Recommendations

  1. Sexual safety 1–3
    • Every individual has the right to be free of:
      • sexual assault; where a person assaults, witnesses, procures, coerces or commits gross sexual indecency upon another person, without the person’s consent
      • sexual harassment; behaviour that is intentionally offensive, humiliating, intimidatory or predatory in nature that subjects a person to any unwanted sexual act, request, favour, remark, connotation or conduct
  2. Safe sexual practice 1–4
    • Use condoms and vaginal dams to reduce risk of STI's
    • Use pre-exposure prophylaxis (PrEP) to reduce risk of HIV
    • Arrange contraception prior to sexual encounters to avoid unintended pregnancy
    • Stay emotionally healthy and in control by deciding:
      • whether and when to have sex
      • when to start having sex
      • who to have sex with
      • how to have sex
      • to have safe sex every time
    • Do not have sex with a person who has a visible sore, ulcer or lump on the genitals or around the anal area
  3. Communication 1
    • If having unprotected sex, talk about risks with partner
    • Open discussion fosters a shared understanding of the need for protected sex in some cases
  4. Other ways to have sex
    • Explore diverse ways to enjoy physical intimacy that reduces risk of STIs or unintended pregnancies
    • Use condoms on sex toys and change the condom for each person. Wash toys and hands after use
  5. Avoid alcohol and other drugs 3
    • Excessive alcohol and other drug intake may affect a person's ability to provide consent or make safe decisions
    • Monitor alcohol and other drug intake to stay in control and make safe and rational sexual choices
  6. Act on unprotected sex 1,3
    • After an unprotected sexual encounter, have a sexual health check-up and consider emergency contraception or post-exposure prophylaxis (PEP) for HIV

Note:

1. The facts 1,3,4

  • The most common STIs in Australia are chlamydia, genital herpes, genital warts, trichomoniasis, gonorrhoea, hepatitis B, syphilis and HIV
  • Syphilis is a significant concern in rural and remote regions of Australia
  • > 50% of STI notifications in Australia are among 15–24 year olds
  • STIs often don't cause symptoms
  • People are always at risk of an STI after an encounter of unprotected sex
  • Those who use illicit drugs or consume excessive amounts of alcohol are twice as likely to acquire an STI
  • Provide Resources 1–4.

2. Priority groups and testing intervals 3,5,6

  • Stigma and discrimination in some priority groups can lead to fears of disclosure and heightened secrecy
  • See Resource 5. for detailed testing intervals
  1. Newborns
    • Some STIs can be transmitted from a mother to child during pregnancy or childbirth e.g. syphilis, herpes, chlamydia, etc
    • Screening is performed before and after pregnancy
  2. Children and young people 3,5,6
    • Always consider decision making capacities of young people < 18 years
    • Refer to age and cultural specific services to provide management strategies. See Resource 5.
A child with an STI may indicate sexual abuse. See Child safety reporting
  1. Aboriginal and Torres Strait Islander people 3,5–7
    • STIs occur at significantly higher rates in this group
    • A Reproductive health check is recommended annually or opportunistically as indicated
    • Discussing sexual health matters can cause feelings of ‘shame’
    • In some communities it is considered taboo for men and women to discuss sexual behaviour with each other
    • Always refer to an Aboriginal and Torres Strait Islander Health Worker or Health Practitioner. See Resource 4–6.
  2. Men who have sex with men (MSM) 3,5,6,8
    • This group are increasingly affected by STIs due to reduced condom use
    • A Reproductive health check is recommended annually for all men who have had any type of sex with another man in the previous year
    • All MSM who fall into one or more of the following categories should be tested up to four times a year:
      • unprotected anal sex
      • > 10 sexual partners in 6 months
      • participation in group sex
      • recreational drug use during sex
      • are HIV-positive
      • see Resource 7.
  3. People in custodial settings 3,5,6
    • Regular Reproductive health check-ups are recommended for all inmates of a prison
  4. Sex industry workers 5,6,9
    • There is no evidence that sex workers in Australia have higher rates of STIs than the general population
    • A sex industry worker cannot work, or a brothel licensee/manager cannot allow a sex industry worker to work, when known to be infected with an STI
    • Regular testing for STIs and blood borne viruses is recommended. Frequency is determined in consultation with the sex worker and guided by risk assessment
    • Sex workers may request more frequent testing to comply with jurisdictional-based legal frameworks and workplace requirements. See Resource 8.
  5. Travellers and mobile workers 2,4,6
    • Travellers for recreation or work e.g. fly in fly out (FIFO) workers may behave differently when travelling, putting them at risk of STI exposure
    • A Reproductive health check is recommended opportunistically
    • Confirm hepatitis B status and vaccinate if not immune. See Hepatitis B
  6. Refugees and migrants 3,5,6
    • Language and culture, trauma, trust, stigma, cost, low awareness and knowledge, unfamiliarity with the Australian health system, traditional beliefs, and fear put this population at high risk of STI infection
    • Use an interpreter for those from non-English speaking backgrounds
    • Offer a full STI screen according to thePrimary Clinical Care Manual
  7. People who are deaf or hearing impaired 3
    • Includes those who are late-deaf and deaf-blind
    • Consider barriers to accessing health care, the environment and interpreters
  8. People with disability 3
    • Consider those with impaired cognitive function
    • May have limited capacity to communicate or make informed decisions
    • Facilitate access to appropriate support workers and interpreters
  9. Gender and sexually diverse people 3,5
    • Experience poor mental health and high rates of substance abuse, social isolation and exclusion and subsequently poorer health outcomes
    • May have a sexual orientation that increases their risk of sexual and mental health problems
    • Facilitate access to appropriate support workers and service options. For gender and sexually diverse Aboriginal and Torres Strait Islander people, see Resource 9.
  10. Older people 3
    • Elderly people have sex
    • Consider presence of Reproductive health, inappropriate sexual behaviour, frailty, mobility and communication deficits (hearing, sight and speech)

3. STI testing and treatment

  1. Maintain confidentiality 3
    • Discuss ways the health service protects patient confidentiality e.g. using a health service endorsed coding system when requesting and receiving STI specimens and results
    • Discuss ways patients can protect their testing and treatment confidentiality, by carefully considering who they discuss health issues with
  2. Informed consent
    • Discuss:
      • identifying and treating STIs to improve health and reduce risk of transmission
      • how the test is done e.g. urine, swab or blood
      • what the test does, and does not provide
      • if and when repeat testing will be necessary
      • the requirements for a notifiable infection if the result is positive
      • that partners will need to be offered testing and treatment if results are positive. See 4. Contact tracing
  3. History1
    • Whether disclosed or not, a history should include:
      • types of sexual behaviour
      • when exposure occurred
      • previous STIs and treatment
  4. Prior to the results
    • Discuss:
      • how and when to obtain results
      • 5. Education and prevention to avoid future risk
      • safe sex practices
    • Discuss implications of a positive result:
      • access to professional support e.g. social worker or counsellor
      • family or friend support
      • options for medical treatment and follow-up
      • need for leave from employment
  5. After the results
    • For a negative result discuss:
      • what the result does and does not provide
      • if or when repeat testing is necessary (STI window periods)
      • safe sexual practices
    • For a positive result:
      • allow for an open relaxed discussion. Listen and encourage questions
      • be guided by the person’s response to determine how much information to
        provide and avoid overloading them
      • offer ongoing social-emotional support and management
      • refer to a local sexual health clinic or service for counselling. See Resource 10.
      • ensure the person has a support network
      • discuss 4. Contact tracing
      • provide 5. Education and prevention to avoid future risk

4. Contact tracing 9

  • Contact tracing is the identification and treatment of sexual contacts of a person who has tested positive for an STI; it isn't complex or time consuming
  • Essential to control spread of the infection. Requires sensitivity and confidentiality
  1. Procedure 9
    • Discuss the reasons for contact tracing:
      • to ensure partners are offered screening and treatment to avoid health risks
      • the public health implications and health outcomes for untreated STIs
      • most people don’t know they have an STI and can continue to spread it to others
    • Identify partner(s) that need to be informed. Use cues e.g. locations, events

Table 1. Tips to let a sexual contact know to be tested

Method

Tips

In person or by phone

  • Most people like to be told in person
  • Most people report that telling their partner(s) was easier than they thought it would be
  • Do it straight away. If delayed the discussion may never happen
  • Plan the conversation. For sample conversations see Resource 11.
  • Don’t feel the need to provide a lot of details. Provide a fact sheet, a website or phone numbers to contact
  • Avoid phrases like “you’ve given me chlamydia” which may make a partner defensive

By SMS or email

  • If anyone else might read the SMS or email, use another method
  • Be direct, objective, factual and free of emotion
  • For SMS or email contact tracing examples see Resource 11.

Some people may react badly to being told they are at risk of an STI. If a person thinks their partner could become abusive, consider using an anonymous email or SMS or ask their health provider

This service is for legitimate purposes. Consider implications to the recipient. Under Australian law, the use of a telecommunication service to menace or harass is a criminal offence. If potential misuse of this service is reported to police by a message recipient, the provider will cooperate with a police investigation

  • Allow the person the opportunity to inform their contacts. See Table 1.
    • discuss how a partner might react to the news
    • for concerns of a violent reaction or a history of domestic violence offer referral to the local sexual health clinic for social work support. See Resource 10.
  • Schedule a follow-up visit or phone call to determine if the person was able to contact trace their partner(s)
  • If the contact tracing process is problematic, refer to a specialist service. See Resource 10.
It is the responsibility of clinicians to perform contact tracing if the person has not done so

5. Education and prevention 6

  • Every inquiry is an opportunity for preventative sexual and reproductive health education without judgement
  • Preventative education is the same for all people; to encourage safe sexual and reproductive health
  • Tailor education to an individual’s lifestyle, belief, culture, sexual practices and risk behaviours e.g. speaking with a young Aboriginal man from a remote community will differ to speaking with an older urban lesbian woman
  • Provide written, verbal or website information. Provide Resource 8.
  1. Vaccination 6
    • Vaccination is the most effective means of reducing and preventing the transmission of hepatitis A and B and HPV
  2. Condoms 6
    • Condoms and water-soluble lubricant reduces STI risk by 97% for penetrative sex
    • Offer to demonstrate correct condom use. Discuss where affordable or free condoms and lubricant can be accessed; usually free from rural and remote health facilities
    • Discuss safe sex messages and partner negotiation to ensure condom use
  3. Reducing sexual partners
    • Reducing sexual partner numbers reduces STI risk
    • Mutual monogamy eliminates the risk of STIs
    • Encourage honest sexual relationships by communication
  4. Clean injecting equipment
    • Blood borne infections and STIs are closely linked
    • Injecting drug users should be alerted to the risks of sharing injecting equipment
    • Provide service information where clean injecting equipment can be obtained. See Resource 10.
  5. Safe sexual choices 1–4
    • Encourage to openly communicate, consent and negotiate safe sexual practice
    • Discuss abstaining from sex and having a Reproductive health check prior to a new sexual relationship
    • Taking a break or saying ‘no’ are healthy sexual practice options and removes the risk of contracting or passing on STIs
  6. PrEP and PEP
    • These antivirals can be prescribed by the MO/NP if HIV exposure is or was likely within 72 hours

6 Contraception 10

  • In choosing a contraceptive method, the person might be influenced by:
    • culture
    • efficacy
    • side effects
    • pregnancy risk
    • reversibility
    • age
    • relationship status
    • personal beliefs
    • socioeconomic circumstances
    • usability
    • level of protection
    • accessibility
    • cost
    • incorrect use or failure
    • clinical follow-up requirements
  • Provide resources so a person can make an informed choice about their current and future fertility. See Resources 3. and 12.
  • See Table 2.

Table 2. Contraception types 10

Long acting reversible contraception (LARCs)

  • Suitable for women of any age
  • Provides no protection against STIs
  • The hormonal intrauterine deveice (IUD) (e.g. Mirena™) is 99.8% effective. The copper IUD is 99.2% effective. Bothcan be removed at any time and is immediately reversible. Replaced every 5–10 years
  • Implant (e.g. Implanon™) are inserted under the skin of the inner arm above the elbow. 99.9% effective. Replaced every 3 years or removed earlier if required
  • Depot medroxyprogesterone acetate is an IM injection every 12 weeks and is 94–99.8% effective. There may be a delay in return to fertility after stopping the injection

Short acting hormonal methods

  • The contraceptive vaginal ring is a soft plastic ring that releases low doses of oestrogen and progestogen, is self-inserted, and remains in the vagina for 3 weeks. It is removed and replaced with a new ring a week later. 93–99% effective
  • Combined oral contraceptives (COC) (‘the pill’) are oestrogen and progestogen pills that relies on consistent daily use to be 93–99% effective
  • The progestogen only pill (‘mini-pill’) is a progestogen only pill that relies on consistent daily use to be 93–99% effective

Barrier methods

  • The male condom is a latex or polyurethane sheath, rolled onto an erect penis before sex. 87–98% effective in preventing pregnancy
  • The female condom is a polyurethane sheath, inserted into the vagina before sex. 79–95% effective in preventing pregnancy
  • The diaphragm is a dome-shaped silicone cap, placed in the vagina over the cervix before sex to stop sperm entering the uterus. 82%–86% effective in preventing pregnancy

Lactational amenorrhoea method

  • Breastfeeding reduces the probability of ovulation (egg release) occurring
  • 98% effective when menstrual periods have not returned AND the mother gave birth less than 6 months ago AND the mother is exclusively breastfeeding

Fertility awareness based methods (FABMs)

  • FABMs rely on specialist education to identify the fertile phase of the menstrual cycle to indicate when sex should be avoided to prevent pregnancy. FABMs are 75%–99.6% effective

Withdrawal

  • Withdrawal is where the penis is withdrawn from the woman’s vagina before ejaculation
  • Can be highly effective but is not recommended as a form of contraception

Abstinence

  • Abstinence, ‘taking a break’ or saying ‘no’ to penetrative sex is an option which is 100% effective in preventing pregnancy

Sterilisation

  • Sterilisation is permanent contraception which can’t be reversed
  • Sterilisation methods are 99.5% effective
  • Female sterilisation (tubal ligation) involves an operation blocking the fallopian tubes to stop the passage of the ovum (egg)
  • Male sterilisation (vasectomy) involves a simple operation performed under local anaesthetic on the vas deferens to prevent sperm from joining the ejaculate fluid

Emergency contraception (EC)

  • Reduces the risk of unintended pregnancy after unprotected sex
  • EC (levonorgestrel 1.5 mg) is not a method of regular contraception
  • The oral emergency contraception can be taken up to 5 days after unprotected sex but it is most effective if taken in the first 24 hours. Up to 85% effective when taken within 72 hours
  • The copper IUD is inserted in the first 120 hours (5 days) after sex. Provides immediate and ongoing contraception provided the implant is retained. 99% effective

For all above, see the Primary Clinical Care Manual for further information
Check for PBS and LAM for approval or restrictions

7. Termination of pregnancy

8. References

9. Resources

  1. Queensland Health sexual health resources and information
  2. A detailed list of sexually transmitted infections is available from the Australian STI Management Guidelines for use in primary care
  3. 4 C’s of safe sex – Consent, Condoms, Contraception, and Communication
  4. Body Talk
  5. The Australian Sexually Transmitted Infection and HIV Testing Guidelines 2019
  6. Young Deadly Free sexual health resources for health professionals and Aboriginal and Torres Strait Islander people
  7. The Drama Downunder
  8. Sex workers STI management and testing guidelines
  9. Sexually and gender diverse Aboriginal and Torres Strait Islander people information
  10. List of Queensland sexual health and HIV services
  11. Contact tracing services Let them know or The Drama Downunder
  12. Contraception Options - Which one is best for me?
  13. ASHM Publications (2013) Guide to Australian HIV Laws and Policies for Healthcare Professionals and National and Queensland guidelines

Last updated: November 2024

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