,4,6:
In contrast for males, penile urethral gonorrhoea is almost always symptomatic and symptoms may include1,6:
Complications
Untreated chlamydia and gonorrhoea can lead to various complications in both males and females, highlighting the need for prompt identification and treatment of infection.
Table 1 outlines some complications associated with untreated C. trachomatis and N. gonorrhoeae infection.
Molecular testing should be undertaken for those suspected of having chlamydia or gonorrhoea, or those at risk of infection. Certain groups (e.g. MSM, pregnant people, sex workers, Aboriginal and Torres Strait Islander people, gender diverse and transgender people) require special testing approaches due to increased risk of infection, adverse health outcomes or community prevalence.11 A full STI check-up including HIV and syphilis serology at initial presentation is recommended.11
Chlamydia is diagnosed via nucleic acid amplification tests (NAATs) (e.g. polymerase chain reaction [PCR]).5 NAATs are highly sensitive and the only recommended test for chlamydia.5 Microbiological culture of C. trachomatis is difficult and not routinely recommended.12
NAATs are also used to diagnose gonorrhoea.6 They are highly sensitive but do not provide any information on antibiotic susceptibility.6 Gonococcal microbiological culture has high specificity and allows for antibiotic susceptibility testing, but is less sensitive than NAATs.6
Some differential diagnoses for genital tract chlamydia infection may include lymphogranuloma venereum, gonorrhoea, bacterial vaginosis, vaginal candidiasis, trichomonas or Mycoplasma genitalium infection.13 For gonorrhoea, other conditions such as chlamydia, trichomonas, vaginal candidiasis, bacterial vaginosis or urinary tract infections may cause similar symptoms.14
Anatomical sites sampled for chlamydia and gonorrhoea testing will depend on the individual’s presentation, sexual history and risk factors.5,6 Self-collection of samples for testing by NAAT is common practice for asymptomatic patients.5 In symptomatic patients undergoing examination, a swab can be taken by the clinician (e.g. an endocervical swab if a speculum examination occurs).5,6 First-pass urine can be tested in people without a vagina (or if a vaginal swab cannot be taken) – it is less sensitive than a self-collected vaginal swab.5,6 An anorectal swab is recommended for all individuals who have anorectal symptoms, and for all MSM regardless of whether they are symptomatic.5,6 Similarly, a pharyngeal swab for NAAT is recommended for MSM for both gonorrhoea and chlamydia, even if asymptomatic.5,6
Gonococcal culture
Gonococcal cultures should be collected from all infected sites prior to commencing treatment to determine antibiotic susceptibility and to contribute to antimicrobial resistance surveillance.6 It is recommended that a culture is performed on a site if an individual is experiencing symptoms at that site.6 Pending culture results should not delay commencing treatment, and antibiotics can be administered prior to receiving the culture results.6
The goals of treatment for both chlamydia and gonorrhoea are to resolve symptoms, reduce complications and prevent transmission and reinfection. Sometimes a clinical diagnosis is made based on symptoms and risk factors. Certain presentations may warrant starting empiric treatment while awaiting confirmation of results. Examples include patients presenting with anorectal symptoms, symptoms of PID or epididymo-orchitis, where timely treatment is critical.15–17
Chlamydia
Doxycycline is the standard first-line therapy for chlamydia.5,18 Azithromycin is an alternative option if doxycycline is contraindicated (e.g. in pregnancy, if there are adherence or medicine interaction concerns).3,18
Previously, azithromycin was the first-line treatment, as it was a convenient single dose. However, a meta-analysis showed azithromycin 1 g orally may be up to 20% less efficacious than 7 days of doxycycline when treating anorectal chlamydia. A subsequent randomised trial of 625 Australian MSM with asymptomatic anorectal chlamydia demonstrated consistent findings.19,20 Azithromycin is also increasingly implicated in antimicrobial resistance for other STIs, therefore doxycycline is preferred.21
Gonorrhoea
The recommended treatment for gonorrhoea infection in Australia is ceftriaxone in combination with azithromycin.6 The recommended dose of oral azithromycin varies depending on the site of infection.4 The current combination treatment approach is highly effective and important in reducing the contribution to more widespread antimicrobial resistance.4,6 However, reduced susceptibility to these agents has been increasingly reported in urban Australia.6 Until recently, the combination of amoxicillin, probenecid and azithromycin was still recommended for gonorrhoea in some remote Australian areas. However, this changed to ceftriaxone with azithromycin, due to an increase in penicillin resistance in remote communities in the Northern Territory.22
Antimicrobial resistance is a growing problem in the treatment of gonorrhoea.1 Resistance to penicillin, tetracyclines, macrolides, sulphonamides and quinolones has been detected.23 Gonococcal surveillance programs are in place in some countries to track resistant strains.
Table 2 provides a summary of the current treatment approach for various presentations of chlamydia and gonorrhoea infection in Australia. Uncomplicated chlamydia or gonorrhoea infection refers to localised urogenital, anogenital, pharyngeal and ocular infections that are not associated with bacteraemia or ascending spread to other organs.24,25 Complicated infections and their treatment is beyond the scope of this article, as are other infections associated with C. trachomatis.
Consistent and correct condom use can prevent the transmission of chlamydia and gonorrhoea.1,2 There is currently no available vaccine to prevent either infection. The serogroup B meningococcal vaccine (4CMenB) is currently being investigated for its ability to provide cross-protection against N. gonorrhoeae.26
The use of doxycycline to prevent bacterial STIs (doxycycline post-exposure prophylaxis [doxy-PEP]) can offer protection against acquiring syphilis, chlamydia and, to a lesser extent, gonorrhoea, if taken within 72 hours of unprotected sexual intercourse.27 Controversy remains on whether the risk of changes to the microbiome and potential increased antimicrobial resistance as a result of using doxy-PEP outweighs the benefits of preventing these STIs, with research ongoing.27
Sexual contact should be avoided for 7 days after chlamydia and/or gonorrhoea treatment is commenced, or until the treatment course is completed and symptoms have resolved, whichever is later.5,6 Patients should be advised not to have sex with partners from the last 6 months for chlamydia, or the last 2 months for gonorrhoea, until partners have been tested and treated, if necessary.5,6 Notification of sexual partners is recommended and can be done anonymously by patients via websites such as Let Them Know (https://letthemknow.org.au/).5,6 With the consent of the patient, a clinician may support with contact tracing if necessary.
Reinfection with chlamydia and gonorrhoea is common.5,6 Retesting at 3 months is recommended to detect reinfection.5,6 A test of cure is not routinely recommended for chlamydia, except in specific circumstances (e.g. in pregnancy).5 A test of cure is recommended for gonorrhoea in cases where a culture was not collected before treatment, the culture indicated antimicrobial resistance or if a non-standard treatment regimen was used.6 Screening for other STIs should be performed if not done at the initial presentation.5,6
Patient-delivered partner therapy (PDPT) is where antibiotic treatment is prescribed or supplied for the sexual partner(s) of a patient diagnosed with chlamydia (index patient).5 The prescription or treatment is given directly to their partner(s) by the index patient.5 In jurisdictions where PDPT is approved, it can be considered for heterosexual index patients with anogenital or oropharyngeal chlamydia, whose partners are unlikely to seek chlamydia testing or treatment.5 PDPT can also be considered with cases of repeat infections where partners have not been treated.5 Guidance on PDPT for chlamydia is available in Victoria, New South Wales and the Northern Territory.5 The decision to use PDPT should be weighed against the potential to miss co-infections or complications in the partner(s) of the index patient.
Pharmacists may be among the first healthcare professionals that patients approach for guidance and treatment for STIs, particularly if presenting with symptoms of infection. Recognition of symptoms that may warrant onward referral to a medical practitioner is essential.
Pharmacists can support adherence to current recommended treatment regimens for STIs. This may include extended doxycycline courses, which ensures the resolution of infection and improves antibiotic efficacy.28 Pharmacists can also encourage patients to notify sexual partners regarding an STI diagnosis, enabling those partners to obtain timely treatment.
Doxy-PEP may be appropriate for some at-risk groups, providing an additional option to conventional STI prevention strategies. Evidence is building for doxy-PEP use and by following the Australasian Society for HIV, Viral Hepatitis & Sexual Health Medicine (ASHM) guidance, pharmacists can ensure they are providing evidence-based information to patients who wish to know more about this prevention strategy (see https://ashm.org.au/initiatives/doxy-pep-statement/).27
Chlamydia and gonorrhoea are two of the most prevalent bacterial STIs. Patients may be asymptomatic, and both can lead to serious complications if left untreated. Chlamydia is relatively easy to treat, however emerging antimicrobial resistance to first-line gonorrhoea treatments may complicate its management. Reinfection is common with both, and robust contact tracing of sexual partners is recommended.
Case scenario continuedAfter noting that doxycycline would need to be taken at least 2 hours before or after Ashley’s iron tablets, you also suspect an interaction with isotretinoin.28 You check the Australian Medicines Handbook (AMH), which highlights a risk of benign intracranial hypertension and that concurrent use should be avoided.29 You phone Ashley’s GP to recommend a safer, yet effective, alternative of azithromycin 1 g orally as a single dose. The GP and Ashley thank you for your help. |
Ivette Aguirre (she/her) BAppSc (MedLabSc), BPharm, GradCertPharmPrac, MClinPharm, FANZCAP (Inf Dis) is the senior clinical pharmacist at the Melbourne Sexual Health Centre (MSHC), a part of Alfred Health. She mentors pharmacists, technicians and pharmacy students during their rotations at MSHC, and is interested in the impact of pharmacist reviews in HIV clinics and emerging treatments for sexually transmissible infections such as Mycoplasma genitalium.
Kathryn (Kate) Mackie (she/her) BPharm, GradDipClinPharm, BCGP, FANZCAP (Inf Dis, Gen) is a senior clinical pharmacist at Alfred Health (including Melbourne Sexual Health Centre) and Barwon Health, working in infectious diseases, HIV, viral hepatitis and sexual health. With 20 years of experience in this area, she is engaged in clinical pharmacy research and contributes to undergraduate and health professional education.
Hana Numan (she/her) BPharm (NZ), PGDipClinPharm (NZ), MPS (NZ)
[post_title] => Chlamydia and gonorrhoea [post_excerpt] => Chlamydia and gonorrhoea are two of the most prevalent bacterial sexually transmitted infections (STIs) globally. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => chlamydia-and-gonorrhoea [to_ping] => [pinged] => [post_modified] => 2025-09-17 16:17:03 [post_modified_gmt] => 2025-09-17 06:17:03 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=30154 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Chlamydia and gonorrhoea [title] => Chlamydia and gonorrhoea [href] => https://www.australianpharmacist.com.au/chlamydia-and-gonorrhoea/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( [td_post_template] => single_template_4 ) [is_review:protected] => [post_thumb_id:protected] => 30528 [authorType] => )td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30516 [post_author] => 3387 [post_date] => 2025-09-15 12:20:04 [post_date_gmt] => 2025-09-15 02:20:04 [post_content] => Administered to the nasal mucosa, a spike-based formulation triggers rapid local defences that clear the COVID-19 virus where it enters. In 2022, a year after Australia’s longest COVID-19 lockdowns, researchers from the Centenary Institute and the University of Sydney received a grant of almost $1 million from the NSW COVID-19 Vaccine Acceleration Research Grants Program to develop an intranasal COVID-19 vaccine. Now, new research has been released by the team – finding that their formulation can stop infection in the nose before the virus spreads through the body, and to other people. [caption id="attachment_30517" align="alignright" width="150"]Dr Erica Stewart, Centenary Institute[/caption] Australian Pharmacist sat down with Dr Erica Stewart, first author and researcher at the Centenary Institute when the work was undertaken, to discuss how the vaccine works, its applications and why it could be the key to stopping the spread.
What is the vaccine’s mechanism of action?
By acting where the virus first enters, the nasal vaccine prompts a rapid, effective immune response that eliminates the virus, Dr Stewart said. ‘The adjuvant we used was Pam2Cys, a Toll-like receptor 2 (TLR2), and we showed that it was able to stimulate the immune response in the nasal passages,’ she said. ‘We formulated the SARS-CoV-2 spike protein with this adjuvant, which emulates bacteria to alert the immune system that there is a danger and it should respond.’ When administered as a booster after a standard injection, the treatment also provided additional protection to vital organs, including the lungs and brain – pointing to the benefits of focusing immune responses within the upper airways.Why target the nasal mucosa?
The nasal passage is an increasingly promising site for vaccine adjuvant formulation, Dr Stewart said. ‘It’s becoming more and more clear that the nasal passage is a very different immune environment to an injection in the muscle.’ Internationally, there are some other pre-clinical models of mucosal vaccines. ‘But most of those mucosal vaccines are viral vectors because there aren't a lot of vaccine adjuvants that have been found to be effective nasally, which is part of the novelty of this study,’ she said. The team had previously looked at intranasal vaccination in mice, using a model where the vaccine entered both the lungs and the nose. ‘However, the main takeaway from this research was, when [administering] a very small volume to just the nose, we still got a really strong immune response in the blood,’ she said. ‘We also looked into the nose itself, and we could see that the immune cells were retained for long periods in the nasal passages, where they will be able to respond to infection quickly.’ There’s hope that these vaccines can potentially prevent infection and transmission by building immune defences directly in the upper airways where the virus first takes hold – a frontier that traditional vaccines have yet to reach. ‘We currently reduce disease severity really well, but we're still trying to block transmission,’ Dr Stewart said. ‘That's what nasal vaccines are aiming to address.’Who would benefit most from a nasal COVID-19 vaccine?
Vulnerable populations who are more susceptible to severe disease, hospitalisations and death. ‘Sometimes you'll hear people say, “COVID-19 is over” – but people are still dying of it, including the elderly, immunocompromised people and those with other comorbidities,’ Dr Stewart said. Similar to how younger, healthy patients are advised to get the flu vaccine to protect more vulnerable members of the community – this vaccine offers an additional layer of protection. ‘It would be the vulnerable people who are benefiting, but the vaccine would be for everyone to try to reduce the circulation of the virus in our community,’ she said.How would the vaccine fit into the routine immunisation schedule?
With most people vaccinated against COVID-19 or exposed to the virus, the mucosal vaccines will likely be used as a booster. ‘In the mouse model, both the vaccine as a booster or as a primary vaccination induced nasal immunity,’ Dr Stewart said. It’s assumed that the nasal vaccine will be used as an annual seasonal dose, similar to the flu vaccine or COVID-19 boosters for certain populations. ‘We do have some evidence that the vaccine can neutralise against other variants, but [we need to explore] how well it protects people and for how long, because that would indicate whether continuous boosters are needed,’ she said. It’s also anticipated that the nasal vaccine will be self-administered. ‘There are studies looking into self-administration of nasal vaccines, which could really help with distribution and access to these vaccines in the community,’ she said. This mode of administration could be particularly beneficial for those who are needlephobic, including children. ‘For people who cannot stand getting a needle, this is a less invasive method of vaccination,’ Dr Stewart said. The researchers say that while more work is needed, the results show strong potential for nasal vaccines to complement existing COVID-19 vaccines and provide an extra layer of protection against the virus in the future. [post_title] => Intranasal vaccine stops infection at the source [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => intranasal-vaccine-stops-infection-at-the-source [to_ping] => [pinged] => [post_modified] => 2025-09-15 13:32:22 [post_modified_gmt] => 2025-09-15 03:32:22 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=30516 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Intranasal vaccine stops infection at the source [title] => Intranasal vaccine stops infection at the source [href] => https://www.australianpharmacist.com.au/intranasal-vaccine-stops-infection-at-the-source/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 30519 [authorType] => )
td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30559 [post_author] => 3410 [post_date] => 2025-09-22 12:23:06 [post_date_gmt] => 2025-09-22 02:23:06 [post_content] => A new report lays bare the impact of chronic pain in young people. During Kids in Pain Week (22–28 September), an expert shares practical steps for pharmacists to improve care. Sydney-based Laura was just 10 years old when a bout of shingles left her with constant, debilitating pain. Laura went from being a fit and active middle sister to being unable to walk or move without a wheelchair at the age of 11, and completely reliant on her family for care. Doctors were stumped and investigations proved fruitless. ‘I was so sick of doctors – waiting for the doctors and waiting to do anything and just so ready to give up,’ Laura said. [caption id="attachment_30566" align="aligncenter" width="500"]Laura with her mum Michelle[/caption] When living with chronic pain, it’s easy to feel misunderstood and lonely, she shared. ‘Laura was having a really hard time, was depressed, barely talking and struggling. It was so hard to see her like that,’ Laura’s mum, Michelle said. ‘People underestimate how chronic pain may start as a physical issue but then becomes a mental health issue when everything is so uncertain and you aren’t sure if life will ever be what it was.’ Around one in five children aged 6–18 live with chronic pain, which equates to approximately 877,000 Australian kids – according to Australian Bureau of Statistics (ABS) data. The inaugural Kids in Pain Report from Chronic Pain Australia shows how pain affects every aspect of these children’s lives, as well as their families, and the many who are likely unaccounted for, said pharmacist and Chronic Pain Australia chairperson, Nicolette Ellis MPS. ‘In 2019 the World Health Organization recommended that chronic pain be recognised as a condition in its own right and provided a way to capture that in healthcare data with ICD-11 coding,’ she said. ‘But chronic pain isn’t recognised as a condition in Australia; it’s recognised only as a symptom of an injury or another condition.’ [caption id="attachment_30564" align="aligncenter" width="500"]
Nicolette Ellis MPS[/caption] Without robust prevalence data, chronic pain will remain missing from national policy – including the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme, Ms Ellis warned. ‘That cascades down into service planning and investment, which is not currently matched to need,’ she said. ‘For example, Australia only has nine specialist paediatric pain clinics; Tasmania and the Northern Territory have none, so families often travel 4–6 hours for specialist appointments.’
What does chronic pain look like in children?
Most (71%) of children experience musculoskeletal pain, typically due to rheumatoid arthritis and autoimmune conditions as well as lower-back pain, knee pain and other joint pain. Migraine and headaches, abdominal pain, connective-tissue disorders, neuropathic pain and pelvic pain are also prominent. ‘Most children have overlapping conditions – for example, migraine with abdominal pain, or musculoskeletal and neuropathic pain – so it’s rarely a single tidy diagnosis,’ Ms Ellis said. There is a high correlation between neurodivergence and pain, with almost three-quarters (72.9%) of children with chronic pain having at least one neurodivergent diagnosis. ‘Life can be more stressful for neurodivergent individuals, producing hormones that amplify pain signals,’ she said. About 60% of children with chronic pain also identified as female. ‘Women and girls have denser nerve networks and different immune systems,’ Ms Ellis said. ‘Fluctuations in oestrogen can also increase pain signals, while testosterone tends to reduce them.’Why is there such a long road to diagnosis?
For over 64% of children living with chronic pain, it took at least 3 years to receive a diagnosis. ‘Culturally, there’s a belief that persistent pain is an “older person’s condition”,’ Ms Ellis said. ‘So many children’s pain is dismissed.’ It’s often assumed there is another reason driving the symptoms. ‘Common explanations given to families are anxiety, a mental-health issue, “growing pains” that will resolve, or school avoidance,’ she said. ‘That invalidates the child and parent, and delays diagnosis.’ Children can face significant challenges navigating the healthcare system, getting answers, and accessing quality treatment, leading to cascading consequences. ‘Around 80% of children have a secondary mental health challenge, report sleep issues and forgo sport and similar activities,’ she said. ‘Over 80% miss school, about 1 day per week on average, with many finding the school system inflexible and invalidating, with pain dismissed or labelled as avoidance.’ Should a child experience ongoing, persistent pain, it should be taken ‘very seriously’ by health professionals – including pharmacists – with early intervention and thorough assessment ideally taking place within the first 3–6 months. ‘Early action reduces chronicity, helps build tools and confidence in self-management, and helps keep children in school and engaged socially,’ Ms Ellis said.What’s the pharmacist’s role?
Parents reported that they often see their pharmacist first to discuss their child's pain condition. To expedite diagnosis and ensure appropriate care, Chronic Pain Australia has released a Pharmacist Guide which includes language tips for discussing pain with children, ways to explain pain, and what good pain management looks like. ‘Pharmacists should ask how long the pain has been present and validate that it’s challenging to live with,’ Ms Ellis said. ‘Emphasise the importance of seeing a local GP for assessment and early diagnosis.’ Other key language tips include using ‘lives with pain’ over ‘suffers from’. Pharmacists should also describe ‘bad” or ‘challenging’ days rather than ‘flare-ups’. ‘Link with local providers, such as occupational therapists, physiotherapists and psychologists – who understand different communication and treatment needs, including for neurodivergent children who may express pain differently,’ she said. When addressing children with neurodivergence, pharmacists should inquire how best to communicate with them, what topics to avoid and what information would help. ‘Communication should always be age-appropriate and family-centred,’ Ms Ellis said. ‘The goal is to create a friendly, approachable environment where children feel comfortable sharing, while parents can help fill in the picture when needed.’How should symptom management be approached?
Management approaches for chronic pain depend on the child, condition, and whether function improves, Ms Ellis said. ‘In paediatric pain medicine we try to avoid medicines and use them sparingly, but if a non-functional child becomes functional on a medicine that may restore quality of life – that should be central to pain management.’ Ms Ellis recalls an example of a 14-year-old girl prescribed an opioid to be taken before menstruation for 4–5 days. While some healthcare professionals were quick to label this approach an addiction risk, it perhaps kept her in school during severe periods while investigations took place for endometriosis or polycystic ovarian syndrome. ‘Pharmacists concerned about higher-risk medicines should focus conversations on functional benefit, asking “Is this improving your ability to do things?”’ she said. ‘If not, initiate a discussion about whether to continue therapy, given the potential harms.’ With her mum’s support and extensive physical therapies, Laura was able to walk into her first day of high school without a walking stick. While she has good and bad days and constant flare ups, there are wins along the way – such as being able to start carrying a backpack rather than relying on a roller case. ‘It’s an invisible disability with constant pain that isn’t linear – there are different levels and sensations all the time and that changes the way I approach daily life,’ Laura said. ‘[But] when mum said I will keep fighting for you – it was almost like a promise, and she’s always kept it.’ [post_title] => Early action prevents lifelong chronic pain in children [post_excerpt] => A new report lays bare the impact of chronic pain in young people. An expert shares practical steps for pharmacists to improve care. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => early-action-prevents-lifelong-chronic-pain-in-children [to_ping] => [pinged] => [post_modified] => 2025-09-22 16:18:00 [post_modified_gmt] => 2025-09-22 06:18:00 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=30559 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Early action prevents lifelong chronic pain in children [title] => Early action prevents lifelong chronic pain in children [href] => https://www.australianpharmacist.com.au/early-action-prevents-lifelong-chronic-pain-in-children/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 30562 [authorType] => )
td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30152 [post_author] => 8451 [post_date] => 2025-09-22 09:00:34 [post_date_gmt] => 2025-09-21 23:00:34 [post_content] =>The various dementias are a huge cause of death in Australia. Despite some light on the horizon, there are still no effective treatments. AP explores the latest in dementia research.
Dementia is the second leading cause of death in Australia.1 The number of people living with the disease is expected to increase substantially as the population ages, potentially straining health systems.2
Despite accelerated research, including trials of more advanced compounds and recent Victorian Government grants supporting mRNA-based projects, effective treatments remain elusive.3
According to Dementia Australia's Executive Director of Services, Advocacy and Research, Dr Kaele Stokes (she/her), an estimated 433,000 Australians are currently living with dementia, including 29,000 people living with younger-onset dementia (when symptoms emerge before age 65).1
While there have been important advances in pharmaceutical research in the dementia field in recent years, Dr Stokes says, new medicines to date have limited application, availability and efficacy, and they do not stop the progression of dementia.
It is important to ensure health systems support everyone living with dementia now, she adds, noting that the new medicines may not work for many people with the condition, particularly patients who have lived with dementia for some time.
‘We don’t have an approach here in Australia that focuses on the importance of brain health across the life course,’ she says.
‘While we’re good at picking up other diseases, such as cardiovascular disease or diabetes, and putting steps in place to ensure the risks of severity in those conditions are minimised, we don’t really have conversations about brain health in a healthcare setting.’
Diagnosing dementia for younger and older people
Dr Stokes says while diagnostic tools are improving, diagnosing dementia is still a complex process.
Dementia is still seen as an older person’s disease, she adds, and it can be difficult for a person in their 40s or 50s to receive a dementia diagnosis.
According to a 2025 study in Translational Psychiatry, young-onset dementia in people aged under 65 years globally increased substantially in prevalence and incidence between 1990 and 2021 compared with overall people with dementia – and with a higher burden on women.4 The three highest risk factors were smoking, high body mass index and high fasting plasma glucose levels, while population growth was the largest contributor to the significant increase.4
‘There’s still a real fear and stigma around wanting to talk about brain health or talking to a healthcare professional about concerns around changes in cognition,’ Dr Stokes says.
‘But actually there are lots of reasons why it’s important to do that. A mix of pharmacological and non-pharmacological interventions can make a difference to quality of life and reduce the stress that somebody might be experiencing.’
It is important for people to focus on modifiable risk factors, potentially reducing the risk of developing dementia by about 45% by avoiding smoking or drinking too much and by maintaining a healthy diet, exercising regulary, and ensuring hearing and vision problems are identified and dealt with, Dr Stokes says.
For those at later stages of their lives, it’s important to avoid social isolation and to keep the brain active, she adds.
‘Learning new things can be really important – stretching the brain, firing up the neurons, to keep your brain active.’
Pharmacological advances
Healthcare professionals have high hopes for the potential benefits of newly available monoclonal antibody treatments for Alzheimer’s disease.5
University of Melbourne and Florey Institute Professor of Dementia Research Colin Masters, widely recognised as a world expert in the field of neurodegenerative diseases, estimates there are about 100 compounds in the pharmaceutical pipeline presently that are progressing through the trial stages.
‘Better forms, more effective forms, are coming within the next couple of years,’ he declares. ‘We’ve got to learn how to use them and manage all the adverse effects as well.’ He is optimistic about the future of dementia treatments – potentially including a routine vaccination.
‘The writing is on the wall,’ he says. ‘If the passive immunotherapies work, then everyone will be working on an active vaccination program. In other words, at age 50 or whatever, you just run up to your primary care physician, they do a blood test, you’re on the pathway – you get a shot of peptide in your arm.’
The most promising drug now on the horizon is trontinemab, Prof Masters says. It's a reinvented form of the monoclonal antibody gantenerumab – a drug that didn’t make it to market because of a lack of efficacy. Even so, he adds, gantenerumab has been found effective for certain conditions. ‘We’ve been trialling it for nearly 10 years now,’ Prof Masters says, ‘and we published in Lancet Neurology9 [in June 2025] that in early-onset familial types of Alzheimer’s disease, gantenerumab in high doses was effective in pre-clinical disease in young individuals who are at 100% risk of developing Alzheimer’s disease.’ Trontinemab, he adds, is the natural successor to gantenerumab.
In April, Roche announced the results of a phase II trial of trontinemab delivered via the “Brainshuttle” system, which found ‘rapid and deep, dose-dependent reduction of amyloid plaques in the brain’.10 At the same time, Roche announced it would begin a phase III trial of the drug later this year.10
‘It’s the next generation; it’s a major advance,’ Prof Masters says, explaining that the bispecific molecule of trontinemab is designed to go straight across the blood-brain barrier, so doses of the drug can be far smaller.
‘It’s the first antibody designed to do this, and a lot of companies are copying it right now, because it works so well.’
According to data released from the Roche trials, trontinemab causes far fewer and less severe adverse effects than gantenerumab, he points out.
Other promising Alzheimer’s disease treatments include the monoclonal antibody donanemab. It is marketed as Kisunla by Eli Lilly, and in May 2025 it was approved by the Therapeutic Goods Administration.11
Lecanemab, marketed as Leqembi, has not yet been approved in Australia, but Prof Masters says full results of a pre-clinical trial are expected by the end of 2027 and he and his colleagues expect a positive result.
All these monoclonal antibody drugs are most effective in the early stages of Alzheimer’s disease, so early diagnosis is critical.12 In July this year, the Victorian Government also announced more than $537,000 in grants to two Florey researchers for two Alzheimer’s research projects.
These are aimed at treating and preventing the disease with mRNA technology, which was developed during the pandemic for COVID-19 vaccines.13
Pharmacist dementia support in the community
PSA’s Dementia Support Pharmacist Project in South Australia is an innovative project and model of practice aimed at keeping people with dementia at home and in the community for longer.14
Two pharmacists are employed on the project. They job-share to support clients with dementia medication management needs, understanding and choices, says South Australia and Northern Territory PSA Manager Helen Stone FPS (she/her).
The pharmacists act as patient advocates, provide flexible care for patients with complex comorbidities, and work with other members of the care team, including GPs, community pharmacists, nursing and care workers and families, she adds. Initial appointments are held in the patient's home, preferably with follow-ups either personally, by telephone or collaboration application such as MS Teams. A report prepared by the pharmacist is shared with the patient and, with consent, to treating medical and care teams, which may recommend an action plan to change or deprescribe medicines. Education about medicine use in dementia is also provided to health professionals and community groups across regional areas of the state.
‘This is a much-needed service; it is accessible, but there are a lot more people we can’t yet support,’ Ms Stone says. PSA has demonstrated that pharmacists working directly with patients and liaising with the care team can provide valuable support for patients with complex conditions and multimorbidities.
The project began in May 2024 and has been extended to June 2026. Ms Stone recently submitted a proposal to SA Health to expand the program and include a further five FTE pharmacists to cover metropolitan Adelaide.
Dementia care pharmacists can help with complex deprescribing of medicines and tapering of antidepressants where needed. They can provide professional advice to family members caring for patients with dementia that can empower carers as advocates in cases, for instance, of inadequate pain management.
Medicine administration frustrations can be avoided when dose time changes can be suggested.
Project pharmacist Dee-Anne Hull MPS (she/her) says pharmacist dementia support work helps in areas where it is needed most. ‘It has shown us where gaps in health care are in rural and remote areas of our state, but also within the pharmacy profession itself,’ she says. ‘A lot of pharmacists openly admit that dementia scares them, and they don’t really know where to start.
‘My advice is to make this an area of focus for CPD activities; check out the numerous PSA resources available, particularly those on palliative care and deprescribing, but also check out websites like Dementia Australia, Dementia Training Australia and the Wicking Dementia Centre,’ she adds.
‘Think about ways that you could support someone who is caring for a person living with dementia and the carer’s burden that may be associated with this, because that’s often where the support is needed the most.’
Positive response
Dementia Support Pharmacist Project pharmacist Nicola Sander MPS (she/her) says she has seen ‘overwhelming support and positive feedback’ for the project.
‘We have seen considerable benefit for people who are still living at home and are trying to manage their medicines.
Ms Sander sees this dementia support career pathway as ideal for an early career pharmacist and suggests that training in deprescribing and dementia-specific areas would be useful.
After a lengthy consultation with one client living at home, the client’s family and her doctor, Ms Sander recommended medicine management changes. The doctor was reluctant, so the client’s daughter found a doctor who was willing to be part of a multidisciplinary team, Ms Sander says, which included deprescribing strategies and pain support management.
After a recent visit to the geriatrician, the client’s daughter reported that her mother’s Mini‐Mental State Examination had improved from 12/30 to 19/30.
The daughter and the geriatrician attributed the client’s improvement to ‘better control of pain and overall improvement to her mood, as she has felt more supported and less depressed' since.
Ms Stone, whose Churchill Fellowship palliative care research – To articulate a framework for the role of Palliative Care Pharmacist in community and aged care in Australia – Churchill Trust15 – informed the Dementia Support Pharmacist Project, says that education, training and curiosity help pharmacists to start understanding dementia care more fully.
She encourages everyone to complete a Program of Experience in the Palliative Approach (PEPA) placement.
‘A dementia diagnosis can be devastating for people and their families; medications can have a benefit but can also impair cognition, so support from a pharmacist can be very valuable.'
References
[post_title] => Advancing dementia care in pharmacy [post_excerpt] => The various dementias are a huge cause of death in Australia. Despite some light on the horizon, there are still no effective treatments. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => advancing-dementia-care [to_ping] => [pinged] => [post_modified] => 2025-09-22 16:18:21 [post_modified_gmt] => 2025-09-22 06:18:21 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=30152 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Advancing dementia care in pharmacy [title] => Advancing dementia care in pharmacy [href] => https://www.australianpharmacist.com.au/advancing-dementia-care/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 30558 [authorType] => )
- Australian Institute of Health and Welfare. Dementia In Australia. 2024. At: www.aihw.gov.au/reports/dementia/dementia-in-aus/contents/population-health-impacts-of-dementia/deaths-due-to-dementia
- Dementia Australia. Dementia facts and figures. 2024. At: www.dementia.org.au/about-dementia/dementia-facts-and-figures
- Florey Institute for Neuroscience and Mental Health. Harnessing mRNA to prevent and slow Alzheimer’s disease. 2025. At: https://florey.edu.au/news/2025/07/harnessing-mrna-to-prevent-and-slow-alzheimers-disease/
- He Q, Wang W, Zhang Y, et al. Global burden of young-onset dementia, from 1990 to 2021: an age-period-cohort analysis from the global burden of disease study 2021. Transl Psychiatry 2025. Epub 2025, 17 February.
- Ramanan VK, Armstrong MJ, Choudhury P, et al. Antiamyloid monoclonal antibody therapy for Alzheimer disease. Neurology 2023;101(19)842–52. At: www.neurology.org/doi/10.1212/WNL.0000000000207757
- World Health Organization. Dementia. 2025. At: www.who.int/en/news-room/fact-sheets/detail/dementia
- Mayo Clinic. Alzheimer’s disease. 2025. At: www.mayoclinic.org/diseases-conditions/alzheimers-disease/symptoms-causes/syc-20350447
- Eyting M, Xie M, Michalik F, et al. A natural experiment on the effect of herpes zoster vaccination on dementia. Nature 2025. Epub 2025 2 April. At www.nature.com/articles/s41586-025-08800-x
- Safety and efficacy of long-term gantenerumab treatment in dominantly inherited Alzheimer's disease: an open-label extension of the phase 2/3 multicentre, randomised, double-blind, placebo-controlled platform DIAN-TU trial. Bateman, Randall J et al. Lancet Neurology 2025; 24(4):316–30.
- Roche. Roche presents novel therapeutic and diagnostic advancements in Alzheimer’s at AP/PD 2025. 2025. At: www.roche.com/media/releases/med-cor-2025-04-03
- Burge K. Treatment to slow early Alzheimer’s gets TGA approval. newsGP 2025. At: www1.racgp.org.au/newsgp/clinical/treatment-to-slow-early-alzheimer-s-gets-tga-appro
- Promising results of new Alzheimer’s drug published – early diagnosis is key. 2023. At: www.dementia.org.au/media-centre/media-releases/promising-results-new-alzheimers-drug-published-early-diagnosis-key
- Victoria State Government. mRNA Victoria. Research. July 2025. At: https://djsir.vic.gov.au/mrna-victoria/research
- Sander N, Jull DA. Bridging the gap: how dementia support pharmacists are transforming care in rural South Australia. Issue 91. June 2, 2025. At: https://ruralhealth.org.au/partyline/bridging-the-gap-how-dementia-support-pharmacists-are-transforming-care-in-rural-south-australia/
- Stone H. To articulate a framework for the role of the palliative care pharmacist in community and aged care in Australia. Winston Churchill Trust 2025. At: www.churchilltrust.com.au/project/to-articulate-a-framework-for-the-role-of-palliative-care-pharmacist-in-community-and-aged-care-in-australia/
td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30542 [post_author] => 8451 [post_date] => 2025-09-17 11:29:30 [post_date_gmt] => 2025-09-17 01:29:30 [post_content] => Pharmacists are asked to lead the shift from reliever-only inhalers to inhaled corticosteroid-containing regimens and to minimise short courses of oral corticosteroids. Just under 3 million Australians live with asthma. The condition has the eighth-highest disease burden in the nation, and it is one of the most significant chronic conditions in children. Guided by the results of large trials, recommendations for asthma management in adults and adolescents are changing, and pharmacists need to be aware of updated guidelines. The Australian Asthma Handbook was updated yesterday (16 September 2025) to reflect new thinking on asthma care and management.What are the key updates?
Three key changes have been made to the Australian Asthma Handbook, including:
- All adults and adolescents with confirmed asthma should be taking inhaled corticosteroid-containing treatment and not as-needed short-acting beta2-agonists (SABAs) alone. Asthma can be well controlled with maintenance and reliever therapy, and a small proportion of patients with severe asthma may be eligible for biologics.
- An emphasis on the importance of limiting oral corticosteroids, which have been associated with a range of different harms, including damage to bone health, cataracts and type 2 diabetes.
- Health professionals should be aware the handbook has greater guidance for treating children aged 1–5 who are living with asthma and a recommendation that some older children should also be on low-dosage ICS maintenance therapy.
Why have the guidelines been updated?
Overuse of SABAs has been linked to poor asthma control and preventable hospitalisations. ‘The evidence is that the risks of SABA alone have become clearer and that we were overusing a not very effective and not very safe therapy,’ said Professor Nick Zwar, Executive Dean of Bond University’s Faculty of Health Sciences and Medicine, and Chair of the Australian Asthma Handbook Guidelines Committee. ‘Budesonide-formoterol, taken only as needed, is recommended in place of SABA. Maintenance and reliever therapy is now recommended as the next step up.’ The risks of SABA overuse include a lack of bronchodilator response over time, and the possibility that some people may have quite a severe asthma attack and end up in the hospital emergency department (ED), or hospitalised, when they don’t need to be. There is very strong evidence to demonstrate that all adolescents and adults living with asthma should be treated with ICS, said pharmacist and Clinical Executive Lead at the National Asthma Council Australia, Debbie Rigby FPS. ‘Just having the SABA alone only treats one component of asthma, which is the bronchoconstriction, whereas having the low-dose ICS helps manage the inflammation and mucus production,’ she said. ‘I think that’s the biggest shift for us, pharmacists and doctors: helping patients to understand that asthma is a chronic inflammatory condition.’What are the risks of poor asthma control?
Inadequately managed asthma can be a life-threatening condition, Ms Rigby stressed, noting there were 474 asthma-related deaths in Australia in 2023. ‘Those deaths shouldn’t be happening. Many of those people who did die from asthma or asthma-related causes would have been perceived as having mild, intermittent symptoms,’ she said. ‘Without wanting to scare patients, we should be really highlighting the consequences of not having good control of their asthma.’Why is SABA still overused?
Despite access to long-acting beta2 agonists (ICS–LABAs), SABA use remains high for a range of reasons. These include cost, convenience and patient reluctance to medicate every day when they are accustomed to using a reliever-only when they have an asthma attack, Ms Rigby said. Health professionals understand that many people are reluctant to use a preventer inhaler, but health professionals need to help them understand that they have a ‘chronic inflammatory condition, which may flare up from time to time’. Effects of the cost-of-living crisis should not be underestimated either. However, the price gap between over-the-counter salbutamol and prescription asthma medicines is now narrowing, with 60-day dispensing for patients who are stable and, from January 2026, the co-payment for medicines being reduced from $31.60 to $25 per prescription. The Australian uptake of Maintenance and Reliever Therapy (MART) has also been slow, despite strong evidence and subsidy on the Pharmaceutical Benefits Scheme. The evidence of large-scale trials has shown the importance of shifting patients with mild asthma onto anti-inflammatory reliever therapy on an as-needed basis, Ms Rigby said. ‘The evidence basically says it reduces the risk of severe exacerbations requiring ED or hospitalisation, or requiring oral corticosteroids,’ she said. For practical guidance on discussing the guideline changes with patients, the role of prescribing pharmacists, and how biologics fit into care, don’t miss the October cover story in Australian Pharmacist. [post_title] => New asthma guidelines released [post_excerpt] => Pharmacists are asked to lead the shift from reliever to inhaled corticosteroid regimens and to minimise use of oral corticosteroids. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => new-asthma-guidelines-released [to_ping] => [pinged] => [post_modified] => 2025-09-17 17:13:31 [post_modified_gmt] => 2025-09-17 07:13:31 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=30542 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => New asthma guidelines released [title] => New asthma guidelines released [href] => https://www.australianpharmacist.com.au/new-asthma-guidelines-released/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 30545 [authorType] => )
td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30154 [post_author] => 11158 [post_date] => 2025-09-17 08:26:54 [post_date_gmt] => 2025-09-16 22:26:54 [post_content] =>Case scenario
Ashley, a 23-year-old female, presents to your pharmacy with a prescription for a 7-day course of doxycycline 100 mg twice daily. She tells you she has had some mild vaginal discharge and that her STI screen has come back positive for vaginal chlamydia. You establish that she is currently taking ferrous sulfate 325 mg once daily as she is vegan, isotretinoin 30 mg once daily for acne, and has an etonogestrel implant in situ. She has no known allergies.
Note: The authors recognise that gender identity is fluid. In this article, the words and language we use to describe genitals and gender are based on the sex assigned at birth.
Learning objectivesAfter reading this article, pharmacists should be able to:
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Chlamydia and gonorrhoea are two of the most prevalent bacterial sexually transmitted infections (STIs) globally.1,2 They are preventable and curable infections that are usually transmitted through vaginal, oral or anal sex.1,2 Conjunctival infection can occur in neonates born to mothers carrying a chlamydia or gonorrhoea infection, or in adults via exposure to genital secretions.1–4 Both chlamydia and gonorrhoea can lead to serious health complications if left untreated, ranging from effects on fertility and pregnancy to blindness (in untreated ocular gonorrhoea infection).1,2
Chlamydia is caused by the gram-negative bacterium Chlamydia trachomatis.2 Gonorrhoea is caused by the gram-negative bacterium Neisseria gonorrhoeae.1
Chlamydia is relatively simple to treat, being susceptible to doxycycline and azithromycin.5 Gonorrhoea treatment may be more challenging due to emerging antimicrobial resistance to first-line treatments, particularly in urban Australia.6 All people diagnosed with chlamydia and gonorrhoea should be offered antibiotic treatment to resolve symptoms, prevent complications and to decrease transmission to others.1,2
Pharmacists can support patients by providing information on safe-sex practices, any prescribed medicines, in addition to providing advice or referring where appropriate.
The World Health Organization (WHO) estimates there were around 128.5 million new infections with C. trachomatis in 2020 among adults aged 15–49 years globally.2 In Australia, those under 30 years of age are at greatest risk of infection.5 There were 102,222* cases of chlamydia notified to the Australian government’s National Notifiable Diseases Surveillance System (NNDSS) in 2024, with an almost equal distribution of infection between males and females.7 This was an increase of almost 20% compared to the 86,810 case notifications in 2014.7 Across all ages, infections in females over this time period remained similar, however infections in males increased by approximately 40%.7
The WHO estimates that 82.4 million adults aged 15–49 years old acquired gonorrhoea worldwide in 2020.1 In Australia, gonorrhoea is most prevalent in men who have sex with men (MSM), remote Aboriginal and Torres Strait Islander communities, street-based sex workers, and returned travellers reporting sex overseas (in high prevalence countries).6,8 In recent years, there has been a rise in prevalence in the general population, especially in females of reproductive age.6 There were 44,547* cases of gonorrhoea notified to the NNDSS in 2024.7 This is almost triple the 15,674 cases notified in 2014.7
Co-infection with both chlamydia and gonorrhoea is relatively common.9 A study of high-prevalence Aboriginal communities in remote Australia found half of female and one-third of male participants aged 16–19 had one or more STIs.10 Chlamydia and gonorrhoea were the most common co-infections.10
*Figures correct as of May 2025.
Chlamydia
Chlamydia is often described as the “silent STI” because 85–90% of infections are asymptomatic.5 If symptoms do appear, they may not present until up to 3 weeks after sexual contact with an individual with chlamydia infection.2
Common chlamydia symptoms for males include2,5:
For females, symptoms include2,5:
Gonorrhoea
Gonorrhoea symptoms usually appear within 2 weeks of exposure.1 Infection is usually asymptomatic in females.1
If symptoms occur in females, they include1,4,6:
In contrast for males, penile urethral gonorrhoea is almost always symptomatic and symptoms may include1,6:
Complications
Untreated chlamydia and gonorrhoea can lead to various complications in both males and females, highlighting the need for prompt identification and treatment of infection.
Table 1 outlines some complications associated with untreated C. trachomatis and N. gonorrhoeae infection.
Molecular testing should be undertaken for those suspected of having chlamydia or gonorrhoea, or those at risk of infection. Certain groups (e.g. MSM, pregnant people, sex workers, Aboriginal and Torres Strait Islander people, gender diverse and transgender people) require special testing approaches due to increased risk of infection, adverse health outcomes or community prevalence.11 A full STI check-up including HIV and syphilis serology at initial presentation is recommended.11
Chlamydia is diagnosed via nucleic acid amplification tests (NAATs) (e.g. polymerase chain reaction [PCR]).5 NAATs are highly sensitive and the only recommended test for chlamydia.5 Microbiological culture of C. trachomatis is difficult and not routinely recommended.12
NAATs are also used to diagnose gonorrhoea.6 They are highly sensitive but do not provide any information on antibiotic susceptibility.6 Gonococcal microbiological culture has high specificity and allows for antibiotic susceptibility testing, but is less sensitive than NAATs.6
Some differential diagnoses for genital tract chlamydia infection may include lymphogranuloma venereum, gonorrhoea, bacterial vaginosis, vaginal candidiasis, trichomonas or Mycoplasma genitalium infection.13 For gonorrhoea, other conditions such as chlamydia, trichomonas, vaginal candidiasis, bacterial vaginosis or urinary tract infections may cause similar symptoms.14
Anatomical sites sampled for chlamydia and gonorrhoea testing will depend on the individual’s presentation, sexual history and risk factors.5,6 Self-collection of samples for testing by NAAT is common practice for asymptomatic patients.5 In symptomatic patients undergoing examination, a swab can be taken by the clinician (e.g. an endocervical swab if a speculum examination occurs).5,6 First-pass urine can be tested in people without a vagina (or if a vaginal swab cannot be taken) – it is less sensitive than a self-collected vaginal swab.5,6 An anorectal swab is recommended for all individuals who have anorectal symptoms, and for all MSM regardless of whether they are symptomatic.5,6 Similarly, a pharyngeal swab for NAAT is recommended for MSM for both gonorrhoea and chlamydia, even if asymptomatic.5,6
Gonococcal culture
Gonococcal cultures should be collected from all infected sites prior to commencing treatment to determine antibiotic susceptibility and to contribute to antimicrobial resistance surveillance.6 It is recommended that a culture is performed on a site if an individual is experiencing symptoms at that site.6 Pending culture results should not delay commencing treatment, and antibiotics can be administered prior to receiving the culture results.6
The goals of treatment for both chlamydia and gonorrhoea are to resolve symptoms, reduce complications and prevent transmission and reinfection. Sometimes a clinical diagnosis is made based on symptoms and risk factors. Certain presentations may warrant starting empiric treatment while awaiting confirmation of results. Examples include patients presenting with anorectal symptoms, symptoms of PID or epididymo-orchitis, where timely treatment is critical.15–17
Chlamydia
Doxycycline is the standard first-line therapy for chlamydia.5,18 Azithromycin is an alternative option if doxycycline is contraindicated (e.g. in pregnancy, if there are adherence or medicine interaction concerns).3,18
Previously, azithromycin was the first-line treatment, as it was a convenient single dose. However, a meta-analysis showed azithromycin 1 g orally may be up to 20% less efficacious than 7 days of doxycycline when treating anorectal chlamydia. A subsequent randomised trial of 625 Australian MSM with asymptomatic anorectal chlamydia demonstrated consistent findings.19,20 Azithromycin is also increasingly implicated in antimicrobial resistance for other STIs, therefore doxycycline is preferred.21
Gonorrhoea
The recommended treatment for gonorrhoea infection in Australia is ceftriaxone in combination with azithromycin.6 The recommended dose of oral azithromycin varies depending on the site of infection.4 The current combination treatment approach is highly effective and important in reducing the contribution to more widespread antimicrobial resistance.4,6 However, reduced susceptibility to these agents has been increasingly reported in urban Australia.6 Until recently, the combination of amoxicillin, probenecid and azithromycin was still recommended for gonorrhoea in some remote Australian areas. However, this changed to ceftriaxone with azithromycin, due to an increase in penicillin resistance in remote communities in the Northern Territory.22
Antimicrobial resistance is a growing problem in the treatment of gonorrhoea.1 Resistance to penicillin, tetracyclines, macrolides, sulphonamides and quinolones has been detected.23 Gonococcal surveillance programs are in place in some countries to track resistant strains.
Table 2 provides a summary of the current treatment approach for various presentations of chlamydia and gonorrhoea infection in Australia. Uncomplicated chlamydia or gonorrhoea infection refers to localised urogenital, anogenital, pharyngeal and ocular infections that are not associated with bacteraemia or ascending spread to other organs.24,25 Complicated infections and their treatment is beyond the scope of this article, as are other infections associated with C. trachomatis.
Consistent and correct condom use can prevent the transmission of chlamydia and gonorrhoea.1,2 There is currently no available vaccine to prevent either infection. The serogroup B meningococcal vaccine (4CMenB) is currently being investigated for its ability to provide cross-protection against N. gonorrhoeae.26
The use of doxycycline to prevent bacterial STIs (doxycycline post-exposure prophylaxis [doxy-PEP]) can offer protection against acquiring syphilis, chlamydia and, to a lesser extent, gonorrhoea, if taken within 72 hours of unprotected sexual intercourse.27 Controversy remains on whether the risk of changes to the microbiome and potential increased antimicrobial resistance as a result of using doxy-PEP outweighs the benefits of preventing these STIs, with research ongoing.27
Sexual contact should be avoided for 7 days after chlamydia and/or gonorrhoea treatment is commenced, or until the treatment course is completed and symptoms have resolved, whichever is later.5,6 Patients should be advised not to have sex with partners from the last 6 months for chlamydia, or the last 2 months for gonorrhoea, until partners have been tested and treated, if necessary.5,6 Notification of sexual partners is recommended and can be done anonymously by patients via websites such as Let Them Know (https://letthemknow.org.au/).5,6 With the consent of the patient, a clinician may support with contact tracing if necessary.
Reinfection with chlamydia and gonorrhoea is common.5,6 Retesting at 3 months is recommended to detect reinfection.5,6 A test of cure is not routinely recommended for chlamydia, except in specific circumstances (e.g. in pregnancy).5 A test of cure is recommended for gonorrhoea in cases where a culture was not collected before treatment, the culture indicated antimicrobial resistance or if a non-standard treatment regimen was used.6 Screening for other STIs should be performed if not done at the initial presentation.5,6
Patient-delivered partner therapy (PDPT) is where antibiotic treatment is prescribed or supplied for the sexual partner(s) of a patient diagnosed with chlamydia (index patient).5 The prescription or treatment is given directly to their partner(s) by the index patient.5 In jurisdictions where PDPT is approved, it can be considered for heterosexual index patients with anogenital or oropharyngeal chlamydia, whose partners are unlikely to seek chlamydia testing or treatment.5 PDPT can also be considered with cases of repeat infections where partners have not been treated.5 Guidance on PDPT for chlamydia is available in Victoria, New South Wales and the Northern Territory.5 The decision to use PDPT should be weighed against the potential to miss co-infections or complications in the partner(s) of the index patient.
Pharmacists may be among the first healthcare professionals that patients approach for guidance and treatment for STIs, particularly if presenting with symptoms of infection. Recognition of symptoms that may warrant onward referral to a medical practitioner is essential.
Pharmacists can support adherence to current recommended treatment regimens for STIs. This may include extended doxycycline courses, which ensures the resolution of infection and improves antibiotic efficacy.28 Pharmacists can also encourage patients to notify sexual partners regarding an STI diagnosis, enabling those partners to obtain timely treatment.
Doxy-PEP may be appropriate for some at-risk groups, providing an additional option to conventional STI prevention strategies. Evidence is building for doxy-PEP use and by following the Australasian Society for HIV, Viral Hepatitis & Sexual Health Medicine (ASHM) guidance, pharmacists can ensure they are providing evidence-based information to patients who wish to know more about this prevention strategy (see https://ashm.org.au/initiatives/doxy-pep-statement/).27
Chlamydia and gonorrhoea are two of the most prevalent bacterial STIs. Patients may be asymptomatic, and both can lead to serious complications if left untreated. Chlamydia is relatively easy to treat, however emerging antimicrobial resistance to first-line gonorrhoea treatments may complicate its management. Reinfection is common with both, and robust contact tracing of sexual partners is recommended.
Case scenario continuedAfter noting that doxycycline would need to be taken at least 2 hours before or after Ashley’s iron tablets, you also suspect an interaction with isotretinoin.28 You check the Australian Medicines Handbook (AMH), which highlights a risk of benign intracranial hypertension and that concurrent use should be avoided.29 You phone Ashley’s GP to recommend a safer, yet effective, alternative of azithromycin 1 g orally as a single dose. The GP and Ashley thank you for your help. |
Ivette Aguirre (she/her) BAppSc (MedLabSc), BPharm, GradCertPharmPrac, MClinPharm, FANZCAP (Inf Dis) is the senior clinical pharmacist at the Melbourne Sexual Health Centre (MSHC), a part of Alfred Health. She mentors pharmacists, technicians and pharmacy students during their rotations at MSHC, and is interested in the impact of pharmacist reviews in HIV clinics and emerging treatments for sexually transmissible infections such as Mycoplasma genitalium.
Kathryn (Kate) Mackie (she/her) BPharm, GradDipClinPharm, BCGP, FANZCAP (Inf Dis, Gen) is a senior clinical pharmacist at Alfred Health (including Melbourne Sexual Health Centre) and Barwon Health, working in infectious diseases, HIV, viral hepatitis and sexual health. With 20 years of experience in this area, she is engaged in clinical pharmacy research and contributes to undergraduate and health professional education.
Hana Numan (she/her) BPharm (NZ), PGDipClinPharm (NZ), MPS (NZ)
[post_title] => Chlamydia and gonorrhoea [post_excerpt] => Chlamydia and gonorrhoea are two of the most prevalent bacterial sexually transmitted infections (STIs) globally. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => chlamydia-and-gonorrhoea [to_ping] => [pinged] => [post_modified] => 2025-09-17 16:17:03 [post_modified_gmt] => 2025-09-17 06:17:03 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=30154 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Chlamydia and gonorrhoea [title] => Chlamydia and gonorrhoea [href] => https://www.australianpharmacist.com.au/chlamydia-and-gonorrhoea/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( [td_post_template] => single_template_4 ) [is_review:protected] => [post_thumb_id:protected] => 30528 [authorType] => )td_module_mega_menu Object ( [post] => WP_Post Object ( [ID] => 30516 [post_author] => 3387 [post_date] => 2025-09-15 12:20:04 [post_date_gmt] => 2025-09-15 02:20:04 [post_content] => Administered to the nasal mucosa, a spike-based formulation triggers rapid local defences that clear the COVID-19 virus where it enters. In 2022, a year after Australia’s longest COVID-19 lockdowns, researchers from the Centenary Institute and the University of Sydney received a grant of almost $1 million from the NSW COVID-19 Vaccine Acceleration Research Grants Program to develop an intranasal COVID-19 vaccine. Now, new research has been released by the team – finding that their formulation can stop infection in the nose before the virus spreads through the body, and to other people. [caption id="attachment_30517" align="alignright" width="150"]Dr Erica Stewart, Centenary Institute[/caption] Australian Pharmacist sat down with Dr Erica Stewart, first author and researcher at the Centenary Institute when the work was undertaken, to discuss how the vaccine works, its applications and why it could be the key to stopping the spread.
What is the vaccine’s mechanism of action?
By acting where the virus first enters, the nasal vaccine prompts a rapid, effective immune response that eliminates the virus, Dr Stewart said. ‘The adjuvant we used was Pam2Cys, a Toll-like receptor 2 (TLR2), and we showed that it was able to stimulate the immune response in the nasal passages,’ she said. ‘We formulated the SARS-CoV-2 spike protein with this adjuvant, which emulates bacteria to alert the immune system that there is a danger and it should respond.’ When administered as a booster after a standard injection, the treatment also provided additional protection to vital organs, including the lungs and brain – pointing to the benefits of focusing immune responses within the upper airways.Why target the nasal mucosa?
The nasal passage is an increasingly promising site for vaccine adjuvant formulation, Dr Stewart said. ‘It’s becoming more and more clear that the nasal passage is a very different immune environment to an injection in the muscle.’ Internationally, there are some other pre-clinical models of mucosal vaccines. ‘But most of those mucosal vaccines are viral vectors because there aren't a lot of vaccine adjuvants that have been found to be effective nasally, which is part of the novelty of this study,’ she said. The team had previously looked at intranasal vaccination in mice, using a model where the vaccine entered both the lungs and the nose. ‘However, the main takeaway from this research was, when [administering] a very small volume to just the nose, we still got a really strong immune response in the blood,’ she said. ‘We also looked into the nose itself, and we could see that the immune cells were retained for long periods in the nasal passages, where they will be able to respond to infection quickly.’ There’s hope that these vaccines can potentially prevent infection and transmission by building immune defences directly in the upper airways where the virus first takes hold – a frontier that traditional vaccines have yet to reach. ‘We currently reduce disease severity really well, but we're still trying to block transmission,’ Dr Stewart said. ‘That's what nasal vaccines are aiming to address.’Who would benefit most from a nasal COVID-19 vaccine?
Vulnerable populations who are more susceptible to severe disease, hospitalisations and death. ‘Sometimes you'll hear people say, “COVID-19 is over” – but people are still dying of it, including the elderly, immunocompromised people and those with other comorbidities,’ Dr Stewart said. Similar to how younger, healthy patients are advised to get the flu vaccine to protect more vulnerable members of the community – this vaccine offers an additional layer of protection. ‘It would be the vulnerable people who are benefiting, but the vaccine would be for everyone to try to reduce the circulation of the virus in our community,’ she said.How would the vaccine fit into the routine immunisation schedule?
With most people vaccinated against COVID-19 or exposed to the virus, the mucosal vaccines will likely be used as a booster. ‘In the mouse model, both the vaccine as a booster or as a primary vaccination induced nasal immunity,’ Dr Stewart said. It’s assumed that the nasal vaccine will be used as an annual seasonal dose, similar to the flu vaccine or COVID-19 boosters for certain populations. ‘We do have some evidence that the vaccine can neutralise against other variants, but [we need to explore] how well it protects people and for how long, because that would indicate whether continuous boosters are needed,’ she said. It’s also anticipated that the nasal vaccine will be self-administered. ‘There are studies looking into self-administration of nasal vaccines, which could really help with distribution and access to these vaccines in the community,’ she said. This mode of administration could be particularly beneficial for those who are needlephobic, including children. ‘For people who cannot stand getting a needle, this is a less invasive method of vaccination,’ Dr Stewart said. The researchers say that while more work is needed, the results show strong potential for nasal vaccines to complement existing COVID-19 vaccines and provide an extra layer of protection against the virus in the future. [post_title] => Intranasal vaccine stops infection at the source [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => intranasal-vaccine-stops-infection-at-the-source [to_ping] => [pinged] => [post_modified] => 2025-09-15 13:32:22 [post_modified_gmt] => 2025-09-15 03:32:22 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=30516 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Intranasal vaccine stops infection at the source [title] => Intranasal vaccine stops infection at the source [href] => https://www.australianpharmacist.com.au/intranasal-vaccine-stops-infection-at-the-source/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 30519 [authorType] => )
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Australian Pharmacist is the official journal for Pharmaceutical Society of Australia Ltd.