Sexual Health Check

Question 1

About sexual health check

Answer 1

The prevalence of bacterial STIs in NZ is high compared to other developed nations.

Chlamydia is the most commonly reported STI in NZ with > 70% of infections occurring in people aged 15 to 24 years.

Chlamydia and gonorrhoea is higher in Māori and Pacific peoples.

Since 2014 there has been a syphilis epidemic in Auckland.

Syphilis is mainly being diagnosed in men who have sex with men (MSM) but about 20% are heterosexuals.

All pts should be offered HIV and syphilis serology as part of their STI screen.

Question 2

Assessment

Answer 2

1). Offer a sexual health check:

• as part of a well-woman or well-man check
• when discussing contraception or cervical smear testing
• when a sexually active aged
• if pt has indications for sexual health check.

2). Ask about pt’s sexual history:

–> If pt is asymptomatic, offer the sexual health check with the appropriate routine testing and assessment.

–> If they are concerned about a specific recent sexual event, check the recommended testing interval:

• Chlamydia and gonorrhoea
• HIV
• Syphilis
• Check hepatitis B and human papillomavirus (HPV) vaccination history.
• Offer syphilis and HIV serology routinely.

3). Consider:

• hepatitis B testing in patient groups at risk.
• hepatitis C testing for higher risk patient groups only.

4). Specific assessment (history, examination, and swabs):

• Females
• Males

Question 3

Indications for sexual health check

Answer 3

1. Anogenital symptoms.
2. Man who has sex with men (MSM).
3. > 2 sexual partners in the last year.
4. New sexual partner in the last 3 months.
5. STI within the last year.
6. Sexual contact of someone with an STI, pelvic inflammatory disease, or epididymo-orchitis.
7. Undergoing antenatal screening or being referred for abortion.
8. Having IUD insertion procedure.

Question 4

Sexual history

Answer 4

1. Frame the discussion with:

“We ask everyone the same qs, they may seem intrusive but I’m just trying to find out risks and what tests you may need.”

1. Do you have any problems or symptoms that you are concerned about?
2. Are your sexual partners or contacts male, female, or both?
3. When was the last time you had sex?

• Was this with a regular or short-term sexual partner or contact?
• If regular partner, when was the last time you had sex with someone other than your regular partner?
• With short-term contacts, do you use condoms always, sometimes, never?

1. How many partners or contacts have you had:

• in the last 3 months?
• in the last 12 months?

1. Do sexual encounters include vaginal, oral, or anal sex?
2. Have you previously been diagnosed with a STI?
3. Have any of your sexual contacts had a STI? If so, what was it?
4. Has anyone forced you to have sexual encounters against your wishes?

Question 5

Patient groups at risk

Answer 5

1. Ethnicity and residential factors:

• Māori, Pacific, or Asian ethnicity.
• Born in hyperendemic areas.
• Members of household or close family contacts of hepatitis B-positive individuals.
• Inmates of correctional facilities (past or current).

2. Sexual risk:

• Unprotected sexual contact with a hepatitis B-positive person.
• Previous sexual assault.
• MSM, or their contacts.
• Sex workers, or their contacts.

3. Personal risk factors:

• IV drug user or sexual contacts who use or have used IV drugs.
• Occupational risk.
• Tattoos with non-sterile equipment.

7. Medical history:

• Hepatitis C or HIV infections.
• Undergoing renal dialysis.
• Undergoing chemotherapy or immunosuppressive therapy.
• Pregnancy antenatal screening.

Question 6

Higher risk patients

Answer 6

1. Injecting drug use (may have been only once)
2. Blood products in NZ before 1992 or at any time overseas
3. Tattoos and body piercing
4. History of imprisonment
5. History of hepatitis, jaundice, or abnormal liver functions
6. Lived in or received medical or dental treatments in South East Asia, Middle East, Indian subcontinent, Eastern Europe, or Russia
7. Mother had hepatitis C during pregnancy (low risk of transmission)
8. Close contact with a person diagnosed with hepatitis C

Question 7

Management

Answer 7

1. If discloses having sexual contact with a partner who has been diagnosed with syphilis or HIV, seek sexual health advice.
2. If sexual contact with other STIs, treat presumptively according to the relevant pathway.
3. Promote condom use and offer prescription for condoms.
4. If symptomatic or positive results are returned, treat as per relevant pathway:

• Gonorrhoea
• Chlamydia
• Pelvic Inflammatory Disease (PID)
• Trichomoniasis
• Syphilis
• Human Papilloma Virus (HPV)
• Human Immunodeficiency Virus (HIV)
• Genital Herpes
• Hepatitis B
• Hepatitis C

5. Seek sexual health advice if symptoms do not resolve despite correct management

Question 8

Seek sexual health advice if:

Answer 8

MSM presents with anorectal symptoms.

uncertain of genital examination findings.

patient is a syphilis or HIV contact.

symptoms do not resolve despite correct management.