Gonorrhoea and chlamydia are on the rise and, in WA, notifications have surpassed pre-pandemic levels. Syphilis has re-emerged as a threat: in 2023, the highest number of congenital syphilis cases were reported Australia-wide since 1995.
STI testing is an important part of preventative healthcare. Early detection and treatment can prevent complications of disease and onward transmission. Primary care clinicians are encouraged to test often, treat according to guidelines, undertake contact tracing and educate their patient community about safer sexual behaviours.
Raising the topic
While STIs continue to spread, doctors may feel hesitant to broach the topic of testing, especially when patients have come with an unrelated complaint. A small study conducted in Perth in 2013 indicated that patients would not be embarrassed if GPs initiated discussion about sexual health even if this was unrelated to the presenting complaint.
Interviews with a small number of young women in Victoria indicated that they found routine STI testing acceptable, especially where it is offered based on age demographic.
In WA, opportunistic STI screening is recommended for all sexually active people 40 years or younger. Screening for syphilis at multiple points in pregnancy is now also a part of routine testing in WA. These approaches normalise testing, do not stigmatise those who are tested and are less likely to miss detection in people not known to have risk factors for infection.
Risk groups that should also be offered opportunistic STI screening include:
- People who have recently changed sexual partner or are known to have casual partners
- Men who have sex with men
- People from a high prevalence country, or have a sexual partner from a high prevalence country
- Aboriginal people
- People experiencing homelessness
- People who use methamphetamine and/or inject drugs (7).
Include syphilis testing
STI tests should include syphilis serology. Over the past decade, cases of infectious syphilis have been increasing in Western Australia and Australia. These trends mirror that in other developed countries around the world. Consequently, syphilis serology should now be included as part of all STI testing.
Furthermore, if a patient presents with genital lesions, the lesions should also be swabbed for syphilis PCR.
Prompt management
For up-to-date recommendations on STI treatment, the Silver Book and STI Management Guidelines are important resources to bookmark. Note that syphilis is treated with intramuscular benzathine benzylpenicillin, which is not routinely stocked at community pharmacies. You can order a supply through the Doctor’s Bag and have it stocked in the practice fridge to facilitate prompt treatment.
An important aspect of management is the initiation of contact tracing to address re-infection risk and mitigate onward transmission. Notifying contacts can be done anonymously using website-based portals, and your local sexual health unit can also assist.
STIs are on the rise. So, let’s talk about testing. What are some conversation openers you could use in your practice?
Key messages
- STIs are on the rise, particularly gonorrhoea and syphilis
- Offer STI testing widely
- Syphilis serology should be included in all STI tests.
– References available on request
ED: Dr Phua is a part of the Boorloo Public Health Unit (formally known as the Communicable Disease Control)