Sexually Transmitted Infections

How to get started with an STI discussion?

• Bringing the subject up opportunistically

“ We are offering Chlamydia testing to all sexually active people under the age of 25, would you like to have a test while you’re here or find out more about Chlamydia?”

• Using a ‘hook’

“ Have you heard about HBV or HPV vaccination? They protect against infections that can be sexually transmitted, perhaps we could discuss these while you’re here?”

• As part of a reproductive health consultation

“ Since you’re here today for a pap smear/to discuss about contraception could we also talk about some other
aspects of sexual health, such as an STI check up?”

• Because the patient requests a “checkup” for STIs

“ I’d like to ask you some questions about your sexual activity so that we can decide what tests to do, is that OK?

How to do brief sexual history?

• Are you currently in a relationship?
• In the last 3 months, how many sexual partners have you had? How many partners have you had in the past 12 months?
• Were these casual or regular partners?
• Were your sexual partners male, female or both?
• When was the last time you had vaginal sex/oral sex/anal sex without a condom?
• In the past year were you ever paid for sex?
• Have you previously been diagnosed with an STI?
• Is there anything else that is concerning you?

It is important to find out other risk behaviours

• Have you had any tattoos? If yes, was that here in Australia or overseas?
• Have you ever injected drugs?
• Have you ever shared needles or injecting equipment?
• Have you ever been in gaol?

Which test choices are suitable?

• A sexually active young person under 25 years

PCR for chlamydia - First pass urine OR Self-collected vaginal swab OR Endocervical swab
Consider vaccination for HBV & HPV

• A sexually active Aboriginal young person under 25 years

PCR for chlamydia & gonorrhoea - First pass urine OR Self-collected vaginal swab OR Endocervical swab
Blood test for HBV infection
Consider vaccination for HBV & HPV

• An (asymptomatic) person of any age requesting “a STI checkup”

PCR for chlamydia - First pass urine OR Self-collected vaginal swab OR Endocervical swab
Blood test for HBV , HIV and syphilis infection
Consider vaccination for HBV & HPV

• A man who has sex with men (MSM)

Chlamydia PCR - First pass urine & anal swab
Gonorrhoea PCR - Throat swab & Anal swab
Blood test - HIV, Syphilis, HAV & HBV
Vaccinate for HAV & HBV

• A sex worker

Chlamydia & Gonorrhoea PCR - First pass urine OR Self-collected vaginal swab OR Endocervical swab
Blood test - HIV, Syphilis & HBV
Vaccinate for HBV

• A person who injects drugs

Chlamydia & Gonorrhoea PCR - First pass urine OR Self-collected vaginal swab OR Endocervical swab
Blood test - HIV, Syphilis, HBV & HCV
Vaccinate for HBV

How to do contact tracing?

• Introduce the reasons for contact tracing.

‘It’s really important your partner(s) gets treated so you don’t get the infection again’.
‘Most people with an STI don’t know they have it because they have no symptoms, but still could have complications
or pass it onto a partner’.

• Help identify which partner(s) need to be informed

Use a non-judgemental approach; some people have more than one sexual partner and all can be treated.
‘Try thinking back to when and where you have had sex recently or any special events’.

• Explain the methods and offer choice.

Different methods (in person, phone, SMS, email or letter) might be needed for each partner.
Patient Initiated Referral: Your patient chooses to notify their own contacts; you discuss with them the information they
will provide to their contacts.
Provider Initiated Referral: You, your delegate or another health agency informs the patient’s contacts; get the consent
of your patient; it can be anonymous or not depending on the wishes of your patient. It is indicated in the followings:

• HIV, syphilis and gonorrhoea due to higher morbidity.
• Repeat infections as a partner may not have been tested and treated.
• Within Aboriginal & Torres Strait Islanders communities due to
• stigma and issues around confidentiality.
• Incarcerated or detained partners may be more difficult to contact.
• Casual or ex-partners who are less likely to be notified.
• If the patient requests.

• Support Patient Initiated Referral

– Provide specific STI information – written or web links.
– Discuss how a partner might react and problem solve with the patient.
– Remind them partners could be contacted by telephone, in person, SMS, email or letter. All can be anonymous or not.
– www.letthemknow.com.au
– www.thedramadownunder.info for MSM*
– Your practice staff may be able to assist your patient to send an SMS or email before they leave your clinic.
It is a quick and easy option.
– Provide treatment letter(s) to be given to contacts; see www.gpnsw.com.au for downloadable templates.
– Schedule a follow up visit or phone call to determine if the patient was able to inform their partners. If not notified, offer
further assistance.

• Document discussions in patient notes.

How Far Back in Time to Trace

Contact tracing is not recommended in warts and herpes as there is little proven benefit
Chlamydia - 6 months
Gonorrhoea - 2 months
Syphilis

• Primary syphilis – 3 months plus duration of symptoms
• Secondary syphilis – 6 months plus duration of symptoms
• Early latent syphilis – 12 months

HIV - Start with recent sexual or needle-sharing partners; outer limit is onset of risk behaviour or last known negative result
Hepatitis B -

• 6 months prior to onset of acute symptoms
• For newly acquired cases contact your local public health unit (PHU) &/or specialist physician

Hepatitis C

• 6 months prior to onset of acute symptom; if asymptomatic, according to risk history
• For newly acquired cases contact your local PHU &/or specialist physician

Note - rarely sexually transmitted, usually only in HIV co-infection