Information for health professionals

Consider:

• contact of an STI
• past medical and STI history
• medications, allergies (emphasise antibiotics) and contraception
• last menstrual period
• vaccination history
• recreational drug use.

Check for:

• symptom onset, character, periodicity, duration and relation to sexual intercourse and urination
• similarity to previous problems
• any STI in sexual partner(s)
• anogenital discharge and/or dysuria
• dyspareunia and/or pelvic pain
• ulcers, lumps, rashes or itching.

Ask about:

• any sexual partner(s) and date of last sexual exposure and others in the last three months
• sex of partner(s) including and history of male-to-male contact
• type of intercourse – oral, vaginal, anal
• sex overseas or in high risk areas like beats and saunas
• any history of injecting drug use, what drug, how often
• any tattoo history or blood product exposure.

Urethral swab. 1 to 2 cm inside meatus or of pus performed in symptomatic men for:

• gram stain
• culture and sensitivity on gonorrhoea specific medium
• wet prep if trichomonas suspected (low yield)
• chlamydia NAAT taken 3 to 4 cm down urethra not routinely performed.

Ulcer swab:

• ferpes simplex virus (HSV) NAAT
• syphilis NAAT if clinical suspicion.

Urine sample. First catch urine for:

• chlamydia and gonorrhoea NAAT in symptomatic or asymptomatic men
• mycoplasma genitalium NAAT in symptomatic men
• trichomonas NAAT if history suggests exposure.

Men who have sex with men

The following need to be conducted in addition to the above specimen collection and tests recommended for men.

Throat swab:

• chlamydia and gonorrhoea NAAT in symptomatic and asymptomatic men

Rectal swab:

• best obtained through direct inspection with proctoscope
• if proctoscopy unavailable blind swabs are possible
• chlamydia and Gonorrhoea NAAT in symptomatic and asymptomatic men
• if proctitis clinically diagnosed perform culture and sensitivity on gonorrhoea specific medium.

Vaginal wall swab:

• gram stain for candida and bacterial vaginosis
• culture and sensitivity including candida specific medium.

Vagina posterior fornix:

• pH
• wet prep for trichomonas
• trichomonas vaginalis NAAT if history suggests exposure.

Endocervical swab:

• chlamydia and gonorrhoea NAAT in symptomatic and asymptomatic women
• culture and sensitivity on gonorrhoea specific medium in symptomatic women
• mycoplasma genitalium NAAT if history suggests exposure.

Pap smear:

• Pap smear if abnormal cervix or screening PAP due.

Ulcer swab:

• HSV NAAT
• syphilis NAAT if history suggests exposure

Rectal swab. If anal sex on history:

• best obtained through direct inspection with proctoscope
• if proctoscopy unavailable blind swabs are possible
• chlamydia and gonorrhoea NAAT in symptomatic or asymptomatic women
• if proctitis clinically diagnosed perform culture and sensitivity on gonorrhoea specific medium.

Urine sample:

• First void urine can be tested for chlamydia by NAAT if endocervical swabs not possible.

Vaginal swab. Self collected vaginal swab:

• suitable for asymptomatic screening
• chlamydia and gonorrhoea NAAT.

Female sex workers

The following need to be conducted in addition to the above specimen collection and tests recommended for women.

Throat swab:

• chlamydia and gonorrhoea NAAT.

• Test at first visit
• subsequently as determined by risk markers:
  • Aboriginal
  • Asian born
  • men who have sex with men
  • injecting drug users
  • sex workers
  • overseas sex contact
  • sexual contacts of the above.

• Test at at first visit
• subsequently as determined by risk markers:
  • injecting drug users
  • tattooing
  • receptive anal intercourse
  • blood product exposure out of Australia.

• Test at each visit
• when syphilis is suspected on clinical grounds
• if Human immunodeficiency virus (HIV) infection has been diagnosed.

• Test at each visit.

Antibiotic therapy or other treatment is provided in accordance with recommendations.

Patient education should cover the following:

• natural history of the disease
• sequelae and method of transmission
• the treatment and side effects
• necessity of follow up and investigation and treatment of sexual partners
• public health law specific to notifiable diseases
• use of condoms and abstinence if required following treatment.

Notifiable sexually transmitted infections should be contact traced to allow for timely and appropriate treatment of sexual partners.

At least one follow up visit is essential in order to:

• assess response and compliance to treatment
• assess for side effects of treatment
• determine whether sexual intercourse has occurred since treatment
• perform investigations to demonstrate cure where appropriate
• confirm contact tracing and treatment of sexual partners.

• Local
  • South Australian STI Guidelines – SA Health
• National
  • Australian STI Guidelines for use in Primary Care – ASHM
  • Australian Sexually Transmitted Infection &Hiv Testing Guidelines 2014 for Asymptomatic Men Who Have Sex With Men [broken link - is there a replacement or remove]

• STI/HIV Testing tool [broken link - is there a replacement or remove]
• Self collection of STI specimens [broken link - is there a replacement or remove]

• Australasian Contact Tracing Manual – ASHM
• Let Them Know – Let Them Know notification service
• The Drama Down Under – The Drama Downunder notification service
• Better to Know – Better to Know notification service

• PrEP Access Now, for information on privately importing PrEP – PAN

• SAMESH – South Australian Mobilisation + Empowerment for Sexual Health
• PEACE – Multicultural service, Relationships Australia SA
• AHCSA – Aboriginal Health Council of South Australia
• MOSAIC – Blood borne viruses support service, Relationship Australia SA
• SHINE SA – Sexual health and relationship wellbeing service

• British Association for Sexual Health and HIV (BASHH)
• Centres for Disease Control and Prevention
• Sexual and Reproductive Health - World Health Organization