Opportunistic testing of asymptomatic men and women

The majority of patients seen are asymptomatic. However, this does not mean they are not infected. Often patients request screening or it can be offered at times when they present, e.g. for cervical screening, contraception or a well person's check.

People at highest risk include:

Sexually active males and females who are 40 years or younger, and not in a stable, long-term relationship.
Those who are from a high prevalence country or have a sexual partner who is from a high prevalence country.
People who are experiencing homelessness.
People who have recently changed sexual partner.
People who frequently change their sexual partners.
Men who have sex with men (MSM) and women who have sex with MSM.
Aboriginal people
People who use methamphetamine and/ or inject drugs.

Asymptomatic males

The following investigations should be undertaken:

First void urine (FVU) specimen for gonorrhoea and chlamydia NAAT.
If no urine is available, provide the patient with a specimen jar and ask him to wait until he can void or return an FVU at his earliest convenience. A urethral swab could be used if the patient prefers not to wait. Please see the STI self-testing card (PDF 716KB).
If GeneXpert point-of-care test is available, test specimen/s with point-of-care test and collect an additional swab and urine sample for sending to the laboratory for NAAT testing.
Where available, undertake concurrent macrolide sensitivity testing for suspected gonorrhoea.
Due to increasing transmission of syphilis it is important to include a syphilis serology.

Asymptomatic females

The following investigations should be undertaken:

Self-obtained low vaginal swab (SOLVS) for gonorrhoea and chlamydia NAAT (no transport medium). Please see the STI self-testing card (PDF 716KB).
If GeneXpert point-of-care test is available, test specimen/s with point-of-care test and collect an additional swab and urine sample for sending to the laboratory for NAAT testing.
Where available, undertake concurrent macrolide sensitivity testing for suspected gonorrhoea.
Due to increasing transmission of syphilis it is important to include a syphilis serology.

All cases

If the patient has had receptive anal sex, oro-anal sex, rimming or fingering and no anal symptoms: Patients can be instructed how to take two blind ano-rectal swabs themselves. Refer to the STI self testing card (PDF 346KB) for instructions.
If the patient has had receptive oral sex, and no oral symptoms, take a throat swab for NAAT (no transport medium).
Where appropriate, consider collecting blood for serological tests – syphilis, HIV and hepatitis B. Also test for hepatitis C if there is a history of injecting drug use. It is only necessary to test for hepatitis A if symptomatic or if there is a history of male-to-male and/or oro-anal sex, and if there is an intention to vaccinate, if not immune. Refer to hepatitis A and hepatitis B regarding who should receive vaccine.
Where available, undertake concurrent macrolide sensitivity testing for known or suspected gonorrhoea cases.
Provide safe sex advice and promote condom use.
Review at one week and check results for diagnosis.
Review at three months after exposure – this provides an opportunity to repeat blood tests for syphilis/hepatitis B/HIV. All people who are positive for gonorrhoea or chlamydia should be advised to return for retesting in three months because the risk of re-infection is high.