STI screening recommendations for priority populations

Asymptomatic young people under 35 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 and gonorrhoea (urine/SOLVS/cervix/throat/anus)
  • Syphilis serology
  • Hepatitis B serology – if hepatitis B status is unknown and patient has not completed a course of hepatitis B vaccination, offer testing and if no serological evidence of immunity, i.e. anti-HBs negative, offer immunization. Testing is unnecessary if hepatitis B status is known or if a patient has completed a course of hepatitis B vaccination.

More frequent screening

  • More frequent testing may be required following a particular risk exposure.
  • Repeat testing for chlamydia/gonorrhoea is recommended three months after treatment.

* 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, Sydney.

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:

Clinical indicators of increased STI/BBV risk

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
  • mental illness
  • recreational drug use
  • request for a test.

More frequent screening

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

Follow-up testing

  • People diagnosed with chlamydia or gonorrhoea should be retested in three months.
  • 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 Jan 2013), RACP, Sydney.

Asymptomatic Aboriginal people aged 16 - 35 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 and gonorrhoea (urine/SOLVS/cervix/throat/anus)
  • Syphilis serology
  • Hepatitis B serology – if hepatitis B status is unknown and patient has not completed a course of hepatitis B vaccination, offer testing and if no serological evidence of immunity, i.e. anti-HBs negative, offer immunization. Testing is unnecessary if hepatitis B status is known or if a patient has completed a course of hepatitis B vaccination.

More frequent testing

  • More frequent testing may be required following a particular risk exposure
  • Repeat testing for chlamydia and gonorrhoea is recommended three months after treatment

5-yearly (females only)

  • HPV test: 5-yearly (unless abnormal, then according to HPV test results)

Watch the healthy conversations video (external site) and refer to Let's Yarn (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 people who use methamphetamine and / or 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

More frequent screening

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

5-yearly (females only)

HPV test: 5-yearly (unless abnormal, then according to HPV test results)

* 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 people experiencing homelessness

Asymptomatic people experiencing homelessness

  • People experiencing homelessness can includes people who are couch surfing or have no fixed address, in addition  to people who are living on the streets.
  • People who experience homelessness may be engaging in survival strategies that place them at high risk of STIs and BBVs, e.g. use of alcohol and other drugs (including injecting drugs) or transactional sex (engaging in sexual acts in exchange for shelter, food, alcohol and other drugs).
  • These testing recommendations should apply to asymptomatic people experiencing homelessness regardless of whether they did nor did not use condoms.
  • Refer to Sexually transmitted infection syndromes for patients with genital symptoms.

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

  • Chlamydia and gonorrhoea (urine/SOLVS/cervix/throat/anus)
  • Hepatitis A and B serology. If hepatitis A and B status unknown and patient has not completed a course of hepatitis A and B vaccination, offer testing and if no serological evidence of immunity, i.e. anti-HA negative and/or anti-HBs negative, offer appropriate immunisation (see Guidelines for the Provision of Hepatitis A and B Vaccine to Adults in Western Australia at Risk of Acquiring these Infections by Sexual Transmission (PDF 248KB). Testing is unnecessary if hepatitis A and B status are known or if a patient has completed a course of hepatitis A and B vaccination.
  • Hepatitis C serology (if hepatitis C virus [HCV] negative).
  • Syphilis serology.
  • HIV serology (if HIV negative).

More frequent screening

  • More frequent testing may be required following a particular risk exposure.
  • This population may present infrequently to health care so if a patient is new to your service it is important to opportunistically screen for STIs and BBVs.

5-yearly (females only)

  • HPV test: 5-yearly (unless abnormal, then according to HPV test results)
Current sex workers

First visit

5-yearly (females only)

  • HPV test: 5-yearly (unless abnormal, then according to HPV test results)

Follow-up patients

  • Chlamydia and gonorrhoea (urine/SOLVS/cervix/throat/anus NAAT): Three-monthly – if 100% condom use, more frequently if <100% condom use.
  • Serology: 12-monthly (hepatitis C, HIV, syphilis; hepatitis A and B only if not immunised).
  • 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.
Pregnant and post-partum women
  Not medium or high risk Medium risk* High risk**
At booking visit
  • Chlamydia and gonorrhoea (SOLVS/ cervix/ throat/ anus)
  • Hepatitis B and C serology
  • Syphilis serology
  • HIV serology
  • Chlamydia and gonorrhoea (SOLVS/ cervix/ throat/ anus)
  • Hepatitis B and C serology
  • Syphilis serology
  • HIV serology
  • Chlamydia and gonorrhoea (SOLVS/ cervix/ throat/ anus)
  • Hepatitis B and C serology
  • Syphilis serology
  • HIV serology
28 weeks  
  • Syphilis serology
  • HIV serology
  • Syphilis serology
  • HIV serology
36 weeks  
  • Chlamydia and gonorrhoea (SOLVS/ cervix/ throat/ anus)
  • Chlamydia and gonorrhoea (SOLVS/ cervix/ throat/ anus)
  • Syphilis serology
Delivery  
  • Syphilis serology
  • Syphilis serology
6 weeks post-partum  
  • Syphilis serology
*Medium risk: pregnant/ birthing women to whom one or more of the following risk factors apply
  • one or more new sexual partners after her first syphilis blood test in pregnancy
  • a sexual partner who is a man who has sex with men or is from a high prevalence country
  • sexual partners who have had one or more new sexual partners after the woman became pregnant
  • infectious syphilis in a previous pregnancy
  • a sexually transmitted infection during the current pregnancy or within the previous 12 months
  • has used methamphetamine and/ or injected drugs in the previous 12 months
  • is a culturally or linguistically diverse person
  • is experiencing homelessness
  • is an Aboriginal person
  • is from a geographical area with high prevalence of one or more of the above risk factors

**High risk: pregnant/ birthing women living in an area affected by an ongoing syphilis outbreak. In WA this includes the Goldfields, Kimberley and Pilbara; and the at-risk area the Midwest.

Other populations
  • Refugees and new arrivals
  • Transgender
  • Women who have sex with women

* 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.