Communities in remote settings across Australia have poorer access to health and medical services. Due to the transient nature of FIFO health workers, men living in remote communities often have less opportunity to build rapport and trust with health professionals- which research has shown is essential for men’s health engagement.
The Australian STI Guidelines recommends more frequent testing for STI’s in remote communities due to known higher prevalence of STI’s. Understanding the STI’s common in remote health sites, can better inform men’s health outcomes and reduce transmission.
What is a STI?
As per the Centre for Disease Control- the term Sexually Transmitted Infection (STI) refers to a pathogen that causes an infection through sexual contact. This differs from the term ‘sexually transmitted disease’ (STD) which refers to a specific disease state that has occurred because of an infection.
How Common are STI’s in Australia?
Research from the Kirby Institute reports that some STI’s are on the rise in Australia.
- Chlamydia has risen 12% since 2013.
- Gonorrhoea has risen almost 3 times as high over the past 10-years in major cities. Most diagnoses of gonorrhoea (71%) were in males.
- Syphilis has more than tripled in the past 10-years. Syphilis remains most prevalent in males, at 82% of diagnoses nationally.
Aboriginal and Torres Strait Islander Sexual Health
- Indigenous Australians experience significantly higher rates of STI’s compared to non-Indigenous Australians.
- Diagnosis for chlamydia is twice more frequently diagnosed in Indigenous populations.
- Gonorrhoea and syphilis diagnoses rates are more than 5x higher compared to the general population.
- HPV vaccination has been hugely successful with no diagnoses of genital warts in Aboriginal men (under the age of 21 years) in the year 2022.
What Are Common Types of STI’s in Remote Settings?
The information listed below primarily relates to biological males. Females can often have other symptoms and precautions that are not listed here.
Chlamydia
Approximately 97,000 Australians are diagnosed with chlamydia each year. Chlamydia is usually transmitted during unprotected sex (vaginal, anal, oral). Chlamydia often has no symptoms, so the person with chlamydia (or your sexual partner) usually has no idea that they are infected.
Diagnosis of chlamydia requires a urine sample in a health clinic. Sometimes a swab is collected for further testing. If diagnosed, chlamydia is straightforward to treat with antibiotics.
It is important to not have sex (even with a condom) for 7 days after the antibiotic treatment has been completed. A repeat test 12 weeks after completing the antibiotic treatment is required to confirm that the chlamydia has been treated successfully.
Gonorrhoea
Gonorrhoea is a bacteria disease and is sometimes informally known as ‘the clap’.
Gonorrhoea is usually transmitted by unprotected sex (vaginal, anal, oral), and can often have no symptoms, so the person with gonorrhoea usually has no idea that they are infected.
For some men, there are sometimes symptoms which can arise after a few days. These can include a thick white or yellow discharge from the tip of the penis, burning when passing urine, anal discharge or a dry sore throat.
Diagnosis requires a urine sample in a health clinic. Sometimes a swab is collected for further testing particularly if there is discharge from the penis or anus. If diagnosed, gonorrhoea is straightforward to treat with antibiotics.
It is important to not have sex (even with a condom) for 7 days after the antibiotic treatment has been completed. Sometimes re-testing is advised to confirm that the gonorrhoea infection has been treated successfully, or 12 weeks later to confirm the absence of gonorrhoea from the body.
Trichomoniasis
Trichomoniasis is caused by a parasite and is more common in rural and remote areas of Australia. Trichomoniasis is transmitted during unprotected vaginal sex. It can also be caught by sharing wet towels as the parasite can live on in these items for several hours.
Trichomoniasis can often have no symptoms. Some men may report burning when passing urine or a penile discharge.
Diagnosis requires a urine sample in a health clinic. Sometimes a swab is collected for further testing. If diagnosed, trichomoniasis is easy to treat with antibiotics (usually a single course is required).
It is important to not have sex (even with a condom) for 7 days after the antibiotic treatment has been completed. Your sexual partner/s should also be tested and treated.
Syphilis
Syphilis is a bacteria which is easy to treat, however if left untreated- can potentially be very dangerous. Syphilis rates are higher in men who have sex with men and for Aboriginal and Torres Strait Islander people who live in remote communities. Pregnant women are routinely screened for syphilis in Australia.
Syphilis is transmitted via skin-to-skin contact (during vaginal, oral or anal sex), sharing injecting needles or a needlestick injury, or during pregnancy (known as congenital syphilis)
The symptoms of syphilis can vary, with some people having no initial symptoms. The symptoms of syphilis depend on the stage of infection. There are 4 stages.
Primary Syphilis (10-90 days after infection)
Symptoms can include painless sores in the mouth, penis, anus (vagina or cervix in women). The sores are a circular area of broken skin, in which the centre may appear weepy or have pus.
Secondary Syphilis (7-10 weeks after infection)
Symptoms can include fever, swollen glands in the groin and armpits, headaches, fatigue, hair loss or a red rash on the palms of the hands, soles of the feet, chest or back. The rash is not itchy.
Latent Syphilis
There are usually no symptoms with latent syphilis. The infection is only found by a blood test. If the syphilis is not treated at this stage, it can remain latent or develop into tertiary syphilis.
Tertiary Syphilis
Tertiary syphilis develops in about 1 in 3 people with untreated latent syphilis. This can occur many years after the initial syphilis infection. The syphilis bacteria can begin to damage and impact other parts of your body such as, eyesight, the heart and lungs, brain and the spinal cord.
Treatment for Syphilis
If you test positive for syphilis, your GP or nurse will need to ask you about recent sexual partners. This is extremely important for contact tracing.
The treatment for syphilis is straightforward. An injection of penicillin is given into your muscle by a GP or nurse. You must not have sex, even with a condom, until you have been told by a GP or nurse that the treatment was successful (after a follow-up blood test has been completed).
If left untreated syphilis can have significant effects on a person’s health, which can include- blindness, heart or lung failure, meningitis, dementia and death.
Syphilis and Pregnancy
This is very important information for males who have sex with females, or those seeking to conceive a child. If left untreated, syphilis can pass from the mother to the baby, a condition called congenital syphilis. Congenital syphilis can cause- miscarriage, stillbirth, premature birth, low birth weight, death shortly after birth.
For Clinicians
For clinicians working in remote settings, refer to your local guidelines regarding screening and treatment. These guidelines can be accessed from the CARPA manual, Silverbook and the Queensland Primary Clinical Care Manual.
Real Men’s Health Takeaway
Proactive actions (such as condoms) are the most effective barrier against STI’s.
Your GP or clinic nurse has likely attended hundreds or thousands of STI tests, so don’t let any shame or stigma stop you from asking for an STI test.
