Sexual health screening

This guideline provides screening recommendations that are based on anatomy and is inclusive of gender- affirming surgeries and hormone therapy. All patients should be screened according to the types of sexual activities they participate in. This may include screening throats, rectums, genitals and genital lesions as indicated. Serology should be included during routine STI screening for all patients, including TP EIA, HIV, and Hepatitis A, B & C as indicated. Assess need for immunizations (HPV, HAV, HBV) and HIV PrEP on an individual basis. Self-swabbing, blind swabs and urine CT/GC NATs are appropriate for symptomatic patients who do not desire a physical exam.

Site Asymptomatic Symptomatic Notes

Penile urethra ●● CT/GC NAT urine ●● GC C&S* Listed in order of (with or without ●● CT/GC NAT urine (first collection phalloplasty or catch) All swabs may be self metoidioplasty with ●● Urine dipstick and/or collected urethral lengthening) urinalysis prn If discharge is present, *If urethral symptoms attempt to collect exudate occur after gender- by having patient milk affirming surgery, shaft to avoid further consult with an urethral irritation experienced clinician, as swabs may be contraindicated: RACE line: 604-696-2131 or toll free at 1-877-696-2131 and request the “Transgender Health” option Trans Care BC: 1-866-999-1514 [email protected]

Trans Care BC Primary Care Toolkit 31 BCCDC’s GetCheckedOnline.com is an excellent screening option for asymptomatic clients as well (use Site Asymptomatic Symptomatic Notes

Vagina after ●● CT/GC NAT urine ●● CT/GC NAT urine Listed in order of

vaginoplasty ● collection Some patients may find ● Urine dipstick and/or If pain, discharge or pelvic exams affirming. If urinalysis prn All swabs may be self bleeding occur in the patient preference is for collected early post-operative pelvic exam: period, consult with an CT/GC NAT vaginal experienced clinician: (clinician-collected) RACE line: Note: This test has not 604-696-2131 ●● been validated for use in Trichomonas or toll free at vaginoplasty 1-877-696-2131 Lifelabs: LifeLabs: and request the “Transgender Health” Collected on same sample Under ‘Vaginitis’, indicate option submitted for BV & yeast ‘Chronic/Recurrent’ (liquid Amies culture red-top and write “Transgender Trans Care BC: swab) patient with vaginoplasty” 1-866-999-1514 [email protected] BCCDC PHL: BCCDC PHL: Collected on same sample Use ‘Bacteriology’ submitted for CT/GC NAT requisition, select ●● There is no evidence to (urine or vaginal) ‘Trichomonas NAT’ and support the need for Pap write “Transgender tests of vaginal vault Note: These tests have not patient with vaginoplasty” been validated for use in vaginoplasty

●● BV & yeast Sample must be sent to Collected on same sample LifeLabs. submitted for Trich testing Under ‘Vaginitis’, indicate (liquid Amies culture red-top ‘Chronic/ Recurrent’ swab) and write “Transgender patient with vaginoplasty”

●● Prostate exam prn Assessment can be done by digital exam via lower Note: the prostate is aspect of anterior vaginal not removed during wall vaginoplasty

32 Trans Care BC Primary Care Toolkit code ‘TransCare’ to make an account). Site Asymptomatic Symptomatic Notes

Vagina after total ●● CT/GC NAT urine ●● GC C&S Listed in order of hysterectomy (preferred) or vaginal ●● CT/GC NAT urine collection See BCCDC’s Pelvic (preferred) or vaginal All swabs may be self Exam Decision Support ●● Urine dipstick and/or collected Tool urinalysis prn

●● See “BCCA Screening ●● Trichomonas for Cancer of the Cervix” to determine screening LifeLabs: LifeLabs: recommendations for Collected on same sample Under ‘Vaginitis’, indicate patients with removal of submitted for BV & yeast ‘Chronic/Recurrent’ cervix (liquid Amies culture red-top and write “Transgender swab) patient”

BCCDC PHL: BCCDC PHL: Collected on same sample Use ‘Bacteriology’ submitted for CT/GC NAT requisition, select (urine or vaginal) ‘Trichomonas NAT’ and write “Transgender patient”

●● BV & Yeast

If on testosterone: If on testosterone: Collected on same sample Sample must be sent to submitted for Trich testing LifeLabs. (liquid Amies culture red-top Under ‘Vaginitis’, indicate swab) ‘Chronic/Recurrent’ and write “Transgender Note: Vaginal smears patient” (Nugent scores) are not useful for patients on testosterone

If not on testosterone: Culture or vaginal smear for BV & yeast

Trans Care BC Primary Care Toolkit 33 Site Asymptomatic Symptomatic Notes

Vagina with cervix ●● CT/GC NAT (urine or ●● GC C&S Listed in order of See BCCDC’s Pelvic vaginal) ●● CT/GC NAT urine (first collection Exam Decision Support catch) or vaginal All swabs may be self Tool ●● Urine dipstick and/or collected urinalysis prn

●● Trichomonas

LifeLabs: LifeLabs: Collected on same sample Under ‘Vaginitis’, indicate submitted for BV & yeast ‘Chronic/Recurrent’ (liquid Amies culture red-top and write “Transgender swab) patient”

BCCDC PHL: BCCDC PHL: Collected on same sample Use ‘Bacteriology’ submitted for CT/GC NAT requisition, select (urine or vaginal) ‘Trichomonas NAT’ and write “Transgender patient”

●● BV & Yeast

If on testosterone: If on testosterone: Collected on same sample Sample must be sent to submitted for Trich testing LifeLabs. (liquid Amies culture red-top Under ‘Vaginitis’, indicate swab) ‘Chronic/Recurrent’ and write “Transgender Note: Vaginal smears patient” (Nugent scores) are not useful for patients on testosterone

If not on testosterone: Culture or vaginal smear for BV & yeast

●● Bi-manual exam. Note: patients on ●● If patient declines or is testosterone may not able to tolerate bi- have cervical motion manual, assess for fundal tenderness (CMT) due tenderness only to genital tissue atrophy (presence of CMT not necessarily indicative of Pelvic Inflammatory Disease)

●● Cervical screening prn ●● If due for cervical screening, advise patient that inflammatory exudate may obscure endo-cervical cells, and recommend booking a separate appointment for cervical screening

34 Trans Care BC Primary Care Toolkit Site Asymptomatic Symptomatic Notes

Throat ●● CT/GC NAT ●● GC C&S Listed in order of ●● CT/GC NAT collection All swabs may be self collected

Rectum ●● CT/GC NAT ●● GC C&S Listed in order of ●● CT/GC NAT collection ●● HSV PCR All swabs may be self collected

Lesions (genital and ●● HSV PCR oral) *For lesions suspected ●● LGV* Sample must be sent to of LGV or Syphilis, CT/GC NAT swab BCCDC PHL consult with an Use ‘Bacteriology’ experienced clinician : requisition and write “If RACE line: positive for CT, send to 604-696-2131 NML for testing” or toll free at 1-877-696-2131 and ●● Syphillis* request the “Sexually Transmitted Infection Service” Syphillis PCR buffer: Syphilis PCR buffer: Submit swab in Syphilis PCR Sample must be sent to buffer BCCDC PHL. Use ‘Bacteriology’ requisition and write “For T.pallidum PCR”

No Syphillis PCR buffer No Syphilis PCR buffer available: available: Use CT/GC NAT swab Sample must be sent to (orange Gen-Probe Aptima) BCCDC PHL. Use ‘Bacteriology’ requisition and write “Attn Dr Morshed, for T.pallidum PCR”

Trans Care BC Primary Care Toolkit 35