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WA
STI /HIV Control
Supplement for the
Goldfields, Kimberley,
Midwest and Pilbara
Regions
January 2016
Contents
INTRODUCTION ......................................................................................................................... 2
HEALTH UNITS – CONTACTS ................................................................................................... 3
RATES OF CHLAMYDIA, GONORRHOEA AND SYPHILIS NOTIFICATIONS IN THE
GOLDFIELDS, KIMBERLEY, MIDWEST AND PILBARA REGIONS ......................................... 4
Figure 1: Age-standardised rates of chlamydia notifications in WA by endemic region and
year, 2005-2014 ....................................................................................................................... 4
Figure 2: Age-standardised rates of gonorrhoea notifications in WA by endemic region and
year, 2005-2014 ....................................................................................................................... 5
Figure 3: Age-standardised rates of infectious syphilis notifications in WA by endemic region
and year, 2005-2014 ................................................................................................................ 6
ROLES AND RESPONSIBILITIES OF HEALTH CARE WORKERS IN THE REGIONAL
STI/HIV CONTROL PROGRAM .................................................................................................. 7
Primary Health Care Services (Aboriginal Health Services, Community Health Services and
General Practitioners)............................................................................................................... 8
ENDEMIC REGIONS’ APPLICATION OF STI/HIV CONTROL PRINCIPLES ............................ 9
Trained Workforce and Accessible Health Services ................................................................. 9
Prevention and Education ...................................................................................................... 10
Case Detection ....................................................................................................................... 10
Clinical Management .............................................................................................................. 11
Information and Evaluation ..................................................................................................... 14
REFERENCES .......................................................................................................................... 16
Further reading and resources ............................................................................................... 16
ACKNOWLEDGEMENTS.......................................................................................................... 17
APPENDIX 1 .............................................................................................................................. 18
Sample: GOLDFIELDS FEMALE AND MALE SEXUAL HEALTH CLINICAL
MANAGEMENT FORMS .................................................................................................... 18
Sample: KIMBERLEY STI CLINICAL MANAGEMENT FORMS ......................................... 23
Sample: PILBARA STI CLINICAL MANAGEMENT FORM ................................................. 25
Sample: MIDWEST STI CLINICAL MANAGEMENT FORMS ............................................. 27
APPENDIX 2 .............................................................................................................................. 28
Management of Sexually Transmitted Infections - Treatment Guidelines ........................... 28
1
INTRODUCTION
This supplement to the Silver book :Guidelines for Managing Sexually Transmitted Infections
http://ww2.health.wa.gov.au/Silver-book is to guide practitioners working in regions of Western
Australia (WA) where sexually transmitted infections (STIs) are highly endemic and where
access to primary health care, especially for Aboriginal people, is often challenging due to
distance, geography, climate, culture and language. Different approaches to prevention
education, testing, treatment and management of STIs and HIV are often required in these
areas.
The WA STI/HIV Control Supplement for the Goldfields, Kimberley, Midwest and Pilbara
Regions has been developed in partnership with WA Country Health Service (WACHS),
Regional Population Health Units (PHU) and the Communicable Disease Control Directorate’s
Sexual Health and Blood-borne Virus Program. The supplement is for regions of WA where
rates of infection for syphilis, gonorrhoea and chlamydia are well above the State average
(Figures 1, 2 and 3), particularly in the 15 to 30 year old age group. Prevention and control of
these treatable diseases are important in their own right, and also in reducing the spread of HIV.
This supplement describes useful STI/HIV control strategies for public health and primary health
care settings. The WA STI/HIV Control Supplement for the Goldfields, Kimberley, Midwest and
Pilbara Regions does not replace the Silver book :Guidelines for Managing Sexually
Transmitted Infections http://ww2.health.wa.gov.au/Silver-bookbut provides supplementary
information, which is important in these areas.
If you require further information please contact your local Population Health Unit (PHU) or
direct your inquiries to Disease Control Staff (see local regional contact details below).
2
HEALTH UNITS – CONTACTS
GOLDFIELDS POPULATION HEALTH UNIT (GPHU)

Goldfields Population Health Unit

Public Health Medical Officer/Public Health Physician
Tel: 08 9080 8200
Fax: 08 9080 8201
Tel: 0409 170 056

Senior Public Health Nurse
Tel: 0427 429 553

Regional Sexual Health Team
Tel: 08 9080 8200
KIMBERLEY POPULATION HEALTH UNIT (KPHU)

Kimberley Population Health Unit
Tel: 08 9194 1630

Public Health Medical Officer/Public Health Physician
Tel: 08 9194 1642

Senior Public Health Nurse, STI
Tel: 08 9194 1646

Senior Public Health Nurse, BBV
Tel: 08 9194 1644

Public Health Nurse
Tel: 08 9194 1641
MIDWEST POPULATION HEALTH UNIT (MPHU)

Midwest Population Health Unit
Tel: 08 9956 1985

Public Health Physician

Public Health Nurse
Tel: 08 9956 1971
Mob: 0429 086 740
Tel: 08 9956 1958
Mob: 0427 990285
PILBARA POPULATION HEALTH UNIT (PPHU)

Pilbara Population Health Unit

Public Health Medical Officer/Public Health Physician

Senior Public Health Nurse
Tel: 08 9174 1333

Regional Sexual Health Coordinator:
Tel: 08 5174 1353
Tel: 08 5174 1660
Confidential Fax: 08 9174 1088
Tel: 08 9174 1317
Mob: 0416 008 912
3
RATES OF CHLAMYDIA, GONORRHOEA AND SYPHILIS NOTIFICATIONS IN
THE GOLDFIELDS, KIMBERLEY, MIDWEST AND PILBARA REGIONS
Figure 1: Age-standardised rates of chlamydia notifications in WA by endemic region and
year, 2005-2014
Age-standardised rate per 100,000 population
2,000
1,800
1,600
1,400
1,200
1,000
800
600
400
200
0
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
Year
Goldfields
Kimberley
Midwest
Pilbara
WA (Total)
4
Figure 2: Age-standardised rates of gonorrhoea notifications in WA by endemic region
and year, 2005-2014
Age-standardised rate per 100,000 population
2,000
1,800
1,600
1,400
1,200
1,000
800
600
400
200
0
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
Year
Goldfields
Kimberley
Midwest
Pilbara
WA (Total)
5
Figure 3: Age-standardised rates of infectious syphilis notifications in WA by endemic
region and year, 2005-2014
Age-standardised rate per 100,000 population
90
80
70
60
50
40
30
20
10
0
2005
2006
2007
2008
2010
2009
2011
2012
2013
2014
Year
Goldfields
Kimberley
Midwest
Pilbara
WA (Total)
Definition of terms used
1
Endemic: The constant presence of a disease or infectious agent within a given geographic
area or population group; may also refer to the usual prevalence of a given disease within such
area or group.
Empirical treatment: Treatment given before laboratory results are available.
Outbreak: An epidemic limited to localised increase in the incidence of a disease.
Opportunistic screening: Offering an STI check to patients who have no symptoms or signs of
STIs but are in a high-risk group.
1
Last, JM 2001. A dictionary of epidemiology, 4th edition. Oxford University Press.
6
ROLES AND RESPONSIBILITIES OF HEALTH CARE WORKERS IN THE
REGIONAL STI/HIV CONTROL PROGRAM
Within each region, a variety of health care providers and services are involved with the STI/HIV
control program.
Communicable disease control is the responsibility of the Public Health Unit, which is part of
each region’s Population Health Unit (PHU). Regular review and evaluation of the STI/HIV
control program is required to ensure quality control. The PHU is responsible for provision of
information, training and ongoing support to regional health practitioners in regard to the unique
features of the region; however, in the Kimberley, the PHU and the Kimberley Aboriginal
Medical Services Council share this role.
In each region, the PHU’s Public Health Medical Officer/Public Health Physician
(PHMO/PHP) is responsible for providing standing orders for Department of Health staff if there
is no local Medical Officer (MO) in the town or servicing the community.

It is preferred to integrate the local MO servicing the town/community into the sexual health
program by allowing WACHS staff who have undergone appropriate training to use a
particular MO’s provider number when ordering STI tests. If this is not possible, it is possible
to arrange to use the PHMO/PHP’s provider number.

The PHMO/PHP provides advice on testing, treatment and management of STIs.

All syphilis serology results received by the PHU should be reviewed by the PHMO/PHP
who makes recommendations regarding follow-up and treatment.
Senior Public Health Nurse (Goldfields) - Based in the Goldfields PHU, this position is
responsible for provision of advice, following up notifications, and coordinating contact tracing
as requested. The Senior Public Health Nurse also coordinates the notification process of STIs
in minors. This position also assists in the provision of Sexual Health Clinic Services at
Population Health in Kalgoorlie.
Sexual Health Coordinator (Goldfields) – Also based in the Goldfields PHU this position
coordinates the support, training and ongoing assistance to staff providing sexual health
services across the region. The position also coordinates the Sexual Health Clinic Services at
Population Health in Kalgoorlie.
Senior Public Health Nurse - STI (Kimberley) - This is a regional position that provides sexual
health program support, guidance and expertise to health professionals working in the field.
This position works in partnership with the Sexual and Reproductive Health Officer, based in the
East Kimberley to ensure that there is an effective sexual health program in place at all key
sites across the Kimberley Region and to facilitate the process for new staff to be orientated to
the sexual health program.
Public Health Nurse (Kimberley) - Based in the Kimberley PHU, this position is responsible for
phoning out of positive STI results to practitioners, attending to notifications, maintenance of the
Syphilis database, providing advice to health professionals, coordination of treatment where
indicated and assistance with contact tracing as requested. The Public Health Nurse also
coordinates the referral and notification process of STIs in minors.
7
Public Health Nurse - Communicable Disease Coordinator (Pilbara) - Based in the Pilbara
PHU, this position is responsible for provision of advice, support and training to staff, phoning
out of positive STI results to practitioners, attending to notifications, maintenance of the Syphilis
Register, and coordinating contact tracing as requested.
Sexual Health Nurse (Midwest) - Based in Geraldton in the Midwest PHU, this position is
responsible for provision of advice, support and training to staff, following up notifications, and
coordinating contact tracing as requested. The Sexual Health Nurse also coordinates the
notification process of STIs in minors. This position is also responsible for the provision of
Sexual Health Clinic Services at Population Health in Geraldton.
Sexual Health Team – Based in the PHU in the Goldfields, Kimberley and Pilbara regions, the
Sexual Health Team is available to assist, support and where possible initiate promotion of
sexual health throughout the region.
Primary Health Care Services (Aboriginal Health Services, Community Health Services
and General Practitioners)
Primary health care services can assist with STI/HIV control through the implementation of a
comprehensive sexual health program. This can be supported by the PHU. Each service
should:

nominate a Sexual Health Program or STI Coordinator whose responsibility is to monitor,
maintain and support other staff to provide education, testing, treatment and effective
management of STIs/HIV. This person should maintain close contact with the Public Health
team.

promote and encourage staff and members (e.g. doctors, registered nurses, Aboriginal
Health Workers) to attend sexual health orientation and professional development

work in partnership with other service providers to increase availability of quality sexual
health service delivery for the regional population

participate in evaluation and monitoring of the regional STI/HIV control program.
8
APPLICATION OF STI/HIV CONTROL PRINCIPLES
The following information lists the key elements, which may be different when working in these
regions. All points are referenced in the Silver book: Guidelines for Managing Sexually
Transmitted Infections http://ww2.health.wa.gov.au/Silver-book. The points are grouped under
the five principles of STI/HIV control:
1. Trained workforce and accessible health services
2. Prevention and education
3. Case detection
4. Clinical management
5. Information and evaluation.
Trained Workforce and Accessible Health Services

Orientation to the Sexual Health Program is available for staff through the PHU (see
contact details on page 3 of the supplement).

Cross-cultural training is an essential part of orientation and is available from the PHU
and/or the regional health service. Be aware of the many different perceptions in regard
to the clinical environment, privacy, confidentiality and gender issues, which can create
barriers to patients accessing health services for STI/HIV services. Seek cultural advice
from an Aboriginal Health Worker (AHW) from the PHU or a primary health care service.
A brief training video Healthy Conversations: Yarning about sexual health and bloodborne viruses with your Aboriginal clients is also available from the following web-page:
http://ww2.health.wa.gov.au/Corporate/Articles/A_E/Aboriginal-sexual-health-and-bloodborne-viruses.

Regional sexual health updates are provided several times a year by the PHU with or
without Community Health Management. In addition, the Sexual Health and Blood-borne
Virus Program coordinates STI and blood-borne virus (BBV) quarterly forums (via
videoconference), and Sexual and Reproductive Health WA coordinates an annual faceto-face Aboriginal Sexual Health Forum. Primary health care staff should seek support
from their line-manager to participate in these opportunities for professional development
and collegial support.
9
Prevention and Education

Every STI/HIV consultation is an opportunity for preventive education. Mutual respect
and trust between both parties enables risk behaviours to be clarified and appropriate
information to be delivered.

Encouraging people to return for test results allows a further opportunity for
education and information exchange.

Some discussion points — return for results, abstinence following treatment, regular
STI checks, risky behaviours, and notification requirements. Various resources are
available to assist with education. Refer to the local orientation pack for more details.
Case Detection

Opportunistic testing. Offer STI checks with Well Person Checks, Pap tests, and at
any other appropriate opportunity. This will assist with normalising regular STI/HIV testing
and promote early detection of asymptomatic cases. Be suspicious. Consider STIs as
an underlying cause for a variety of clinical presentations. In endemic areas, STIs are an
important cause of urethral (male) or vaginal (female) discharge, with or without dysuria,
abdominal/pelvic pain, generalised sepsis, pelvic inflammatory disease (PID), epididymoorchitis, Bartholin’s abscess, endocarditis, alopecia and rashes/skin lesions. When in
doubt, ring your medical officer, or public health doctor for advice.

Suspect one STI then test for all. Co-infection with more than one STI is common. A
standard STI investigation should include gonorrhoea, chlamydia, syphilis, hepatitis B
and HIV. The Kimberley PHU also recommends trichomonas testing of females.

Contact tracing. Sex partners of patients with an STI should be offered a full STI/HIV
assessment and empirical treatment. This is the primary health care provider’s
responsibility; assistance is available from the PHU. Antenatal STI screening
should be offered to all pregnant women. STIs can be asymptomatic in pregnancy
and have serious consequences for the infant.
The following screening tests are recommended:

first trimester - HIV, syphilis, hepatitis B and C serology, gonorrhoea and chlamydia
NAAT

between 28 and 36 weeks – HIV, syphilis serology

36 weeks - gonorrhoea and chlamydia NAAT.
The Kimberley PHU also recommends:
10

testing for trichomonas in the first trimester and at 36 weeks. However, it is not known
whether detection and treatment of trichomonas in pregnancy has any effect on
pregnancy outcomes.

syphilis testing of neonatal cord blood as this ensures that neonatal syphilis is not
missed. Contact the Kimberley PHU for information and advice on cord blood
serology – Tel: (08) 9194 1630

Syphilis is often diagnosed by serology alone and is part of a routine STI screen.
Interpretation of serology depends on past serological history, past treatment history as
well as current clinical assessment. Refer to the PHU for assistance in obtaining past
history, management and treatment of syphilis.
 Normalise HIV testing Having an STI or being a contact of an STI is a risk factor for HIV
infection. HIV testing is recommended as an integral part of any STI assessment, after
obtaining informed consent.
 HIV transmission in Aboriginal populations is predominantly heterosexual. . From
2005 to 2014, the age-standardised rate (ASR) of HIV notifications for Aboriginal people
(4.6 per 100,000 population) was similar to the ASR for non-Aboriginal people (4.3 per
100,000 population). The ASR of HIV notifications was higher among Aboriginal females
(4.3 per 100,000 population) compared to non-Aboriginal females (2.2 per 100,000
population), while the ASR for Aboriginal males (4.9 per 100,000 population) was lower
compared to the ASR for non-Aboriginal males (6.4 per 100,000 population). Within this
period, heterosexual exposure to HIV was also more commonly reported among
Aboriginal people notified with HIV (71%) compared to their non-Aboriginal counterparts
(50%). [1]
 Gonococcal conjunctivitis is considered a public health emergency.
Notify the
PHMO/PHP (Goldfields, Kimberley, Midwest and Pilbara) with all suspected cases.
Gonococcal conjunctivitis is usually NOT spread sexually.
Clinical Management

[1]
Use the form. STI clinical management forms (CMFs) are available from the PHU, freeof-charge, to all primary health care providers to assist with obtaining a complete sexual
history, identifying risky behaviours and STI case management. Community Health staff
Epidemiology and Surveillance Program, Department of Health, Western Australia 2015
11
are required to use the STI CMF. See Appendix 1 for sample CMFs from each region.
Midwest clinicians use Kimberley CMF.

History taking includes sexual history, contacts, where a person may have acquired the
infection (i.e. interstate, overseas) as this can influence choice of empirical treatment.
Under 14 years. There are special state-wide protocols for the notification and reporting
of an STI in children under 14 years. Refer to the Regional PHU for details of process
and standard referral forms. Examination and testing

Male and female STI/HIV pathology packs are available from PathWest for specimen
collection. The flow chart in the packs reminds practitioners what specimens to take.

An STI pathology stamp is available for using on the laboratory request form. Cross
out tests not required. Stamps are available from the PHU.

Body and genital examination is recommended best practice in the clinical
management of a patient presenting with STI symptoms or as an STI contact because
STIs can present with painless genital ulcers and body rashes, e.g. syphilis,
donovanosis.

Penicillin resistance is monitored. Swab and culture all purulent discharge to ensure
that gonorrhoea is still sensitive to penicillin.

NAAT (PCR) testing for gonorrhoea and chlamydia is available in all regions.

Genital Ulcer Disease PCR (NAAT). Obtain a dry PCR swab from genital ulcers and
order a “GUD (genital ulcer disease) PCR (NAAT)”, which will test for syphilis,
donovanosis and herpes. See the STI pathology stamp. Self Obtained Low Vaginal
Swabs (SOLVS) are recommended for gonorrhoea and chlamydia NAAT testing if a
female has no genital symptoms and is not due for a Pap smear. The Kimberley PHU
also recommends trichomonas testing of females.
Treatment issues

Empirical treatment (before results are available) is recommended for symptomatic
cases of gonorrhoea and chlamydia and for all sex partners of people with gonorrhoea
and chlamydia regardless of whether they have symptoms. Refer to the Treatment
Guidelines at the end of this supplement (Appendix 2). Copies are also available from the
PHU’s PHMO/PHP.

Empirical treatment (before results are available) is recommended for symptomatic
cases of syphilis and named sex partners of people with syphilis.
12

Non-infectious syphilis. Clinicians are advised to consult with the relevant PHU’s
PHMO/PHP who has access to the patient’s previous syphilis serology results and
treatment history before initiating treatment for non-infectious syphilis.

A ‘LAC pack’ contains ceftriaxone 500 mg, 2 ml of 1% lignocaine and azithromycin 1 g.
Check with the regional standing orders in regard to use of a LAC pack. Refer to
Appendix 2.

A ‘ZAP’ pack contains 1 g azithromycin, 3 g amoxycillin, 1 g probenecid and a patient
advice sheet. Check with the regional standing orders in regard to use of a ZAP pack.
Refer to Appendix 2.

Syphilis treatment must be ordered by a Medical Officer. Re-testing for syphilis on
the day treatment commences, and at three month follow-up, is essential in syphilis
cases to detect a two-titre or four-fold (e.g. 1:16 to 1:4) fall in RPR (rapid plasma reagin
test), indicating a therapeutic response to treatment. For further information contact the
PHU (see page 3 of the supplement)
 Treatment of STIs in children is only to be given after consultation with the local Medical
Officer, Paediatrician or PHMO/PHP as drug dosage may vary.
Contact tracing

Contact time frames are recommended on the STI CMF. Refer to the Australasian
Contact Tracing Manual 2010 and the Silver bookunder each notifiable infection, for
information about how far back to trace.

Contact tracing should be undertaken urgently for gonorrhoea and chlamydia and
infectious syphilis or syphilis of unknown duration. Contact tracing should be initiated
prior to laboratory confirmation of an STI under the following circumstances:

male presenting with discharge/dysuria

female presenting with acute PID symptoms and/or purulent cervical discharge

patient presenting with symptoms of infectious syphilis.

Penicillin resistant gonorrhoea contact tracing should be undertaken with particular
urgency.

Assistance with contact tracing can be obtained from the PHU (see page 3 of the
supplement).

Partner notification. When a patient chooses to notify their sexual partners instead of
providing their names for contact tracing, it is the treating clinician’s responsibility to
follow-up that this has occurred. This can be done during the case review.
13
Case review / evaluation

A desktop case review should be conducted for all cases of STI by the treating
clinician or Sexual Health Program/STI Coordinator (if the service has one). Case review
is recommended 10 days after the initial consultation for gonorrhoea and chlamydia and
at appropriate intervals for syphilis and donovanosis.

Information to consider in a case review - resolution of presenting complaint, test
results, outcome of contact tracing and the patient has been informed of their results. The
case either can be closed or requires follow up.

Follow up screening – all positive STI cases should have a three month follow up
STI/BBV screen to check for re-infection and to cover window periods.

A clinical case review, i.e. a repeat patient consultation is required if:


the index patient was diagnosed with infectious syphilis or HIV

the patient continues to have symptoms.
A clinical case review, i.e. a repeat patient consultation may be required if:

the index patient did not name any sex partners and/or their regular sex partner

none of the sex partners named by the index patient were identified as having the
same infection (this is essential for HIV and infectious syphilis cases and should be
considered for gonorrhoea and chlamydia cases on a case-by-case basis)

the index patient has gonorrhoea where there is no culture test, i.e. antibiotic
sensitivities are unknown.
Information and Evaluation

A completed STI CMF provides health services staff with a record of an STI assessment
and information necessary for contact tracing and case review. This information is also
useful for completing notification forms.

Assistance with evaluation of all aspects of a clinical consultation through to sexual
health program delivery is available from the PHU.

Medical Officers are required by law to notify STIs to the WA Department of Health.
14

Syphilis cases (Goldfields). Practitioners receiving a positive syphilis result can contact
the Regional PHU for more information, support, advice and management assistance.
The PHMO/PHP reviews all syphilis serology results, interprets them in light of the
reason for the test and past serology/treatment history, and makes a recommendation
regarding treatment and/or follow-up syphilis testing.

Syphilis database (Kimberley). The PHU maintains the Kimberley Syphilis database.
The PHMO/PHP reviews all syphilis serology results, interprets them in light of the
reason for the test and past serology/treatment history, and makes a recommendation
regarding treatment and/or follow-up syphilis testing. This is a confidential, named
database. Clinicians are encouraged to use the patient’s full name (not coded) for
syphilis serology, and to avoid marking the request form CONFIDENTIAL. Marking the
request form CONFIDENTIAL will prevent the Kimberley PHMO/PHP from receiving the
result from PathWest.

Syphilis Register (Pilbara). The PHU maintains the Pilbara Syphilis Register. All
clinicians ordering syphilis serology are encouraged to mark “copy to Pilbara PHU” on
the pathology request form. This promotes completeness of data at a central point,
particularly for mobile clients, and ensures correct interpretation of test results. The
PHMO/PHP reviews all syphilis serology results, to interpret them in light of the reason
for the test and past serology/treatment history, and to discuss with clinicians
recommendations regarding treatment and/or follow-up syphilis testing. This is a
confidential, named register. Clinicians are encouraged to use the patient’s full name (not
coded) for syphilis serology.

Rapid results service (Kimberley). The PHU has an agreement with all government
and non-government practitioners that a copy of all STI NAAT test results are sent to the
PHU. Results are downloaded daily and positive results are phoned through to clinicians.
This provides enhanced surveillance to ensure clinicians can initiate contact tracing for
cases of gonorrhoea, chlamydia and trichomonas in a timely (rapid) manner. This service
is particularly important for remote locations.

Rapid results service (Pilbara). The PHU receives results of all STI tests which use the
PHMO/PHP’s provider number, along with results from other regional clinicians who
request a copy of STI test results to be sent to the Regional PHU or PHP (i.e. mark “copy
to Pilbara PHU” on the pathology request form). Results are downloaded daily and
positive results are phoned through to clinicians. This provides enhanced surveillance to
ensure clinicians can initiate contact tracing for cases of gonorrhoea and chlamydia in a
timely (rapid) manner. This service is particularly important for remote locations.
15
REFERENCES
1. Department of Health, 2016. Silver book :Guidelines for Managing Sexually Transmitted
Infections. Communicable Disease Control Directorate, Department of Health,
http://ww2.health.wa.gov.au/Silver-book
2. National HIV Testing Policy (November 2011)
http://testingportal.ashm.org.au/resources/Australian_National_HIV_Testing_Policy_v1-1.pdf
3. Department of Health 2007. WA Endemic Regions STI/HIV Control Supplement: Goldfields
Region.
4. Department of Health 2007. WA Endemic Regions STI/HIV Control Supplement: Kimberley
Region.
5. Department of Health 2007. WA Endemic Regions STI/HIV Control Supplement: Pilbara
Region.
Further reading and resources

The Western Australian STI, HIV, Hepatitis B, Hepatitis C and Aboriginal Sexual Health and
Blood-borne Virus Strategies 2015-2018
http://ww2.health.wa.gov.au/Corporate/Articles/U_Z/WA-Sexual-Health-and-Blood-borneVirus-Strategy-2015-2018

Aboriginal sexual health and blood-borne virus webpage (WA Health):
http://ww2.health.wa.gov.au/Corporate/Articles/A_E/Aboriginal-sexual-health-and-bloodborne-viruses

Australasian Society for HIV Medicine 2010, Australasian Contact Tracing Manual, 4th ed,
http://ctm.ashm.org.au/Default.asp?PublicationID=6

National Strategies for blood-borne viruses and sexually transmissible infections
http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-national-strategies-2010

Each health region produces local resources which assist in this program. Contact the local
PHU for details (see page 3 of the supplement).
16
ACKNOWLEDGEMENTS
In 1997, Kimberley health staffs were involved in the statewide consultation for the development
of the Guidelines for managing sexually transmitted diseases. One of the results of this
consultation was the production of the first Kimberley STI/HIV Control supplement.
This edition of the supplement has been adapted from the WA Endemic Regions STI/HIV
Control Supplement May 2013, and has been updated by the Sexual Health and Blood-borne
Virus Program, with assistance from the dedicated staff from the Goldfields, Kimberley, Midwest
and Pilbara Population Health Units and other sexual health experts.
17
APPENDIX 1
Sample: GOLDFIELDS FEMALE AND MALE SEXUAL HEALTH CLINICAL MANAGEMENT FORMS
Copies can be obtained from the PHU
18
19
20
21
22
Sample: KIMBERLEY STI CLINICAL MANAGEMENT FORMS
23
Name
DOB/Age
Address
Date of last sexual
contact & location
Attempts to locate
(dates, details)& date last
seen in clinic
Epidemiological Rx given
Results of lab tests
ZAP
LA Bicillin
Date
ZAP
LA Bicillin
Date
ZAP
LA Bicillin
Date
ZAP
LA Bicillin
Date
ZAP
LA Bicillin
Date
Gono
pos□
neg□
Other
pos□
neg□
Other
pos□
neg□
Other
pos□
neg□
Other
pos□
neg□
Other
Y□ N□
Y□ N□
Y□ N□
Y□ N□
Y□ N□
Y□ N□
Y□ N□
Y□ N□
Y□ N□
Y□ N□
Chlam
pos□
neg□
pos□
neg□
pos□
neg□
pos□
neg□
pos□
neg□
Syph
new□
old□
neg□
new□
old□
neg□
new□
old□
neg□
new□
old□
neg□
new□
old□
neg□
SEXUAL CONTACT INTERVIEW AND TRACING FORM
Tips for interviewing
Time frames (months)
To jog patient’s memory
To jog the patient’s memory
Inform the patient


Link sexual
encounters with significant
events significant to the
patient, eg rodeos, Easter,
X’mas, visits to relatives

Stress the importance of an accurate
contact history (prevents re-infection of the
patient, female infertility, congenital STI in
babies, STI spreading in their community)

All information re sexual
history and lab tests is
confidential

Be non-judgemental
Disease
Gonorrhoea
mths

Use plain English
Chlamydia
mths
3
Primary syphilis
mths
3
Take your time

Ask direct questions, eg
Who did you have sex with,
Who did you go with?

DO NOT use
ambiguous terms, eg sleep
with
3

Start with the most
recent sexual encounter
and work backwards

Get a description of the contact – where
does s/he live, what does s/he look like, who
does s/he associate with

Ask patient (if literate) to write names of
contacts on paper

Lab test results will go to
their doctor and Kimberley
Population Health Unit (if
“copy to KPHU” printed on
lab form)
24
Sample: PILBARA STI CLINICAL MANAGEMENT FORM
Copies can be obtained from the PHU
25
26
Sample: MIDWEST STI CLINICAL MANAGEMENT FORMS
27
APPENDIX 2
Management of Sexually Transmitted Infections - Treatment Guidelines for the Goldfields, Kimberley,
Midwest and Pilbara Regions
The Regional Population Health Unit‘s (PHU’s) Public Health Medical Officer (PHMO)/ Public Health Physician (PHP), WA
Country Health Service (WACHS), authorises Community Health Nurses currently employed by this WACHS region, who have a
working knowledge of the Department of Health’s Silver book: Guidelines for Managing Sexually Transmitted Infections
http://ww2.health.wa.gov.au/Silver-book, to administer medications under the following guidelines for the treatment of
uncomplicated STIs in adults (16 years and over). Where these specific criteria are not met, further advice from the PHMO/PHP
or local Medical Officer is to be sought prior to treatment:






staff must have undertaken orientation by the PHU and completed the on-line STI e-learning module, “Special Module
for Nurses”, at http://sti.ecu.edu.au/index.php in line with the Nurse Initiated STI Treatment Code
http://www.public.health.wa.gov.au/3/1697/2/nurse_initiated_sti_treatment_code.pm
each case must be assessed for drug sensitivities and medication allergies
a history of pregnancy should be sought from all females
all information is to be recorded on a Clinical Management Form or on the patient’s notes
all treatment is carried out according to the Silver book: Guidelines for Managing Sexually Transmitted Infections
any other treatment will be given under the advice of the PHMO/PHP
PRESENTATION
TREATMENT
NOTE
Signs and symptoms of chlamydia and/or
gonorrhoea, acquired locally or in the Goldfields,
Kimberley, Midwest or Pilbara region. GeneXpert
point-of-care test not available.
“ZAP pack” (Amoxycillin 3 g, Probenecid 1 g and
Azithromycin 1 g) prior to obtaining results
Signs and symptoms of chlamydia and/or
gonorrhoea, acquired outside the Goldfields,
Kimberley, Midwest or Pilbara region. GeneXpert
point-of-care test not available.
“LAC pack” (Ceftriaxone 500 mg IMI in 2 mL of
1% lignocaine plus Azithromycin 1 g oral) prior to
obtaining results
Positive laboratory or GeneXpert point-of-care test
result of genital gonorrhoea and negative
chlamydia result, acquired locally or in the
Goldfields, Kimberley, Midwest or Pilbara region (if
not already treated)
“ZAP pack” (Amoxycillin 3 g, Probenecid 1 g and
Azithromycin 1 g
Sexual partners of clients symptomatic of
chlamydia and/or gonorrhoea, acquired locally or in
in the Goldfields, Kimberley, Midwest or Pilbara
region . GeneXpert point-of-care test not available.
“ZAP pack” (Amoxycillin 3 g, Probenecid 1 g and
Azithromycin 1 g) prior to obtaining results
Sexual partners of clients symptomatic of
chlamydia and/or gonorrhoea, acquired outside the
Goldfields, Kimberley, Midwest or Pilbara region or
if place of acquisition not known. GeneXpert pointof-care test not available.
“LAC pack” (Ceftriaxone 500 mg IMI in 2 mL of
1% lignocaine plus Azithromycin 1 g oral) prior
to obtaining results
Sexual partners of clients symptomatic of
chlamydia and/or gonorrhoea, acquired locally or in
in the Goldfields, Kimberley, Midwest or Pilbara
region. GeneXpert point-of-care test shows
negative chlamydia and gonorrhoea results.
Positive laboratory or GeneXpert point-of-care test
result of chlamydia and negative gonorrhoea result
(if not already treated)
Sexual partners of a confirmed case of chlamydia.
GeneXpert point-of-care test not available.
Azithromycin 1g stat
Single dose
Directly observed therapy
Do not wait for results before treating
If patient has purulent discharge, take an
MC&S swab for gonorrhoea culture in
addition to urine/PCR swab
Single dose
Directly observed therapy
Do not wait for results before treating
If patient has purulent discharge, take an
MC&S swab for gonorrhoea culture in
addition to urine/PCR swab
Single dose
Directly observed therapy
Send urine and/or PCR swab to
PathWest for PCR testing of gonorrhoea
for antibiotic sensitivities.
If patient has purulent discharge take an
MC&S swab for gonorrhoea culture in
addition to urine/PCR swab.
Single dose
Directly observed therapy
Do not wait for results before treating
If patient has purulent discharge, take an
MC&S swab for gonorrhoea culture in
addition to urine/PCR swab.
Single dose
Directly observed therapy
Do not wait for results before treating
If patient has purulent discharge, take an
MC&S swab for gonorrhoea culture in
addition to urine/PCR swab.
Treat to cover Mycoplasma infection
Azithromycin 1 g
Single dose
Directly observed therapy
Azithromycin 1 g prior to obtaining results
Single dose
Directly observed therapy
Do not wait for results before treating
28
Sexual partners of a confirmed case of gonorrhoea,
acquired locally or in the Goldfields, Kimberley,
Midwest or Pilbara region. GeneXpert point-of-care
test not available.
“ZAP pack” (Amoxycillin 3 g, Probenecid 1 g and
Azithromycin 1 g) prior to obtaining results
Sexual partners of a confirmed case of gonorrhoea,
acquired outside the Goldfields, Kimberley,
Midwest or Pilbara region or if place of acquisition
not known. GeneXpert point-of-care test not
available.
“LAC pack” (Ceftriaxone 500 mg IMI in 2 mL of
1% lignocaine plus Azithromycin 1 g oral) prior to
obtaining results
Gonorrhoea infection in anorectal or oral sites
“LAC pack” (Ceftriaxone 500 mg IMI in 2 mL of
1% lignocaine plus Azithromycin 1 g oral) prior to
obtaining results
Benzathine penicillin 1.8 g IMI and azithromycin
1 g orally prior to obtaining results
Genital ulcers (presumptive clinical diagnosis of
syphilis, donovanosis or chancroid)*
Single dose
Directly observed therapy
Do not wait for results before treating
If patient has purulent discharge, take an
MC&S swab for gonorrhoea culture in
addition to urine/PCR swab.
Single dose
Directly observed therapy
Do not wait for results before treating
If patient has purulent discharge, take an
MC&S swab for gonorrhoea culture in
addition to urine/PCR swab.
Single dose
Directly observed therapy
Ensure NAAT and MC&S swab
Do not wait for results before treating
If penicillin allergy or swab positive for
herpes, syphilis, donovanosis or
chancroid, discuss with PHMO/PHP
Sexual partners of a confirmed case of syphilis and
Benzathine penicillin 1.8 g IMI
Ensure syphilis serology blood test
reverse contact trace positive*
If penicillin allergy discuss with
PHMO/PHP
Do not wait for results before treating
* It is strongly recommended that nurses discuss syphilis cases and contacts with a Public Health Medical Officer prior to commencing
treatment.
For further advice or information please contact PHU staff (see page 3 of the supplement).
29
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available in alternative formats on
request for a person with a disability.
© Department of Health 2016