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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  

Accessing Healthcare as a Rural Australian

Living in regional or remote parts of Australia adds another layer of complexity for patients accessing healthcare. In today’s blog post, we discuss strategies to aid people from rural communities to feel that their needs are being addressed, whether that be for someone from a regional place having services transferred to a metropolitan hospital, or for someone from out bush seeking local care. All Australians have the right to access comprehensive health services, but due to geographical location in part, data demonstrates that regional and remote inhabitants have poorer access to primary healthcare (such as a GP), increased rates of hospitalisation, and increased rates of injury and death compared to city folk.1 Read on for how to utilise services to your advantage when you live a distance from a major health network.

Are there even sexual and reproductive health services in my area?

If you’re wanting to find contraception, pregnancy options, abortion or sexual health services in your area, contact us at 1800 My Options (phone line is open from 9am to 5pm Monday to Friday), or use our interactive map to search for a local practitioner who meets your needs.

There are currenlty 7 Women’s sexual and reproductive health hubs in regional Victoria, who can help you with information and support on all types of contraception, sexual health testing and treatment, medical abortion and referral for surgical abortion of pregnancy.

There are telehealth services offering phone/online consults for Medication Abortions, where your scripts will be sent to you after your consults. However, you will still need to attend a clinic in person where you can do your blood test/ultrasound scans.

If you’re after some basic STI testing, you can also use the TestMe service.
TESTme is a free service of Melbourne Sexual Health Centre (MSHC) for rural Victorians aged 25 years and younger, rural Victorian men who have sex with men and Aboriginal and Torres Strait Islander people. It offers self-testing kits for chlamydia and gonorrhea, which will be posted to you.

I’m unsure if I even need to go to the GP or hospital – should I just wait and see?

Generally speaking – no. If you are concerned enough to think you need to seek help, you should not delay. However, if you are seeking some advice, there are some services that you can access online or over the phone, if travel is challenging for you:

  • NURSE-ON-CALL: 1300 60 60 24 
    24/7
    Discuss your health concerns with a registered nurse

  • Healthdirect Symptom Checker
    If you have access to the internet, this symptom checker at can make some general recommendations, and you may be able to wait to see a local GP the next day.

  • Victorian Virtual Emergency Department (VVED)
    24/7
    A public health service for non-life-threatening emergencies – access emergency care from anywhere in Victoria.

  • 1300 MEDICINE: 1300 633 424 
    9am – 5pm, weekdays
    Talk to a registered pharmacist about medicine-related questions (including how to take medicines, possible side effects, and taking medicines during pregnancy or breastfeeding).

  • Pregnancy, Birth and Baby Line: 1800 882 436  
    7am – midnight, 7 days a week
    Talk to a Maternal Child Health Nurse for personal advice and guidance. They can direct you to local support services.

  • For other pregnancy concerns, many maternity units have a phone line you can call for questions about worries such as breaking the waters or early labour. This may be a valuable resource to help guide you regarding if/when you need to present to hospital.

As always, if you have major or persisting concerns, go to the hospital or call 000 if urgent.

Travelling to hospital for repeat appointments is time-consuming and expensive.

Whilst ongoing care from the hospital may be challenging if you live far away, continuing your follow-up after a medical issue can be critical in ensuring your recovery or making sure your long-term health is optimal. For outpatient appointments, many clinicians can conduct Telehealth appointments (either over the phone or by video chat), so ask your doctor if this would be appropriate for you. If it is important you are seen face-to-face, the Victorian Patient Transport Assistance Scheme (VPTAS) exists to provide financial assistance for Victorians who need to travel great distances for specialist medical care.5 Check your eligibility on the VPTAS website and then speak to your doctor about arrangements.

I feel culturally unsafe, or I’m not sure my culture will be understood or respected at hospital.

Unfortunately in Australia, First Nations people experience a burden of disease estimated to be 2.3 times greater for Indigenous people compared to non-Indigenous people.2 Whilst many influences play into this, an important factor is a lack of cultural understanding or sensitivity in interactions, and First Nations peoples’ understandable trepidation about engaging with a system that historically has been pejorative. In Victoria, the Improving Care for Aboriginal and Torres Strait Islander Patients (ICAP) program aims to provide culturally-safe care for First Nations people, and a crucial part of this is the role of Aboriginal hospital liaison officers who can provide linguistic and cultural support to patients.3 Victorian hospitals encourage people to identify themselves as First Nations so they can better meet the specific needs of this community; as such, please feel empowered to self-advocate and ask for Indigenous liaison services if you identify as Aboriginal or Torres Strait Islander. If you don’t feel comfortable asking for formal services, even bringing a support person to hospital (such as a family member or friend) can help. Furthermore, many maternity units offer Koori Maternity Services (KMS) which are geared towards supporting First Nations mums through their pregnancy journey.4

For migrants and people whose first language is not English, accessing healthcare can also be challenging. You can request a free interpreting service if you don’t understand what is being said – so please do not hesitate to ask for this from your medical professional.

I’m facing a challenge which is more likely to affect country folks.

While no matter where you live, staying healthy can be a challenge – living rurally can bring with it some significant barriers to good health.

  • For example, whilst motor vehicle accidents can occur anywhere in Australia, the rates of death from land transport accidents are nearly three times higher in remote areas, and nearly four times higher for very remote areas.1 Always make sure you are buckled up, your car is well-maintained, and never drive when tired.
  • Furthermore, occupational injuries and deaths are more common in rural areas due to practices like farming;6 visit the Safe Work Australia if you have concerns or are seeking workers’ compensation.
  • Rates of smoking and alcohol consumption are higher in the country generally,7 so stay aware and talk to your GP for advice on reducing your intake or quitting.
  • Rural folk face distinct stressors which can affect your mental health. Phone counselling services can support you remotely:
    • Lifeline — call 13 11 14 or chat online, for crisis support and suicide prevention services.
    • Yarning SafeNStrong (YSNS) – call 1800 959 563 for a free and confidential counselling service for Aboriginal and Torres Strait Islander Peoples.
  • For women living outside of major cities, the likelihood of experiencing intimate partner violence is 1.5 times higher.1 If you have concerns about your safety, some Victorian family violence organisations can be found here.
References
  1. Australian Institute of Health and Welfare (AIHW) 2023, Rural and remote health, viewed 30 March 2024, https://www.aihw.gov.au/reports/rural-remote-australians/rural-and-remote-health
  2. Australian Institute of Health and Welfare (AIHW) 2022, Indigenous health and wellbeing, viewed 30 March 2024, https://www.aihw.gov.au/reports/australias-health/indigenous-health-and-wellbeing
  3. Victorian State Government Department of Health 2023, Access and continuing care, viewed 30 March 2024, https://www.health.vic.gov.au/health-strategies/access-and-continuing-care
  4. Victorian State Government Department of Health 2023, Aboriginal maternity services, viewed 30 March 2024, https://www.health.vic.gov.au/patient-care/aboriginal-maternity-services
  5. Victorian State Government Department of Health 2024, Victorian Patient Transport Assistance Scheme (VPTAS), viewed 30 March 2024, https://www.health.vic.gov.au/rural-health/victorian-patient-transport-assistance-scheme-vptas
  6. Australian Institute of Health and Welfare (AIHW) 2021, Geographical analysis of hospitalised injury and injury deaths data, 2017–18, viewed 30 March 2024, https://www.aihw.gov.au/reports/injury/geographical-analysis-injury-data
  7. Australian Institute of Health and Welfare (AIHW) 2024, Use of alcohol and other drugs in Major cities, regional areas, and remote areas, viewed 30 March 2024, https://www.aihw.gov.au/reports/rural-remote-australians/alcohol-drugs-geographic-areas

Is syphilis still around today?

Syphilis “The Great Pretender”: Just Pretending to be Obsolete? 

The term ‘syphilis’ often conjures up images of afflicted artists and writers in Golden Age Paris, Columbus returning from the “New World”, or Al Capone’s release from Alcatraz due to advanced disease. Whilst once referred to as the “infinite malady” by Shakespeare, syphilis has been curable since the discovery of penicillin. Closer to home, we’ve also played a huge role in syphilis research and management. Did you know that the world’s first scientific collection of community-based syphilis data was done right here in Melbourne, in 19101?

However, syphilis is anything but a disease of the past. It is currently experiencing a massive surge in many Australian communities. Australian Government data indicates that, in 2022, rates of syphilis were double that of recorded cases in 2015.2 Let’s take a closer look at what syphilis looks like, and how it can affect your health.

What is syphilis?

Syphilis is caused by a bacterium called Treponema pallidum.

Syphilis infections have several hallmark features, including an initial painless sore (or ‘chancre’) which develops soon after exposure, and then a generalised body rash which occurs several weeks to months later. However, not everybody experiences these ‘classic’ symptoms, and syphilis has been nicknamed “the great pretender” because it can mimic many other diseases, making it hard to identify.

Eventually, if untreated, syphilis infection becomes largely silent for a variable period of time – sometimes for up to a decade, before long-term nervous system, psychological and cardiac symptoms may declare themselves. Because of syphilis’ vague early symptoms followed by a long asymptomatic period, many people with this particular sexually transmitted infection (STI) are not aware they have been infected.

However, it can be very dangerous for long-term health, and is a known cause of congenital disease for babies born by infected mothers. As such, syphilis awareness and testing is becoming a priority in Australia to manage our current outbreak and continue to keep our communities healthy.

Who is at risk?

Everyone who is sexually active is at risk of developing syphilis. However, certain groups are known to be higher risk of contracting the disease, including women of reproductive age, Aboriginal and Torres Strait Islander people (especially those in regional and remote areas with known outbreaks), and men who have sex with men (MSM).2 However, increasing rates of syphilis are also being discovered in the heterosexual community; in a study comparing rates of positive syphilis tests in people being screened at sexual health clinics in major Australian cities, 3 in 1000 tests for women were positive in 2019 (compared to 1.8 per 1000 tests in 2011), and 7.6 in 1000 tests for heterosexual men were positive in 2019 (from 6.1 per 1000 in 2011).3 Whilst these numbers seem only small, the Melbourne Sexual Health Centre has seen a 220% increase in syphilis cases amongst women over the past several years, according to The Age newspaper.4 Furthermore, as syphilis screening in the straight community is not as commonplace as that amongst the MSM community or for those involved in sex work, these numbers are likely under-representing the presence of syphilis in heterosexual networks.

How can I be screened for syphilis?

Luckily, syphilis screening is very straightforward and highly accessible. All it involves is a blood test, and this can be sought from your local GP or via a sexual health centre. Whilst testing for chlamydia and gonorrhoea can be done via urine or swab test, which is somewhat less invasive, syphilis testing does require a blood test, but this is also a good opportunity to screen for blood-borne viruses (BBVs) (given syphilis is known to increase the risk of acquiring HIV in high-risk populations,5 and many BBVs can infect people without symptoms). If you have a lesion on your genitals, anus, mouth or anywhere else that seems suspicious, this can also be swabbed by your doctor.

What does treatment involve?

Syphilis can be cured with penicillin, but the length of treatment depends heavily on how long a patient has had syphilis. If the duration of infection is less than two years, a once-off treatment of intramuscular penicillin is sufficient. If the infection has persisted for over two years, or the length of infection is unknown, it is safer to treat with weekly injections for three weeks to ensure clearance.6 Having regular screening for syphilis with general STI screens (recommended every 6-12 months if sexually active, or more frequently if you have new or multiple partners) can help guide your doctor about how long you may have had syphilis.

Any case of syphilis requires notification to the Department of Health, and ‘contact tracing’ (the process of contacting recent sexual partners to notify them they are at-risk) is performed so they can also be tested and treated. Anyone with syphilis must abstain from sexual activity for at least 7 days after treatment, or until all antibiotics are completed. Given the potential for re-infection, avoid sexual contact with partners from up to the past 12 months until they have been treated as necessary.5

How can I protect myself?

The only way to protect yourself from syphilis is through the consistent use of condoms for all types of sex (or dental dams if performing oral sex). Regular screening is useful to identify and treat syphilis as soon as possible if you do come into contact with it.

Can syphilis affect my pregnancy?

Syphilis screening is a routine test in early pregnancy, most commonly done by your GP when you are diagnosed as pregnant. However, it is possible to contract syphilis throughout pregnancy, so depending on your level of risk your pregnancy care team will decide if you need additional screening (which can be done at 28-32 weeks, at delivery, and at any other occasion if you are deemed at-risk or present with symptoms). Babies born to mothers with syphilis infection (even if appropriately-treated during pregnancy) require specialist follow-up.7 

‘Congenital syphilis’ (a condition seen in babies who are infected with syphilis whilst in the womb) can result in poor pregnancy outcomes such as organ damage or physical deformities for the baby, or potentially miscarriage or stillbirth. Since 2017, Victoria has seen 14 cases of congenital syphilis, including six cases of stillbirth, and this is a major public health emergency.7 To be vigilant about this important issue, syphilis screening across Australia is being stepped up in order to keep mums, babies and everyone safe.

References
  1. Temple-Smith, M 2019, ‘The birth of syphilis surveillance in Melbourne’, The Conversation, viewed 5 April 2024, https://www.themandarin.com.au/106816-the-birth-of-syphilis-surveillance-in-melbourne/  
  2. Australian Government Department of Health and Aged Care 2024, National response to syphilis, viewed 1 April 2024, https://www.health.gov.au/our-work/national-response-to-syphilis. 
  3. Carter, A; McManus, H; Ward, JS; Vickers, T et al. 2023, ‘Infectious syphilis in women and heterosexual men in major Australian cities: sentinel surveillance data, 2011-2019’, Medical Journal of Australia, vol. 218, no. 5, pp. 223-228, viewed 1 April 2024, https://www.mja.com.au/journal/2023/218/5/infectious-syphilis-women-and-heterosexual-men-major-australian-cities-sentinel#1. 
  4. Cunningham, M 2021, ‘Syphilis epidemic in Melbourne suburbs: scientists use genomic sequencing to track STD’, The Age, 17 May, viewed 1 April 2024, https://www.theage.com.au/national/victoria/syphilis-epidemic-in-melbourne-suburbs-scientists-use-genomic-sequencing-to-track-std-20210511-p57qqv.html. 
  5. Wu, MY; Gong, HZ; Hu, KR; Zheng, H et al. 2021, ‘Effect of syphilis infection on HIV acquisition: a systematic review and meta-analysis’, Sexually Transmitted Infections, vol. 97, no. 7, pp. 525-533, viewed 1 April 2024, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8543214/. 
  6. Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) 2021, Syphilis, Australian STI Management Guidelines for Use in Primary Care, viewed 1 April 2024, http://sti.guidelines.org.au/sexually-transmissible-infections/syphilis/. 
  7. Victorian State Government Department of Health 2023, Congenital syphilis in Victoria, viewed 1 April 2024, https://www.health.vic.gov.au/health-advisories/congenital-syphilis-in-victoria. 

5 Cervical Screening Myths

Whilst most people with a cervix are generally familiar with cervical screening, confusion about the difference between Pap smears and Cervical Screening tests is still quite common. Some myths about cervical screening also continue to persist which we know can dissuade people from having regular testing.

So, let’s take a look at some of these myths:

  • Myth #1: You can’t have a CST if you are pregnant, or on your period.

Cervical screening can be performed at any time, including during pregnancy or at any time during your menstrual cycle.

It is perfectly safe to have a CST while you are pregnant.

  • Myth #2: Getting a CST is always painful

While a CST isn’t typically painful, some people can experience some discomfort from the use of the speculum.

If you’re concerned about your CST being painful, you can now ask your doctor for self-collection which does not require the use of a speculum.

  • Myth #3: You don’t need to get a CST after menopause

CSTs are recommended every 5 years from the age of 25 -74, unless your doctor advises otherwise. The risk of getting cervical cancer is the same even after menopause, so it is important to keep having CSTS every 5 years.

  • Myth #4: Pap smears and CSTs are the same thing

While both tests involve taking a sample from your cervix or vagina, they actually test for two different things.

A Pap smear looks for early signs of cervical cancer, while the new CST tests for HPV – human papillomavirus – the major cause of cervical cancer.

  • Myth #5: If you’ve had the HPV vaccine you don’t need to have CSTs

There are many strains of HPV. While the HPV vaccine prevents over 95% of cancer-causing HPV strains, it does not prevent all HPV strains. So even with the vaccine, it is important to get screened every 5 years.

 

Now we’ve got that that’s sorted, if you’re aged between 25-74, have a cervix, are sexually active and it’s been 5 years since your last CST (or pap smear) – make a booking for a CST today!

You should have the test every 5 years if you are aged 25 to 74 years old, have a cervix and have ever been sexually active.

If you need help finding a GP or sexual health clinic that can organise a CST for you, contact us on webchat or 1800 696 784 (weekdays, 9am – 5pm).

Am I old enough for sexual and reproductive healthcare?

If you are a young person and you are having sex, it is important that you know your health rights and the law. You can talk to someone older that you know and trust, or get information from your doctor, nurse, or counsellor.

What if I don’t want my parents to find out?

Confidentiality is a rule that says what you say to someone will not be told to others, unless you agree. This means that if you see a doctor, nurse, or counsellor about sex, contraception, STIs, or abortion they cannot tell anybody else without your permission. The only except to this might be if they suspect you are in danger; in this case, they will discuss with you about what they might need to do.

Am I too young to have contraception, abortion or screening tests?

There is no minimum age for getting contraception, screening for sexually transmitted infections, or having an abortion. Condoms can be purchased from a supermarket, petrol station, or chemist at any age. If you want other contraception options, your doctor can prescribe it or insert it for you. Your doctor or nurse can arrange screening for STIs as well. These tests are done by taking a blood sample, urine test, or swabs. If your tests are positive for infection the doctor will prescribe medications for treatment, and your sexual partner may also need treatment.

It is important that you know what your options are if you have an unplanned pregnancy. If you are under 16 years old and pregnant, you can have an abortion without your parents/ guardian permission. The doctor will make sure that you understand what is involved with having an abortion and get your consent before going ahead with the procedure. Consent means that you sign a document that says you understand and agree to an abortion.

If you want to keep the pregnancy and are under 16, a plan will be made with you about how to keep you safe, and how you are going to support yourself and a baby. You also have the option of fostering or adopting your baby to someone else.

A cervical screening test (CST) is recommended every 5 years for people with a cervix after they turn 25 years old.  This test checks for the human papilloma virus (HPV) that can cause changes to cervical cells, and after many years cause cancer.  Since June 2022, CSTs can be self-collected, meaning you use a swab and take a high vaginal sample yourself. In some circumstances, a doctor or nurse will take a CST using a speculum.  Testing might be more frequent than every 5 years if you have a positive result.

If you want more information about your rights as a young person, go to Victorian Legal Aid.

GPs, nurses, pharmacists…who do I see for what?

Different health professionals provide different sexual and reproductive health services.

It can be confusing to know who to see for what you need. Some services may require a referral or a script, while others don’t. Some services may cost more than others, or may not be covered on your Medicare or Private Health Insurance plan.

Here’s a list of where to go, for some different sexual and reproductive health services:

Photo of a doctor at a desk

General Practitioners (GPs)

Your general practitioner is usually your first point of contact for any health concerns. Choose a GP you feel comfortable with (for example, if you prefer a female GP, or a GP who has a special interest in sexual health).

All GPs should be able to provide:

  • Cervical screening
  • STI testing (eg urine test, blood test, swabs)
  • Some STI treatment (eg prescribing antibiotics)
  • Contraception counselling and prescriptions (eg for the pill, vaginal ring, implant, IUD)
  • Vaccinations (eg for HPV or Hepatitis vaccines)
  • Referrals for further treatment (eg for blood tests, ultrasounds, counselling and specialists)

GPs who have done special training can also provide:

  • Contraception options (eg IUDs, implants, diaphragms, vasectomy)
  • Medication and surgical abortions
  • Bedside ultrasounds
  • Non-directive pregnancy options counselling
  • Specialised STI management (eg for HIV and Hepatitis)

Photo of a nurse in red scrubs

Nurses

Nurses can work in a variety of settings such as GP clinics, sexual health clinics, community health centres and hospitals.

Depending on their qualifications, nurses can help you with:

  • Cervical screening
  • STI testing, treatment and contact tracing
  • Contraception and abortion care
  • Pregnancy testing
  • Midwifery
  • Vaccination
  • Baby and breastfeeding support
  • Education and information

Photo of a person with a gynaecologist

Specialists

A specialist is a medical doctor that is an expert in one specific area of medicine. For example, a gynaecologist specialises in the health of the ‘female’ reproductive system (eg vagina, uterus, and ovaries) and an obstetrician specialises in pregnancy, childbirth and health after birth. Specialists work in private clinics and hospitals.

Specialists can provide surgical procedures as well as other healthcare:

  • Medical and surgical abortions
  • Contraception prescriptions and insertion (eg IUDs and implants, the pill)
  • Tubal ligation
  • STI screening and treatment
  • Colposcopy and treatment

To see a specialist, you will need a referral from a GP first. Sometimes, a GP may refer you to a specialist to investigate a specific concern, such as PCOS, abnormal Cervical Screening results, menstrual concerns or fertility concerns.

Photo of a woman talking to a pharmacist

Pharmacists

A pharmacist prepares and dispenses medications. They advise people on how to use medications (eg potential side effects, dosage, taking other medications at the same time).

You can go to a pharmacist and buy the following without a prescription:

  • Emergency contraceptive pills
  • Pregnancy tests
  • Diaphragms
  • Condoms and dental dams
  • Lubricants
  • Menstrual products (eg pads, tampons, cups)
  • Some ointments and creams for irritation and infections
  • Some pain relief medications

Other medications and devices require a prescription:

  • Most contraception (eg the pill, IUDs, implants, vaginal rings)
  • Medical abortion pills
  • Treatments for STIs and other infections (eg antibiotics)
  • Stronger pain relief medications

Some pharmacies are also able to provide services such as vaccinations and Cervical Screening tests on site. There are Supercare Pharmacies across Victoria that have extended opening hours and nursing support.

Photo of sign saying "Hopsital entrance: emergency department"

Go to the Emergency Department at your local hospital if you are seriously ill or injured. The Emergency Department is open 24 hours a day, with trained medical staff to manage urgent medical problems. These could include:

  • Uncontrolled bleeding
  • Severe pain
  • Allergic reactions to a medication
  • Pregnancy complications
  • Sexual assault

Depending on the hospital and how sick you are, you may have to wait before you are seen by a doctor. You can bring a support person with you.

In case of a medical emergency, call Triple Zero (000) and ask for an ambulance.

 

If you’re looking for sexual and reproductive health services near you – whether they be GPs, sexual health nurses, specialists or pharmacists – we can help! Call us on 1800 696 784, weekdays 9am – 5pm, or email [email protected]

Sex and international travel: What you need to know

When travelling overseas, it is useful to research your destination to take care of your health and potential needs.

Some things to consider include:

  • Research the laws at the destination you are travelling to:
    • Is premarital sex legal? Can you access contraception services if you aren’t married?
    • Are same-sex relationships and sexual acts legal?
    • Are abortion services legal?
  • Where and how to access contraception, including emergency contraception
    • Can you access emergency contraception at pharmacies without a script?
    • Do you have to be a certain age to buy contraception?
    • Do most pharmacies stock the type of contraception you use?
  • Where and how you can access STI checks and treatments
    • Is your destination a high risk country for certain STIs, like HIV?
  • Where and how you can access abortions
    • Can you get an abortion for any reason?
    • Are abortions performed in clinics or hospitals?
    • Are there abortion services where you are staying? Would you need to travel to another city or country?
    • Are medication and surgical options available?
    • How far along can you access an abortion?
  • How much healthcare and medications might cost
    • Could you afford to pay for medicines or a procedure?

Before your trip overseas, it’s a good idea to have the following organised:

  • An STI check to confirm your STI status before you travel.
  • Get any relevant vaccines for your destination.
  • Purchase condoms, dams and lube to take with you.
  • If you are taking the oral contraceptive pill or medications to manage STIs, ensure you have enough of your medication for the duration of your trip and make sure it is in its original packaging.  It’s a good idea to pack some of your medication in your carry-on luggage in the case your check-in luggage is lost or stolen.  It may also be handy to carry any prescriptions with you along with a letter from your doctor to confirm what medication you are carrying.
  • Get travel insurance and make sure it covers you for any sexual and reproductive healthcare, in case you need it.

We wish you safe travels on your next holiday!

Why does my vagina smell?

To put it plainly: all vaginas smell. However, play any given song by a female rapper today and it’s very likely you’ll hear her advertise her sexual desirability by claiming she has “no smell”. There is a definite societal misconception that vaginas with a smell are unhygienic; but what is more concerning and damaging is that society has weaponised the idea by overlying it with a strong element of shame. The subtext is that people with vaginas that smell are unclean, sexually objectionable, and that no partner would want to perform certain sexual acts like oral sex on them as a result. Whilst it’s categorically untrue that vaginas with no smell exist, it’s also true that some smells can represent infection or other concerns (in which case, a trip to the GP’s office is in order).

1. Normal odour

The vagina is a self-cleaning organ with a quite acidic environment. Typical vaginal discharge is clear or white, and often its consistency changes from thin fluid to thick mucous with the phase of the menstrual cycle. It generally doesn’t smell offensive, but certainly has a smell. Additionally, the groin is full of sweat glands which can also contribute to smell. As a general rule, unless there are symptoms like itch or discomfort, or change in the colour, volume or smell of discharge, your smell is most likely normal. Sometimes, in an effort to reduce smell, we can trigger disruption in the microbiome and the pH of the vagina (such as through use of douches, overcleaning, or using deodorant sprays). This approach is not advised – trust that the vagina knows what it is doing! To best support your vagina and reduce smells, wear breathable underwear, avoid panty liners when not necessary (as this can trap moisture), and avoid over-washing.

2. Bacterial vaginosis

Bacterial vaginosis (or BV) is the usual culprit behind a vaginal discharge described as “fishy”, and can be associated with a thin, watery, grey discharge (often more prominent after intercourse). It is due to imbalance or overgrowth of bacteria in the vagina. BV isn’t a sexually-transmitted infection (STI), but it can increase your risk of contracting one. BV can be treated with a course of oral antibiotics – just ensure you abstain from sex whilst you’re having treatment.

3. Trichomoniasis

Trichomoniasis is a common STI which causes offensive vaginal discharge (also sometimes described as “fishy”) and is associated with a clear, yellow or green discharge. When symptomatic, you may also experience itching and burning sensations, discomfort when passing urine and during intercourse, and genital redness. To avoid reinfection, yourself and partner(s) should be treated for trichomoniasis simultaneously with oral antibiotics.

4. Foreign body

A less-common but not unheard-of scenario is a retained foreign body, such as a tampon (which can be easily forgotten). If you have concerns that your vaginal discharge smells “rotten”, self-examine the vagina or see a GP to assess for foreign bodies. Untreated foreign bodies can lead to pelvic infection or, in the case of tampons especially, life-threatening Toxic Shock Syndrome (TSS).

5. Thrush

Thrush is a common scenario, and usually presents as thick clumpy white discharge (like “cottage cheese”). It may smell yeasty, as thrush is a yeast infection, but the discharge and symptoms of irritation are more prominent. Thrush is often triggered by pregnancy or a recent course of antibiotics, but some people are simply more prone to it than others. A GP can usually diagnose thrush on examination, but if in the early stages, taking swabs and seeing if the yeast grows can also be used for diagnosis. Treatment is with creams or pessaries, such as Canestan.

6. Other STIs

In people with vaginas, STIs such as Chlamydia and Gonorrhoea can fly under the radar. They often cause infection asymptomatically, but in some cases, can be associated with a foul-smelling odour, or changes to your vaginal discharge (white, yellow, grey or green are all potentials). You may also have pain with urination, discomfort with intercourse, or general irritation. If STIs progress to pelvic infection, you may also have fevers and abdominal pain. Ultimately, as so many STIs don’t exhibit symptoms, it is best to have regular STI screening (unless in a stable monogamous relationship, this is generally six-monthly, or three-monthly if having frequent new partners or having intercourse without reliable condom use). Always ensure recent partners are tested and treated too if you have any concerns about an STI.

 

If you want to find a GP or sexual health nurse about any vaginal health concerns, you can search for services online or contact 1800 My Options on 1800 696 784 (weekdays, 9am – 5pm).