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Sexual Health in Regional & Remote Populations with Nikki Brandon from SHINE SA
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.
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.
About sexual health | Australian Government Department of Health and Aged Care: https://www.health.gov.au/topics/sexual-health/about
HIV, viral hepatitis and sexually transmissible infections in Australia Annual Surveillance report 2022 (unsw.edu.au): https://www.kirby.unsw. edu.au/sites/default/files/documents/Annual-Surveillance-Report-2022_STI.pdf
Regional and remote populations – STI Guidelines Australia: https://sti.guidelines.org. au/populations-and-situations/regional-and-remote-populations/