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Sexual Health in Regional & Remote Populations with Nikki Brandon from SHINE SA

12 Dec 2023

Nikki Brandon from SHINE SA provides an update on the challenges of STI screening in remote areas, some tips on encouraging screening, and asymptomatic STIs.

Access to inclu­sive and safe sex­u­al health care is essen­tial but can be chal­leng­ing in region­al and remote areas. There are sev­er­al rea­sons for this includ­ing reduced access to med­ical care, health pro­fes­sion­als know­ing their patients in a social con­text, or with locums hav­ing lit­tle oppor­tu­ni­ty to build rela­tion­ships with patients. Sex­u­al Health has been defined by the Aus­tralian Gov­ern­ment as:

  • respect for the right to healthy rela­tion­ships, equal­i­ty and safety
  • safe­ty to express indi­vid­ual sex­u­al­i­ty, sex­u­al ori­en­ta­tion and gen­der identity
  • free­dom from coer­cion, dis­crim­i­na­tion, vio­lence and stigma
  • access to infor­ma­tion and health care 
  • pro­tec­tion from, and treat­ment of sex­u­al­ly trans­mit­ted infec­tions (STIs).

How­ev­er, the rates of STIs such as chlamy­dia, gon­or­rhoea and syphilis are increas­ing. In 2021 there were 86,916 chlamy­dia noti­fi­ca­tions, 26,577 gon­or­rhoea noti­fi­ca­tions and 5570 infec­tious syphilis noti­fi­ca­tions made across the coun­try. The Aus­tralian STI guide­lines were updat­ed in 2022 to assist in the goal of elim­i­nat­ing HIV trans­mis­sion and to address the rise in syphilis noti­fi­ca­tions across Aus­tralia. It is now rec­om­mend­ed that HIV and syphilis test­ing are includ­ed in an asymp­to­matic STI screen.

Test­ing advice is to screen young peo­ple (aged 15 – 35) liv­ing in region­al and remote areas annu­al­ly for chlamy­dia, gon­or­rhoea, HIV and syphilis.

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Tri­chomo­ni­a­sis rates are more com­mon in region­al and remote Aus­tralia and can eas­i­ly be includ­ed in screen­ing (refer to local guide­lines). STI screen­ing should be offered to all who request it, those who have a new sex­u­al partner/​s, have a known expo­sure to any STI or who have a his­to­ry of an STI with­in the last 12 months. 

Tak­ing a sex­u­al his­to­ry may present as a poten­tial bar­ri­er to STI screen­ing; how­ev­er, it should not pre­vent STI screen­ing from being offered. The dis­cus­sion can be quite sim­ple and can begin by nor­mal­is­ing the process with a phrase such as we offer STI test­ing to all peo­ple under the age of 35 as STIs are com­mon, often do not have symp­toms and are impor­tant to treat ear­ly. Would you like to test today?” 

The use of a hook can encour­age screen­ing, with phras­es such as chlamy­dia is very com­mon and often has no symp­toms yet can cause com­pli­ca­tions if left untreat­ed” or there has been a rise in syphilis recent­ly which can be seri­ous for your health but it is easy to test and treat”.

It can also be incor­po­rat­ed into an exist­ing con­sul­ta­tion, for exam­ple as you are here today for cer­vi­cal screening/​contraception/​menstrual irreg­u­lar­i­ties, would you like an STI screen also?” or as we are tak­ing blood/​urine test, today would you like us to include an STI screen?” 

If a test returns pos­i­tive, then a more detailed sex­u­al his­to­ry should be tak­en to include details around the num­ber of sex­u­al part­ners and type of sex. Fur­ther test­ing from oth­er sites may be required to ensure treat­ment guide­lines are adhered to. Treat­ment should be giv­en, and the patient advised of the need to abstain from sex for at least sev­en days fol­low­ing treat­ment. Due to the increase in macrolide resis­tance, doxy­cy­cline is now the first line treat­ment for chlamy­dia, unless com­pli­ance is a con­cern. Sex­u­al partner(s) from the pre­vi­ous two to six months will need to be test­ed and treated.

Pre­sump­tive treat­ment should only be con­sid­ered if there has been sex­u­al con­tact in the last two weeks or if the con­tact part­ner is unlike­ly to return for treat­ment if the result is pos­i­tive. A test of cure is only need­ed for chlamy­dia if the patient is preg­nant or had a rec­tal infec­tion. A test of cure is need­ed with all cas­es of gon­or­rhoea due to reduc­tion in sus­cep­ti­bil­i­ty of first line treatment.