- Transgender people (TG) are either male to female (MtF) or female to male (FtM, trans-men)
- Many TG people will be on cross hormonal therapy
- Some TG people will have had differing forms of ‘gender’ surgery, ranging from Top Surgery (mastectomy) through to hysterectomy and/or gender reassignment surgery such as the removal of the male genital organs and replacement with a neo vagina
- STIs amongst TG do not differ from the non-TG population unless there are other risks factors involved. (e.g. sex working, injecting drug use)
- A through history of sexual practice is needed to identify appropriate testing sites
- STI tests in TG people should reflect all sites exposed regardless of identified gender
- FtM TG people may consider themselves at a lesser risk of STIs but this is not a reason to not offer comprehensive screening.
|Chlamydia||Consider self-collection of samples for testing.|
|Gonorrhoea||Consider self-collection of samples for testing.
If NAAT test result is positive, take swab at relevant site(s) for culture, before treatment. Cultures are the preferred test for samples from non-genital sites.
|Syphilis||If clinical suspicion of syphilis, refer to the syphilis guideline.|
|Hepatitis A||Vaccinate if not immune.|
|Hepatitis B||Vaccinate if not immune.|
|HIV||Repeat test if patient exposed within previous 12 weeks (window period).|
|NAAT – Nucleic Acid Amplification Test|
Specimen collectionClinician collected | Self-collection
Clinical indicators for testing
- The presence of symptoms suggestive of an STI
- History of anal sex in MtF and FtM
- History of vaginal sex in FtM or in post-op MtF
- Consider pharyngeal swabs for people with a history of oral sex, both exclusive and non-exclusive.
- Sexual contact with a partner recently diagnosed with an STI
- Recent past history of an STI
- Any TG people who request testing
- It is not recommended to routinely test for herpes and genital warts with serology. Consider testing for herpes and genital warts only if there are clinical signs and symptoms.
- MtF post op GRS clients who have vaginal sex require NAAT high vaginal swabs
- FtM TG clients who have not had a hysterectomy require cervical screening as per national guidelines
- Symptomatic BV in trans-men requires treatment.
If test results are positive, refer to STI management section for advice on:
Even if all test results are negative, use the opportunity to:
- Educate about condom use and risk minimisation
- Vaccinate for hepatitis A and B, if susceptible
- Discuss and activate reminders for regular testing according to risk, especially if their behaviors indicate the need for more frequent testing
- Discuss (and activate if necessary) specific TG consultations and appropriate hormonal screening tests for TG clients on cross hormones.
100% of TG people are tested according to these guidelines.