Sexual health check

A sexual health check involves taking a sexual history, and offering appropriate testing.  A sexual history should include routine enquiry about intimate partner violence and sexual harm

Indications for testing

• • Patient with possible signs or symptoms of a sexually transmitted infection (STI)
  • Sexual contacts of people with STIs
  • Pregnancy
  • Before termination of pregnancy
  • Before intrauterine device (IUD) insertion in persons with a risk for STIs
  • In persons with a recent change in sexual contact, or multiple sexual contacts
  • Sexually active patients aged under 30 years opportunistically when accessing health care
  • Men who have sex with men (MSM)
  • After a non-consenting sexual encounter
  • At patient’s request

Note:

• If patient is asymptomatic and is concerned about a specific recent sexual event, the recommended testing interval is 2 weeks from time of last unprotected sexual intercourse for chlamydia and gonorrhoea testing, and 3 months for HIV and syphilis testing. If high risk exposure for HIV, an additional HIV test can be carried out at 6 weeks
• If the patient is unlikely to return and has not been previously tested, then test opportunistically at the time of presentation and offer a re-test after the appropriate window periods

NAAT – nucleic acid amplification test

PCR - polymerase chain reaction

*Māori and Pacific women, social deprivation, history of incarceration, contact of trichomoniasis

Note: A first-void urine is not the specimen of choice as it has lower sensitivity than vaginal swabs, but may be useful if the patient declines a vaginal swab.

NAAT – nucleic acid amplification test

PCR – polymerase chain reaction

All sexually active men who have sex with men (MSM) should be screened at least annually.

MSM in the following categories should be screened every 3 months:

• New partner or multiple sexual contacts
• Group sex
• Use of HIV pre-exposure prophylaxis (PrEP)
• Use of recreational drugs during sex (chemsex).

NAAT – nucleic acid amplification test

PCR – polymerase chain reaction

See also transgender and non-binary people guideline

• Transgender, non-binary and intersex people should be offered sexual health screening based on anatomy, sexual practices and patient preference
• Consider self-collection of samples for testing. Examination is recommended if symptomatic
• People with a vagina may be offered self-collected vaginal, anal and pharyngeal swabs depending on sexual practices. A first-void urine might be preferable to the patient but may be a less sensitive test
• Testosterone can cause vaginal dryness; extra lubrication and a small speculum may increase comfort if an examination is needed. Oestrogen cream applied topically to the vagina for approximately two weeks prior to a speculum examination may also be helpful
• People with a neovagina (post genital gender affirmation surgery) should be offered first-void urine testing in addition to a neovaginal swab. Colon-derived neovaginal tissue is inherently more susceptible to bacterial STIs than the penile inversion neovagina
• If examination of a person’s neovagina is needed, consider an initial digital exam using a single digit to assess the length and path of the neovagina. Using an anoscope (instead of a speculum) may facilitate visual examination
• One way to ask about screening is to say, ‘For an STI check up, we usually offer a blood test for HIV and syphilis and testing for chlamydia and gonorrhoea. People can get chlamydia and gonorrhoea in their urine, throat, bottom and cervix. You can do your own swabs of these sites if needed. Have you had sexual contact at any of these sites?’

NAAT – nucleic acid amplification test

*Māori and Pacific people, social deprivation, history of incarceration, contact of trichomoniasis

Clinician collected

Clinician collected for NAAT and culture

• Urethral swabs for gonorrhoea culture should be collected if the patient has frank urethral discharge, and ideally when the patient has not urinated for at least 1 hour. It is not necessary to insert the swab into the urethra
• Vaginal swab should be collected before speculum insertion. Wipe the swab around the vaginal entrance, then insert the swab 4 cm (thumb’s length) into the vagina, count slowly to 5 and replace in the swab container
• Rectal swabs should be collected by inserting a sterile swab 2-4 cm 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
  
  

Self-collected

Self-collection of samples for NAAT testing

• Vaginal swab: instruct the patient to remove the swab from the container, wipe the swab around the vaginal entrance, then insert the swab 4 cm (thumb’s length) into the vagina, count slowly to 5 and replace in the swab container
• Rectal swab: instruct the patient to insert the swab into the anal canal 2-4 cm and then remove and place into the transport tube
• First pass urine: Collect approximately 20-30 mL (1/3 of the standard urine jar) of the first part of the urine stream in a specimen jar, ideally >1 hour after last void
• Pharyngeal swabs should be collected from the tonsils and oropharynx

Click here for information on how to describe self-collection technique to a patient.