Case not closed until contacts are known

By the Metro North Public Health Unit

Across Metro North Health, gonorrhoea notifications increased 55 per cent between 2016 to 2019, when it reached a peak of 1635, dropping slightly to 1576 notifications during 2020 and the height of the COVID-19 lockdown.

Similarly, for syphilis, Metro North recorded an 85 per cent increase between 2016 and 2020, when 323 syphilis notifications were recorded last year, increasingly among young heterosexual men and women.

Against this backdrop of rising infection, it is timely and important that GPs are reminded of contact tracing as a cornerstone in the control of sexually transmitted infections (STI) and an essential part of patient management. Given the demonstrated success of early, intense contact tracing for the control of COVID-19, GPs should be aware of those same principles applied to STI control: regular testing, regular re-testing and contact tracing. It is important for GPs to have contact tracing permanently on their checklist whenever discussing, testing and managing STIs.

Contract tracing is the process of:

• identifying persons who may have contracted a notifiable condition
• informing persons who are unaware that they may have contracted a notifiable condition so that they may seek testing and treatment before complications arise
• providing information to persons who may have contracted a notifiable condition to prevent or minimise transmission of that condition.

There is often a misunderstanding that contact tracing for STI is automatically undertaken by the Department (as done for COVID-19 or HIV). Whilst Contact Tracing Support Officers (CTSO) are available to advise and assist GPs, GPs will need to support patients diagnosed with an STI to do contact tracing by:

• Providing the patient with education about the STI, including asymptomatic transmission, risk of complications if left untreated and risk to the patient of re-infection if their partners are not treated as well.
• Discussing that all sexual contacts need to be considered within the appropriate look-back period for the STI and not just the most recent contact. Information on how far back to trace for different STIs is offered by the Australasian Contact Tracing Guidelines.
• Providing the patient with information regarding the anonymous contact tracing websites that are available: Let Them Know or The Drama Down Under (for men who have sex with men) provide a service to advise sexual partners that they might also be at risk by sending an email or SMS either personally or anonymously.
• Discussing with the patient any barriers there may to contact trace and provide support in response.

GPs can access support, information and advice from the local CTSO at the Metro North Public Health Unit on 07 3624 1111, the Queensland Syphilis Surveillance Service on 1800 032 238 or the HIV Public Health Team on 07 3328 9797.

More information:

• Australasian Contact Tracing Manual
• Communicable Disease Control Guidance and Information: A-Z
• Australian STI Management Guidelines for Use in Primary Care
• Primary Clinical Care Manual 10th edition (2019)
• AHSM guide to Duty of Care to Third Parties and Civil Liability