STD screening

Risk Factors Consideration:

• High-risk Populations:
  • MSM, sex workers, individuals with multiple or anonymous partners.
  • Recent or frequent travel to high-prevalence areas.
  • Aboriginal and Torres Strait Islander people
  • Partners from high-risk groups.
  • Trans and gender diverse people
• Behavioral Factors:
  • Inconsistent use of protection.
  • Substance use in the context of sexual activity.
• Medical Factors:
  • History of chronic illnesses or immunosuppression.
  • History of previous STIs or repeated infections.
  • Lack of vaccination for preventable STIs (HPV, Hepatitis B)

History Taking:

1. Sexual History:
   • Partners:
     • Number of sexual partners in the past 6-12 months.
     • Gender of sexual partners.
     • Type of sexual relationships (monogamous, multiple partners, casual encounters).
   • Practices:
     • Types of sexual activities (vaginal, anal, oral).
     • Use of condoms or other protective measures.
     • Use of any sex toys and sharing practices.
   • Protection:
     • Consistency of condom use.
     • Use of pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP) for HIV.
   • Past History:
     • Previous history of STIs.
     • Last STI testing date and results.
     • History of partner with an STI.
   • Substance Use:
     • Use of drugs or alcohol in the context of sexual activity.
     • History of injecting drug use.
2. Medical History:
   • History of any chronic illnesses.
   • Current medications, including antibiotics.
   • Allergies, particularly to medications used for STI treatment.
   • Vaccination history (HPV, Hepatitis B).
3. Symptoms:
   • Any current symptoms (e.g., discharge, pain, sores, rashes, urinary symptoms).
   • Duration and severity of symptoms.
   • Recent changes in symptoms.
4. Risk Factors:
   • Recent travel to areas with high STI prevalence.
   • Sexual activity with high-risk populations (e.g., sex workers, MSM, drug users).
   • Partner’s risk factors (e.g., multiple partners, known STI history).

Physical Examination:

1. General Examination:
   • Vital signs (temperature, pulse, blood pressure).
   • General physical appearance (signs of systemic illness).
2. Genital Examination:
   • Males:
     • Inspection of the penis, scrotum, and perineal area for lesions, sores, discharge, and swelling.
     • Palpation of the testes and epididymis for tenderness or masses.
   • Females:
     • Inspection of the external genitalia for sores, lesions, discharge, or swelling.
     • Speculum examination of the vagina and cervix to inspect for discharge, lesions, or other abnormalities.
     • Bimanual examination to assess for tenderness or masses in the uterus and adnexa.
   • Trans and Gender Diverse Individuals:
     • Tailored examination based on anatomy and patient preferences.
3. Extragenital Examination:
   • Oral Cavity:
     • Inspection of the mouth and throat for lesions, sores, or other abnormalities.
   • Rectal Examination:
     • Inspection and palpation for sores, discharge, or other abnormalities.
   • Skin Examination:
     • Inspection of the body, particularly areas with possible contact, for rashes or lesions.

Indications for Asymptomatic STI Testing:

• Request for STI testing.
• Increased risk of STI:
  • New sexual partner
  • Living/traveling to high-prevalence areas
• Known exposure to STI or history of STI in the past 12 months.
• Partner of special subpopulation or anyone at increased risk.

Blood Tests:

• HIV (antigen/antibody test):
  • Repeat if recent exposure (6-week window period if Ag/Ab test).
• Syphilis serology:
  • If recent exposure, repeat at 12 weeks and presumptively treat.
• Hepatitis B:
  • HBsAg – Hepatitis B surface antigen
  • Anti-HBs – Hepatitis B surface antibody
  • Anti-HBc – Hepatitis B core antibody
  • Establish HBV status and immunize if not previously documented.

Gonorrhoea and Chlamydia Testing:

• Site/Specimen:
  • Urethral first pass urine (FPU)
  • Self-collected vaginal swab
• Test:
  • Nucleic Acid Amplification Test (NAAT)
  • Vaginal swab preferred over FPU for sensitivity.
  • Endocervical swab if speculum examination indicated.
• Specimen Collection:
  • Clinician collected
  • Self-collection

Notes:

• Positive gonorrhoea NAAT test:
  • Recall for treatment.
  • Collect specimens for gonorrhoea culture for antibiotic sensitivity.
• Extragenital swabs (pharyngeal and anorectal):
  • Not routine for women unless increased risk or contact with gonorrhoea/chlamydia.

Asymptomatic Screening Recommendations:

• Not recommended unless indicated by guidelines:
  • Hepatitis C
  • Trichomonas
  • Mycoplasma genitalium
  • Bacterial vaginosis
  • Human papillomavirus (HPV)
  • MSM and PLWHIV may require HPV vaccination if not included in school programs.

Prevention:

• Discuss HIV PrEP if appropriate.
• Provide and promote condom use.