PLWHIV - People living with HIV
- As HIV is an STI, people diagnosed with HIV are at risk of other STIs. It is important that baseline STI testing is offered to all people living with HIV (PLWHIV).
- HIV progression and transmission is increased and facilitated by STIs so an annual offer of routine screening is advised, regardless of risk history.
- Hepatitis B, hepatitis C and herpes co-infection are common among PLWHIV.
- Most STIs have a similar presentation and natural history in PLWHIV, although people with profound immunosuppression may have unusual presentations and need specialist management. Sexual transmission of hepatitis C has been reported among men who have sex with men (MSM) with HIV. For further information, see MSM guideline.
- HIV care providers should discuss sexual history, safer sex, contraception and conception plans with PLWHIV
- Current evidence suggests that all PLWHIV should start ART as soon as possible after diagnosis.
|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.
Anti-HBs titres should be regularly checked and PLWHIV should receive boosters to maintain Anti-HBs >10.
|Hepatitis C||If antibody positive, test for hepatitis C NAAT to determine if patient has chronic hepatitis C.|
|NAAT – Nucleic Acid Amplification Test
Anti-HBs – Hepatitis B surface antibody
Specimen collectionClinician collected | Self-collection
Clinical indicators for testing
- At diagnosis of HIV, testing for other STIs and blood-borne viruses should be offered.
- Chlamydia, gonorrhoea and hepatitis C testing should be performed at least annually for men who have sex with men (MSM)
- 3 monthly syphilis serology for MSM with routine HIV monitoring.
- 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.
- Local support, through a sexual health clinic, is available to assist primary care professionals to manage any often quite complicated situation.
- Women with HIV should be offered annual cervical screening.
If test results are positive or clinical indicators present, 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.
- 100% PLWHIV should have evidence of baseline serology for hepatitis A, hepatitis B, hepatitis C and syphilis in records.
- 100% sexually active PLWHIV are offered STI testing at least annually.