Screening of asymptomatic men and women

Screening of asymptomatic men and women
  • The majority of patients seen are asymptomatic. However, this does not mean they are not infected. Often patients request screening or it can be offered at times when they present, e.g. for cervical screening, contraception or a well person's check.

    People at highest risk include:

    • sexually active young males and females who are 25 years or younger, and not in a stable, long-term relationship
    • those travelling away from home
    • those living in areas with a high incidence of STIs
    • people who have recently changed sexual partner
    • people who have multiple sex partners
    • men who have sex with men
    • substance users.
Asymptomatic males

The following investigations should be undertaken:

  • physical examination is important as often patients may not be aware of lesions
  • a first void urine (FVU) specimen for gonorrhoea and chlamydia NAAT
  • if no urine is available, provide the patient with a specimen jar and ask him to wait until he can void or return an FVU at his earliest convenience. A urethral swab could be used if the patient prefers not to wait. Please see the STI self testing card (PDF 346KB).
  • if GeneXpert point-of-care test is available, test specimen/s with point-of-care test and collect an additional swab and urine sample for sending to the laboratory for NAAT testing.
Asymptomatic females

The following investigations should be undertaken:

  • physical examination is important as often patients may not be aware of lesions
  • endocervical swabs for NAAT for those examined
  • endocervical swabs for MC&S, if pus is present or cervix is inflamed
  • a self-obtained low vaginal swab (SOLVS) for NAAT is the preferred specimen in an asymptomatic female who declines to have a physical examination. Add first void urine (FVU) for NAAT if possible
  • FVU for NAAT only, is acceptable if a woman declines to give either vaginal or endocervical swabs
  • If GeneXpert point-of-care test is available, test specimen/s with point-of-care test. If patient has no discharge from the cervix and the cervix is not inflamed, collect an additional swab and urine sample for sending to the laboratory for NAAT testing. If patient has discharge from the cervix and/or the cervix is inflamed, collect two endocervical swabs for sending to the laboratory for antibiotic susceptibility testing; one for microscopy, culture and sensitivity (MC&S) and another for NAAT testing.
All cases
  • If the patient has had anally receptive sex, take two anal swabs for both gonorrhoea (culture and sensitivity) and chlamydia (NAAT). Alternatively, the patient can be instructed how to take two blind anal swabs himself or herself. Refer to the STI self testing card (PDF 346KB) for instructions.
  • If the patient has had receptive oral sex, take two throat swabs for both gonorrhoea (culture and sensitivity) and chlamydia (NAAT).
  • Where appropriate, consider collecting blood for serological tests – syphilis, HIV and hepatitis B. Also test for hepatitis C if there is a history of injecting drug use. It is only necessary to test for hepatitis A if symptomatic or if there is a history of male-to-male and/or oro-anal sex, and if there is an intention to vaccinate, if negative. Refer to Viral hepatitis. about who should be vaccinated.
  • Provide safe sex advice and promote condom use.
  • Review at one week and check results for diagnosis.
  • Review at three months after exposure – this provides an opportunity to repeat blood tests for syphilis/hepatitis B/HIV. All people who are positive for gonorrhoea or chlamydia should be advised to return for retesting in three months because the risk of re-infection is high.
  • Rectal chlamydia always requires a proof of cure at one month. Persistent infection raises the possibility of lymphogranuloma venereum (LGV) and further specific testing is required.