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Notifiable infections and partner notification: Who needs to know about my STI?

You might have heard the term “notifiable disease” or “notifiable infection” during COVID lockdowns, but what you might not know, is that some sexually transmissible infections (STIs) can also be notifiable infections. What this means is that the Department of Health automatically gets notified when there’s a positive test result – either by a pathology lab or by a doctor or medical practitioner. This process is called surveillance, which helps to monitor and track outbreaks, and manage epidemics and pandemics. This also helps the Department of Health get targeted messaging out to communities and areas that may be more impacted by the infection than others. However, rest assured, no information about you or your health becomes public.

However, depending on the infection itself, you might be contacted by health authorities. Also, you might want — or need — to notify people you have been in sexual contact with. This is where partner notification or ‘contact tracing’ comes in.

What is partner notification?

The terms ‘partner notification’ and ‘contact tracing’ are often used interchangeably. These terms refer to the process of informing partner(s) of a person with STIs that they are also at risk of having an STI such as chlamydia or HIV, and they should seek testing and treatment. The main purpose of partner notification is to assist partners who may be unaware of their risk to have testing, treatment and prevent serious symptoms and onward transmission.

Partner notification can be carried out in three different ways: 

  1. Patient referral:  the index patient themself informs the partners that they should seek testing and treatment. This is often referred to as partner notification. 
  2. Provider referral: a health-care professional informs partners of their need for testing and treatment. This is often referred to as contact tracing. 
  3. Conditional referral:  a combination of the previous two strategies. 

If you want to let a partner know but don’t want them to know it’s come from you specifically then there are anonymous services that you can use to send a message to them: 

Which STIs are notifiable?

The most pressing notifiable STI at this time is MPox. Local Public Health Units are monitoring the spread of infection and notification of cases. Post-exposure preventative vaccination (PEPV) can be given preferably within 4 days of contact if: 

  • Someone has contacted you to let you know they have symptoms or confirmed case of mpox; or  
  • If you’ve attended sex on premises venues (SOPVs) and public/private events (particularly where sexual or intimate contact may occur) in areas where local transmission of mpox is occurring.  

For other STIs:

  • Chlamydia – notify partners from the last 6 months;
  • Gonorrhoea – notify partners from the last 2 months;
  • Syphilis – notify partners from the last 3, 6 or 12 months depending on stage of infection;
  • HIV* – If you are diagnosed with HIV and have a detectable viral load and have had sex with someone without a condom in the 72 hours before your diagnosis let them know so that they can access PEP (Post Exposure Prophylaxis). Otherwise, if you are diagnosed with HIV, your diagnosing health worker has a responsibility to ensure that your sexual and needle-sharing contacts are followed up, where possible. Assistance with partner notification may be provided by the department through its partner notification officers.
    *People Living With HIV on treatment with an undetectable viral load can not transmit HIV. Undetectable = Untransmissible (U=U)

Which STIs aren’t notifiable?

There are STIs that are NOT notifiable, because they are super common, and can be easily treated or managed.  These include:

  • Herpes Simplex Virus (cold sores and genital herpes)
  • Genital warts/HPV
  • Bacterial vaginosis
  • Candida or thrush
  • Molluscum contagiosum
  • Urinary Tract Infections

While these conditions are often associated with sexual contact, they are not considered notifiable. This is particularly in the case of the Human Papilloma Virus (HPV) and the Herpes Simplex Virus (HSV). For instance, asymptomatic infections with HSV-1 (cold sores) are common; 70 -90% per cent of adults have circulating antibodies to HSV-1, indicating previous infection but may never had any outbreaks or way of knowing they have the virus. Similarly, 12–15% of adults have antibody evidence of exposure to the HSV-2, but again, many may not have any outbreaks or awareness that they have been exposed to the virus. 

Read more:

Healthdirect Australia: Notification of illness and disease

Victoria State Government: Department of Health

Can vaccinations prevent Sexually Transmitted Infections (STIs)? 

Yes and no! Basically, it depends on the STI.  

Vaccinations are very effective in prevention of Human Papilloma Virus (HPV), Hepatitis A and Hepatitis B viruses, and monkeypox (Mpox). Despite ongoing research, there are currently no vaccinations for prevention of viral Hepatitis C and HIV, nor any bacterial STIs such as chlamydia, gonorrhoea and syphilis.1 However, the good news is that these STIs can all be treated.  

HPV vaccination 

HPV is a very common STI which usually shows no symptoms and goes away by itself. In a small number of people, HPV can cause serious illness and is responsible for most genital warts and cervical cancers. HPV spreads by sexual contact. 

The vaccination that prevents HPV is known as Gardasil ®9 and is free for anyone aged between 12 and 25 years of age. The vaccine works best if it is given before exposure to the virus – that is, before you become sexually active.  

It is recommended and free for:  

  • All Australians aged 9-25 years.  
  • High risk groups including:
    • People living with HIV
    • Significantly immunocompromised groups
    • Men who have sex with men. 

Australian children aged from 12-13 can access the vaccination through the Secondary School Immunisation Program. You can also access the vaccine through your GP, pharmacy or local immunisation provider.2 

Hepatitis A vaccine  

Hepatitis A is an acute liver infection and is caused from contaminated food and water. The virus spreads through faecal-oral transmission and can also occur during sex, especially men who have sex with men. While the virus is highly contagious, most people recover completely.  

Hepatitis A vaccination is recommended for people in high-risk groups and for unvaccinated people who have been in contact with someone who has hepatitis A. The vaccine can protect someone who has been exposed to the virus if given within two weeks of contact. Two doses taken 6 months apart is recommended for long lasting protection. 2 

It is recommended for high-risk groups including: travellers to developing countries, frequent visitors to remote indigenous communities, sewerage workers, men who have sex with men, childcare workers, intellectually disabled and their carers, injecting drug users, people with chronic liver disease and people with haemophilia needing regular blood transfusions.2 

It is available free for Aboriginal and Torres Strait Islander children (between 12-24 months) who live in remote regions. 2 

Hepatitis B vaccine 

Hep B is an infection of the liver caused by the hepatitis B virus. It is spread when blood, semen or another body fluid passes from an infected person to a non-infected person. Spread can occur through sexual contact, sharing needles or from mother to baby at birth 

Vaccination is recommended and free for:  

  • All babies and young people under 20 years of age  
  • People who are at risk including:
    • Aboriginal and Torres Strait Islander people
    • Household contacts and sexual partners of people living with hep B
    • Injecting drug users and those on opioid substitution therapy
    • Men who have sex with men
    • People living with HIV
    • People living with hepatitis C
    • People from high prevalence countries2 

While most adults who contract hepatitis B recover completely and do not need ongoing treatment, children who contract the virus are more likely to develop chronic hepatitis B. All babies should be given the Hep B vaccine within 24 hours of birth and then further doses at 2 months, 4 months and 6 months of age, as part of a combination vaccine. Babies born to mums with hepatitis B should be vaccinated within 12 hours of birth as well be given another medicine called ‘hepatitis B immunoglobulin’.3 

If you are under 20 years old and did not receive the vaccines in childhood, or if you are a refugee or other humanitarian entrant of any age, you can get a free catch-up vaccination.3 

Mpox vaccine 

Mpox, related to the smallpox virus, is a rare virus which, until recently, was mainly isolated to returned travellers. The disease which spreads through close physical contact and effects mostly men who have sex with men, has recently seen local transmission, particularly in Victoria. While usually resulting in a mild illness, some people may develop serious illness and require hospitalisation. At the mpox vaccination is not currently recommended as a routine travel vaccine, but is recommended, available and free, for eligible people: 

  • Men who have sex with men 
  • Sexually active trans and gender diverse people, if at risk of mpox exposure 
  • Sex workers, particularly those with clients who are at risk of mpox exposure 
  • Sex-on-premises venue staff and attendees 
  • People living with HIV, if at risk of mpox exposure 
  • Sex partners (including anonymous or intimate contacts) of the above 
  • Laboratory personnel working with orthopoxviruses 
  • Healthcare workers at risk of exposure to patients with mpox 

The mpox vaccination involves 2 doses, provided 28 days apart. It takes 14 days to become effective. 

To find a local mpox immunisation provider, search here: Mpox immunisation providers – Better Health Channel.  

Future use of vaccinations to prevent STIs 

With no vaccine available for Hepatitis C, HIV or herpes and increased drug resistance to bacterial STIs, researchers are focussing on new vaccinations to reduce burden of disease. While there have been some promising vaccine developments, further investment and action is required both to combat the rising epidemic of STIs and ensure continued effectiveness of existing vaccines. 1 

While we await these developments the best way to protect yourself against STIs is by using condoms, having regular STI checks and knowing the sexual health of your partner (s). Addressing both prevention and control of STIs is a public health priority. 

References:  

  1. Raccagni AR, Alberton F, Castagna A, Nozza S. ‘Vaccines against Emerging Sexually Transmitted Infections: Current Preventive Tools and Future Perspectives’, New Microbiol. 2022 Jan;45(1), pp. 9-27, viewed 2 July 2024, https://www.newmicrobiologica.org/PUB/allegati_pdf/2022/1/9.pdf    
  2. Australian Government Department of Health and Aged Care 2024, Getting vaccinated, viewed 5 July, 2024  https://www.health.gov.au/topics/immunisation/getting-vaccinated?language=und#routine-vaccines-are-free  
  3. Better Health Channel, Hepatitis B immunisation, viewed 3 July, 2024 https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/hepatitis-b  
  4. Department of Health, Mpox (Monkeypox), viewed 19 July, 2024, https://www.health.vic.gov.au/infectious-diseases/mpox-monkeypox#vaccination  

Green Whistle and IUD insertions

IUDs (intrauterine devices) are an increasingly popular method of contraception for many people – they are extremely effective at preventing pregnancy. They are small, T-shaped devices inserted into your uterus, with a fine nylon thread attached. There are hormonal and non-hormonal types of IUDs. IUDs must be inserted by a specially trained doctor or nurse. 

IUD insertion 

When you are having an IUD inserted, the painful part happens when the IUD is passed through the cervix into your uterus. This pain typically lasts for around 10-30 seconds. The amount of pain can vary from person to person, and is influenced by things like the position and angle of your cervix. Sometimes it’s less painful for people who have given vaginal birth. Different clinics offer different types of pain relief for IUD insertions, such as over the counter pain relief tablets, local anesthetic spray or full sedation. 

Diagram of a uterus with an IUD

About the green whistle 

A medication called ‘Penthrox’ (or the ‘green whistle’) is a form pain relief that is offered by some IUD clinics around Victoria. The green whistle is commonly given by paramedics, or in emergency departments when patients are in acute pain caused by things like fracture, burns, or large wounds. It contains a medication called methoxyflurane, which is vaporised in a green inhaler.  

Photo of a green whistle

To take the medication, you put the ‘green whistle’ in your mouth and are in control of how many times you breathe in. You typically take breaths for the 10 – 30 seconds that there is pain, then stop using it. Some of the side effects may include drowsiness, cough, dizziness, headache, nausea, and confusion. Side effects wear off in about 30 minutes. 

Green whistle and IUD insertions 

Studies in the UK and Europe have shown how easy and effective the green whistle is to use.  Feedback from IUD patients using the green whistle has also been positive, with most saying they would repeat the procedure when they are next due to change their IUD.  

Despite IUDs being extremely safe and reliable (over 99% effective at preventing pregnancy), only a small percentage of Australians actually use them (for example, only 6.3% of Australian women use hormonal IUDs 1). This means that people may be at risk of unwanted pregnancy, if they are reliant on other, less effective means of contraception. While there is growing awareness of contraceptive methods such as IUDs, there is also growing awareness of how uncomfortable IUD insertion procedures can be – which may discourage people from utilising them (for example, see ABC News 2022). 

The green whistle adds to the available pain relief options for anyone interested in an IUD. 

If you are interested in finding services that provide IUD insertions with different pain relief options, contact 1800 My Options (1800 696 784, weekdays 9am – 5pm) or online.  

 

  1. Grzeskowiak LE, Calabretto H, Amos N, Mazza D, Ilomaki J. Changes in use of hormonal long-acting reversible contraceptive methods in Australia between 2006 and 2018: A population-based study. Aust N Z J Obstet Gynaecol 2021;61(1):128–34. doi: 10.1111/ajo.13257. 

 

Are Abortions Traumatising?

There are many myths in relation to how abortion can impact someone’s mental health. One persistent myth is that having an abortion is something that will harm the pregnant person mentally, and cause them trauma.

In relation to abortion and mental health, The American Psychological Society has concluded that:  

“Large longitudinal and international studies have found that obtaining a wanted abortion does not increase risk for depression, anxiety, or suicidal thoughts.”

This research was predominantly based on a ground-breaking longitudinal study with abortion seekers, known as ‘The Turnaway Study.’ In short, the findings reflected the reality that for most women, an abortion is not inherently traumatic, nor does it cause ongoing mental health crises. In fact, it reflected that the opposite is true – that the mental health of abortion seekers who were denied an abortion is most negatively affected.

Women and pregnant people often report a variety of mixed feelings after an abortion, including relief as a dominant emotion. However, this does not mean that everyone experiences abortion in the same way, nor does it mean that everyone experiences exactly the same emotions or trajectories post-abortion. Some abortion-seekers report challenging feelings post-abortion in relation to their individual circumstances.

Personal, familial, cultural and social factors will all impact on an individual’s decisions regarding abortion. It may be helpful to explore this with a non-judgmental friend, family member, community member or counsellor. It is extremely important that people can exercise their autonomy and are free from coercion in relation to this decision. The best mental health outcomes are seen in people who receive the support they need, to make a decision in a timely, autonomous manner. 

You can find some accredited non-directive pregnancy options counsellors by contacting 1800 My Options or searching online. 

The Abortion Project offers some post-abortion peer-support groups in some states of Australia.

The Royal Women’s Hospital and Children By Choice have some great activities to help you explore your pregnancy options in relation to an unintended, unwanted, or unplanned pregnancy: