Infectious DiseasesTier 2Disease (DEADMAN)

Genito-urinary conditions - sexually transmitted infections (STIs)

Description

Sexually transmitted infections encompass bacterial (chlamydia, gonorrhoea, syphilis), viral (HSV, HPV, HIV), and protozoal (trichomoniasis) organisms transmitted through sexual contact - each with distinct presentations but shared principles around screening, partner notification, and co-infection risk

Among the most common notifiable conditions in sexually active populations, with chlamydia and gonorrhoea the most frequently diagnosed bacterial STIs in most high-income settings

Transmission requires mucosal or blood contact during sexual activity - risk varies by organism (highly transmissible: gonorrhoea, chlamydia; more variable: HIV, depending on viral load and exposure type) and is increased by concurrent STIs (genital ulceration/inflammation increases HIV transmission/acquisition risk)

Nucleic acid amplification testing (NAAT) is now standard for chlamydia/gonorrhoea given superior sensitivity to older culture methods, with site-specific sampling (urogenital, pharyngeal, rectal) guided by sexual practice history
Full STI screen (including syphilis serology and HIV testing) should be routinely offered alongside testing for the presenting concern, given high co-infection rates

Most bacterial STIs (chlamydia, gonorrhoea) are treated with short-course targeted antibiotics; partner notification and treatment is essential to prevent reinfection and ongoing transmission
Test of cure is indicated for some infections (e.g. gonorrhoea, given rising antimicrobial resistance) but not routinely required after standard chlamydia treatment in uncomplicated infection
Notifiable disease reporting requirements apply to most STIs, varying by jurisdiction

HIV co-infection (screen routinely), antimicrobial-resistant gonorrhoea (a growing concern), partner notification/contact tracing, pregnancy-specific management considerations

Full STI screening (not just testing for the presenting symptom) should be routine given high rates of asymptomatic co-infection and concurrent STIs - a patient presenting with one confirmed STI has a meaningfully elevated pre-test probability of another

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