Goal: Increase testing for STIs in young populations
Description of this change:
- 90% of young people attending the practice are tested according to these guidelines.
- 100% of young people tested have hepatitis B and human papillomavirus (HPV) vaccination status recorded.
Person responsible: Clinical Director
When to be done: May 2020 – extended to September due to COVID-19
Plan
| Task | Person responsible | Timeframe |
| Discuss with doctors | CD | March 2020 |
| Marketing | CD | May – September 2020 |
| PredictionWhat you think will happen when the test is carried out | MeasuresWhat will determine if the predictions are correct |
| Auditable outcomes 90% of young people attending the practice are tested according to these guidelines. 100% of young people tested have hepatitis B and human papillomavirus (HPV) vaccination status recorded. | |
Do
What actually happened when you ran the test
The initial response to Google Posts was a 5% increase in STD checks requested. (Data – pathology register) – Paused due to COVID-19.
Study
Describe the measured results and how they compared to the predictions
Act
Describe what modifications you’ll make for the next cycle based on what you’ve learned
Key points
- Rates of chlamydia and gonorrhoea diagnoses in Australia are highest amongst people aged 15-24 years.
- Most young people attend a general practice at least once a year and are often unaware of their risk of infection and that STIs are often asymptomatic. The 8th edition of the RACGP Guidelines for Preventive Activities in General Practice recommends annual testing for chlamydia infection in all sexually active people aged 15-29 years (for both sexes). Currently, chlamydia is detected in approximately 1 in 20 young Australians who have screening tests in general practice
- Negotiating to see all young people alone, discussing confidentiality, minimising costs, and routinely offering STI screening (using self-collected samples, when appropriate) to all young people can help overcome barriers to STI testing
- Providing care to adolescents, particularly younger adolescents, may involve a complete psychosocial (“HEADSS”) risk assessment and an assessment of the young person’s capacity for decision-making and consent whilst be aware of child protection issues and mandatory reporting requirements.
Testing advice:
- Opportunistically offer chlamydia screening to all young people at least annually.
- Testing for chlamydia, hepatitis B, syphilis and HIV is recommended, as per the Standard Asymptomatic Check-up Guideline.
- Confirm hepatitis B status and vaccinate if not immune.
Specimen collection
Clinician collected | Self-collection
Clinical indicators for testing
- Testing for other infections and more frequent testing should be considered based on local STI prevalence, symptoms, clinical findings, diagnosis with an STI, contact with someone with a diagnosed or suspected STI and risk assessment (including specific sexual behaviour and condom use).
- 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.
Cervical screening and STI tests
An endocervical swab for Nucleic Acid Amplification Test (NAAT) may be collected at the time of cervical screening. Currently, in Australia, cervical screening is not recommended until a young woman has turned 18 years old or two years after first intercourse, whichever is later.
Special considerations!
Special considerations!
Privacy
Ask the young person about the best way to contact them with test results and reminders. From the age of 15 years, young people can apply for their own Medicare card.
Consent
- Young people under 18 years may be capable of giving consent to treatment provided they have sufficient understanding of the nature and effect of the treatment. There is specific legislation in New South Wales and South Australia that relates to the medical treatment of children and minors and common law applies in other jurisdictions.
- See the Adolescent Health GP Resource Kit, 2nd Edition for more information.
Child protection
- Requirements for mandatory reporting of child sexual abuse vary between jurisdictions. Contact the relevant department to clarify requirements in your state or territory.
- Reporting abuse and neglect: State and territory departments responsible for protecting children
- Age of consent laws
- Australian legal definitions: When is a child in need of protection?
Follow up
If test results are positive, refer to relevant STI management section:
Even if all test results are negative, use the opportunity to:
- Educate about negotiating safe sex, how to use condoms and risk minimisation. When appropriate, address contraception needs
- Vaccinate for hepatitis A, hepatitis B and human papillomavirus (HPV), if susceptible
- Offer reminders for regular screening tests, e.g. annual chlamydia test.
- 90% of young people attending the practice are tested according to these guidelines.
- 100% of young people tested have hepatitis B and human papillomavirus (HPV) vaccination status recorded.
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