STI screening recommendations for priority populations

• Due to the increased prevalence of some STIs in young people, opportunistic testing should be offered annually.
• More frequent testing may be required following a particular risk exposure.
• These recommendations should apply regardless of whether condoms are used.

Recommended STI and BBV tests

• Chlamydia and gonorrhoea (first void urine; throat and rectal swabs; self-obtained lower vaginal swab).
• Hepatitis B serology – if hepatitis B status is unknown and patient has not completed a course of hepatitis B vaccination.
• HIV serology, if known to be HIV positive.
• Syphilis serology.

Follow up

• For any positive diagnoses, refer to the relevant disease section for management and follow up. 
• Offer vaccination for HPV and HBV where indicated.
• Screen for HPV in people with a cervix aged 25-74 years as per National Cervical Screening Program recommendations. 

People with genital symptoms should have a full STI history and check-up, including appropriate diagnostic tests, for STIs and BBVs. Refer to Sexually transmitted syndromes for genital symptoms.  

*Australian STI Management Guidelines (external site)

• It is recommended that all men who have had sex with another man in the previous 3 months be offered an STI test.
• GBMSM who are in a monogamous relationship or are not sexually active should be offered an STI test at least annually.
• These recommendations apply regardless of whether condoms are used.

Recommended STI and BBV tests:

• Chlamydia and gonorrhoea (first void urine; throat and rectal swabs)
• Hepatitis A, B and serology if hepatitis A and B status unknown and patient has not completed a course of hepatitis A and B vaccination
• Hepatitis C serology annually, unless known to be hepatitis C antibody positive in the past, in which case test for hepatitis C RNA to determine if patient has chronic hepatitis C
• HIV serology, if not known to be HIV positive
• Syphilis serology.

Follow up:

• For any positive diagnoses, refer to the relevant disease section for management and follow up.
• Offer hepatitis A and B vaccination if patient does not have serological evidence of immunity and has not completed a course of hepatitis A and B vaccination, 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 and Injection Drug Use
• Offer mpox vaccination if patient has not completed a course.
• Consider vaccination for HPV.
• Consider HIV pre-exposure prophylaxis (PrEP), HIV post-exposure prophylaxis (PEP), Doxy-PEP (syphilis and chlamydia post exposure prophylaxis) and hepatitis B PEP, as appropriate.
• Screen for HPV in people with a cervix aged 25-74 years as per National Cervical Screening Program recommendations.

People with genital symptoms should have a full STI history and check-up, including appropriate diagnostic tests, for STIs and BBVs. Refer to Sexually transmitted infection syndromes for patients with genital symptoms.  

*Australian STI Management Guidelines (external site)

• Watch the Healthy conversations video (eternal site) and refer to Let's yarn (external site) for tips on culturally appropriate ways to discuss sexual health with Aboriginal clients.
• Offer testing opportunistically or as part of an annual MBS Item 715 Health Check
• Testing frequency:
  • Annually (people who are less sexually active or in a monogamous relationship) to 
  • 3 monthly (people from a high prevalence area, who have changed sexual partner/s, had >1 STI diagnosis, for whom substance use heighten risk)
• These recommendations apply regardless of whether condoms are used.

Recommended STI and BBV tests:

• Chlamydia and gonorrhoea (first void urine; throat and rectal swabs; self-obtained lower vaginal swab)
• Syphilis serology
• HIV serology, if not known to be HIV positive
• Hepatitis B serology if hepatitis A and B status unknown and patient has not completed a course of hepatitis A and B vaccination.

Follow up:

• For any positive diagnoses, refer to the relevant disease section for management and follow-up.
• Offer vaccination for HPV and HBV, where indicated.
• Screen for HPV in people with a cervix aged 25-74 years as per National Cervical Screening Program recommendations.
• Repeat testing for chlamydia and gonorrhoea is recommended three months after treatment.

People with genital symptoms should have a full STI history and check-up, including appropriate diagnostic tests for STIs and BBVs. Refer to Sexually transmitted infection syndromes for patients with genital symptoms. 

* Aboriginal and Torres Strait Islander People | Australian STI Management Guidelines (external site)

• People who use drugs, particularly individuals who use methamphetamine and or inject drugs may also partake in sexual risk-taking behaviours.
• Opportunistic testing for STIs and BBVs should be offered annually for people who use drugs not in the context of sex.
• Testing for STIs and BBVs should be offered 3 monthly for people who use drugs, especially stimulants, in the context of sex.
• More frequent testing may be required following particular risk exposures.
• These recommendations apply regardless of whether condoms are used, and whether or not safe injecting practices are reported. 

Recommended STI and BBV tests:

• Chlamydia and gonorrhoea (first void urine; throat and rectal swabs; self-obtained lower vaginal swab)
• 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
• Hepatitis C serology unless known to be hepatitis C antibody C positive in the past, in which case test for hepatitis C RNA to determine if patient has chronic hepatitis C
• HIV serology, if not known to be HIV positive
• Syphilis serology.

Follow up:

• For any positive diagnoses, refer to the relevant disease section for management and follow-up. 
• Offer hepatitis A and B vaccination if patient does not have serological evidence of immunity and has not completed a course of hepatitis A and B vaccination. 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 and Injecting Drug Use (PDF 248KB). 
• Offer vaccination for HPV where indicated.
• Screen for HPV in people with a cervix aged 25-74 years as per National Cervical Screening Program recommendations.
• Consider HIV post-exposure prophylaxis (PEP), hepatitis B PEP and Doxy-PEP (syphilis and chlamydia post exposure prophylaxis), as appropriate. 

People with genital symptoms should have a full STI history and check-up, including appropriate diagnostic tests, for STIs and BBVs. Refer to Sexually Transmitted infection syndromes for patients with genital symptoms. 

*Australian STI Management Guidelines (external site)

• Homelessness includes people who are street present, couch surfing, staying in temporary accommodation, have no fixed address and those housed in long-term hostels and shelters.
• 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 (sexual acts in exchange for shelter, food, alcohol and other drugs).
• This population may present infrequently to health care so it is important to offer opportunistic testing for STIs and BBVs. 
• Opportunistic testing for STIs and BBVs should be offered annually.
• More frequent testing for STIs and BBVs may be required following particular risk exposures.
• These testing recommendations should apply regardless of whether condoms are use and whether or not safe injecting practices are reported. 

Recommended STI and BBV tests:

• Chlamydia and gonorrhoea (first void urine; throat and rectal swabs; self-obtained lower vaginal swab)
• Hepatitis A and B serology
• Hepatitis C serology depending on risk exposures
• Syphilis serology
• HIV serology if not known to be HIV positive.

Follow up:

• For any positive diagnoses, refer to the relevant disease section for management and follow-up. 
• Offer vaccination for HPV and HBV where indicated. 
• Screen for HPV in people with a cervix aged 25-74 years as per National Cervical Screening Program recommendations. 

People with genital symptoms should have a full STI history and check-up, including appropriate diagnostic tests, for STIs and BBVs. Refer to Sexually transmitted infection syndromes for patients with genital symptoms.

*For symptomatic patients, refer to sexually transmissible syndromes.

**More frequent testing may be indicated for pregnant/ birthing people on a case-by-case basis if they have STI symptoms, unsafe sex and/or partner change in between these testing intervals. STI risk is higher in people to whom one or more of the following risk factors apply

• one or more new sexual partners after the first syphilis blood test in pregnancy
• a sexual partner who is a man who has sex with men
• sexual partners who have had one or more new sexual partners after the person 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 person who is from, or has had sex with someone who is from a high prevalence country
• is a person experiencing homelessness
• is an Aboriginal person
• is from a geographical area with high prevalence of one or more of the above risk factors

For advice on HTLV-1 in pregnant people, see the ASHM and NACCHO Decision making in HTLV-1 resource (external site).

• Frequency of testing should be discussed with the patient based on their risk exposures.
• Offer testing more often if condom and dental dam is <100% (including history of condom breakages or slippages) or at the request of the person. 
• Medical certificate: Can be certificate of attendance only and is not a 'clearance', i.e. should only state date screening was performed. 

Recommended STI and BBV tests:

• Chlamydia and gonorrhoea (first void urine; throat and rectal swabs; self-obtained lower vaginal swab)
• 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
• Hepatitis C serology
• HIV serology if not known to be HIV positive
• Syphilis.

If condom breakage or slippage (regardless of whether there has been ejaculation):

• Discuss with the sex worker how long it has been since the breakage, the last time they had a sexual health test, and their sexual practices to determine when the initial testing should be. 
• If the sex worker has been testing regularly and uses condoms in their personal and professional lives, recommend STI testing 7 days after breakage or earlier if symptoms present.
• If the sex worker has not had a recent test, offer baseline testing immediately and then follow-up testing 7 days after breakage or earlier if symptoms present. 
• If baseline testing performed: inform the sex worker of incubation periods and that STIs detected on baseline testing are not a result of the breakage. 
• Consider emergency contraception, HIV prophylaxis (PEP), Doxy-PEP (syphilis and chlamydia post exposure prophylaxis) and hepatitis B PEP as appropriate. Offer repeat swabs in 2 weeks and repeat serology in 3 months after appropriate window periods. 

Follow up:

• For any positive diagnoses, refer to the relevant disease section for management and follow up.
• Offer hepatitis A and B vaccination if patient does not have serological evidence of immunity and has not completed a course of hepatitis A and B vaccination. 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 and Injecting Drug Use.
• Offer mpox vaccination if patient has not completed a course.
• Offer vaccination for HPV where indicated.
• Screen for HPV in people with a cervix aged 25-74 years as per National Cervical Screening recommendations. 

People with genital symptoms should have a full STI history and check-up, including appropriate diagnostic tests, for STIs and BBVs. Refer to Sexually transmitted infection syndromes for patients with genital symptoms. 

*Australian STI Management Guidelines (external site)

• People in custodial settings - refer to Health care: Corrective Services (external site) and People in custodial settings - Australian STI Management Guidelines (external site)
• Refugees and migrants to Australia - Australian STI Management Guidelines (external site)
• Transgender people - Australian STI Management Guidelines (external site)
• Women who have sex with women - Australian STI Management Guidelines (external site)

*Australian STI Management Guidelines (external site)