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REFREC011
INFECTIOUS DISEASES REFERRAL RECOMMENDATIONS
Diagnosis / Symptomatology
Evaluation
Management Options
Referral Guidelines
People may raise sexual health issues
in the context of:
Refer to Guidelines for Managing
Sexually Transmitted Diseases. A
Guide for Primary Health Care
Providers. Health Department of
Western Australia. Communicable
Disease Control Branch. 2001.
Sexual Health Clinics offer free
diagnosis and treatment in
a
confidential setting.
Circumstances for discussion and/or
referral are indicated below with
reference
to
appropriate
specialty/specialties.

Asymptomatic screening

Common symptomatology

Sexual health advice
Diagnosis / Symptomatology
Any treatment must include screening
and treatment of partner(s).
Most patients self refer to Sexual
Health Services.
Section 1.2 History and Examination
Evaluation
Management Options
Referral Guidelines
Asymptomatic screening
Last updated February 2006
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REFREC011
HIV Testing
See: Guidelines for Managing
Sexually Transmitted Diseases. A
Guide for Primary Health Care
Providers. Health Department of
Western Australia. Communicable
Disease Control Branch. 2001.
Section 2.4
Sexual history including risk factors for
HIV.
Negative results:

For example:

Men who have sex with men

Injecting drug users (IDU)

From a country
incidence of HIV

Blood transfusion/products pre
1985
with

Partners of any of the above.

Current or history of STI’s
Patient counselling re safer
sex behaviour. Remember the
3 month window period.
Indeterminate results:
high

Positive results:

Repeat test on second blood
sample

A positive Elisa must be
confirmed by Western Blot
before informing patient

Discuss with Sexual Health
Clinic or Infectious Diseases
Physician
Investigations:
HIV antibodies. Repeat at 3 months
after at-risk exposure/behaviour
Note: Pre-test discussion would include
areas
such
as
window
period,
significance of positive and negative
results.
Discuss with Sexual Health
Clinic
Delivery of results in person by person
ordering the test.
Pregnant women and their sexual
partner(s) should routinely be screened
for HIV risk behaviours.
Those
screening positive for lifestyle factors
should then be offered pre-test
counselling and then tested for HIV.
Post- Exposure Prophylaxis to
prevent HIV
Sexual history to assess the type of
exposure and the risk that the contact is
positive for HIV.
Take baseline serology for HIV,
Hepatitis B, C, and Syphilis. Take
routine STI screening tests.
If a high risk exposure to HIV
through sexual or intra venous
contact
Patients must be given prophylaxis within
72 hours, but the sooner the better –
preferably within 24 hours.
See Operational Guidelines, Health
Department of Western Australia.
If possible the source contact should be
tested.
Refer to Sexual Health/ Infectious
Diseases/ Immunologist/HIV Specialist
for advice including management and
contact tracing.
Refer to Sexual Health/ Infectious
Diseases/ Immunologist/HIV Specialist
for advice including management.
Treat with Combivir tablets twice daily
for four weeks.
Follow-up serology at 4 weeks, 3
months and 6 months.
Last updated February 2006
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REFREC011
Screening for sex industry
workers
Antenatal screening
KEY POINTS:
If working full-time:

4-6 weekly swabs/ urine testing.

Three monthly serology.

Annual Pap smears.
KEY POINTS:
Identify those at risk. For example:
TOP screening or IUCD insertion

Free on-site screening and
treatment without prescription.

Confidentiality / anonymity
assured - can supply false
names, without requirement to
disclose Medicare number.

Hepatitis A and B
immunisation.

Free Condoms.
Treatment depends on diagnosis and
must include treatment of partner(s)
where appropriate.
Most self-refer to Sexual Health
Clinics.
Discuss with Sexual Health Clinic:
Safe treatment options in pregnancy

Young single women
Gonorrhoea management

High local prevalence of STDs
Contact tracing

Previous history of STDs
Herpes management

Recent partner change
Sexual history is important.
All women should be examined at the
onset of labour for herpes lesions.
Screening during first trimester and
repeat at 36 weeks if there is continuing
risk.
Note: 20% of the adult population are
infected with herpes simplex type 2
virus.
KEY POINTS:
Treatment and contact tracing as
appropriate prior to procedure.

Last updated February 2006
Available at Sexual Health Clinic:
All patients should be screened
prior to procedure.
Positive syphillis serology
HIV management
Bacterial vaginosis
Discuss positive findings with
Specialist Obstetrician.
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Diagnosis / Symptomatology
Evaluation
Management Options
Referral Guidelines
Common symptomatology
Dysuria/discharge in men
See: Guidelines for Managing Sexually
Transmitted Diseases. A Guide for
Primary Health Care Providers. Health
Department of Western Australia.
Communicable
Disease
Control
Branch. 2001.
Section 1.5 Syndromes
Last updated February 2006
KEY POINTS:
Sexual history is important.
Men should not pass urine for 23 hours prior to examination.
Screening for men should
include a meatal swab for
gonorrhoea culture so that
sensitivities can be obtained,
and either a urethal swab or a
first catch urine test for
chlamydia.
Guidelines for Managing Sexually
Transmitted Diseases. A Guide for
Primary Health Care Providers. Health
Department of Western Australia.
Communicable
Disease
Control
Branch. 2001.
Refer cases that do not respond
to treatment or have
complications.
Complex contact tracing.
Section 2.1 and 2.2
Treatment of notifiable infections.
Contract tracing (partner screening and
treatment) is essential and may
be accessed through local
Sexual Health Clinic.
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Genital rashes
KEY POINTS:
Treat as appropriate
Common rashes include:
See: Guidelines for Managing Sexually
Transmitted Diseases. A Guide for
Primary Health Care Providers. Health
Department of Western Australia.
Communicable
Disease
Control
Branch. 2001.
See: Guidelines for Managing Sexually
Transmitted Diseases. A Guide for
Primary Health Care Providers. Health
Department of Western Australia.
Communicable
Disease
Control
Branch. 2001.
Genital warts
Section 3: Non Notifiable Infections
Scabies
Genital herpes
Tinea cruris
Psoriasis
Refer those who are not responding to
treatment or if diagnosis uncertain to
dermatology or sexual health
depending on local access.
Section 3: Non Notifiable Infections
Pubic lice
Molluscum contagiosum
Non-specific balanitis
Genital Warts not responding to
treatment by GP are best referred to a
Sexual Health Clinic.
Investigations:
Consider –
Viral swab for genital herpes
Screening for other STDs if
appropriate
Skin biopsy or HPV DNA testing
if diagnosis unclear
Last updated February 2006
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REFREC011
Vaginal discharge
See: Guidelines for Managing Sexually
Transmitted Diseases. A Guide for
Primary Health Care Providers. Health
Department of Western Australia.
Communicable
Disease
Control
Branch. 2001.
Section 1.5 Syndromes
KEY POINTS:
Full history and vaginal examination
are essential.
Common causes include:
Physiological
Candida/thrush
Bacterial vaginosis
Trichomonas
Retained Tampon
Cervicitis:
-
herpetic
-
chlamydial
-
gonococcal
-
non-specific
Treat as appropriate with treatment of
partners for trichomoniasis.
Refer to Sexual Health Clinic for
persistent or recurrent infections.
See:
Guidelines for Managing Sexually
Transmitted Diseases. A Guide for
Primary Health Care Providers. Health
Department of Western Australia.
Communicable
Disease
Control
Branch. 2001.
Section 3.1: Bacterial Vaginosis
Section 3.2: Trichomoniasis
Section 3.3: Candidiasis
Investigations:
High vaginal swab for Candida,
bacterial vaginosis and
trichomonas.
Endocervical swabs for
gonorrhoea and Chlamydia.
Cervical cytology.
Last updated February 2006
Asymptomatic culture findings of
Candida or Gardnerella do not require
treatment.
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Abdominal pain
KEY POINTS:
See: Guidelines for Managing Sexually
Transmitted Diseases. A Guide for
Primary Health Care Providers. Health
Department of Western Australia.
Communicable
Disease
Control
Branch. 2001.
Sexual history is important.
Section 1.5: Lower Abdominal Pain

Symptomatology – pain,
discharge, pyrexia.

Out of phase bleeding.

Presence of IUCD.

Recent delivery or abortion.
Investigations:
Liaise with Sexual Health Clinic for
contact tracing or as appropriate.
See: Guidelines for Managing Sexually
Transmitted Diseases. A Guide for
Primary Health Care Providers. Health
Department of Western Australia.
Communicable
Disease
Control
Branch. 2001.
Section 3.15: Pelvic Inflammatory
Disease
Consider for admission:
Unresponsive to treatment (4872 hours).
Positive pregnancy test with
pelvic pain + - fever. (consider
septic abortion).
Diagnosis uncertain.
Pelvic abscess suspected.
Severe nausea and vomiting.
Endocx/urethral/vaginal swab.
Adolescent.
HCG.
Compliance not assured.
FBC/ESR.
HIV positive.
First catch urine
chlamydia/gonorrhoea PCR.
Mid stream urine culture.
Consider:
Pelvic ultrasound.
Last updated February 2006
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Epididymo-orchitis
KEY POINTS:
See: Guidelines for Managing Sexually
Transmitted Diseases. A Guide for
Primary Health Care Providers. Health
Department of Western Australia.
Communicable
Disease
Control
Branch. 2001.
Sexual history is important.
Section 3.11: Epididymo-orchitis
Consider the following conditions:
Torsion – important to exclude
Trauma
See: Guidelines for Managing Sexually
Transmitted Diseases. A Guide for
Primary Health Care Providers. Health
Department of Western Australia.
Communicable
Disease
Control
Branch. 2001.
Section 3.11: Epididymo-orchitis
If any doubt regarding torsion
immediate referral for surgical
assessment is mandatory.
Gonococcal epididymitis should be
referred to Sexual Health Clinic.
Bacterial:
-
Chlamydia – the most
common cause in men
under 35.
-
E.Coli – the most common
cause in men over 35.
-
Gonorrhoea.
-
TB.
Screen and treat sexual partners.
All treatment should be reviewed to
ensure adequate response.
Neoplasia – any suspicion
always warrants further
investigation.
Viral infections eg mumps.
Investigations:
Consider:
Urethal swabs for gonorrhoea
and Chlamydia.
MSU.
Ultrasound scan.
Last updated February 2006
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Diagnosis / Symptomatology
Evaluation
Management Options
Referral Guidelines
Sexual Health Advice
KEY POINTS:
Treat any underlying disease.
Identify at risk behaviour eg.
Frequent partner change, lack of
barrier contraception, same sex
partner.
Refer to Sexual Health Clinic for sexual
counselling advice or refer to
appropriate agency eg. Drug and
Alcohol Centre.
Identify triggers for at risk
behaviour, eg. Alcohol, drug
abuse, past sexual or physical
abuse.
Potential for behavioural change
Investigations:
Offer STD screening
Erectile Dysfunction
Investigations:
CBC
blood sugar
testosterone
All men who experience erectile
dysfunction will have psychological
issues. However, underlying physical
causes should be treated eg. Diabetes,
medication, alcohol, neurological or
vascular conditions.
Consider referral of severe dysfunction
to Endocrinology / sexual dysfunction
service for outpatient assessment.
blood lipids
LFTs
Last updated February 2006
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