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.

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.

Ref­er­ences
About sex­u­al health | Aus­tralian Gov­ern­ment Depart­ment of Health and Aged Care: https://​www​.health​.gov​.au/​t​o​p​i​c​s​/​s​e​x​u​a​l​-​h​e​a​l​t​h​/​about
HIV, viral hepati­tis and sex­u­al­ly trans­mis­si­ble infec­tions in Aus­tralia Annu­al Sur­veil­lance report 2022 (unsw​.edu​.au): https://www.kirby.unsw. edu​.au/​s​i​t​e​s​/​d​e​f​a​u​l​t​/​f​i​l​e​s​/​d​o​c​u​m​e​n​t​s​/​A​n​n​u​a​l​-​S​u​r​v​e​i​l​l​a​n​c​e​-​R​e​p​o​r​t​-​2​0​2​2​_​S​T​I.pdf
Region­al and remote pop­u­la­tions – STI Guide­lines Aus­tralia: https://​sti​.guide​lines​.org. au/pop­u­la­tions-and-sit­u­a­tion­s/re­gion­al-and-remote-pop­u­la­tion­s/