Sexual health — STI screening, PrEP, partner notification

Definition / Overview

Contact tracing in sexual health is the systematic process of identifying, notifying, and managing the sexual partners of a person diagnosed with a sexually transmitted infection (STI) or blood-borne virus (BBV). The goals are to break chains of transmission, identify and treat those with asymptomatic infections, and reduce ongoing community burden of disease.

In Australia, this responsibility is shared between the clinician, the patient, and public health authorities. As a GP, you have both a clinical and a public health duty in this space. Understanding which conditions require mandatory notification, how to support patient-led partner notification, and when to involve specialist sexual health services is central to everyday practice.

Notifiable Diseases in Sexual Health: Regulatory Framework

Mandatory Notification

In Australia, notification requirements are governed by state and territory public health legislation. While specifics vary by jurisdiction, the following STIs and BBVs are notifiable across most Australian states and territories:

• Key GP action: Notification is triggered by a confirmed laboratory result or, in some jurisdictions and for some conditions, clinical diagnosis alone. Do not delay notification awaiting partner outcomes.
• Most notifications are submitted through an online portal or paper-based form to the relevant state or territory health protection unit. Laboratories often co-notify for positive pathology results, but the treating clinician remains responsible for ensuring notification occurs.
• In many states, labs notify automatically for chlamydia and gonorrhoea; however, the GP retains responsibility for partner notification and clinical management.

When Notification Should Not Be Delayed

• Syphilis in pregnancy: notify immediately due to risk of congenital syphilis; this is a public health emergency requiring rapid partner treatment.
• HIV newly diagnosed: refer to or discuss with a specialist infectious disease or sexual health physician urgently.
• A cluster of gonorrhoea cases with suspected antimicrobial resistance: notify the local public health unit promptly.

Partner Notification: Principles and Practice

Definition and Responsibility

Partner notification (also called contact tracing) involves informing sexual contacts that they may have been exposed to an STI, so they can be tested and treated. The primary responsibility lies with the index patient, but the GP has an active role in initiating and supporting this process.

Look-Back Periods

The look-back period (how far back to trace contacts) varies by condition:

• For conditions where the date of acquisition is uncertain (HIV, hepatitis C), specialist sexual health services should coordinate partner notification.

Methods of Partner Notification

1. Patient Referral (Patient-Led)

• The most common approach in general practice.
• The index patient informs their own partners directly.
• The GP counsels the patient on what to say, provides written information or a contact card if available, and advises partners to attend their own GP or a sexual health clinic.
• All current sexual partners should ideally be tested and treated simultaneously to prevent re-infection (the "ping-pong" phenomenon).

2. Provider Referral

• The clinician (or a sexual health contact-tracing officer) notifies partners directly, with the index patient's consent.
• Used when the patient is unable or unwilling to notify partners themselves, or when the condition poses significant public health risk (e.g. HIV, early infectious syphilis).
• Sexual health services have dedicated health advisers who can assist with this process.

3. Expedited Partner Therapy (EPT)

• Provision of a prescription or medication to the index patient to pass on to their partner(s) without the partner attending a clinician first.
• EPT is not universally legal or recommended in all Australian jurisdictions; check local guidelines.
• Most appropriate for chlamydia and gonorrhoea in specific circumstances; specialist sexual health input is recommended before using EPT routinely.

4. Digital/Online Notification

• Anonymous online notification services exist (e.g. some states support SMS-based partner notification services).
• Useful for casual or anonymous contacts where the index patient does not have direct contact details.
• Refer patients to local sexual health service resources for this option.

Condition-Specific Contact Tracing Guidance

Chlamydia

• Most common bacterial STI in Australia; high rates of asymptomatic infection.
• Look-back: 6 months.
• All current partners should be tested and treated simultaneously.
• Preferred treatment for partners: doxycycline 100 mg orally twice daily for 7 days (or azithromycin 1 g orally as a single dose if adherence is a concern; note reduced efficacy data for azithromycin).
• Test of cure is not routinely required unless symptoms persist, pregnancy, or concerns about re-infection.
• Retest the index patient at 3 months due to high re-infection rates.

Gonorrhoea

• Look-back: 2-3 months (or last sexual partner if longer interval).
• Increasing antimicrobial resistance: treat with ceftriaxone 500 mg IM as a single dose (first-line as per current Australian guidelines; note some guidelines use 1 g if pharyngeal infection confirmed).
• Dual therapy (adding azithromycin 1 g) is no longer universally recommended in Australian guidelines due to rising azithromycin resistance; follow current Therapeutic Guidelines.
• Test of cure with culture (not NAAT alone) is recommended for all cases of gonorrhoea due to resistance concerns: swab for culture 2 weeks after treatment completion, or if using NAAT, at least 72 hours post-treatment.
• Refer or discuss with sexual health specialist if treatment failure or complicated infection.

Syphilis

• Early referral to, or discussion with, a sexual health specialist or infectious disease physician is strongly recommended for all cases.
• This is especially critical in pregnancy due to the risk of congenital syphilis.
• Look-back periods vary by stage (see table above).
• Treatment: benzathine penicillin G 1.8 g (2.4 million units) IM as a single dose for primary, secondary, and early latent syphilis.
• Partners should be assessed clinically and serologically; empirical treatment of recent contacts (within 90 days of exposure) is often recommended without waiting for serology results.
• Sexual health services have dedicated health advisers who achieve significantly higher rates of partner notification and treatment for syphilis.

HIV

• All newly diagnosed HIV requires immediate discussion with, or referral to, a clinician experienced in HIV management (HIV specialist, infectious disease physician, or specialist sexual health physician).
• Partner notification for HIV is complex and emotionally sensitive; specialist health advisers are best placed to coordinate this.
• Post-exposure prophylaxis (PEP): partners with potential recent exposure (within 72 hours) should be offered PEP. PEP should be commenced as soon as possible after exposure and within 72 hours. Refer to an emergency department or sexual health clinic if the GP is not experienced in PEP prescribing.
• Pre-exposure prophylaxis (PrEP) should be discussed with ongoing contacts of people living with HIV.

Hepatitis B

• Acute hepatitis B is notifiable; most adults clear the infection without treatment, but contacts require assessment.
• Sexual contacts of acute hepatitis B cases should receive hepatitis B immunoglobulin (HBIG) and hepatitis B vaccine as soon as possible (ideally within 14 days of exposure).
• Chronic hepatitis B partners should be vaccinated if not immune.

Hepatitis C

• Newly acquired hepatitis C is notifiable.
• Sexual transmission is uncommon in heterosexual couples but occurs in gay, bisexual, and other men who have sex with men (GBMSM), particularly in the context of rectal trauma or recreational drug use.
• Partners should be offered HCV serology. Refer to a specialist for management of HCV in the index patient; highly effective direct-acting antiviral (DAA) therapy is now available via the PBS.

The GP's Role: Practical Steps in Consultation

1. Diagnose and treat the index patient promptly with appropriate first-line therapy.
2. Notify the relevant state or territory health authority as required for notifiable conditions (via online portal, phone, or paper form as per local process).
3. Counsel the patient on the importance of partner notification; use non-judgmental, patient-centred language.
4. Determine who needs to be notified using the appropriate look-back period.
5. Agree on a notification method with the patient: patient-led, provider-led, or assisted referral to sexual health service.
6. Document the discussion and agreed plan clearly in the clinical record.
7. Provide written resources or contact cards where available.
8. Advise the patient to abstain from unprotected sexual contact until they and their partners have completed treatment.
9. Schedule follow-up for test of cure (where indicated) and retesting (e.g. 3 months for chlamydia).
10. Refer to sexual health services for complex cases: HIV, syphilis, gonorrhoea with treatment failure, or patients with multiple partners where provider-led notification is required.

Special Populations

Pregnancy

• Syphilis and gonorrhoea in pregnancy require urgent specialist collaboration.
• Chlamydia in pregnancy: treat with azithromycin 1 g orally as a single dose (doxycycline is contraindicated in pregnancy); test of cure at 3-4 weeks post-treatment.
• Trichomoniasis in pregnancy is associated with adverse outcomes (preterm delivery, low birth weight); treat with metronidazole 400 mg orally twice daily for 7 days (single high-dose regimens are generally avoided in the first trimester).

Aboriginal and Torres Strait Islander Communities

• Rates of STIs, particularly syphilis, gonorrhoea, and chlamydia, are substantially elevated in many Aboriginal and Torres Strait Islander communities.
• An ongoing syphilis outbreak across northern and central Australia has required targeted public health responses; GPs working in these regions must be familiar with local outbreak protocols and enhanced contact-tracing requirements.
• Engage with community-controlled health organisations and local public health units for culturally safe partner notification approaches.
• Screen proactively: STI screening is recommended annually for sexually active Aboriginal and Torres Strait Islander people under 30 years (and 2-yearly up to age 35) as part of the annual health check (MBS item 715).

GBMSM

• Higher rates of gonorrhoea, syphilis (including neurosyphilis), LGV, and HIV.
• 3-monthly STI and HIV screening is recommended for GBMSM at higher risk.
• PrEP is PBS-funded for HIV-negative GBMSM and others at substantial ongoing risk; discuss with eligible patients.
• Hepatitis C testing at each sexual health screen for GBMSM with risk factors.

Young People (Under 25 Years)

• Chlamydia screening is recommended annually for sexually active women under 25 years (RACGP Red Book).
• Opportunistic testing is preferred; the National Chlamydia Screening Programme supports this approach.

Ethical and Medico-Legal Considerations

Confidentiality

• Partner notification must balance the index patient's right to confidentiality with the duty to protect third parties from harm.
• Patient-led notification is the preferred first approach because it preserves patient confidentiality.
• If a patient refuses to notify partners and a significant risk of harm exists (e.g. HIV-positive patient continuing unprotected sex with an uninformed partner), the GP may have grounds to breach confidentiality in limited, legally defined circumstances. Seek guidance from your medical defence organisation and the relevant state/territory health authority before doing so.

Documentation

• Document the partner notification discussion, the agreed method, and the patient's response. If a patient declines, document this clearly.
• Notification forms submitted to the health department are generally separate from the clinical record and are managed under public health legislation with their own confidentiality provisions.

Mandatory Reporting vs. Clinical Duty

• Mandatory notification to the health department is a legal obligation under public health legislation and is distinct from partner notification, which is a clinical and ethical obligation.
• Both are required; they serve different functions.

MBS and PBS Considerations

• MBS item 715: Annual health check for Aboriginal and Torres Strait Islander patients; includes STI screening as a key component.
• MBS item 36/37: Standard and longer consultation items for STI management and counselling; complex partner notification discussions warrant a longer consultation.
• PBS-listed treatments relevant to this domain:
• Doxycycline: PBS-listed for chlamydia
• Metronidazole: PBS-listed for trichomoniasis and bacterial vaginosis
• Benzathine penicillin G: available through sexual health services and hospital pharmacies for syphilis
• Ceftriaxone: PBS-listed for gonorrhoea
• DAA therapy for hepatitis C: PBS-listed (requires specialist initiation in most states, though some jurisdictions allow GP-led prescribing with training)
• PrEP (emtricitabine/tenofovir): PBS-listed for eligible patients

Key Exam Points

• Notification is mandatory for chlamydia, gonorrhoea, syphilis, HIV, and hepatitis B/C (newly acquired) in all Australian jurisdictions; do not delay for partner outcomes.
• Look-back periods differ by condition and stage; know syphilis staging look-backs specifically.
• All current partners must be treated simultaneously to prevent re-infection.
• Syphilis and HIV require early specialist involvement; do not manage in isolation in general practice without specialist support.
• Syphilis in pregnancy is a public health emergency; act immediately.
• Test of cure is required for gonorrhoea (culture-based), chlamydia in pregnancy, and where treatment failure is suspected.
• Cultural safety is essential, particularly in communities with high STI prevalence; use appropriate screening strategies and engage community resources.
• Document all notification and partner notification discussions, including when patients decline.

Sources

• PBS Schedule (Pharmaceutical Benefits Scheme)
• MBS Online (Medicare Benefits Schedule)
• RACGP Red Book, Guidelines for preventive activities in general practice
• RACGP clinical guidelines