Reduction in bulk-billing GPs stalls STI testing

Diagnostics & MedTech News: Australians are being urged to get regular tests for sexually transmitted infections (STIs) amid warnings of a significant rise in cases, combined with low testing levels. An RMIT expert is available for comment. 

Dr Margaret Heffernan OAM, behavioural researcher, said “A sexually healthy population is everybody’s business! Whilst getting tested for STIs is quick and easy by a healthcare professional, the decreasing rates in testing levels can be partially explained by system and socio-cultural factors.”

“Accessibility to and affordability of healthcare clinics has seen many clinics move from bulk-billing to fee-for-service, despite the STI test being either free or low-cost. With cost-of-living demands on discretionary income expenditure, increasingly daily living expenses are prioritised at the expense of healthcare expenditure,” Dr Heffernan explained. 

According to Dr Sudha Pottumarthy-Boddu, Clinical Microbiologist, 2023 saw a resurgence of STIs, with notifications significantly higher than in 2019, especially for syphilis < 2 years duration (8.6 % increase), gonococcal infection (16% increase), and congenital syphilis (400% increase).

“Multisite STI screening for multiple pathogens is recommended for sexually active adults at risk to identify both symptomatic and asymptomatic infections,” she said.

Current guidelines recommend testing for asymptomatic patients to include first-catch urine for chlamydia and gonorrhea PCR testing, along with a blood test for HIV antigen/antibody, syphilis serology, and hepatitis B serology (HBsAg, anti-HBs, anti-HBc).

Cultural attitudes also contribute to the problem, as stigma and discomfort around sexual health persist. For example, in areas with a shortage of male GPs, men may be reluctant to seek care from female practitioners, and vice versa. Additionally, not all GPs, parents, and teachers are adequately trained or comfortable discussing sexual health, leading to low sexual health literacy.

Dr Heffernan said “Whilst perceiving ourselves to be sexually liberated, individuals are compromised and stigmatised by sexually transmitted infections. Normalising and desensitising sexual health and treatment is the first step.  

“It then requires a determination by peak bodies to prioritise funding of resources to educate, inform, and make STI testing accessible and a routine part of every health check.” 

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