Regional & remote

Overview

People in regional and remote populations differ from urban populations in having less access to medical care. Specialist STI services are less likely to be available and there may be considerable waiting times for appointments with GPs.
Gay, lesbian, bisexual and transgender and intersex (GLBTI) communities may be less visible in rural and remote areas and people may be reluctant to identify as GLBTI.
Aboriginal and Torres Strait Islander people represent a higher proportion of the population in many remote areas.
Clinicians in regional and remote areas should have a low threshold for offering STI testing opportunistically.
Potential barriers include regional and remote health professionals knowing patients in a social context, or they may be locums and have little opportunity to build a relationship with patients.

Testing advice

Regular testing for chlamydia, syphilis and HIV is recommended, as per the Standard Asymptomatic Check-up Guideline.
Confirm hepatitis B status and vaccinate if not immune.

In addition, testing for gonorrhoea is recommended in this population.

Infection	Consideration
Gonorrhoea	Consider Self-collection of samples for NAAT testing Vaginal swab: instruct the patient to insert the swab into the vagina like a tampon and then remove and place into the transport tube. Rectal swab: instruct the patient to insert the swab into the anal canal 2-4cms and then remove and place into the transport tube. FPU (First pass urine): Collect approximately 20 ml (1/3 of the standard urine jar) of the first part of the urine stream in a specimen jar at the time you are consulting the patient. The patient does not need to have held their urine for more than 20 minutes prior to specimen collection. A midstream urine (MSU) or early morning specimen (i.e. first void urine) are not required for NAAT. Click here for information on how to describe self-collection technique to a patient. 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.
NAAT – Nucleic Acid Amplification Test

Infection

Consideration

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.

NAAT – Nucleic Acid Amplification Test

Specimen collection

Clinician collected | Self-collection

Clinical indicators for testing

All sexually active young people <30 years should be offered a chlamydia test, at least annually.
Contacts of an STI should be offered STI check and treated presumptively for the STI.
STI check should be offered when an STI is diagnosed or when a person requests STI check.
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.

Special considerations

Time until test results are available may be longer than in urban areas. As a result failure to return for results may be more common in regional/remote areas. A lower threshold for presumptive treatment may be appropriate.
Gonorrhoea may be treated differently in regional/remote areas.
Cervical screening should be offered, according to the national screening guidelines.
The CARPA Manual has advice specifically for health professionals working in central and northern Australia.

Follow up

If screening test results are positive, refer to STI management section for advice:

Even if all test results are negative, use the opportunity to:

Educate about condom use and risk minimisation
Vaccinate for hepatitis B
Discuss and activate reminders for regular testing according to risk, especially if their behaviors indicate the need for more frequent testing.

Auditable outcomes

100% young people (<30 years) in regional and remote areas are offered a chlamydia test annually.

Last Updated: Friday, 27 November 2015