STBBI prevention guide: Screening and diagnostic testing

This guide includes an overview of practices for the screening and diagnostic testing of sexually transmitted and blood-borne infections (STBBI) by healthcare professionals practicing in public health or primary care settings.

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Screening and diagnostic testing

STBBIs are frequently asymptomatic and can lead to serious complications if left undiagnosed or untreated. STBBI screening can raise awareness about signs and symptoms and provide an opportunity to discuss transmission and prevention measures. Screening increases the possibility of early detection and treatment, prevents or limits complications and lessens potential for transmission. Offer screening for STBBIs during routine care, with special attention to individuals who are more likely to be exposed. Age, gender, medical and sexual history as well as risk factors all inform the decision to screen. More frequent screening may be appropriate for individuals with ongoing risk factors. Screening for STBBIs can be normalized by using statements such as, “I always suggest testing for STBBIs. Are you okay with being tested?”

Many STBBIs have similar risk factors and transmission modes, and co-infection is common. If an STBBI is suspected, take the opportunity to screen for other STBBIs. Some STBBIs can cause inflammation, ulcers or both and increase the risk of HIV acquisition and transmission. Consult etiology specific guides for screening recommendations.

Clinical presentation and sexual and substance use history will help inform what specimens and samples to collect, from which anatomical sites (pharyngeal, genital, rectal) and the type of diagnostic tests. Depending on type of sexual activity, it may be necessary to collect specimens from multiple anatomical sites. Consult etiology specific guides or the STI-associated Syndromes guide for information on diagnostic tests.

Barriers to screening and testing

Underscreening for STBBIs results in missed opportunities to detect infection and thereby prevent transmission. There are several common STBBI screening barriers at the individual, healthcare and social level.

Individual barriers

Healthcare barriers

Social barriers

Individuals may be more vulnerable to STBBI and more likely to experience barriers to screening and testing if they have experiencedFootnote 9:

These barriers and STBBI-related stigma can be reduced by offering screening in a person-centred, culturally safe and trauma-informed manner, as part of routine care. Motivational interviewing techniques can be used to identify barriers and the means to overcome themFootnote 10.

The use of urine and other self-obtained specimens, like vaginal and rectal swabs, can increase acceptance of screening in persons reluctant to be examined. Self-testing (e.g., HIV self-testing) and point of care (POC) testing (where available) can also facilitate uptake of screening.

References

Footnote 1

Banks I. No man's land: Men, illness, and the NHS. BMJ. 2001;323(7320):1058-1060. doi: 10.1136/bmj.323.7320.1058 [doi].

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Footnote 2

Myles A. The role of physicians’ attitudes and the provision of hepatitis C virus treatment to people who inject drugs. Open Medicine Journal. 2016;3(1).

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Footnote 3

Wagner AC, Girard T, McShane KE, Margolese S, Hart TA. HIV-related stigma and overlapping stigmas towards people living with HIV among health care trainees in canada. AIDS Education and Prevention. 2017;29(4):364-376.

Return to footnote 3 referrer

Footnote 4

Gott M, Galena E, Hinchliff S, Elford H. “Opening a can of worms”: GP and practice nurse barriers to talking about sexual health in primary care. Fam Pract. 2004;21(5):528-536.

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Footnote 5

Fuzzell L, Fedesco HN, Alexander SC, Fortenberry JD, Shields CG. “I just think that doctors need to ask more questions”: Sexual minority and majority adolescents’ experiences talking about sexuality with healthcare providers. Patient Educ Couns. 2016;99(9):1467-1472.

Return to footnote 5 referrer

Footnote 6

Loeb DF, Lee RS, Binswanger IA, Ellison MC, Aagaard EM. Patient, resident physician, and visit factors associated with documentation of sexual history in the outpatient setting. Journal of general internal medicine. 2011;26(8):887-893.

Return to footnote 6 referrer

Footnote 7

Greenwood NW, Wilkinson J. Sexual and reproductive health care for women with intellectual disabilities: A primary care perspective. Int J Family Med. 2013;2013:642472. doi: 10.1155/2013/642472 [doi`].

Return to footnote 7 referrer

Footnote 8

White W, Brenman S, Paradis E, et al. Lesbian, gay, bisexual, and transgender patient care: Medical students' preparedness and comfort. Teach Learn Med. 2015;27(3):254-263.

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Footnote 9

Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada. A summary of the pan-canadian framework on sexually-transmitted and blood-borne infections. Can Commun Dis Rep. 2018;44(7/8):179-81.

Return to footnote 9 referrer

Footnote 10

Hall K, Gibbie T, Lubman DI. Motivational interviewing techniques: Facilitating behaviour change in the general practice setting. Aust Fam Physician. 2012;41(9):660.

Return to footnote 10 referrer

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