Transgender

Overview

  • Transgender people (TG) are either male to female (MtF) or female to male (FtM, trans-men)
  • Many TG people will be on cross hormonal therapy
  • Some TG people will have had differing forms of ‘gender’ surgery, ranging from Top Surgery (mastectomy) through to hysterectomy and/or gender reassignment surgery such as the removal of the male genital organs and replacement with a neo vagina
  • STIs amongst TG do not differ from the non-TG population unless there are other risks factors involved. (e.g. sex working, injecting drug use)
  • A through history of sexual practice is needed to identify appropriate testing sites
  • STI tests in TG people should reflect all sites exposed regardless of identified gender
  • FtM TG people may consider themselves at a lesser risk of STIs but this is not a reason to not offer comprehensive screening.

Testing advice

InfectionConsideration
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.
HIV Repeat test if patient exposed within previous 12 weeks (window period).
NAAT – Nucleic Acid Amplification Test

Specimen collection

Clinician collected
Self-collection 

Clinical indicators for testing

  • The presence of symptoms suggestive of an STI
  • History of anal sex in MtF and FtM
  • History of vaginal sex in FtM or in post-op MtF
  • Consider pharyngeal swabs for people with a history of oral sex, both exclusive and non-exclusive.
  • Sexual contact with a partner recently diagnosed with an STI
  • Recent past history of an STI
  • Any TG people who request testing
  • 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

  • MtF post op GRS clients who have vaginal sex require NAAT high vaginal swabs
  • FtM TG clients who have not had a hysterectomy require cervical screening as per national guidelines
  • Symptomatic BV in trans-men requires treatment.

Follow up

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

World Professional Association for Transgender Health Standards of Care.

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
  • Discuss (and activate if necessary) specific TG consultations and appropriate hormonal screening tests for TG clients on cross hormones.

Auditable outcomes

100% of TG people are tested according to these guidelines.

Last Updated: Monday, 16 February 2015