STI screening and management — structured SAQ (15 marks)

(a) The structured STI panel (4 marks)

One mark per correctly named test, maximum four. [1][2]

• Chlamydia and gonorrhoea NAAT — self-collected vaginal swab is the test of choice; first-pass urine is acceptable; add anorectal and pharyngeal swabs based on reported exposures. The friable mucopurulent cervix strongly suggests chlamydia or gonorrhoea.[1]
• Syphilis serology — combined treponemal (CMIA or EIA) plus non-treponemal (RPR) testing; the laboratory runs the algorithm.[1]
• HIV serology — antigen/antibody combination assay; window period 2 to 6 weeks; offer PrEP if ongoing risk.[1]
• Hepatitis B (HBsAg, anti-HBs, anti-HBc) and hepatitis C antibody — one-time HCV testing for every adult; vaccinate against HBV if non-immune.[1]
• Cervical screen (HPV plus LBC co-test) — performed if due; PCB in a symptomatic woman warrants cervical screening regardless of recall status, because screening is not diagnostic.[1][5]

(b) First-line chlamydia treatment, with the pregnancy switch (4 marks)

Two marks for the correct non-pregnant regimen, two marks for the pregnancy switch and rationale. [1][4]

• Non-pregnant first-line regimen: doxycycline 100 mg orally twice daily for 7 days. Doxycycline is now preferred over azithromycin because it outperforms azithromycin for anorectal chlamydia in women, which is common and often unrecognised.[1][4]
• Alternative (non-pregnant): azithromycin 1 g orally as a single dose — only when adherence to seven days is unlikely and anorectal infection is less likely.
• Pregnancy switch: azithromycin 1 g orally as a single dose is the recommended regimen in pregnancy; doxycycline is contraindicated because of fetal tooth discoloration.[1]
• Advise no sexual contact for 7 days after starting treatment, or until the course is complete and symptoms resolved, whichever is later.[1]

(c) Partner notification and PDPT (4 marks)

One mark per point, maximum four. [1][3]

• The diagnosing doctor is responsible for initiating and documenting the partner notification discussion in the same consultation.
• Chlamydia trace-back window: at least 6 months before the diagnosis, or to the last negative test.[1]
• Three notification strategies: patient referral (index informs partners), provider referral (clinic contacts partners without naming the index), and patient-delivered partner therapy (PDPT) — the index delivers a prescription or packaged medication to their partner. PDPT is approved in Victoria, NSW and the NT for heterosexual index patients with anogenital or oropharyngeal chlamydia where partners are unlikely to attend for testing.[1][3]
• Notification to the state or territory health department is statutory — chlamydia is a notifiable disease under the relevant Public Health Act.[1]

(d) Follow-up and retesting (3 marks)

One mark per point. [1]

• Test of cure is not routinely recommended for non-pregnant patients treated with the recommended regimen (repeat NAAT at 4 weeks after treatment is only needed in pregnancy, where the test of cure is recommended).[1]
• Retest at 3 months after treatment regardless of whether the partners were treated, because reinfection is common — schedule the follow-up at the time of treatment.[1]
• Counsel sexual abstinence for 7 days after the start of treatment, until symptoms resolve, and until all sex partners from the last 6 months have been tested and treated if necessary.[1]