In this section
Common sexually transmitted infections (STI) include gonorrhoea (Neisseria gonorrhoeae), chlamydia (Chlamydia trachomatis), syphilis (Treponema pallidum), Mycoplasma genitalium, and Trichomonas vaginalis. Most of these are easily treatable with antibiotics, but can cause significant morbidity if left untreated, including infertility, miscarriage, ectopic pregnancy, and neonatal/infant infections . Blood borne infections (that are also STIs) include HIV, hepatitis C and hepatitis B.
Rates of STI infection vary according to country of origin and are not well quantified. Two recent Australian studies have found very low rates of STIs in newly arrived refugees – a study of 2610 refugees aged 15 years and older in Western Australia found a prevalence of 0.8% for chlamydia and no episodes of gonorrhoea infection  and a study of 1136 Karen refugees in Melbourne found a prevalence of 0.3% for chlamydia, and no cases of HIV, gonorrhoea or syphilis infection . Other Australian studies have found the prevalence of syphilis was 0-5% in adult, predominantly African, cohorts[4-7] although there were no paediatric cases in two cohorts.[8, 9] There have been very few people with HIV, although HIV does not necessarily preclude a visa being granted, and changes to the health waiver for humanitarian entrants in 2012 mean there may be increasing numbers of people with HIV arriving.
A high proportion of female (and some male) refugees and asylum seekers have experienced sexual violence/assault . A UK study of unaccompanied child refugees found that one quarter of African girls reported having been sexually assaulted or raped , and unaccompanied minors are at highest risk of sexual assault . Most asylum seekers and refugees will not have had adequate medical care or testing for sexually transmitted infections (STIs) after the assault. It is important to be aware that adolescents/adults are also at risk of acquiring STIs after arrival in their new country .
Pre-migration STI screening is limited. All permanent migrants to Australia have a visa health assessment before travel – this includes:
There is no routine testing for other STIs as part of the pre-migration screen. Asylum seekers in detention aged ≥15 years have screening for HIV, Hepatitis B, HCV and syphilis as part of detention health screening.
Given limited pre-migration screening and possible exposure, including through sexual violence, STI screening should be considered in the post-arrival refugee health assessment, although universal screening is not supported by current evidence (
2016 ASID guidelines). Early diagnosis can allow appropriate treatment to prevent long-term complications. People may be reluctant to disclose a history of sexual assault and the issue needs to be addressed specifically in a sensitive manner.
Many STIs are asymptomatic and will only be picked up on routine screening tests. Common presentation for STIs include:
Initial post arrival refugee health screening includes:
For information on appropriate specimen collection and treatment, see table 1.
Note: In a child/adolescent, particularly one who is not usually sexually active, it is usually appropriate to test for STIs using urine rather than high vaginal swab.
If a remote history of sexual violence against a child is disclosed, consider referral to a service experienced in managing child sexual abuse  (e.g. Gatehouse centre at RCH). If there is recent sexual assault follow usual procedures via
Victorian Forensic Paediatric Medical Service (VFPMS).
1st line therapy (adult doses)
vaginal swab for culture and PCR or Urine for
500mg IM AND Azithromycin
Syphilis (T. pallidum)
(usually EIA, with confirmatory testing as required), Swab of
primary chancre for PCR if indicated
See Syphilis guideline
vaginal swab or Urine for PCR
vaginal swab PCR
(HIV Ab) with confirmatory testing
(HepB sAg, cAb, sAb)
(Hep C Ab)
Immigrant health resources. Authors: Vanessa Clifford and Georgie Paxton, January 2014. Last review May 2017. Contact firstname.lastname@example.org