Sexual Health

Question 1

What are the most common STIs in general practice?

Answer 1

1. Chlamydia
2. Gonorrhoea
3. Hepatitis B
4. Syphilis
5. HIV

Question 2

Epidemiology of chlamydia

Answer 2

> 80% occurs in people <29y
up to 75% are asymptomatic
Rates are higher in ATSI and MSM

Question 3

What is the approximate risk of infection with STI in asymptomatic sexually active patients <29y

Answer 3

5% for chlamydia

0.5% for gonorrhoea

Question 4

Burden of chlamydia infections

Answer 4

Women with untreated chlamydia have a 2-8% risk of infertility (annual screening of women <25 halves this rate)

Untreated pregnant women with chlamydia have a 20-50% chance of infecting their infant at delivery

Question 5

Important information to gauge from a sexual history

Answer 5

Demographic features
Recent sexual activity
Gender and number of partners
Contraception and barrier methods
Travel history
Immunisation status (hep A and B)
Other risk factors for blood-borne infections
Pre-existing medical conditions, esp other STIs
Known sexual contact with an STI

Question 6

Low -average risk of STI group and screening recommendations

Answer 6

Heterosexual, non-ATSI asymptomatic patients 20-29y living in metropolitan location

Urine, cervical or genital PCR for chlamydia
Confirm HBV immune status
Consider other infections based on risk assessment
Opportunistic screening - aim for annual

Question 7

Medium-high risk of STI group and recommendations for screening

Answer 7

<20y age
Living in rural or remote location

Urine, cervical or genital chlamydia PCR
Confirm HBV immune status
Consider other infections based on risk assessment
Opportunistic screening as indicated - aim for annual

Question 8

Who is considered higher risk for STIs and what is recommended screening

Answer 8

ATSI people
People who inject drugs
Sex workers

Test for chlamydia and gonorrhoea
Serology for HIV, syphilis and Hepatitis A and B (if not immune)
Hep C serology if IVDU

Offer Hepatitis A/Ba vaccine if not immune

Recommend every 12 months

Question 9

Who is considered highest risk for STIs and recommended screening

Answer 9

Asymptomatic MSM
Higher still if:
- unprotected anal sex
- >10 partners in past 6 months
- Participate in group sex
- use recreational drugs during sex
- HIV positive

Urine, throat and rectal swabs for chlamydia and gonorrhoea
Serology for HIV, syphilis and Hepatitis A/B
Offer hepatitis A and B vaccination if not immune
Every 12 months unless in higher risk category, then up to every 3months

Question 10

Management sexual contacts of known STI

Answer 10

Test and treat presumptively while awaiting results for gonorrhoea and chlamydia +/- other screening based on individual risk

Question 11

Screening of syphilis in pregnancy

Answer 11

At booking
Those at high risk: repeat at 28 weeks and at delivery

During outbreak e.g. ATSI women from high risk area or women with ATSI partners from high risk area: booking, 28/40, 36/40, ,at delivery and 6 weeks postnatal

Question 12

How to test for chlamydia

Answer 12

Men: FPU NAAT
MSM: +/- throat and ano-rectal NAAT

Women:

• endocervical NAAT
• self-collected NAAT swab
• FPU NAAT
• Ano-rectal NAAT if symptomatic or history of anal sex (can be self-collected)

Question 13

How to test for gonorrhoea

Answer 13

Males (Non-MSM): FPU NAAT, urethral culture + NAAT if symptomatic

MSM: FPU NAAT
Urethral + throat +/- anorectal NAAT and culture even if asymptomatic

Females:
Endocervical NAAT + culture if symptomatic, self-collected NAAT +/- culture, FPU NAAT. Throat +/- anorectal NAAT/culture if history of oral/anal sex respectively

MCS is required for antibiotic susceptibility, culture is much less sensitive than NAAT at non-genital sites - if not already collected, culture samples should be obtained at time of treatment

Question 14

Anonymous contact tracing online:

Answer 14

www. letthemknow.org.au
www. thedramaownunder.info (MSM)
www. bettertoknow.org.au (ATSI)