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.
There is no role for chlamydia serology as a screening test as antibodies elicited during infection are long-lived, meaning a positive antibody test will not distinguish between a previous and a current infection and are non-specific for genital serovars. Chlamydia serology may be useful in specific circumstances, for example, investigating atypical pneumonia in babies or in identifying late stage Lymphogranuloma Venereum (LGV) infection.
Laboratory tests based on nucleic acid amplification (NAAT) technologies remain the first choice for diagnosis of chlamydial infections during pregnancy and in other settings. NAAT testing for identifying LGV serovars of Chlamydia trachomatis has superseded the use of serology for diagnosis but is only available in some specialist settings.
While topical and oral anti-fungal agents are the recommended treatment for candidiasis, an adequate clinical and microbiological assessment should be undertaken before they are prescribed or self-administered by patients for recurrent or persistent symptoms of vulvovaginal candidiasis. It is important to rule out other causes of vulvovaginal symptoms such as bacterial vaginosis or genital herpes first so that the other infections are not left untreated. Moreover, inappropriate use of antifungal drugs can lead to increased fungal resistance, especially in non-albicans species of candida.
Ureaplasma species are part of the normal genital microbiota and there are typically high rates of colonisation of the organism in sexually active adults. Testing or screening for genital infection with ureaplasma species is not recommended outside specialist or research settings as they have not been established as a cause of lower genital tract disease.
The introduction of a duplex testing item into the MBS for nucleic acid amplification testing (NAAT) of chlamydia and gonorrhoea has resulted in laboratories performing this duplex test even if a test for only one organism was requested. Use of NAATs as a screening test for gonorrhoea in low-prevalence populations is not advised due to their low positive predictive value. However, an adequate sexual history needs to be taken in all cases to allow for the identification of higher risk groups within the population including men who have sex with men (MSM), the Aboriginal and Torres Strait Islander population, heterosexuals who travel overseas and people with multiple sexual partners. There are potential harms associated with false positive test results and incorrect diagnosis of gonococcal infections. Therefore it is recommended that use of NAAT for gonorrhoea should be reconsidered in low prevalence (i.e. <1% prevalence) populations.