Sexual health testing for heterosexuals may not be adequate: GP

Melbourne GP Dr George Forgan-Smith told newsGP that the standard sexual health test for self-declared heterosexuals did not include throat swabs or anal swabs.
 
‘A simple declaration of homosexuality or heterosexuality may not be enough to get them the screening they require. If they have oral or anal sex, we need to check those places, no matter their sexuality,’ he said.
 
‘We don’t always fully explore a person’s sexual experiences, meaning we can miss important risks. For a homosexual male, we do proper sexually transmitted infection (STI) screens – throat, bum swab, bloods and urines. That’s standard.’
 
‘But a percentage of heterosexual women have oral sex. A percentage will have anal sex. And a percentage of hetero men are anally penetrated as well. We don’t routinely throat or anal swab women and men who declare themselves hetero,’ he said. 
 
He said that GPs were broadly very good at testing men who have sex with men, but could improve for others.
 
‘We do it poorly for women, except for family planning. Women have sex in all sorts of ways, but for some reason, we’re not offering these swabs. There may be people who only have oral sex, and people who value their virginity and have anal sex as an alternative,’ he said.
 
‘We assume when men say they are heterosexual, it means they’re only having sex with cisgender women. What if they’re having sex with transgender women? It happens – so we have to ask. If it means a little embarrassment, I would rather that than missing an infection,’ he said.
 
He gave the example of a former male patient who was married to a woman – but who had sex with transgender women while on overseas holidays.
 
Dr Forgan-Smith said a large part of the issue was how difficult many GPs found asking patients about their sex lives.
 
‘We need to get over the embarrassment of asking icky questions about sex and behaviours. I teach doctors to ask their patients if they have sex with men, women or sometimes both. We have to be a little bit bold to ask these questions, and we shouldn’t be afraid to ask. But a lot of people are – and that’s a disservice to the community,’ he said. 

‘Many GPs are too embarrassed to ask, or don’t want to make the patient embarrassed. But if you’re confident, the patient is confident.
 
‘I recommend having a follow-up response. If they look at you funny, the response is, “It’s important we know to make sure you get the correct testing”.
 
‘The patient wonders why you’re asking such an intrusive question – but if it’s taboo, they’re not getting the right screening. No one has a fever until you check their temperature.’
 
Dr Forgan-Smith also said that GPs should offer a sexual health check-up to newly pregnant women, as a result of having sex without condoms.
 
The RACGP’s Red Book states that younger asymptomatic heterosexuals are at low-average risk, and should have a urine, cervical or genital swab, with other infections to be considered based on a risk assessment.

sexual-health sexually-transmitted-infections