After appropriate pre-test discussion, all of the STI tests listed should be offered:
3-monthly testing for sexually transmitted infections in all men who have had any type of sex with another man in the previous 3 months*
|
Blood Tests
|
NAAT/PCR^ tests for gonorrhoea and chlamydia:
|
|---|
|
- HIV antibody/antigen: If not known to be HIV-positive
- Hepatitis A antibody: Test if not vaccinated. Vaccinate if antibody negative
- Hepatitis B surface antigen, core antibody, surface antibody: Test if not vaccinated. Vaccinate if no history or documentation of full vaccination course
- Hepatitis C: Test once a year in people living with HIV, on PrEP or with history of injecting drug use
|
- First pass urine defined as the first part of the urine stream, not the first urine of the day
|
|
^NAAT - Nucleic Acid Amplification Test test e.g. Transcription- Mediated Amplification (TMA), Strand Displacement Amplification (SDA), Polymerase Chain Reaction (PCR).
|
* Men who have sex with men (MSM) who are not sexually active or in monogamous relationships may be tested less frequently, but at least annually.
Specimen collection
Clinician collected for NAAT/culture/microscopy
Urethral swabs for microscopy should be collected when the patient has not urinated for at least 1 hour and only if the patient has frank urethral discharge. Squeeze the urethra to express the discharge and collect on urethral swab. It is not necessary to insert the swab into the urethra.
Rectal swabs should be collected by inserting a sterile swab 2-4cms into the anal canal and moving the swab gently side to side for 10-20 seconds.
Pharyngeal swabs should be collected from the tonsils and oropharynx.
High vaginal swab of vaginal discharge smeared onto a glass slide, air dried and sent for microscopy. Swab inserted into transport medium for culture.
Self-collection of samples for NAAT testing
Vaginal swab: instruct the patient to insert the swab into the vagina like a tampon and then remove and place into the transport tube.
Rectal swab: instruct the patient to insert the swab into the anal canal 2-4cms and then remove and place into the transport tube.
FPU (First pass urine): Collect approximately 20 ml (1/3 of the standard urine jar) of the first part of the urine stream in a specimen jar at the time you are consulting the patient. The patient does not need to have held their urine for more than 20 minutes prior to specimen collection. A midstream urine (MSU) or early morning specimen (i.e. first void urine) are not required for NAAT.
Click here for information on how to describe self-collection technique to a patient.
Screening for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) using NAAT/PCR. Confirmation of positive NG result by culture is not necessary and should not delay treatment, but to assist surveillance for antimicrobial resistance, gonorrhoea culture should be collected prior to administering antibiotics.
All people living with HIV should be tested for STIs three-monthly, including a blood test for syphilis (even if they are only having six-monthly viral load monitoring) unless they are not sexually active or are at low risk.
All HIV-positive MSM should have at least annual HCV testing.
Infections for which testing is not recommended:
Lymphogranuloma venereum (LGV): asymptomatic testing not recommended. Pleas see anal-rectal syndromes for testing patients with proctitis.
Sexually transmitted hepatitis C virus is rare in HIV-negative MSM, and testing is not recommended unless blood-borne virus risk factors are present (e.g. injecting drug use) or if the patient is on PrEP, to align with PrEP guidelines.
Herpes simplex virus: serology is not recommended in any group due to unclear benefit and and difficult interpretation of results.
Mycoplasma genitalium testing in asymptomatic MSM is not recommended because the benefits of screening have not been established. Testing recommendation in symptomatic MSM or contacts of infection can be found at mycoplasma genitalium.
Trichomonas vaginalis is rare in MSM and asymptomatic testing is not recommended.
Human papilloma virus (HPV) testing in asymptomatic MSM is not recommended because the benefits of screening and optimal screening technology have not been established. However, an annual digital anorectal examination for HIV-positive MSM older than 50 years is advised to detect early HPV-related anal cancers.
For trans MSM with a cervix, cervical screening tests are recommended in accordance with national guidelines. Self collected swabs may be an option for eligible people - National Cervical Screening Guidelines.
