Australasian Chapter of Sexual Health Medicine
Recommendations from the Australasian Chapter of Sexual Health Medicine on herpes, chlamydia, candidiasis, ureaplasma & gonorrhoea. The Australasian Chapter of Sexual Health Medicine (AChSHM) is a Chapter of the Royal Australasian College of Physicians (RACP) Adult Internal Medicine Division that connects and represents Sexual Health Medicine Fellows and trainees in Australia and New Zealand.
1.
Do not order herpes serology tests unless there is a clear clinical indication.
Herpes serology is not an appropriate screening test in asymptomatic patients and does not accurately confirm whether the person is infected or is a transmission risk to others from asymptomatic shedding. Clinicians also need to consider whether test results will influence treatment or outcomes because, if they do not, then testing is a waste of finite health resources and is not indicated. Herpes serology tests only have good sensitivity and specificity in high prevalence populations. However, selective use of herpes serological tests may be justified for particular groups, such as those at high risk for STIs and human immunodeficiency virus (HIV) infection who are motivated to reduce their sexual risk behaviour; HIV-infected patients; patients with sexual partners with genital herpes; and in cases where a woman appears to have a first episode of herpes simplex virus (HSV) during pregnancy.
This recommendation is endorsed by The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG).
Supporting evidence
- Guerry SL, Bauer HM, Klausner JD, Branagan B, Kerndt, PR. Recommendations for the selective use of herpes simplex virus type 2 serological tests. Clinical Infectious Diseases 2005; 40(1): 38-45.
- New Zealand Herpes Foundation. Guidelines for the Management of Genital Herpes in New Zealand. 10th Ed, 2013.
- Scoular A. Using the evidence base on genital herpes: optimising the use of diagnostic tests and information provision. Sexually Transmitted Infections 2002; 78(3): 160–165.
- Strick L, Wald A. Type specific testing for herpes simplex virus. Expert Review of Molecular Diagnostics 2004; 4: 443-53.
How this list was made
With the assistance of the Royal Australasian College of Physicians as part of Evolve, the Australasian Chapter of Sexual Health Medicine (AChSHM) Council produced and distributed to its membership an online survey. The survey listed 5 examples of clinical practices in sexual health medicine which may be overused, inappropriate or of limited effectiveness in a given clinical context.
Members were asked to comment on these examples and to suggest other low-value practices which may be a sizeable issue in the specialty. Based on the feedback, 8 items were identified for further investigation by AChSHM Council through an evidence review. This resulted in the final list of 5 recommendations which were endorsed by the Council on 15 December 2016.
In July 2018 the Australasian Chapter of Sexual Health Medicine undertook a review of their Top-5 recommendations. Due to changes in evidence, and physician support, recommendation 5 was replaced. The removed recommendation read: “Reconsider the use of nucleic acid amplification testing for gonorrhoea in low-prevalence (i.e. <1% prevalence) populations and people who do not belong to a higher risk group.”
- 1 Do not order herpes serology tests unless there is a clear clinical indication.
- 2 Do not screen for chlamydia using serological tests.
- 3 Do not treat recurrent or persistent symptoms of vulvovaginal candidiasis with topical and oral anti-fungal agents without further clinical and microbiological assessment.
- 4 Do not test for ureaplasma species in asymptomatic patients.
- 5 Do not prescribe testosterone therapy to older men except in confirmed cases of hypogonadism