Australasian Chapter of Sexual Health Medicine
Recommendations from the Australasian Chapter of Sexual Health Medicine on herpes, chlamydia, candidiasis, ureaplasma & gonorrhoea. The Australasian Chapter of Sexual Health Medicine (AChSHM) is a Chapter of the Royal Australasian College of Physicians (RACP) Adult Internal Medicine Division that connects and represents Sexual Health Medicine Fellows and trainees in Australia and New Zealand.
Reconsider the use of nucleic acid amplification testing for gonorrhoea in low-prevalence (i.e. <1% prevalence) populations and people who do not belong to a higher risk group.
The introduction of a duplex testing item into the MBS for nucleic acid amplification testing (NAAT) of chlamydia and gonorrhoea has resulted in laboratories performing this duplex test even if a test for only one organism was requested. Use of NAATs as a screening test for gonorrhoea in low-prevalence populations is not advised due to their low positive predictive value. However, an adequate sexual history needs to be taken in all cases to allow for the identification of higher risk groups within the population including men who have sex with men (MSM), the Aboriginal and Torres Strait Islander population, heterosexuals who travel overseas and people with multiple sexual partners. There are potential harms associated with false positive test results and incorrect diagnosis of gonococcal infections. Therefore it is recommended that use of NAAT for gonorrhoea should be reconsidered in low prevalence (i.e. <1% prevalence) populations.
This recommendation is endorsed by The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG).
- Donovan B, Dimech W, Ali H, Guy R, Hellard M. Increased testing for Neisseria gonorrhoeae with duplex nucleic acid amplification tests in Australia: implications for surveillance. Sexual Health 2015; Epub ahead of print. doi: 10.1071/SH14179.
- Fifer H, Ison CA. Nucleic acid amplification tests for the diagnosis of Neisseria gonorrhoeae in low-prevalence settings: a review of the evidence. Sexually Transmited Infections 2014; Epub ahead of print. doi: sextrans-2014-051588.
With the assistance of the Royal Australasian College of Physicians, the Australasian Chapter of Sexual Health Medicine (AChSHM) Council produced and distributed to its membership an online survey. The survey listed 5 examples of clinical practices in sexual health medicine which may be overused, inappropriate or of limited effectiveness in a given clinical context.
Members were asked to comment on these examples and to suggest other low-value practices which may be a sizeable issue in the specialty. Based on the feedback, 8 items were identified for further investigation by AChSHM Council through an evidence review. This resulted in the final list of 5 recommendations which were endorsed by the Council on 15 December 2015.
- 1 Do not order herpes serology tests unless there is a clear clinical indication.
- 2 Do not screen for chlamydia using serological tests.
- 3 Do not treat recurrent or persistent symptoms of vulvovaginal candidiasis with topical and oral anti-fungal agents without further clinical and microbiological assessment.
- 4 Do not test for ureaplasma species in asymptomatic patients.
- 5 Reconsider the use of nucleic acid amplification testing for gonorrhoea in low-prevalence (i.e. <1% prevalence) populations and people who do not belong to a higher risk group.