STI checks for men

STIs are under-diagnosed and often missed as many men have no symptoms or minor symptoms that clear quickly

  • STIs can be at any age but are more common under 35 years
  • STI checks routinely recommended in 15–34 year age group
  • Times to offer an STI check include
    • Offer opportunistic Standard STI check every 6 months (twice a year) and use a recall system
    • As part of another consultation
    • As part of Adult Health Check
    • If symptoms and risk factors suggest STI
    • If asked for by person, even if not long since last check
    • Opportunistically if 15–34 years, especially if from outside the community
    • During community-wide screening and during outbreaks
  • Offer opportunistic Standard STI check every 6 months (twice a year) and use a recall system

Risk factors for STIs

  • Living in a community with high STI rates
  • Age
    • High risk — sexually active under 35 years
    • Highest risk — sexually active under 25 years
  • STI in past 12 months
  • New sexual partner in past 3 months and/or more than 1 partner in past 6 months
  • Drug or alcohol use — increases high risk behaviours, eg multiple sexual partners, unsafe sex
  • Recent travel

Additional risk factors for HIV

  • Existing STI
  • Behavioural risk factors  — person or their partner is a man who has sex with men, is transgender/sister-girl, from overseas or person who injects drugs

Types of STI checks for men

  • Standard — pathology testing with no detailed history or examination
  • Full — pathology testing plus history and examination, contact tracing

Point of care (POC) testing for STIs

  • POC testing for chlamydia/gonorrhoea/trichomonas is available in some clinics
  • POC and laboratory tests are completed on the same collection site (single urine sample is usually enough volume for all tests, additional POC swabs are required for other sites)
  • Always do syphilis serology and other laboratory tests regardless of POC result
    • Syphilis POC testing is only suitable in restricted situations and can only be carried out by trained operators — refer to your health service guidelines or a trained colleague 

Standard STI check

Indications

  • Opportunistic
  • Adult Health Check, yearly STI check, community screening
  • 3 month re-test following a positive test result

Do

  • Urine — request
    • NAAT for chlamydia, gonorrhoea AND if in Northern Territory — trichomonas
    • Gonorrhoea culture
    • Also do POC Test if available
  • Take blood for HIV serology and syphilis serology
    • Also do syphilis POC test if indicated 
  • If hepatitis B status unknown or not immune (no evidence of previous infection or immunisation) —  HBsAg, Anti-HBc, Anti-HBs
  • Tell man to come back for results from laboratory or POC Test 

Sometimes there is not enough time or only some samples can be collected. It is still useful to do some tests from Standard STI check

Follow-up

  • If any positive result — do the rest of Full STI check including history, examination, treatment, contact tracing
  • When giving STI check results — be very clear about what has been tested for and what conditions the results relate to
    • Do not say things like "You have the all-clear" or "You don't have an STI"

Full STI check

Indications

  • Symptoms including discharge, pain on passing urine, sores
  • Asks for check
  • Positive result from Standard STI check — for additional assessment
  • Contact (partner) of someone with an STI

Ask

  • Discharge from penis
  • Pain on passing urine
  • Sores, rash, lumps on genitals
  • Any other symptoms or concerns
  • Sexual partners
    • Regular/casual partners. Do they have other partners
    • New partners in past 3 months
    • Number of partners in past 6 months
    • Other men

Check

  • File notes
    • Date and results of last STI check
    • Treatment offered and completed
    • Hepatitis B status
  • Head-to-toe check — with attention to
    • Rash — including hands and feet
    • Hair loss
    • Mouth — for ulcers
    • Groin for enlarged or tender lymph nodes. If present — check lymph nodes at other sites
    • Penis, scrotum, anus for sores, other lesions, rashes. If present — see Genital ulcers and lumps 
Collect — for all men
  • Urine — request
    • NAAT for chlamydia, gonorrhoea, trichomonas
    • Gonorrhoea culture
    • Also do POC Test if available 
  • Blood for HIV serology, syphilis serology
    • Also do syphilis POC Test if indicated
  • If discharge — penile swabs x 2 (NAAT and MC&S) — ideally before collecting urine
  • If Hepatitis B status unknown or not immune (no evidence of previous infection or immunisation) — blood for HBsAg, Anti-HBc, Anti-HBs
  • If urinary symptoms and 45 years or over
    • Mid-stream urine
    • OR first catch urine if can't get second sample
    • Request — MC&S for UTI
  • If genital sore — swab base of ulcer (sore, scab, lump) or fluid from blister
    • Request — NAAT for herpes, syphilis, donovanosis
  • If man has sex with men — anal swab x 2 AND throat swab x 2. Request 
    • NAAT for chlamydia, gonorrhoea
    • Gonorrhoea culture 

Do

  • If symptoms of STI — offer immediate treatment of symptoms
  • In communities with high STI rates — think about presumptive treatment (immediate treatment even if no symptoms). Treat for gonorrhoea (will also treat chlamydia) if
    • Asks for treatment or thinks he has put himself at risk
    • At high risk and unlikely to return for results
    • 15–34 years with leucocytes 1+ or more in urine
  • Ask for names of partner/s for contact tracing if syndromic or presumptive treatment given or if pathology positive
  • If behavioural risk factors for  HIV consider medical consult for PrEP
  • Offer STI and safer sex education
  • Tell man to come back for results

Follow-up

  • If positive results — see STI management
  • When giving results for STI check be very clear about what has been tested for and what conditions the results relate to
    • Do not say things like "You have the all-clear" or "You don't have an STI"