This year marks the 10th anniversary of the Australian STI Management Guidelines for Use in Primary Care. Since its launch in 2014, the easy-to-understand online resource has become a go-to guide for healthcare workers in primary care when it comes to the prevention, testing, and treatment of sexually transmissible infections (STIs). The guidelines also include practical information on priority populations and how to sensitively conduct risk assessments.
We spoke to researchers, physicians, and sexual health educators to find out more about the history of the guidelines, how it’s being used in-practice nationally, and its potential outside of Australia.
The need for accessible guidance
Through a partnership between ASHM and the Australasian Sexual and Reproductive Health Alliance (ASRHA), and with funding support from the Australian Government Department of Health, the Australian STI Management Guidelines for Use in Primary Care were developed between 2012-13. The development employed a consensus-based approach drawing upon previous research and best practice focusing on primary care.
Dr Christopher Bourne, Chair of the Editorial Subcommittee during the creation of the guidelines, says that from the start the guidelines aimed to unite existing advice while addressing gaps in previous clinical guides, such as information around syndrome, aetiology, key populations, and asymptomatic screening.
Underlying the development was the need for the guidelines to be easy to access and use. As such, the guidelines were designed with online delivery in mind, whereas previous STI guidelines often relied on physical copies, limiting their reach.
“The new approach and online format allow for its widespread dissemination and engagement with the STI and blood-borne viruses (BBV) sectors, as well as linkages to related health program areas,” explains Dr Bourne.
The online format of the guidelines also means it can be updated to reflect rapidly-evolving news and advice, such as the recent re-emergence of mpox and syphilis in Australia.
“STI testing and management is constantly evolving and adapting in line with research, guidelines, and sociopolitical cultural trends,” explains Dr Karen Freilich, a GP and sexual health educator. “Resources that provide quick reference guides to ensure medicine is kept up-to-date are extremely useful.”
"It’s a wholly important resource and I am grateful that it is freely and easily accessible."
The Australian STI Management Guidelines for Use in Primary Care officially launched at the Royal Australian College of General Practitioners’ (RACGP) annual conference 2014.
The guidelines are recognised as an Accepted Clinical Resource by the Royal Australian College of General Practitioners, and have been endorsed by over 10 associations, societies, and college across Australasia, including the Royal Australasian College of Physicians, the Australian Indigenous Doctors’ Association, and the New Zealand Sexual Health Society.
Guidelines in practice
The guidelines have quickly established themselves as a reliable resource for healthcare professionals in primary care settings.
One of these clinicians who calls upon the guidelines for guidance regularly is Dr Karen Freilich.
“As a GP, we are usually the first point of call for STI screening and management. We see a range of patients and presentations, and often are the ones suggesting STI screening or testing,” says Dr Freilich. “From a clinical perspective, the STI Guidelines are the ideal mix of succinct but detailed as needed, and very user friendly!”
Dr Nick Medland, Chair of the Guidelines Oversight Committee, highlights the advantages of the guidelines’ flexibility and trusted reputation for healthcare workers practicing in Australia.
“Australia’s STI guidelines are unique globally and reflect Australia’s highly accessible health care system, where most STIs are diagnosed and treated in general practice and community-based health settings,” explains Dr Medland. “However, it is a challenge for GPs and health workers to access trusted and up-to-date and high-quality information on STI management. This role is perfectly filled by the Australian STI management guidelines.”
"The guidelines have proven very popular with and accessible for healthcare care providers and are a visible legacy for Australian sexual health medicine,"
Changing with the times
Between 2020 and 2022, ASHM undertook a major update of the guidelines which was overseen by a Steering Committee of clinical advisors, with input from representatives from sexual and reproductive health, peer, and alcohol and other drugs organisations.
Many of the updates made in 2022 remain more relevant than ever in 2024, such as measures around syphilis testing and congenital syphilis prevention. One major change is the recommendation that HIV and syphilis testing should be included whenever STI testing is indicated. In addition to reducing stigma by normalising HIV and STI testing, the updated recommendation also aims to encourage earlier detection.
“This change aims to address the rising incidence of syphilis and support the goal of eliminating HIV transmission in Australia, ” explains Dr Jason Ong, Sexual Health Physician and Member of the major update Steering Committee.
Importantly, updates throughout the guidelines increased emphasis on cultural safety and ensured all language was gender affirming to promote patient-centred care.
“These updates reflect a comprehensive, multidisciplinary review to align with evolving evidence and improve sexual health outcomes,” says Dr Ong, sexual health physician and Member of the major update Steering Committee.
You can read more about the process and changes of the 2020-22 Major Update in Sexual Health journal.
In 2023 – 2024, a minor review was conducted of several sections of the guidelines. Updated sections are listed on the ‘What’s New’ webpage. Going forward, the guidelines will undergo a minor review annually to address changes to any management advice, and to respond to feedback submitted by key stakeholders and users of the guidelines.
Impact at home and abroad
Not only have the guidelines helped empower healthcare workers, but they have also been used to inform broader national policy.
The guidelines have been cited in vital government strategies guiding Australia’s efforts towards the reduction and elimination of STIs, including the latest National Aboriginal and Torres Strait Islander Blood Borne Viruses and Sexually Transmissible Infections Strategy and the Fourth National Sexually Transmitted Infections Strategy.
Dr Ong highlights that the guidelines’ value is not just contained to Australasia — its potential is global.
“While the Australian STI Management Guidelines are primarily designed for use in primary care within Australia, they also contribute to the global body of knowledge on STI management,” says Dr Ong.
“The sharing of best practices and successful strategies across countries enhances the effectiveness of STI management worldwide.”
ASHM would like to thank the Committee Members, Subcommittee Members, advising representatives and experts, and staff who have worked and continue to improve the Australian STI Management Guidelines for Use in Primary Care!
