STI screening recommendations for priority populations

Asymptomatic young people under 25 years
  • These recommendations should apply regardless of whether condoms are used or not.
  • Patients with genital symptoms should have appropriate diagnostic tests and also be opportunistically screened for other STIs.

Annually (for those who have changed sexual partner/s)

  • Chlamydia (urine/SOLVS/cervix)
  • Hepatitis B serology – immunise, if negative.

More frequent screening

  • More frequent testing may be required following a particular risk exposure.
  • Repeat testing for chlamydia is recommended three months after treatment.
  • If a patient is immunised against hepatitis B virus (HBV), further serology is unnecessary.

* Royal Australasian College of Physicians, Australasian Chapter of Sexual Health Medicine, 2004, Clinical Guidelines for the Management of Sexually Transmissible Infections among Priority Populations (external site) (Last accessed Jan 2013), RACP, 

Men who have sex with men
  • These recommendations should apply regardless of whether or not condoms are used. A regular partner, increasing age or bisexuality is not necessarily protective of an STI.
  • Patients with genital symptoms should have appropriate diagnostic tests and should be opportunistically screened for other STIs.

With or without symptoms, all men who have had sex with another man in the previous year should be offered tests for STIs at least once a year in the following way:

  • gonorrhoea (throat/urine/anus)
  • chlamydia (throat/urine/anus)
  • hepatitis A serology – immunise if negative
  • hepatitis B serology – immunise if negative
  • syphilis
  • HIV serology (if HIV-negative).

Clinical indicators

These include:

  • any anal sex
  • any anal symptoms (bleeding, itching, discharge, pain)
  • HIV-positive
  • past history of gonorrhoea or chlamydia
  • sexual contact with someone recently diagnosed with an STI
  • request for a test.

More frequent screening

Testing three to six monthly is recommended for men who attend sex-on-premises venues (SOPVs), use recreational drugs or seek partners via the internet.

Follow-up testing

  • People diagnosed with chlamydia or gonorrhoea should be retested in three months.
  • Once a patient is immunised against HAV and HBV further hepatitis A or B serology is unnecessary.
  • For people with HIV, HBV surface antibody levels should be checked annually.

* Royal Australasian College of Physicians, Australasian Chapter of Sexual Health Medicine, 2004, Clinical Guidelines for the Management of Sexually Transmissible Infections among Priority Populations (external site) (last accessed January 2013) RACP, Sydney.

Asymptomatic Aboriginal people aged 16 - 29 years
  • These recommendations should apply regardless of whether condoms are used or not.
  • Patients with genital symptoms should have diagnostic tests and also be opportunistically screened for other STIs and BBVs.

Bi-annually (for those who have changed sexual partner/s)

  • Chlamydia (urine/SOLVS/cervix)
  • Gonorrhoea (urine/SOLVS/cervix)
  • Hepatitis B serology – immunise, if negative.

More frequent screening

  • More frequent testing may be required following a particular risk exposure
  • Repeat testing for chlamydia and gonorrhoea is recommended three months after treatment
  • If a patient is immunised against hepatitis B (HBV), further serology is unnecessary.

Watch the healthy conversations video (external site) for tips on culturally appropriate ways to discuss sexual health with Aboriginal clients.

* Silver BJ, et al. Incidence of curable sexually transmissible infections among adolescents and young adults in remote Australian Aboriginal communities: analysis of longitudinal clinical service data. Sex Transm Infect 2015; 91:135–141. doi:10.1136/sextrans-2014-051617

Asymptomatic sexually active people who injected drugs in last 12 months
  • The lifestyles of people who inject drugs may also involve sexual risk taking behaviours. Therefore, the sexual health needs of people who inject drugs, as well as health issues associated with their drug practice, need to be addressed.
  • These recommendations should apply regardless of whether condoms are used or not, and whether or not safe injecting practices are reported.
  • Patients with genital symptoms should have appropriate diagnostic tests and also be opportunistically screened for other STIs.

Annually

  • Chlamydia SOLVS or urine for NAAT.
  • Hepatitis B serology – immunise if negative.
  • Hepatitis C serology (if hepatitis C virus [HCV] negative).
  • Syphilis.
  • HIV serology (if HIV-negative).

Consider

Hepatitis A serology – immunise if negative.

More frequent screening

More frequent testing may be required following a particular risk exposure.

Once a patient is immunised against hepatitis A virus (HAV) and HBV further serology is unnecessary.

* Royal Australasian College of Physicians, Australasian Chapter of Sexual Health Medicine, 2004, Clinical Guidelines for the Management of Sexually Transmissible Infections among Priority Populations (external site) (Last accessed January 2013), RACP, Sydney.

Current sex workers
  • Routine history and examination with all sites tested.
  • Swabs/urine: Swab sites – vagina, anus, oropharynx, endocervix. Collect first void urine.
  • Serology: Hepatitis A, B, and C, HIV, syphilis. (Immunisation for hepatitis A and B should be offered).

Once a patient is immunised against hepatitis A virus (HAV) and HBV further HAV and HBV serology is unnecessary.

Follow-up patients

  • Swabs: Three-monthly – if 100% condom use, more frequently if <100% condom use.
  • Serology: 12-monthly (hepatitis B and C, HIV, syphilis).
  • Cytology: 12-monthly (unless abnormal smear, then according to smear results).
  • If condom breakage:
    • follow-up within three days (set baseline)
    • repeat swabs in two weeks
    • baseline serology – repeat at three months.
  • Medical certificate: Can be certificate of attendance only and not a 'clearance', i.e. should only state date screening was performed.
  • Exclusion periods: Seek advice from an experienced sexual health physician.